CPAP may improve golf performance

Regular golfers often have a handicap - a measure of their golfing ability. This allows them to play against other players of different skill levels. The lower the handicap, the better the golfer. This study assessed whether CPAP improved golf handicaps in regular golfers with at least moderate obstructive sleep apnea (OSA). The study authors included golfers without OSA as a control group. Compliance with CPAP was monitored digitally from the CPAP machine itself.

The results showed that the control group did not improve their handicap scores, but the CPAP user group did. The improvement was more dramatic with the better golfers (Handicap < 12). Of note, the golfers were very compliant with their CPAP use - using them for 6.3 hrs per night for 91% of nights.

The authors concluded that the handicap scores improved due to regular CPAP use. They theorized that CPAP use can improve cognitive functioning, and this was what improved golf performance.

The authors note that getting patients to use CPAP is a challenge - perhaps this study will give some OSA patients motivation to use their CPAP.

Caffeine and sleep disruption

Most of us have used caffeine. And most of us have heard that caffeine consumed close to bedtime can worsen sleep quality. I tell my patients to not have caffeine within 8 hours of desired bedtime. This was what I was taught in sleep fellowship. Apparently, there are few studies that have determined that people should stop consuming caffeine within so many hours of bedtime.

This study sought to determine how caffeine affects sleep quality when taken at bedtime and at 3 and 6 hours prior to bedtime. It's a small study, with only 12 healthy, younger volunteers. The volunteers did not have insomnia but did consume caffeine regularly. Sleep was measured by subjective report and by objective home monitoring. The results showed that the 400mg of caffeine negatively impacted sleep quality when taken at bedtime and at 3 and 6 hours prior to bedtime. Interestingly, caffeine affected both subjective and objective sleep quality when it was taken at bedtime and 3 hours before bedtime. However, the study participants did not report reduced sleep quality when caffeine was consumed 6 hours prior to bedtime. But objective home measurement showed that the caffeine taken 6 hours prior to bedtime did negatively impact sleep. This lack of perceived disruption in sleep quality may explain why some patients ignore recommendations to eliminate caffeine consumption close to bedtime.

Snoring, sleepiness, and cardiovascular disease

Snoring is common. Habitual snoring is defined as occurring at least 3 days per week. Studies show that 10 - 20% of women and 29 - 39% of men snore habitually. Almost all of my patients with obstructive sleep apnea (OSA) snore, but not all snorers have OSA - studies show that over a third of snorers do not have OSA. Studies have not convincingly linked snoring without OSA to cardiovascular disease (CVD).

Studies have shown that OSA without subjective sleepiness does not increase CVD risk as much as those with OSA that do report sleepiness. This study sought to determine if people who snore and are sleepy, but do not have a history of OSA are at increased risk of developing CVD. Researchers studied >2000 healthy men and women with an average age of 73.5 years. Snoring and sleepiness were assessed with self-report questionnaire. Participants were followed for 10 years on average.

Results showed that 36% of those that reported habitual snoring and sleepiness developed CVD. In contrast, only 22% of those with no snoring or sleepiness, 23% of those with sleepiness but no snoring, and 26% of those with snoring but no sleepiness developed CVD. The researchers concluded that sleepy snorers had a significantly greater risk of developing CVD than the other groups.

However, these results must be interpreted cautiously. First, OSA was not ruled out in all participants with a sleep study. Second, self-reported snoring is not reliable - especially if there is no bedpartner to report it. Also, the authors admitted that the association between sleepy snorers and CVD disappeared when the way they asked about sleepiness was more stringent.

CPAP therapy may improve blood pressure in resistant high blood pressure

Obstructive sleep apnea (OSA) has been linked to high blood pressure (HTN). In fact, one cause of reversible HTN is untreated OSA. And sometimes we see improvement in HTN with treatment of OSA, especially severe OSA. Here is a study that showed just that. Researchers studied patients with resistant HTN and moderate-to-severe OSA. The results showed that blood pressure dropped significantly after 6 months of CPAP therapy, compared to those patients who did not receive CPAP therapy.

