Periodontitis linked to obstructive sleep apnea

Periodontitis is inflammation of the ligaments and surrounding structures that support the teeth. Apparently it is associated with increase risk of heart disease. It is related to mouth breathing. Here is a study showing an increased risk of obstructive sleep apnea (OSA) in patients with periodontitis. It's not that surprising since many OSA patients breathe through their mouth at night, and wake up with dry mouth.

Certain sleeping pills may increase risk of pneumonia

Benzodiazepines (BZD) are an older class of medicines that have been used for insomnia - examples include Restoril and Valium. Here is a study that links BZD use to pneumonia in a UK community. I don't have access to the full article, but another review of the article says that researchers think the BZDs may reduce immunity. I was not aware of that - I would think that BZDs could increase pneumonia risk because they may suppress drive to breathe, especially when combined with other sedating medications and alcohol.

Obstructive sleep apnea damages cardiovascular system to same extent as diabetes

Obstructive sleep apnea (OSA) has been linked to higher rates of cardiovascular disease. This study looked at a small number of patients with moderate to severe OSA. In particular, they studied their cardiovascular systems using sophisticated imaging equipment, and compared the findings to diabetics without OSA. The results showed that both OSA and diabetes causes a similar amount of damage to the cardiovascular systems

Protected sleep time allows medical trainees to sleep more

In the last few years, the hours worked by medical interns and residents has come under scrutiny. Regulations have been put in place to limit the number of hours worked in an attempt to reduce patient errors. Here is an article about a study showing that if you give medical trainees 5 hour protected time to sleep while on call, they will sleep an extra hour on average. However, the researchers did not measure medical errors, so it's not clear if that extra hour of sleep made any significant difference.

Chronic insomnia and obstructive sleep apnea

Patients with chronic insomnia can have problems falling asleep and staying asleep. For those that wake up at night, it can be difficult to know what wakes them up - after all, they were asleep! I've followed Dr. Krakow's work over the years, and he has a practice and does research over in New Mexico. His work has provided evidence that some "insomnia" patients actually have obstructive sleep apnea (OSA), and that treating the OSA can reduce the insomnia.

Dr. Krakow et al did a study published in the Journal Sleep. He did sleep studies on 20 patients who presented only with insomnia. These patients did not have other symptoms of OSA, although half of them snored. The mean body mass index was <25 and most were tired but not sleepy. The results showed that 11 patients had OSA and another 7 patients had a milder version of OSA called upper airway resistance syndrome. So that means 19/20 patients had some form of sleep disordered breathing. What we don't know is how these patients developed chronic insomnia. But the results help confirm what I see clinically quite often - that insomnia is not just a psychological problem but can be triggered by medical disorders like OSA.

More sleep may reduce pain

Studies have shown that total and partial sleep deprivation can increase pain sensitivity. Dr. Roehrs et al did a study published in the Journal Sleep, in which they determined whether an extended bedtime would increase alertness and reduce pain threshold in sleepy individuals.

They enrolled 18, healthy, pain free but sleepy patients who most likely were sleep deprived. The patients were randomly selected to either continue their current sleep schedules or to extend their sleep upto 10 hours per night for four nights. The results showed that on average, those with the extended sleep duration had reduced sleepiness and reduced pain sensitivity. The study authors speculate that being sleepy can increase pain sensitivity. They concluded that reversal of mild chronic sleep loss improves pain sensitivity. They think that sleep loss could increase systemic inflammation, which could increase the sensitivity to pain.

I'm not sure what these results mean for clinical practice. In my experience, chronic pain patients have chronic insomnia from various reasons - pain, certain medications for pain, and inadequate sleep hygiene. Sleep deprivation is not usually present and these chronic pain patients couldn't sleep any more. Some chronic pain patients are sleepy during the day, but not from sleep deprivation, but from the pain medications.

Non-drug treatment of restless legs syndrome

Restless legs syndrome (RLS) is an uncomfortable sensation in the legs that occurs at rest, more often in the evening, and is relieved temporarily with movement. We don't know what causes RLS, but researchers think it may have something to do with dopamine dysregulation. RLS is often treated with prescription medications. However, sometimes non-medicine treatments can help. This article reviews some of the evidence supporting those non-drug treatments.

Regular exercise has been shown to relieve RLS. Proposed mechanism is an increase in circulation, release of endorphins, and increase in dopamine. More recently, pneumatic compression stockings have shown to be helpful. These are air filled wraps worn around the legs - they repetitively fill and empty the air resulting in a massaging action and can improve circulation. If you don't have a pair of pneumatic compression stockings laying around, regular massage has been shown to be helpful, perhaps by increasing circulation, a counter stimulation action, or generation dopamine. Near-infrared light has been shown to be helpful, possibly by increasing circulation. Acupuncture has not been shown to be effective for RLS when compared to no treatment. Certain vitamins and minerals have been shown to be helpful - vitamin E, vitamin B12, multivitamins with vitamin C, glucosamine, zinc, folic acid, vitamin D, and magnesium made the list.

RLS has been associated with low iron, and sometimes I use iron therapy to help with the symptoms. This often takes months of daily iron intake to increase the levels. I don't recommend people taking iron though unless the level is low, as too much iron is not healthy.

Kids do get recommend amounts of sleep

Lots of press about how kids are getting too little sleep. And lots of ink about how too little sleep contributes to childhood obesity. This article discusses new research showing that kids get as much sleep as recommended. Time to focus on the more likely problem of childhood obesity - diet.

More convenient way to do light therapy

Using bright lights to shift circadian rhythms can be helpful for certain sleep disorders. Making the lights portable has been a challenge. Researchers have devised a pair of glasses that uses green light to aid in shifting your circadian rhythm. This article describes the glasses and how they may be used for jet lag and other sleep timing disorders like delayed sleep phase disorder.

Possible chemical identified that causes excessive sleepiness

Patients who can not remain awake but for no known cause are sometimes not responsive to our standard stimulant medications. This is frustrating for the patients, as there has been less research done on this than on more common problems like obstructive sleep apnea and insomnia.

Here is an article about a small study our of Emory. Researchers have isolated a chemical in the cerebrospinal fluid (CSF) of patients with excessive sleepiness, called primary hypersomnia. The CSF chemical acts similar to medicines like Valium. In this study, alertness was improved by giving a medicine that blocks the effect of Valium. These results are interesting, because other studies have not found the same alerting affects of that medicine.

But if researchers can pinpoint the chemical, than novel drug therapies may be helpful in improving the lives of those suffering from primary hypersomnias.

Older Americans sleep as well as younger Americans

In my training, I was taught that older adults, in general, go to bed early, get up early, and have poorer sleep overall than younger adults. This article discusses new research about the sleep habits of older Americans. Researchers did telephone surveys and found that many of the respondents had sleep schedules and sleep quality similar to those of younger adults.

These results are not actually surprised, as recent studies have shown similar results and Dr. Ancoli-Israel has lectured about this recently. It is true that some sleep disorders are more prevalent as we age, but getting older does not automatically mean you are destined for poor sleep.

Music therapy for insomnia

This article discusses a new, non-drug approach to treating insomnia. I don't know much about it, although I have known about it for a few years. I don't understand exactly how it works, either. Apparently, researchers attach electrodes to the scalp of insomnia patients. The electrodes record brain wave activity. A sophisticated software program analyzes the mathematics behind the brain waves and then creates music based on that pattern. The music is then piped in through headphones to the patient. The study showed a significant decrease in insomnia symptoms as reported by study subjects. No sleep studies were done to confirm the effects, and patients knew if they were getting the treatment - two aspects that affect the results. If this new type of therapy proves to be beneficial in larger, controlled, and blinded studies, it may be a good non-drug approach. I am not sure how it would be delivered though - only through major medical centers or through a sleep clinic?

Ambien increases risk of falls in hospitalized patients

Here's another article about Ambien and increased fall risk. This study was done at Mayo, where Ambien was associated with a significantly increased risk of falls in hospitalized patients. Mayo has decided not to use Ambien anymore in their hospitalized patients, and instead, use a drug free approach. Details were not given about that approach, and hopefully they will have success. Poor sleep quality during hospitalization can be a challenge, and I am not sure standard behavioral therapies used on an outpatient population would work during an acute hospitalization. More studies will be needed for sure.

Type B natriuretic peptide and obstructive sleep apnea

Obstructive sleep apnea (OSA) has been shown to increase the risk of cardiovascular disease. Type B natriuretic peptide (BNP) is a hormone secreted by the heart when it is stressed. There is conflicting data about the association of OSA and elevated BNP levels, especially in asymptomatic patients, and among women. This study analyzed the association between OSA and BNP in a community-based sample of women. All participants had overnight sleep studies and blood work done the next morning.

The results showed a dose-response relationship between increasing OSA severity and elevated BNP levels, even after adjusting for confounding variables like age, body-mass index, blood pressure, and kidney function. The study authors theorize that during an OSA event, the chest cavity has a reduced pressure, and more blood enters that region. More blood also gets to the heart, stretching the walls a little more. This stresses the heart and BNP is released. Also, OSA can cause low oxygen levels, and this may stress the heart, which would then release more BNP. The authors conclude that BNP could serve as a marker in OSA patients who may be at increased risk for cardiovascular disease.

Weight loss pill helps reduce obstructive sleep apnea severity

Obstructive sleep apnea (OSA) usually gets worse with weight gain, and better with weight loss. A new, combination medication, Phentermine + Topiramate, has been shown to help in weight reduction. This study evaluated the safety and efficacy of Phentermine + Topiramate compared to placebo for treatment of obese patients with moderate to severe OSA that were unwilling or unable to use CPAP. Both groups received a standardized weight reduction counseling program and the study lasted for 28 weeks.

The results showed that the Phentermine + Topiramate treatment showed significant improvements in sleep apnea severity, subjective sleep quality, weight loss, and systolic blood pressure when compared to placebo. Of note, the placebo group also had a reduction in OSA severity and weight reduction, just not as much as the treatment arm. There were no serious adverse events reported, except one case of kidney stones in a patient who already had a history of them. Topiramate typically causes fatigue, but this was not present, probably due to the stimulating effects of the Phentermine.

Phentermine is an appetite suppressant, and was once used in the combination weight loss medication Fen-Phen. The Fen part, or fenfluramine, was taken off the market because it was associated with heart valve damage. Topiramate is an anti-seizure medication, but has been shown to reduce weight through an unknown mechanism. It's not clear from this study if the combination of the two would be better than Phentermine alone. Also, this study was for 7 months, but what would happen when the medications were discontinued? Or would this have to be a life-long treatment?

Comparing sleep between fibromyalgia and rheumatoid arthritis

Both fibromyalgia (FMS) and rheumatoid arthritis (RA) are chronic pain conditions, can disrupt sleep, and result in subjective daytime sleepiness and fatigue. This article discusses a comparison between the two conditions with regard to objective sleep quality at night and daytime sleepiness in women. Researchers did standard sleep studies and surveyed the patients for their subjective experiences.

The results showed that there was similar nighttime sleep disturbance between those with FMS and RA. The FMS patients reported greater subjective daytime sleepiness and fatigue than those with RA. But the sleep studies showed relatively low daytime sleepiness in FMS and an intermediate amount in the RA patients.

These results support clinical findings - that FMS patients are generally not sleepy, but very fatigued. Fatigue can not be measured like sleepiness. Patients with RA are more sleepy, and this is supported with objective testing. RA patients are also fatigued. The authors of the study concluded that FMS patients have less sleepiness and more fatigue due to hyperarousal. This could be true, but unfortunately it is difficult to treat.

Throat muscle paralysis mechanism discovered

Obstructive sleep apnea (OSA) occurs when the throat closes too much during sleep. And when we dream, the throat (as well as other muscles) close the most, as the brain temporarily "paralyzes" our muscles so we don't act out the dreams we are having. This article discusses research showing how the brain paralyzes the throat muscles when we dream, which could lead to OSA. This is exciting (at least to me) and has implications for future medical treatments for OSA.

Energy drinks may disrupt sleep in combat troops

Here is article about energy drink consumption by our soldiers. The results showed that those soldiers who consumed more energy drinks also reported less sleep at night and more daytime sleepiness. The article implies that the energy drinks are somehow responsible for the reduced nighttime sleep and daytime sleepiness. That doesn't seem likely to me. More likely is that the soldiers are sleep deprived from other sources, like being in combat! They are tired the next day and reach for the energy drinks to help them make it through the day, not the other way around.

Insomnia medications can increase memory and concentration problems

This article discusses how certain medications used for insomnia can increase mild memory and concentration problems in older people. The medications mentioned were benzodiazepines, like valium and anti-histamines, like benadryl but also the "PM" over the counter sleep aids. The study authors acknowledged that some patients may need these medications despite the risk. But at least for insomnia, non-drug treatments have been shown to improve sleep quality. Talk to your doctor or a sleep physician about how you can improve your sleep, rather than resorting to medications.

Wind farm noise may disrupt sleep

In this article, researchers surveyed the sleep quality of people living near and far from farm turbines. The results showed that the closer a person live to the wind farm, the more disrupted their sleep, secondary to the noise generated by the turbine. Persons close to the turbine also had poorer mental health. My first thought was that perhaps the difference in self-reported sleep and mental health was due to being lower socioeconomic status, but the study authors said they controlled for that.

Weight loss may improve sleep quality

This article discusses research showing that modest weight loss (about 15 pounds) may improve self-reported sleep quality by 20%. I've seen this happen in my clinic, and the results can be impressive. Researchers think that belly fat may be responsible for sleep disruption, and losing the belly fat may be what helps improve sleep.

Insomnia increases cardiovascular risk?

Many of my patients with insomnia are understandably worried about the physical effects of insomnia. They are concerned that their insomnia will lead to cardiovascular disease (heart attack or stroke, for example) or death. To date, no studies have convincingly shown that primary insomnia increases risk of physical problems - it has been shown to increase rates of depression.

Here is an article about a study trying to link insomnia to increased risk of heart attack and stroke. However, the study authors did not separate the different types of insomnia, meaning the results are difficult to interpret. More specifically, they did not separate the effects of primary insomnia from secondary insomnia (as from sleep apnea) and even people who just decide to get too little sleep. Since the last two categories of insomnia can increase cardiovascular risk, it could make all insomnia seem risky, but this is artificial.

Young children with cystic fibrosis at risk for obstructive sleep apnea

This article discusses how young patients with cystic fibrosis, a chronic lung disease, are at increased risk for obstructive sleep apnea.

Chronic sleep loss in rats

Studies and news reports keep coming about how sleep loss / sleep deprivation is associated with obesity and type 2 diabetes - but the studies are far from conclusive. One problem is that it is difficult to control diet and sleep behavior in humans over a long period of time. Animal studies may help us understand the link between sleep and obesity, since animals can be controlled in the lab. Animal studies in the past have shown links between sleep loss and metabolic changes, but this is usually weight loss and could be due the stress of forced wake time.

Vetrivelan et al have performed an interesting study on rats published in this month's Sleep Journal. They produced brain lesions in the hypothalamic regions of rats as an animal model for chronic, partial sleep loss, and they followed the rats for 2 months (relatively long time for a rat).

Results showed that on average, the brain lesions resulted in 40% reduced sleep compared to normal rats - equivalent to reducing sleep from 8 hours to 4.8 hours per night in humans. However, the rats with brain lesions did not become obese or develop metabolic syndrome. In fact, there was a decrease in blood glucose, cholesterol, and triglycerides!

The authors are not sure why there is a different response in rats and humans to sleep deprivation. When humans voluntarily go without sleep, their food intake increases and are less active. However, the rats in this study did not consume more food and were more active than control rats. The authors concluded that chronic sleep loss per se does not lead to obesity or the metabolic syndrome, at least in rats.

General anesthesia similar to sleep

This article discusses research discussing how general anesthesia may cause deep sleep. Researchers studied the brains of mice under anesthesia and found that the anesthetics turn off wake-promoting neurons and turned on sleep-promoting neurons. However, anesthesia is still not normal sleep. But general anesthesia can allow anesthesiologists to identify individuals at risk for obstructive sleep apnea - I get frequent referrals for this very problem, since the anesthesiologist is "watching them sleep" for hours!

Electronic nose may be able to detect sleep apnea

Although I did not even know they existed, electronic noses have been developed to diagnose certain medical disorders. This article, researchers discusses a study to determine if an electronic nose could detect obstructive sleep apnea (OSA), by measuring volatile compounds in the patinents' breath. It's not clear how the researchers determined if the participants had OSA, as the article mentions only "sleep examinations." If that means sleep studies, then that would be more accurate. The results did show that the electronic nose did predict OSA. They concluded that the electronic nose could help determine who needs a sleep study and who does not.

Obstructive sleep apnea and heart attack protection?

This article discusses a study showing that patients with obstructive sleep apnea (OSA) may have less heart muscle damage during a non-fatal heart attack. These results contradict other studies showing an increased risk of heart attack with untreated OSA.

Some of the doctors in the study urge caution saying that perhaps the chronically low level of oxygen in OSA sufferers may protect some heart attack victims. Also, the study showed that the frequency of heart attacks was not decreased by OSA, just the damage to the heart muscle from the heart attack. Interesting study and more studies will be needed to sort this out.

Electronic devices, sleep duration, and childhood obesity

This article discusses research about pediatric obesity, sleep duration, and electronic devices in the bedroom. Not surprisingly, the more electronic devices (cell phone, TV, video games) were in the bedroom, the more likely the kid would be obese. Also, for each additional hour of sleep, obesity risk was reduced.

It's not clear from the article what contributes to what. I am convinced that screen time affects kids and adult sleep. Getting these devices out of the bedroom can improve sleep quality and duration. I am not convinced that just getting more sleep will reduce childhood obesity. More sleep may improve mood and academic performance, both of which can be negatively affected by insufficient sleep.