Workweek sleep restriction and weekend make up sleep

Here is an interesting study about the effect of mild sleep restriction and make up sleep. In this study, researchers took young, healthy volunteers and had them restrict their sleep from 8 hours down to 6 hours for 6 nights in a row. Then they let them sleep upto 10 hrs per night for 3 nights. During this study, they measured blood markers of inflammation, sleepiness, and performance with a computerized test.

The results showed that cortisol levels did not change with sleep restriction, but did fall below baseline after the recovery sleep. This is interesting to me on two fronts. One is that sleep deprivation did not raise cortisol levels. More interesting was the effect of recovery sleep on lowering cortisol from the baseline. I assume it's the relatively increased amount of deep sleep obtained during recovery that played a role in lowering cortisol levels.

Another marker for inflammation, interleukin-6, did increase during sleep restriction and fell back to baseline with recovery sleep. And subjective and objective sleepiness increased after restriction but returned to baseline after recovery. However, performance deteriorated significantly after restriction and did not improve completely after recovery. And this was after just one week of restriction. It will be interesting to see long term studies that would replicate this week after week, like what many working people do. Would performance continue to decline and not fully recover on weekends? Or would acclimation happen, such that performance level decrements stopped or where recovery sleep became better at improving performance?

Drowsy driving

This article discusses a survey about driving while sleepy. Lots of drivers still do it. The survey showed more than a quarter of respondents admitted to drowsy driving in past 30 days. This was more common in young drivers. Perhaps it's because more young drivers take risks and are more likely to stay up later. Drowsy driving is a serious problem. If you are sleepy, do not drive. If you get sleepy while driving, you should pull over to a save location and take a brief nap. Or if you are driving with someone else, switch drivers.

Poor sleep quality and Alzheimer's disease

This article discussed research about Alzheimer's disease and sleep. Researchers looked at a marker for Alzheimer's, called beta-Amyloid. The results showed that those with lower sleep quality and shorter sleep duration had higher levels of beta-Amyloid. However, sleep duration and quality was determined by subject self-report. It will be helpful to see if the relationship holds up with objective sleep measurements.

Obstructive sleep apnea and cardiovascular disease

Obstructive sleep apnea (OSA) is associated with elevated risk of cardiovascular disease. However, it's been difficult to show a causal link because OSA occurs so commonly with other risk factors, like obesity and high blood pressure. This article discusses research showing that OSA is independently associated with a marker (troponin) for heart muscle injury. The more severe the OSA, the higher the level of this marker. And the relationship held true after adjusting for 17 other variables.

CPAP and weight

Elevated weight contributes to obstructive sleep apnea (OSA). Some studies even suggest that OSA can contribute to elevated weight. Many of my patients know this and hope that they may lose weight by treating their OSA. This study is part of a larger one that examined the effect of CPAP therapy on neurocognitive functioning in patients with OSA. CPAP usage was monitored by the CPAP device - so the researchers knew if the patient was actually using CPAP enough. The researchers randomly assigned participants to either real CPAP or sham (fake) CPAP. The results showed that participants on real CPAP gained weight over six months, whereas those on the sham CPAP lost weight over the same time period. And interestingly, weight gain was greater the more the participant used the real CPAP per night. This effect was not seen in those on the sham CPAP. Finally, the results were independent of age, gender, race, OSA severity, and sleepiness.

Keep in mind that we are talking about small changes in weight - The real CPAP users, on average, gained less than one pound at the six month mark. And the sham CPAP users, on average, lost about 1.5 pounds during the same six months. The study authors do not know the reason for the weight increase in real CPAP users. They postulated that perhaps people with OSA burn more calories when they sleep due to the effects of stopping breathing - and that treating the OSA with real CPAP can mitigate that effect. I'm not sure I buy that argument. More studies will certainly be needed.