Short sleep, blood sugar, and hormone regulation

Lots of hoopla in the news about relationship between short sleep and obesity. Studies are showing that reduced sleep leads to more eating. In this month's Sleep Journal, St-Onge et al did a study to test the effects of sleep duration on hormones and metabolites involved in energy balance regulation.

They studied normal weight, health men and women in the sleep lab. They had them sleep for 4 hours per night x 3 nights and then three weeks later let them sleep 9 hours per night x 3 nights. During each three night portion, their food intake was strictly controlled and monitored.

Results showed no effect of short sleep on glucose, insulin, or leptin levels, as previously shown in other studies. The authors point out that those other studies allowed participants to eat at will, rather than the limited eating allowed in the current study. It may be that overeating in the other studies is what produced the blood glucose changes seen.

In this study, short sleep caused increases in ghrelin in men, but not in women. Ghrelin can increase appetite. Women had reduced levels of GLP-1, but men did not. GLP-1 is known to increase satiety. So men and women may overeat for different reasons in context of short sleep duration if allowed to eat whenever and as much as they want.

It is difficult to extrapolate these results to overweight individuals, who may be metabolically different than the healthy participants in this study.

Tension Tamer before bed may improve sleep

This article discusses research showing that using visualization and abdominal breathing for 10 minutes before bed may improve insomnia.

Getting elbowed at night may mean you have obstructive sleep apnea

Here is article that confirms what we see daily in clinical practice - that is that people who get woken up by their bedpartner via their elbow for snoring and/or stopping breathing are more likely to have obstructive sleep apnea (OSA). But don't be reassured if you think you don't have OSA just because you don't get elbowed at night. While it's easy to hear snoring, it's more difficult to notice pauses in breathing, as those are not usually loud or disruptive to your bedpartner. Better thing to do is talk with your doctor about getting an evaluation for OSA.

Sleep deprivation increases risk of athletic injury in teens

I've blogged about how sleep can affect athletic performance. This article discusses a study showing that teenager athletes were more prone to an athletic injury if they slept less than 8 hours. I remember not sleeping more than 6 hours per night for most of my high school years, so I imagine kids get that much or even less nowadays with all the technological gadgets available.

Video game playing and sleep fragmentation

Playing video games before bed can disrupt sleep and often reduce available sleep time, leaving kids and many adults sleep deprived. This article is about a study showing that the longer a child played video games before bed, the more broken up their sleep. It could be the light from the screen suppressing melatonin secretion and/or more stimulation from playing more. Either way, limit your child's screen time.

Red blood cell distribution width and obstructive sleep apnea

Red blood cell distribution width (RDW) is a blood test that measures the variability of the size of red blood cells, and is usually reported in common blood work to check for anemia. In the October edition of the Journal of Clinical Sleep Medicine is an article about RDW and obstructive sleep apnea (OSA) - researchers theorize that inflammation, low oxygen levels, and/or sleep fragmentation from OSA could increase the RDW. In this study, researchers studied 108 patients with OSA. Results did show a positive correlation between RDW and OSA severity. However, the numbers are hard for me to interpret. They did not include RDW values for patients without OSA. The RDW values for mild, moderate, and severe OSA are as follows: 13.15 +/- 1.7, 13.10 +/- 2.3, and 14.67 +/- 2.5. I'm no hematologist, but those values seem pretty similar, especially the ones for mild and moderate OSA. There is too much overlap in the values for me to understand the clinical significance. The study authors state that the RDW could not be used as a screening tool because it could be affected by various independent variables. They state that the RDW may be used to give earlier appointments to patients with high RDW values so that they may be treated eariler, since their OSA severity may be worse. I'm not so sure and home sleep studies may be a better and more specific screening and / or diagnostic tool.

Dolphins may sleep with only half of their brains at a time

I used to love that show Flipper when I was a kid. They don't make good dolphin-centered programs anymore. This article discusses how dolphins appear to be staying awake as long as 15 days. The researchers think that dolphins may sleep with only one-half of their brain at a time. This allows them to stay awake and alert continuously.

Sleep deprivation and fat cell insulin resistance

This article discusses research about the effect of sleep deprivation on fat cells. They studied young, healthy people - allowing some to sleep only 4.5 hours per night and the other to sleep 8 hours for a few days. They examined each groups fat cells and determined that the short sleepers had more resistance to insulin. They concluded that sleep deprivation may impair our fat cells' ability to respond to insulin, which may lead to diabetes.

These findings are interesting, but there are some problems with the conclusions, as pointed out in the article. For example, most people do not get only 4.5 hours per night, more like 6 hours. Do they have the same effect. Also, most do not deprive for only a few days, but for months / years. Does our body adapt and do the fat cells than have normal insulin sensitivity? More research is definitely needed.

More sleep helps children in school

Here is an article about how more sleep helps kids - seems obvious but at least here is some scientific evidence. For kids that got more sleep, they were less emotional, better focused, and better behaved. There are some good tips in the article for parents as well - monitor for sleepiness, which should be relatively low at a elementary age if they are getting enough sleep.

Newer sleep aids are associated with falls in elderly

Older sleep aids that are related to Valium have been shown to increase falls in elderly patients, especially those with dementia. This article shows how elderly people are at much higher risk of falls with the newer sleep aids like Ambien.

CPAP use and high blood pressure.

It's well known that obstructive sleep apnea (OSA) is linked to high blood pressure (HTN). However, it's less clear that CPAP reduces HTN. In the October edition of Journal of clinical Sleep Medicine is a study attempting to show just that. Researchers studied veterans with known OSA who also had HTN and diabetes (DM). They monitored their CPAP use and followed them for upto one year.

Results showed that both systolic and diastolic blood pressure decreased significantly with CPAP use. This effect was most prominent with African-American patients, but still present in European-Americans. Interestingly, CPAP use did not reduce the subjects fasting blood sugar levels or long term blood sugar control as measured by their hemoglobin A1C.

Obstructive sleep apnea and coronary atherosclerosis

This article discusses research about obstructive sleep apnea (OSA) and coronary artery plaques, which are blockages in the arteries supplying the heart with blood. The softer the plaque, the more dangerous it is. The results showed that more severe OSA was associated with more soft plaque formation. Also, the more severe the OSA, the greater chance of having more than one artery with plaque. This was a small study, and more research needs to be done to determine if CPAP reduces the atherosclerosis.

Non-sleep aids being used to treat insomnia

This article discusses a concerning trend in the treatment of insomnia - physicians are prescribing less traditional sleep aids in favor of using non-traditional medications that are sedating, like anti-epilepsy and anti-psychotic medications. Although these medications can be safe when used for their indicated diseases, there is very little data to support their use in insomnia. The results highlight the difficulty in treating it with medications. Usually, physicians will start with the typical sleep aids like Ambien. When those stop working, other medications are tried such as the ones listed above. However, for long term treatment of insomnia, cognitive behavioral therapy (CBT) has been shown to be superior. The problem is that too few doctors know how to do CBT and it is much more difficult to implement than just taking a pill.

Blinking rate can help determine sleepiness level

People's pupil response has been used to objectively measure sleepiness, but I don't think the research is conclusive. Here is an article discussing research showing that measuring blink rate in addition to pupil response can be a better measure of sleepiness.

Sleep and memories

This article discusses research about how our brain processes memory while asleep, even during anesthesia. This is new information and goes against how sleep researchers thought the process worked.

Melatonin may improve sleep in patients taking beta-blockers

Beta blockers are a class of high blood pressure medications that have been around for decades. It is well known that beta blockers can disrupt sleep, possibly contribute to nightmares, and cause daytime fatigue. Beta blockers (along with non-steroidal anti-inflammatory medications) can reduce melatonin secretion, the hormone that is produced at night to help us sleep.

In the October edition of the Journal Sleep is a study about melatonin use in patients with high blood pressure on chronic beta blocker use. This study was a randomized, placebo controlled double blinded assessment. Patients' sleep was measured objectively in a sleep lab and at home for 3 weeks wtih actigraphy. Results showed statistically significant improvement in total sleep time, sleep efficiency, and onset to sleep with the melatonin in the sleep lab and at home. There was no sign of tolerance or side effects to the melatonin, or rebound sleep problems after stopping the melatonin.

These results are promising, as many patients need to take beta blockers for their long term cardiovascular health. Since this study was only three weeks long, we don't know the long term effects of melatonin use, so caution is warranted. Also, getting quality is difficult, since the FDA does not regulate the production of melatonin.

Removing tonsils and adenoids improves obstructive sleep apnea and bed-wetting

This article discusses research showing that removing tonsils and adenoids in children can resolve obstructive sleep apnea (OSA) and bed-wetting.

Insomnia can affect relationships

Here is an article about research on effects of insomnia... "The research showed people with insomnia were four times as likely to have relationship problems, three times as likely to feel depressed and three times as likely to suffer from a lack of concentration."

I believe it, as chronic insomnia, can be an all consuming problem. The insomniac may not be able to focus on anything or anyone else but their sleeping difficulties. I don't think this is a problem unique to insomniacs, however, but would be seen in any number of chronic medical illnesses.