Bottom line - CPAP therapy is not a weight loss treatment - if it were, compliance would be much better and I would have a line of people outside my office wanting to get CPAP. But adherence to CPAP therapy is low and CPAP won't make people lose weight. Weight loss is achieved only with dietary change and exercise.

Systems of obstructive sleep apnea and cancer risk

There have not been many studies looking at an association between obstructive sleep apnea and cancer. It's possible that obstructive sleep apnea theoretically could increase risk of cancer due to inflammatory changes, oxidative stress, possible immune dysfunction, and intermittent low oxygen levels. This study with a large population from Denmark with purple work or study. The researchers assessed possible obstructive sleep apnea by asking him questions about snoring, stopping breathing while asleep, and subjective daytime sleepiness. No subsided for performed, so short of sleep apnea was not officially diagnosed or ruled out in this population. The researchers then compared the incidence of developing cancer with the obstructive sleep apnea symptoms.

The results did not show any significant association between snoring, history of stopping breathing while asleep, or sleepiness with incidence of cancer. However, as reviewed in the article, assessing for the presence of obstructive sleep apnea by just asking patients about their symptoms is not all that accurate. It would be better for these patients to have had sleep studies to actually determine if obstructive sleep apnea was present.

This study does not support a strong association between obstructive sleep apnea symptoms and risk of cancer. More studies need to be undertaken to determine if an actual diagnosis made from a sleep study is associated with elevated risk of developing cancer. And then whether or not treating the obstructive sleep apnea reduces that risk.

Eexercise and sleep

Exercise has been shown to improve sleep quality. This study was looked at the relationship between physical activity and subjective and objective sleep in midlife women. Physical activity was assessed with questionnaires and the level of activity was split into 3 domains. The first domain was labeled Active / Living and consisted of things like watching television and active transportation such as walking to work. The second domain was Household / Care-giving activities such as housework and child care. The last domain was Sports / Exercise which included participation in recreational activity or sports. The women's sleep was measured via in-home sleep study, daily sleep diaries, and questionnaires about their sleep.

The results showed that women who consistently participated in regular Sports / Exercise had better objective and subjective measurements of sleep, including sleep quality, sleep continuity, and depth, but not sleep duration. Women in this group also had reduced odds of meeting the diagnostic criteria for insomnia. This relationship was observed despite statistical adjustment for factors such as body mass index and other health behaviors. This association was not seen for those women in the domains of Active / Living and Household / Care-giving.

The relationship between the Sports / Exercise group and sleep was strongest when the pattern of activity existed over multiple years rather than just exercising immediately prior to the sleep assessment. In other words, regular exercise over many years may improve sleep more than sporadic exercise.

The effects of sleep deprivation on facial appearance

This article received lots of press. Researchers took photographs of subjects after 8 hours of normal sleep and after 31 hours of sleep deprivation following only 5 hours of sleep the night before. The researchers then asked volunteers to list facial cues they associate with looking fatigued. The final list consisted of hanging eyelids, red eyes, swollen eyes, glazed eyes, dark circles under the eyes, pale skin, wrinkles around the eyes, rash / eczema, and droopy mouth corners. Finally, the researchers had participants rate the photographs for the fatigue cues.

The results showed that the fatigue cues were significantly found in the photographs of sleep deprived subjects - no big surprise. With the exception of glazed eyes, all of the cues that correlated with looking fatigued were also affected by sleep deprivation.

This research is interesting in that these cues for fatigue may help others determine if someone is too fatigued to be safe at work or while driving.

Improvement in facial appearance after CPAP treatment for obstructive sleep apnea

Here is an interesting article about changes in facial appearance after CPAP treatment for obstructive sleep apnea (OSA). Researchers took 20 subjectively sleepy subjects diagnosed with OSA but not treated. They took detailed photographs using specialized digital photography techniques before and after several months of CPAP treatment. They then had 22 raters look at the before and after treatment photos to assess which ones were post-treatment and what changes were present.

The results showed that treatment with CPAP is rated as more alert, more youthful, and more attractive than before CPAP use. In this study, the researchers had the subjects subjectively rate their level of sleepiness. As expected, sleepiness levels did improve overall. However, there was not a strong correlation between the person feeling more alert and being perceived more alert by the raters. This may be because the subjective scale for sleepiness is limited, and perhaps an objective measure of sleepiness may have correlated better.

Finally, the results did not support the popular belief that dark, swollen, and baggy circles under the eyes are a main feature of sleepiness in those with OSA. Of course, it could be a feature in those who are sleepy from other causes, like sleep deprivation.

Since adherence to CPAP is not great, perhaps the results of this study will provide more motivation for individuals to use their CPAP regularly.

Sleep deprivation and food purchases

Another study linking diet and sleep. This article describes research with normal weight, healthy men after one night of sleep deprivation. Researchers gave the men about $50.00 to buy groceries the morning after a normal night's sleep or a night of sleep deprivation. After the night of sleep deprivation, the men bought more food and food that had more calories. The sleep-deprived men also had elevated levels of ghrelin, a hormone involved in appetite, but this did not correlate with food purchase behavior.

The take home message was to not go grocery shopping after a night of sleep loss. I wonder if the effect would taper for the many Americans who have chronic, partial sleep deprivation?

Obstructive sleep apnea and melanoma

Obstructive sleep apnea (OSA) can cause repetitive drops in oxygen levels. This in turn can increase chronic inflammation and possibly reduce the body's ability to detect and fight tumor cells. This article describes research showing that the more severe the OSA, the more aggressive the melanoma. The reason the two conditions may be linked together is not described in detail in this article - low oxygen levels are implicated. I wonder if using CPAP would help with melanoma treatment?

Yoga may improve insomnia

This article discusses research showing that twice a week yoga may help woman with breast cancer sleep better. Improvements were seen in sleep quality and duration in women with a clinical diagnosis of insomnia and in those that just had mild sleep disruption. Those that were in the yoga group reduced sleep medicine use by 21 percent per week. Those not in the yoga group increased their sleep aid use by 5 percent per week. The participants use Gentle Hatha yoga, which focuses on physical postures, and Restorative yoga, with an emphasis on relaxation, breathing and meditation. I've never done yoga, so I am not sure if other types of yoga would also benefit sleep quality.

CDC says 9 million Americans take sleeping pills

This article discusses new research from the Centers for Disease Control (CDC) that says that 9 million Americans report taking sleeping pills, whether prescription or over-the-counter to improve their sleep. This study was a survey, and there is nothing new from a clinical standpoint. Some highlights included that women are more likely than men to take sleeping pills, 5 percent versus 3 percent. More whites take pills - nearly 5 percent, compared to 2.5 percent of blacks and 2 percent of Hispanics. Prescription use increases with age, to 7 percent of those 80 and older.

Taking sleeping pills is not the only way to get better sleep. Talk to your doctor about seeing a sleep medicine physician, who can work with you to improve your sleep without necessarily resorting to pills.

Gestational diabetes and obstructive sleep apnea

Gestational diabetes refers to having high blood sugars during pregnancy. Sometimes it is associated with excess weight gain during pregnancy.

This article discusses research showing that pregnant women with gestational diabetes are nearly seven times more likely to have obstructive sleep apnea (OSA) than other pregnant women. Also, the women who did not have gestational diabetes got an additional hour of sleep and had less broken up sleep than women who had gestational diabetes.

The researchers suggested that women who have gestational diabetes consider getting evaluated for OSA.

Singing may improve snoring

Obstructive sleep apnea (OSA) is a sleep disorder where the muscles that make up the back of the throat collapse when asleep, causing reduced air flow to the lungs. Snoring very often accompanies OSA. When I diagnose a patient with OSA, some of them ask me if there are any exercises that can reduce snoring and OSA. There have been studies showing that people who play certain wind instruments can improve snoring and OSA.