Insomnia and workplace accidents

This article discusses research about insomnia and work place accidents. Since I don't have access to the article, I have to go on what the article say, and this is confusing. I'm confused because the author describes the condition as sleep loss and insomnia at the same time. People with insomnia are generally not sleepy - they may be fatigued, but don't doze off. That's why we say they have insomnia - they can't fall asleep (or fall back asleep after waking up). Insomniacs want to sleep more, but can't. This condition is very different from those that can sleep fine, but choose not to sleep enough. Those folks will be sleepy at work, but it's from sleep deprivation. Also, people with other sleep disorders, like obstructive sleep apnea (OSA) can have insomnia and sleepiness from the OSA.

I agree with the authors conclusion that sleep aids are not the best treatment for many with chronic insomnia - cognitive behavioral therapy is a better option. I also agree with screening workers for sleep disorders - but doing that is challenging and would probably be a topic for another post.

Benzodiazepines and dementai

This article discusses a research study showing that older adults who take certain medications called benzodiazepines (like Valium) are at increased risk of developing dementia. Benzodiazepines are often used for the treatment of sleep difficulties. However, the researchers did not assess for sleep problems in these patients. Obstructive sleep apnea (OSA) can cause sleep problems and could impact memory. Therefore, the benzodiazepines could be linked to dementia because the patients were taking them for the OSA. Thus, we need more studies to determine if there is a true link between these medications and cognitive disorders.

Sleepiness predictive of cognitive decline in the elderly

This article from the Sleep Journal discusses a study to see if sleep complaints are associated with declining memory in the elderly. Researchers asked older participants how they slept, if they were sleepy in the daytime, and what medications they took, and followed them over an 8 year period.

Results showed that there was a positive association between self-reported sleepiness and memory decline. This was the case even after adjustment for the study center location, gender, age, educational level, baseline memory, insomnia severity, and prescribed sleep medicine.

The authors speculate that excess sleepiness may result from early stage brain lesions in those with cognitive decline. They also mentioned that obstructive sleep apnea (OSA) may contribute. The authors did not perform sleep studies, so some of the participants could be sleepy solely from untreated OSA.

More on sleep loss and bone health

This article discusses research showing that sleep deprivation in rats resulted in weakened bones. This finding could hold true for humans, meaning that sleep loss could contribute to osteoporosis.

Sleep problems in young adulthood and Alzheimer's Disease

This article discusses research in mice showing a potential link between sleep problems in young adulthood and development of Alzheimer's Disease later in life.

Obstructive sleep apnea and pregnancy

This article discusses research about obstructive sleep apnea (OSA) and pregnancy. Pregnant women have a higher chance of developing pre-eclampsia, a condition that leads to protein loss in the urine and high blood pressure in pregnancy. OSA also increases the risk that the newborn will require neonatal care in an ICU. Screening for OSA when pregnant may help prevent some of these problems.

Poors sleep quality linked to high blood pressure

This article discusses research demonstrating a link between self-reported poor sleep quality and resistant high blood pressure (HTN) in women. The artcle does not discuss possible causes. I think the common factor may be obstructive sleep apnea (OSA), which is a known cause of poor sleep quality and is linked to HTN. Because the research did not ask about OSA, I would guess that many of the women have that condition. Since OSA is treatable, and a reversible contributor to HTN, men and women should talk to their doctor about poor sleep quality.

Sleep loss affects bone health

This article discusses research showing that sleep loss can affect bone health, including changes to bone marrow in animals. If the results are also true for humans, than it supports studies showing sleep loss increases inflammation and possibly artery clogging.

Snoring and obstructive sleep apnea severity

Most people with obstructive sleep apnea (OSA) snore regularly. But not all snorers have OSA. And screening those individuals is tough. In the Sleep Journal, researchers studied the acoustical properties of snorers, to see if they could predict sleep apnea severity. They used a microphone that was placed near the patient and used sophisticated software to analyze the signals. They then compared the snoring qualities to actual sleep study results and found that they could predict OSA severity based on those snoring acoustics. The authors suggest that this method could be used as a screening tool to help distinguish those that snore with from those without OSA.

Obstructive sleep apnea did not statistically improve with weight loss surgery

Interesting study showing that weight loss from weight loss surgery did not significantly improve obstructive sleep apnea (OSA) severity compared to those on a standard weight loss program. The surgery patients lost more weight and had a greater reduction in OSA severity. But statistically, it was not different. I am not so sure about these results. It seems like the study was underpowered to show a significant effect. My experience is that weight reduction can reduce OSA significantly. I agree that these patients should not assume their OSA is improved just because they have lost weight. It is better to have a repeat sleep study to see if they still have OSA.

Women and men and their pets

Not sure why I am posting this other than to mix up the topics a little. Apparently, this survey showed that women are more likely to sleep in bed with their pets compared to men. Not really surprising though.

Restless legs syndrome and heart disease

This link discusses research showing a potential link between restless legs syndrome (RLS) and heart disease. This was based on an observational study in thousands of women. The results showed that heart disease was twice as likely in those with RLS than in those without. This does not mean that RLS causes heart disease, only that the two conditions are related somehow. It could be that some of these women also have other conditions, like obstructive sleep apnea, that increases risk of heart disease.

Sleepiness in third trimester common, but may signal underlying obstructive sleep apnea

This article discusses research showing that sleepiness during the third trimester is common, but may not be normal. Some of the sleepiness could be due obstructive sleep apnea (OSA). The authors conclude that screening for sleep related breathing disorders should be done in pregnant women, and I agree. Especially if a pregnant woman has known OSA but is not using CPAP. Untreated OSA can increase risk for a small baby, called intrauterine growth retardation.

Smoking associated with disturbed sleep.

Here is a link to an article about a study showing how smoking is linked to reduced sleep amounts and more disturbed sleep compared to non-smokers. It could be the nicotine, but also other factors could disrupt sleep.

Asthma linked to daytime tiredness in children

This article discusses research showing that kids with asthma may be more sleepy during the day. However, the results showed that the asthma does not affect sleep quality, sleep duration, or bedtime. The researchers are not sure why asthma is linked to feeling tired in the daytime. It may be due to increased work of breathing at night, but this may not be reported by parents - just experienced by the child. More research is needed to determine if better control of the asthma results in less daytime tiredness.

Puberty and deep sleep

This article discusses research showing that deep sleep is necessary for adequate hormone levels in puberty. Insufficient or disturbed sleep may impact development by interfering with this process. So make sure your tweener is getting enough sleep - adequate sleep is competing these days with screen time from iPads. iPhones, etc.

Snoring not associated with increased mortality, cardiovascular disease, or stroke

As I have mentioned before, snoring has been implicated in cartoid artery blockages in animals, but not in humans. Obstructive sleep apnea (OSA), however, has been associated with cardiovascular disease and strokes. Here is a study from the Sleep Journal about snoring in humans. Researchers studied 380 subjects by having them undergo a home sleep study to assess snoring and OSA. The subjects were then followed for 17 years and their mortality information, cardiovascular disease incidence, and stroke incidence were recorded.

The results showed no association between snoring and mortality, cardiovascular disease, or strokes, when controlling for OSA and other factors. The results help us appreciate the importance of sleep studies, as they allow us sleep physicians to distinguish snoring from OSA.

Sleeping pills do not always work for insomnia

This article discusses a survey done in the UK showing that 4 out of 10 people said sleeping pills do not help their insomnia.

Crying to sleep safe for babies emotional health in the long term

This article discusses research showing that modern day approaches to helping your infant to sleep on their own, do not cause long lasting emotional or physical problems. The methods monitored were controlled comforting, where the parent(s) gradually lengthen the time interval to respond to baby's crying, and camping out in the bedroom.

Insomnia may be genetic

This article discusses how sleep research is beginning to demonstrate a genetic component to some insomnia. This really isn't brand new, as we always knew that only some people are prone to insomnia. However, it may one day help in treating this disorder. And it give some hope to insomnia suffers by quoting Dr. Espie, an insomnia expert across the pond. He mentions that psychological treatment for insomnia, even "genetic" insomnia is effective - I agree. If you're struggling with insomnia, find a sleep clinic that does cognitive behavioral therapy for insomnia.

Sleepwalking can continue into adulthood

Many children sleepwalk and in most cases, this is normal and they will outgrow this. This article discusses how sleepwalking can continue into adulthood, and is more common than we used to think.

Acupuncture may increase deep sleep

This article discusses research showing that acupuncture may increase deep sleep. I have heard from some patients and friends anecdotally, acupuncture has helped their insomnia.

Obstructive sleep apnea increases cardiovascular mortality in the elderly

Obstructive sleep apnea (OSA) has been shown to increase risk of cardiovascular disease and mortality, and CPAP has been shown to reduce that risk. Studies have focused mainly on younger or middle age patients. This study discusses research showing similar results in elderly patients.

Nighttime eating and restless legs syndrome

Over the past few years, nighttime eating has been studied more. We are only beginning to understand this problem. It's been in the news some since there have been cases of patients eating in their sleep while taking certain sleep aids. There is a good article in the August edition of the Journal of Clinical Sleep Medicine that reviews nighttime eating and its association to restless legs syndrome RLS).

In summary, the study authors explain that nighttime eating is common among RLS patients. In some cases, sleep aids contributed to the nighttime eating. Medications used to treat RLS may improve the nighttime eating as well. Finally, in patients with insomnia but without RLS typically do not have nighttime eating while taking sleep aids. Therefore, the authors concluded that there is something about RLS that triggers the nighttime eating in patients taking sleep aids.

Men who co-sleep may have lower testosterone at night

This article discusses research showing that in men who co-sleep with their baby have lower testosterone levels at night than man who do not co-sleep. The researchers do not know why this happens or even the significance. One theory is that the lower testosterone levels may help men be more responsive to their babies.

Restless legs syndrome and soap

I saw this article titled "Can a bar of soap cure your nighttime leg cramps?" and wanted to comment. I think the author is confusing two separate disorders - restless legs syndrome and nocturnal leg cramps. They say that a bar of soap under the mattress may improve restless legs syndrome, but the title implies nocturnal leg cramps. The confusing part is that both conditions may respond to magnesium, which purportedly is given off by soap - I don't know if that is true. But it seems that if magnesium was given off by soap, how would putting it under your mattress help? Also, they mentioned lavender soap may help, as the lavender can help sleep. Maybe, but why not just use lavender aromatherapy? If you have leg cramps or restless legs, see your doctor first.

Obstructive sleep apnea common in women

This article discusses research about the prevalence of obstructive sleep apnea (OSA) in women. I was taught that men are about two times more likely to have OSA than women until women reach menopause. Than the prevalence is about equal for both men and women. But this study showed that about half of the women in their sample had some form of OSA, with 14% having severe OSA. Hopefully the word will get out and women will talk to their doctor or a sleep physician about getting evaluated.

Sleep problems may signal onset of Alzheimer's Dementia

This article discusses research showing that sleep difficulties may be an early sign of Alzheimer's dementia.

Snoring is linked to behavioral problems in toddlers

This article reviews research showing that toddlers who snore on a regular basis are more prone to behavioral problems. This could be because chronic snoring is often a marker for obstructive sleep apnea (OSA). And treating the snoring (and underlying OSA) could improve a child's behavior. If your child snores regularly, you may want to have him or her evaluated by an ear, nose, and throat doctor (an ENT) or a sleep physician.

This article discusses research showing that the light from tablets close to bedtime can lead to sleeplessness. I have seen this in some of my patients. The light can suppress Melatonin, the hormone that gets secreted when it is dark. My patients have used filters to block out blue light or a software program called f.lux.

Exercise training improves daytime functioning in sleep apnea patients

Exercise may improve obstructive sleep apnea (OSA) severity, even in the absence of weight loss. The less severe the OSA, the better patients may feel in the daytime. This article in the August edition of the Journal of Clinical Sleep Medicine is about a study done to see if exercise training can improve daytime functioning even without reducing OSA severity.

In the study, they had a group of people do supervised exercise for 12 weeks versus the control group that did only stretching for 12 weeks. The two groups of participants were similar with the exception of their baseline sleepiness scores, with the exercise group reporting a little more sleepiness than the stretching group.

The results of the study showed that at the end of the 12 weeks, the OSA severity was 25% lower in the exercise group. The exercise group also had less depressive symptoms, less fatigue, and more vigor than the stretching group. Exercise training caused a lowering if subjective sleepiness, but this was not statistically significant. Exercise training improved physical functioning, vitality, and mental health as measured by questionnaires. Interestingly, there was no difference in participants performance on tests of cognition with exercise versus stretching.

Now you may say that the improvements in exercise were due to OSA severity reduction, not because of the exercise itself as the authors proposed. But, only improvement in fatigue was linked to reduction in OSA severity in the exercise group. All of the other improvements occurred in the exercise group even when the OSA severity remained the same.

These findings are exciting, because not everyone feels better on CPAP. Perhaps exercise may improve their functioning, even though they still have OSA.

Obstructive sleep apnea, sleeping problems, and special education

This article discusses research showing that children with obstructive sleep apnea or sleeping problems are more likely to need special education classes.

Overactive bladder and obstructive sleep apnea

This article discusses research showing a link between overactive bladder and obstructive sleep apnea (OSA) in women. This fits with my experience, as untreated OSA can contribute to nighttime urination, and CPAP often helps.

Stomach sleeping and erotic dreaming

This article describes research showing that in people who slept more on the their stomach, reported dream content that was more sexual in nature, including being tied and locked up. Dreams were also more likely to be about being persecuted in stomach sleepers. The researchers speculated that sleeping on your stomach may deprive your brain temporarily of oxygen which could result in the type of dream content reported by the subjects. I'm not sure about the decreased oxygen levels with sleeping on your stomach. However, it could be that some patients inadvertently bury their face in the pillow which could been be misinterpreted by their sleeping brain as being tied up or locked up. Also, I am not convinced you can control the content of your dream by the position that you sleep in. It may be better just to sleep in a position that is most comfortable.

Obstructive sleep apnea, stroke, obesity, and type 2 diabetes

Obstructive sleep apnea (OSA), stroke, elevated weight, and type 2 diabetes often exist together. Sorting out what contributes to what is difficult to do. The authors of the study in the Sleep Journal studied how OSA severity is related to cardiovascular disease (CVD) in obese type 2 diabetics. The subjects were studied with home sleep tests and asked subjectively about CVD.

The results showed that the risk of stroke increased with the OSA severity. However, OSA severity did not correlate with increased risk of other CVD like coronary heart disease or heart attack. The authors concluded that moderate to severe OSA could further increase stroke risk in obese type 2 diabetics. Of course, more studies will be need to see if treating OSA in those patients reduces stroke risk.

Sandpipers that sleep less mate more and have more offspring

This article describes research findings that a certain type of Sandpiper that sleeps less was able to mate more and have more offspring. The scientists involved in the study are not sure about why the birds get less sleep but the birds did not appear to have any negative effects from the sleep loss. Researchers are hoping to study the birds brains in order to understand the role of sleep and the effects of sleep loss. Unfortunately, many studies have shown that sleep loss in humans does affect her performance. Perhaps by studying these birds brains, we can figure out how to improve performance in humans who have endured sleep loss.

Sleep apnea can increase risk for type 2 diabetes

This article discusses research showing that obstructive sleep apnea (OSA) may increase risk for type 2 diabetes - which is typically adult onset and often linked to obesity. However, researchers studied healthy young men and measured their insulin sensitivity and insulin levels. In those men with OSA, they showed signs of reduced insulin sensitivity and increased insulin levels, which are precursors to diabetes. Now the article does not state whether the patients with OSA were treated.

Snoring and carotid artery blockages

Snoring has been linked to blockages in carotid arteries in animals, but it's not clear if snoring contributes to blocked arteries in humans. In the August edition of the Sleep journal, researchers perform the study on subjects that had had strokes or mini strokes (TIAs). They had the patient's complete questionnaires about snoring and they graded the degree of carotid artery narrowing by ultrasound.

The results showed no association between snoring and carotid artery narrowing. However this study did not assess for obstructive sleep apnea which could increase the risk of stroke. Therefore, in patients who have had strokes, or mini strokes, it can be helpful to have them assessed for obstructive sleep apnea.

Obstructive sleep apnea is linked to decreased insulin resistance.

This article describes research showing that children with obstructive sleep apnea have decreased sensitivity to insulin. Decreased sensitivity to insulin can be seen in diabetes. The researchers hypothesized that oxygen level decreases seen in obstructive sleep apnea could be responsible for the decreased sensitivity to insulin. Results of this study suggest that it is important to screen patients with diabetes or who are prediabetic for obstructive sleep apnea.

Learning while asleep

This article discusses research showing that some learning can occur during sleep. In this study, researchers exposed subjects to a sound paired with a certain smell that affects breathing during sleep. They did this enough times so that the subjects had the breathing reaction just to the sound alone, even when the smell did not accompany it (think Pavlovian response).

The researchers then tested the subjects when awake and found that they reacted to the sound alone, even when there was no smell along with it. This means that the learning occurred while asleep, as the subjects had no memory of either the sound or smell. Pretty cool, huh?

Patients having bariatric surgery may not report symptoms of obstructive sleep apnea

This article discusses research showing that in patients undergoing bariatric surgery, they often do not report symptoms of obstructive sleep apnea (OSA) as often. This is despite a rather high incidence of OSA in this population. The results of this study are consistent with my clinical experience. I often get patients referred from bariatric surgeons who otherwise would not come to a sleep disorders clinic. Because untreated obstructive sleep apnea is dangerous for patients undergoing bariatric surgery, it may be beneficial to screen all patient's undergoing potential weight loss surgery for obstructive sleep apnea. Since patients report less symptoms, the screening used may be better if it is objective rather than relying on patient reports. Of course, I understand that patient's thinking about bariatric surgery may see this as one more obstacle in their path to achieving weight loss. However, due to the perioperative risk it would be beneficial to get screened for sleep apnea, whether they experience symptoms or not.