Here is an article about a singer that has developed a singing program to be used 20 minutes a day to reduce snoring. In this study, they took people who snored and had mild to moderate OSA. They excluded those with severe OSA or morbid obesity (BMI at least 40). They had them do the 20 minute daily singing for an unspecified amount of weeks. The results showed that snoring frequency, but not loudness was reduced significantly. Also, subjective reports of daytime sleepiness was improved in the singers vs the non-singers. However, the researchers did not objectively measure the level of sleep apnea at the end of the study. So it can not be said that singing improved their OSA. I also can't tell if more of the singing group lost weight, which would explain the decrease in snoring, rather than the singing itself.

CPAP water chambers and chronic sinus symptoms

Many of my patients ask if using CPAP can contribute to sinus problems. It is rare that CPAP use increases sinus problems. Much more common is that CPAP use reduces sinus symptoms.

Most people who use a CPAP use a water chamber to increase the moisture content in the air. Distilled water is supposed to be used and the water chamber is cleaned weekly. However, bacteria can still live in the chamber (called colonization). This study in the Journal of Clinical Sleep Medicine investigated whether bacterial colonization of the water chambers was associated with chronic sinus symptoms.

Researchers swabbed the water chambers and different types of bacteria did grow. Overall, almost 50% of the water chambers tested grew bacteria. However, there was no association between bacterial colonization of the water chamber and chronic sinus problems. The researchers concluded that bacterial colonization of the water chambers seems to be of no clinical significance.

Exercise and insomnia

I was taught that regular exercise can improve sleep quality. My patients have told me that sometimes they sleep better if they are "worn out" from exercise or just physical exertion. Exercising upon awakening can help regulate your body clock, giving it a routine. This study in the Journal of Clinical Sleep Medicine studied 11 women with an average age of 61 years. They had the women wear actigraphs, which measure sleep at home. The women also did moderate aerobic exercise 3-4 times per week. The results showed that exercise duration did not correlate with sleep improvements. But sleep duration did correlate with exercise duration - the shorter the total sleep time, the shorter the exercise duration the next day. This makes sense to me. From my own experience, if I get little sleep while on call, I am less likely to exercise the next morning.

Insomnia may affect thinking tests

Insomnia is a very common disorder. It's hard to diagnose and sleep studies are often not helpful. Primary insomnia (PI) means the insomnia is not caused by another disorder. PI is also common. Studies have not shown that patients with PI suffer any objective neurocognitive (thinking performance) deficits.

Here is an interesting study in the Journal Sleep. Dr. Edinger discusses subtypes of insomniac - those who sleep a normal amount versus those who are short sleepers, and those who are alert in the daytime vs those who are sleepy. In this study, sleep duration was measured with overnight sleep studies. Level of daytime sleepiness was measured with a daytime sleepiness test.

Physiologic hyperarousal is a common problem with insomniacs. This refers to elevated nervous system activity - think adrenaline. This can disrupt nighttime sleep but also allow sleep deprived people to be alert in the daytime. The results of this study showed that insomniacs with hyperarousal had lower neurocognitive test scores. Of note, people who were sleepy but not insomniacs also had lower neurocognitive test scores.

As mentioned in the commentary on this article, this study has real world implications. Insomniacs with hyperarousal may respond, at least in part, to biological treatments to lessen hyperarousal. And those insomniacs that do not have hyperarousal may respond more to psychological treatments like cognitive behavioral therapy.

Obstructive sleep apnea linked to glaucoma

Glaucoma is an eye disease that can lead to blindness. This article discusses research that patients with obstructive sleep apnea (OSA) are at risk of developing glaucoma. And this study showed that OSA is an independent risk factor for developing glaucoma and that OSA is not just a marker of poor health, which also could lead to glaucoma. So if you have OSA, see your eye doctor if you are having any problems with your eyes.

Sleep not to blame for all fatigue

Many of my patients feel that fatigue is due to how long they sleep. In some cases it can be. But fatigue has many causes. This article discusses research showing no link between self reported sleep duration and fatigue. Unfortunately, certain sleep disorders may be occurring without the persons awareness, like obstructive sleep apnea (OSA). OSA can cause fatigue, and treatment of OSA can help. So before concluding that your fatigue is not related to your sleep quality, talk to your doctor.