Yoga may improve chronic insomnia

This article discusses research showing that yoga may improve chronic insomnia.

Smoking linked to more severe obstructive sleep apnea.

This article is about house smoking may increase the severity of obstructive sleep apnea (OSA). The authors explain that the correlation between smoking and OSA has not been studied in detail. The results of this study showed that smokers were more likely to have moderate to severe OSA, whereas nonsmokers were more likely to have mild OSA. The severity of OSA was particularly increased in those smokers who smoked at least 1 pack per day for 10 years.

They concluded that the results suggest smoking thikens the lining of the back of the throat, which causes narrowing of the air passages. This then leads to a worsening of the OSA.

So if you are smoker, this study provides yet another reason to give up the habit.

Violent cartoons disrupt sleep of preschoolers

This article discusses research showing that violent cartoons, meant for older children, can disrupt the sleep of preschoolers. This makes sense to me, as younger children can not understand what they are watching. The researchers recommend age-appropriate shows for pre-schoolers.

Short sleep duration and breast cancer

This article discusses research showing an association between post-menopausal women with short sleep durations and aggressive breast cancer. There was no association between the aggressiveness of the cancer and sleep duration in pre-menopausal women. The researchers obtained sleep duration by asking the women how long they slept on average, and this method is not the most accurate. It's not clear why the link between short sleep duration and aggressiveness of breast cancer - it could be that insufficient sleep causes our bodies to be in a chronically inflamed state, which perhaps may be more advantageous for certain tumors. More studies are needed to see if better or more sleep could reduce the aggressiveness of breast and other cancers.

Insomnia, obstructive sleep apnea, or daytime sleepiness is linked to insulin resistance

This article discusses research showing that patients with insomnia, obstructive sleep apnea (OSA), or excessive daytime sleepiness are more likely to have insulin resistance. This is no surprise to me, as research has shown a link between OSA and diabetes before. But this research may prompt primary care physicians to test their patients for diabetes if they also experience insomnia or daytime sleepiness, or have known OSA.

Sleep researcher idenitifies area of brain that wakes you up when oxygen levels drop

This article discusses how a sleep researcher demonstrates the area of the brain affected by low oxygen levels at night when sleep apnea occurs. The area is called the parabracheal nucleus (PBN) and is responsible for waking your brain up if your oxygen level gets too low. That's a good thing, so that people with obstructive sleep apnea keep breathing when asleep. The results also showed that a neurotransmitter called GABA can reduce the PBN's ability to wake the brain up. This is important because some sleeping pills enhance GABA - and could therefore reduced the PBN's effectiveness!

Sleep duration and response to Hepatitis B Vaccination

There has been a lot of press about this, so I thought I would review this article published this month in the Sleep Journal. The premise of the article is that sleep deprivation has been shown to affect the immune system. But this study set out to determine if sleep duration would predict if patients would respond to Hepatitis B vaccinations.

Researchers studied 125 healthy subjects aged 40-60 years old. They had the patients record sleep diaries and rated their sleep quality for 3 days before and after each of three Hep B vaccination injections. After the study was started, they did measure 104 patients sleep with a home sleep test, called an actigraph.

The researchers broke up sleep into three categories - less than 6 hours, 6-7 hours, and more than 7 hours. The results showed that the shorter the sleep duration, the lower the response to the vaccinations. The findings were independent of age, sex, and BMI, which apparently have beeen shown to affect vaccination response. Only sleep duration, not sleep quality or sleep efficiency, was correlated with vaccination response.

The researchers did not measure daytime sleepiness. So it is not known if the subjects who got 6 hours but were not sleepy also had a decreased immune response. In other words, this study does not tell us if sleep deprivation (needing 8 hours, but only getting 6 hours) or just getting 6 hours or less is associated with the decreased immune response. Some people are short sleepers, needing only 4-6 hours of sleep per night. Do they really have lowered immune response? My intuition is that sleep deprived individuals would have the lowered immune response, not short sleepers. Perhaps experiements should be done on those who sleep 8 hours, but need to sleep 10 hours. So it may not be the absolute number of hours of sleep, just the number of hours obtained relative to the number hours needed to feel rested.

Sleep deprivation can affect visual search performance

This article discusses research showing that the longer you stay awake, the slower you may be at completing tasks requiring vision. The results are particularly important for those occupations such as air traffic controllers, etc. The results showed a slowing down, but the accuracy was apparently the same.

Sleep may improve exposure therapy in phobias

This article discusses research showing that sleep may improve the effect of exposure therapy. This was done in patients who fear spiders. Results showed that fear was reduced when participants were shown videos of spiders and then allowed to sleep. This makes sense, as sleep is thought to be involved in memory and may allow the participants to remember the video better, and become better desensitized to seeing spiders.

Teenagers worry about lost sleep

This article discusses research showing that some teenagers are worried about not getting enough sleep. This is not new, but is of concern. Children and adolescents need sleep to be maximize academic potential and health. At the end of the article, it discusses how increased screen time (such as TV, computer, and smart phone use) contribute to lost sleep.

Neuroscientist advises NASA about importance of proper lighting to sleep

This article features a neuroscientist who is advising NASA about replacing its outdated lighting on spacecraft with high tech adjustable lights. This may improve astronauts sleep quality, since light affects sleep and other aspects of our daily functioning.

Herbal remedies and insomnia

There is a review of the efficacy of herbal remedies in treating insomnia. The aim of the study was to review the published literature on treating insomnia with herbal remedies.

Valerian root was shown to probably be safe, but the studies regarding efficacy were inconclusive. Kava-kava was shown in one study to be effective, but safety concerns including skin reactions, neurological complications, and liver damage have prompted the FDA to issue an advisory statement about its use. Chamomile and St. John's wort have very few articles supporting their use in treating insomnia. Lemon balm, passionflower, and lavender have no published articles on their efficacy in insomnia.

While the temptation to try these herbal remedies is understandable, just because a compound seems "natural" does not mean it is safe and/or effective in managing insomnia. Cognitive behavioral therapy (CBT) has been shown to be safe and effective for insomnia, and does not involve ingesting any substances. With CBT, you learn skills that will help you sleep for the rest of your life.

CPAP improves sleepiness in mild and moderate obstructive sleep apnea

This article discusses research by Dr. Weaver showing how CPAP benefits patients with mild to moderate obstructive sleep apnea (OSA), not just severe OSA. This has been my clinical experience - I find that the OSA severity does not often match how sleepy patients feel. I've had some patients who barely meet criteria for OSA be extremely sleepy, and improve significantly with regular CPAP use.

Light at night may increase depression

This article discusses research showing a link between nighttime light and depression. Low light levels from night lights and televisions were enough to increase the risk of depression.

Broken up sleep in elderly can lead to nursing home placement

This article discusses research showing that women with fragmented sleep were 3 times more likely to end up in nursing homes when followed over five years. This is what we see in clinical practice as well. Often patients who are older and with dementia, begin to sleep in the day and stay up all night. Caregivers are unable to reverse this sleep timing, and they are left with no choice but to place their loved one in a nursing home.

Sperm whales sleep in a vertical position.

This article discusses findings that some sperm wales apparently drift and a vertical position while asleep for short periods of time. I am not sure what this has to do with human sleep but it's still interesting (to me).

This article discusses research findings in rats. Researchers sleep deprived some rats after they were exposed to a traumatic event. The results showed that those sleep deprived rats exhibited less behavior problems from the post-traumatic event, compared to rats who were allowed to sleep normally after the event. These results are similar to what I wrote about in a similar blogpost.

It makes sense that not allowing the rats to sleep right after the event may interfere with the rats' ability to encode memories of the event. More studies are needed in humans to see if the same effect occurs.

Shift work and police officers

This article discusses research out of the Univeristy of Iowa regarding shift work and police officers. The results showed that shift workers on the police force that slept fewer than six hours per night were more susceptible to chronic fatigue and health problems, such as being overweight, and developing diabetes or heart disease. The article discusses some ways to help, which include allowing officers to get 7-8 hours of sleep between duties.

Obese rats have more broken up sleep and daytime sleepiness

Here is an article about a study presented at annual meeting of the Society for the Study of Ingestive Behavior. Researchers fattened rats with high fat diets and measured their sleep behavior. They found that the obese rats slept more in the daytime, indicating they were sleepier than normal rats. Also, the obese rates had more sleep fragmentation. Researchers think that obesity can reduce Orexin levels, which may increase sleepiness. This research supports other research showing that obesity alone increases daytime sleepiness.

New recommendations for pediatric snoring and sleep apnea

The American Academy of Pediatrics recently release new guidelines for children who snore. This is helpful information, as we are seeing more children with sleep-disordered breathing. I limit my practice just to adults, but I am very fortunate to have Dr. James Roy as one of my partners. He is a pediatrician and board certified sleep specialist, one of the few in the country.

Depression and insomnia

This article discusses insomnia and depression, two problems that often exist together. Research has already shown that chronic insomnia can increase the risk of developing depression. The study in this article showed that if someone has residual insomnia after depression begins to improve, they are at increased risk of relapsing into depression again.

Sleep quality and cell phones

This article discusses research about the affects of late night texting on sleep quality. Obviously, getting texts all night will disrupt sleep. But also, the light from the little screen is enough to suppress secretion of melatonin, which can also reduce sleep quality. The article mentioned Dr. Breus, who is an insomnia expert, and he gives some tips on improving sleep in kids with cell phones. Limiting screen time in the evening and certainly at night can help.

Zeo app for iPhone may help you sleep better

This article discusses a new, free iPhone app from the company that makes the Zeo. This app can help improve sleep quality. Of course, it won't replace a sleep physician, but it may be helpful as an adjunct.

Sleep and dementia

This article reviews 4 studies presented at the 2012 Alzheimer's Association International Conference®. They showed that sleep quality and sleep duration can affect risk of cognitive decline in the elderly. However, researchers do not know if improving sleep quality will reduce or prevent cognitive decline. Another study showed that sleep disordered breathing is related to dementia, which makes clinical sense.

Compression stockings may improve obstructive sleep apnea

This article reviews a recent study showing that compression stockings may improve obstructive sleep apnea. I discussed this more during a previous post.

This is the theory behind why the stockings may help. Fluid can accumulate in the lower legs during the day because for much of the day, the legs are lower than the heart, and gravity pulls the fluid down into the legs. This fluid usually gets resorbed back into the blood stream when the patient lays down at night, as the legs are at the level of the heart. But this fluid expands the blood volume and it can leak out at other locations, such as the back of the throat. This causes swelling and worsens the narrowing seen in OSA. The stockings can prevent the fluid accumulation in the legs to begin with, thus limiting swelling in the back of the throat when the patient lays down.

Caffeine associated sleep disturbance

This month's Sleep Journal has an article about genetic influences on caffeine's ability to produce sleep disturbances. Dr. Byrne and others surveyed over two thousand individuals for caffeine's propensity to cause sleep disturbance. The study authors then analyzed millions of gene fragments from the study participants and discovered that several genes are thought to influence caffeine induced insomnia. This is interesting because it could help in our assessment of the etiology of insomnia and may improve our treatments.

Neurotransmitters involved in paralyzing the muscles during dream sleep

This article discusses research discussing how our brain paralyzes our muscles while we dream. Researchers used to think it was due to only one neurotransmitter, but this research points to two neurotransmitters. This could have treatment implications for patients that have REM sleep behavior disorder, a form of sleepwalking.

Two theories on why we sleep

This article from the HuffPo talks about two theories about why we sleep.

Unemployed may have trouble sleeping

Here is an article about a survey done at Consumer Reports about how unemployed people expressed more trouble staying asleep. Work-place stresses were a common reason for not sleeping well. A significant part of the article was dedicated to getting a new mattress. While this may improve some people's sleep, I would caution that some insomnia symptoms could be from other sleep disorders, like obstructive sleep apnea - and a new mattress most likely would not help that.

Provigil in the news

ABC News recently did a story about off-label use of Provigil, a stimulant that is approved by the FDA to improve sleepiness in narcolepsy, obstructive sleep apnea, and shift work disorder. Apparently, there is an increasing number of Americans who are taking Provigil, and the article implies that it is being taking for off-label reasons - to improve focus and daytime energy. The article talks about a few people, most of who remain anonymous. They all tout the benefits of taking Provigil. It's not stated whether these individuals have been diagnosed with a sleep disorder or if they received their prescriptions from their doctor or online.

ABC News did an "experiment" on one person - a software company CEO who takes Provigil daily. They had him stop the Provigil for 3 days. He noticed a "very slight" change in his own speech, whatever that means. They had him do cognitive tests off the Provigil. The next day, he took the Provigil, and reports feeling more alert in 17 minutes. This is implausible, as it most likely had not even been absorbed into his bloodstream yet - this makes me think there is a significant placebo effect at work here. After he took the Provigil, he repeated the same cognitive tests and reportedly did much better. ABC News implies the Provigil is what helped - but could he have done better just because he was repeating tests he had taken the day before? In other words, he may have improved due to learning what to expect from the test, not from taking Provigil.

Taking Provigil off-label could be dangerous. Recently, a life-threatening rash has been reported in some taking Provigil. Not discussed in the article is that Provigil, and it's new brother Nuvigil, may reduce the effectiveness of oral contraceptives, making unwanted pregnancy more likely. Finally, the article mentions that there are no studies showing that performance improves with Provigil. In fact, if you take Provigil to offset sleep deprivation, there is a good chance that you will not gain much, as sleep loss itself reduces performance. I wonder how much placebo effect the people in the article are receiving, as they all think they are taking "Viagra for the brain" as stated in the article.

Instead of taking Provigil to give yourself a theoretical edge, it would be better to eat right, exercise daily, get enough sleep, and prepare better for whatever life brings your way.

Acute sleep deprivation can affect immune system

Studies have shown sleep loss could affect the immune system - it can weaken some aspects of it that fight pathogens, and possibly strengthen another part that may attack our own tissues. A study was published in the July edition of the Sleep Journal by Dr. Ackermann and others about sleep loss and the immune system. They studies healthy, young males in the sleep lab for 3 days straight. The first night was an adjustment night, the second night was an 8 hour sleep opportunity, and the participants were kept awake for the entire time during the third night. Blood was drawn every three hours during the study.

The results showed that there was an overall increase in circulating granulocytes (a type of immune cell involved in fighting bacteria) in the blood after the acute sleep deprivation night. The study authors suggest that the increase in circulating granulocytes is a response to the stress of acute sleep deprivation. The health consequence of this are not yet known. However, there is evidence that increased granulocytes are associated with cardiovascular disease. This could provide the missing link between studies showing an association between sleep deprivation and cardiovascular disease. It's not known whether the granulocyte concentration would remain elevated or even be elevated with chronic partial sleep deprivation, versus a night of total sleep deprivation as in this study. It is possible that over the long term, the immune system compensates for chronic partial sleep loss. Apparently this compensatory effect has been demonstrated in long term shift workers.

Obstructive sleep apnea slightly worse in winter months

This article discusses research done in Brazil that showed a small worsening in obstructive sleep apnea during winter months versus summer months. Researchers are not sure why, but speculate that it could be due to more frequent upper airway infections or wood burning stoves during winter months. Also, some patients may be more inclined to seek treatment in the winter months as opposed to the summer months.

REM sleep behavior disorder risk factors

This blogpost from the Huffpo discusses research findings about REM sleep behavioral disorder (RBD). RBD is a form of sleepwalking where patients act out the content of the dreams they have at night - see my prior post about it. We don't know why RBD occurs, but it is most common in older men and is often associated with Parkinson's Disease. This study showed that people who smoke, have a head injury, or exposed to pesticides are at increased risk of developing RBD.

Risk of obstructive sleep apnea in wind musicians

I remember reading an article demonstrating that playing the didgeridoo, an Australian wind instrument (see this Youtube clip), could improve mild obstructive sleep apnea (OSA). More recently, a study came out showing that speech therapy may also improve OSA. These studies suggest that altering upper airway muscle tone may reduced OSA severity.

Last month's Journal of Clinical Sleep Medicine had an article about musicians and OSA. Dr. Ward and others surveyed musicians if they have OSA. The results showed that those musicians that played double reed wood instruments like the oboe, bassoon, and English horn, had a significantly lower risk of having OSA compared to those playing non-wind instruments.

The researchers theorize that plying specific wind instruments may improve upper airway musculature enough to reduce OSA - due to the way the musician has to purse their lips and make a buzzing sound into the double reed. Before you pick up a bassoon though, realize that the musicians surveyed were professionals, playing on average 16.5 hours per week. Apparently, double reed instruments are also notoriously difficult to learn to play properly. Using a CPAP at night while asleep sounds much easier to me!

Learned skills may be enhanced with sleep

Here is an article, representative of several I saw about new research about sleep and memories. The article titles imply you can learn things while asleep. But that is not what the research showed. In this study, participants learned to play two different tunes on a keyboard. Researchers played one of the tunes while participants slept and concluded that the participants better recalled the tune played while they slept. The results do NOT mean you can learn things while you sleep. These participants had already learned the tunes - playing the tunes for them only enhanced their recall.

JetBlue pilot may have lost it due to lack of sleep

This article discusses how the JetBlue pilot that recently had a meltdown on the plane may have had a psychotic breakdown due to lack of sleep.

Insomnia linked to watching TV online

This article discusses research showing that people who report having insomnia are more likely to watch TV online or use a tablet to watch TV - these findings are new. The results also showed what we already knew about people with insomnia - they are more likely to be divorced females between 35-54 years old, and self-employed or unemployed. Perhaps people with insomnia watch more online TV as they are more likely to watch TV in bed and in the middle of the night. On an IPAD, for example, someone could watch TV in bed with headphones and not wake a bedpartner. I am not trying to give anyone ideas here, as this practice is terrible sleep hygiene.

Treating dream sleep-related obstructive sleep apnea

In last month's edition of the Journal of Clinical Sleep Medicine is an article by Dr. Su and others about treating a subtype of obstructive sleep apnea (OSA) that is defined as occurring mainly during dream (REM) sleep - I'll call it REM OSA for short. To give you some background, our sleep can be broken down into two categories: Dream or REM sleep and non-REM sleep. OSA typically occurs in both stages, but can be more prominent in REM sleep. And as described above, some patients have OSA almost exclusively in REM sleep.

Sleep researchers are not sure if REM OSA causes the same type of daytime symptoms as regular OSA - and are thus not sure if treatment will improve quality of life. REM OSA is more common in females and in those with smaller neck circumferences. In this study, Dr. Su assessed daytime functioning with questionnaires to see if CPAP helps.

The results did show that treating REM OSA with CPAP improved daytime functioning, including improved sleepiness, fatigue, mood, and overall status. They concluded that patients with REM OSA should be treated with CPAP. This has been my clinical experience as well.

Cannabinoids and Obstructive Sleep Apnea

Marijuana can reduce nausea and vomiting in cancer patients, and researchers have made synthetic versions of the active ingredient in Marijuana, called cannabinoids. This article discusses how sleep researchers are studying the effects of these cannabinoids on obstructive sleep apnea (OSA). This is exciting, as currently there is no medication that can treat OSA.

Australian Olympic Committee bans prescription sleeping pills

This article describes how the Australian Olympic Committee (AOC) is banning prescription sleeping pills for Australian Olympic athletes. Per the article, the AOC is concerned about addiction to the sleeping pills after a retired Olympic swimmer, Grant Hackett, said he became addicted to a form of Ambien, called Stillnox.

I'm not sure how banning the use of these prescriptions during the games will prevent athletes from using them after the games are over. Most people who use these medications do not become addicted to them. If the medications improve sleep, this may actually improve athletic performance, as I discussed in a previous blogpost.

Sleep Can Affect Parkinson's Disease Symptoms

This article discusses interesting research about sleep and Parkinson's Disease (PD). I wasn't aware that some patients experience a reduction in their PD symptoms after sleeping, whether it's in the morning after a full night of sleep or after a daytime nap. Researchers are trying to find out why this symptom reduction occurs, but so far have not been able to come up with the answer.

Obstructive Sleep Apnea severity and Diabetes Marker

This article discuss research findings showing that obstructive sleep apnea (OSA) severity is linked to hemoglobin A1C (HgbA1c), a marker for diabetes severity. The more severe the OSA, the higher the HgbA1c. This comes as no surprise as we have known about an association between untreated OSA and diabetes.

Women with polycystic ovarian syndrome and obstructive sleep apnea more likely to have prediabetes

This article discusses how women with a condition called polycystic ovarian syndrome (PCOS) and obstructive sleep apnea (OSA) are at increased risk of being prediabetic. See my other blogpost about OSA and PCOS.

Infants Sleep Environments More Important Than Genetics

Here is an article about a study confirming what I already knew - that establishing a pro-sleep environment early in a child's life will help them sleep better.

Obstructive Sleep Apnea and Diabetic Neuropathy

This article discusses study results showing that obstructive sleep apnea (OSA) is linked to diabetic neuropathy. Researchers think it may be due to the repetitive oxygen level drops during OSA that increases the risk of neuropathy. It would interesting to note if treating the OSA reduces the neuropathy risk.

CPAP Use and Glucose Tolerance in Obstructive Sleep Apnea

This article reports on findings by Dr. Weinstock and others in the May edition of the Journal Sleep. Impaired glucose tolerance (IGT) is a precursor to diabetes. Studies have shown a link between obstructive sleep apnea (OSA) and IGT as well as diabetes. But there are few studies about the effects of treating OSA and the impact on IGT or even diabetes. Dr. Weinstock studied 50 individuals with at least moderate OSA and IGT, but not full blown diabetes. They treated the participants with real CPAP for 2 months and then fake CPAP for two more months. The results showed that in IGT was reduced only in those with severe OSA and obesity. In fact, for every hour of increased CPAP use, there was a significant improvement in glucose tolerance. There was also an effect seen in those with excessive sleepiness, regardless of weight or OSA severity - however there were not enough participants in this category to be statistically significant.

The study authors concluded that for those with obesity and mild to moderate OSA, 8 weeks of CPAP is not helpful in improving glucose tolerance. Eight weeks of CPAP did improve glucose tolerance (although it did not normalize it) in those with severe OSA regardless of obesity. Therefore, it may be helpful to screen patients with IGT for sleep disordered breathing and to especially treat those with severe OSA. This may reduce the chance of those patients going on to develop full blown diabetes. Of course, more studies are needed to demonstrate that effect.

Obesity and Depression Linked to Excessive Sleepiness

This article confirms something I have been seeing more and more in my clinic - people who struggle with obesity are feeling excessively sleepy, and it's not due to disrupted sleep or obstructive sleep apnea. Since OSA does cause sleepiness, and is strongly associated with obesity, it's difficult for me to tell which obese people are sleepy from OSA versus from obesity without a sleep study.

The article also discusses research that shows that people who are depressed can be excessively sleepy from the depression itself, rather than from a separate sleep disorder like OSA. I see this too in my sleep clinic, but less often, and it's still important to rule out sleep disorders like OSA.

Bottom line: If you're feeling sleepy in the daytime, despite getting enough sleep, talk to your doctor or a sleep physician.

Untreated Sleep Apnea Affects Teenagers Development

This article is about research showing that teenagers who have untreated obstructive sleep apnea (OSA) have higher rates of emotional, social, and academic problems. Researchers controlled for age, body mass index, ethnicity, and race. These finding are understandable if you think about how OSA disrupts sleep on a nightly basis - and good sleep is important to the normal development of children and teenagers.

Hospital Noises May Disrupt Sleep

This article talks about research showing that noises in hospitals can disrupt sleep. In this study, 12 healthy people were studied outside of the hospital and "hospital" noises were pumped in - like IV machine beeps and talking. Frequently, these sounds briefly disrupted sleep, sometimes without the person's knowledge and sometimes causing brief increases in heart rate. The authors suggest making hospitals less noisy, which may improve sleep, and may help patient's heal faster.

Sleepiness in NFL Players Associated With Staying With the Team

This article discusses research findings presented at the Sleep Meeting in Boston. Dr. Winter has shown an association between recently-drafted NFL players' subjective sleepiness and their likelihood of staying with team. The conclusion is that finding out the reason for the sleepiness, and treating it, may help in retaining that player.

Daytime Sleepiness and Obesity

Obstructive sleep apnea (OSA) can cause excessive daytime sleepiness, and many patients with OSA are obese. However, some obese patients with OSA are still sleepy despite regular treatment with CPAP. Several studies have linked excessive sleepiness with obesity in patients without OSA. Clinically, I see both conditions often enough, and sleep researchers do not understand exactly why these patients are sleepy. Drs. Panossian and Veasey at the University of Pennsylvania published a review article in the May edition of the Journal Sleep about this topic.

The article describes how patients with OSA who undergo bariatric surgery sometimes have a dramatic improvement in subjective sleepiness a few weeks after the surgery. I have seen this in my clinic as well, even though the patients may still have OSA. Again, the reason for the improvement in sleepiness is not known.

Food can affect sleepiness too. The article describes a complicated system of hormones and other bloodstream chemicals that are released in response to food ingestion that can inhibit our alertness.

There is a group of cells in a deep part of the brain called the hypothalamus, and these cells are involved in maintaining our wakefulness. In narcolepsy, these cells die off, resulting in excessive daytime sleepiness. Some studies are showing that these cells can stop functioning normally in the context of obesity, and this could contribute to sleepiness.

The authors conclude by stating that in patients who are obese, OSA is a common enough disorder that it should be ruled out if the patient is sleepy. If there is no OSA to explain the sleepiness, than it could be due to a combination of the obesity itself and dietary influences. How we treat that sleepiness is still up in the air - for now it appears that weight loss may improve alertness. Easier said than done.

Treating Obstructive Sleep Apnea May Improve Depression

This article discusses research that shows that treating obstructive sleep apnea (OSA) may improve depressive symptoms. This has been by experience clinically and other studies have shown this. However, I have some concerns about this study. The researchers screened for depression by using a tool called the PHQ-9. It is a good tool, but some of the questions are related to fatigue and poor sleep, which can be seen in patients with untreated OSA without depression. In other words, patients with untreated OSA can seem depressed on a PHQ-9 test from the sleep disruption due to the OSA, not from depression. In this study, the patients with depression who were the most sleepy, benefited the most from treatment of their OSA. This makes me wonder again if the PHQ-9 scores were improved only because sleepiness improved, not because depression improved.