Week of camping can reset sleep schedule

Research has shown that our modern lifestyle can make it hard to get to bed early enough. Not just indoor lighting, but the screens from electronic devices used close to bedtime can delay sleep. This article discussed a study about the effects of light on sleep. Researchers took volunteers who normally slept after midnight and 8 am. They had them sleep in tents outdoors for one week with no external lighting of any kind, and no cell phones. After a week, the volunteers had shifted their sleep schedules two hours earlier. Researchers said the participants melatonin levels changed, being secreted earlier.

The headline of this article is misleading, however. The week of camping won't have a lasting affect when the volunteers go back home to their routines. They would have to restructure their time so that their homes are relatively dark and to not use electronic devices close to bed.

Lunar cycle may impact sleep

The moon has been implicated in changes in human behavior. Here is an article about a study about how the lunar cycle may affect sleep. Researchers studied volunteers that slept two nights in a completely dark bedroom where they could not see the moon. The results showed that around the full Moon, brain activity related to deep sleep dropped by nearly a third. Melatonin levels also dipped. The volunteers also took five minutes longer to fall asleep and slept for 20 minutes less when there was a full Moon. I don't have access to the actual article, so I am not sure if the volunteers subjectively reported that they felt their sleep was different. And in my experience, most of my patients with insomnia do not report any association with lunar cycle and sleep quality. Of course, women sometimes have subjective changes in sleep quality due to menstrual cycle, but that is not correlated with lunar cycle.

It would be interesting to see how the same experiment done over the entire lunar cycle.

Obstructive sleep apnea may reduce exercise capacity

This article discusses research showing a link between obstructive sleep apnea (OSA) and decreased exercise capacity. Specifically, the results showed that severe OSA was associated with reduced functional aerobic capacity, impaired heart rate recovery after exercise, and higher resting, peak, and post-exercise blood pressure. The study did not determine if treating the OSA improved exercise capacity.

Sleep deprivation may contribute to prejudice and stereotyping

Here is an interesting article about research on sleep deprivation. The researcher did three studies, where she sleep deprived students and assessed their prejudice and stereotyping of others. Her results suggest that sleep deprivation may negatively impact people's expression of prejudice and stereotypes. It's not clear how sleep deprived the students were during the experiment - was it a total night of sleep loss, or chronic partial sleep loss?

In the article, the researcher is quoted saying, "In our research, we found that sleep functions as a self-regulatory resource that, when depleted, leaves people less able to control their thoughts, attitudes and behaviors in a non-prejudicial manner." And, she is quoted saying, "By having a good night's sleep and being well-rested, individuals are more likely to be able to act appropriately in situations."

Of course, being sleep deprived is no excuse for behaving inappropriately, no matter how tired we may be.

Decreased sleep quality linked to premature skin aging

Here is an article discussing research showing that decreased sleep quality may increase risk of premature aging and decrease the skin's ability to recover from sun exposure. Sleep quality was assessed with a subjective sleep questionnaire, and it's not clear if the results were linked to decrease total sleep amount and / or reduced sleep quality. Also, I have to assume, but do not know for a fact, that the researchers controlled for other factors that affect skin like tobacco use.

Sharing hotel room with stranger to save money

This article discusses a company that attempts to pair strangers up in the same hotel room to reduce the cost of the room. This would not appeal to me, however. Being asleep means I am vulnerable, and I wouldn't be comfortable with a stranger in the room. For more secure travelers, it may be a way to save money.

Sleep duration may impact concussion test scores

In sports, concussions are a big deal. Trainers, doctors, and coaches need accurate information to determine if a player is ready to play again, or if the player needs to rest due to concussion. This study shows that sleep durations < 7 hours can worsen the tests used for concussion, even when the player has no concussion. This means that players should be getting as much sleep as possible, especially the night before the concussion testing, to make the testing as accurate at possible.

Obstructive sleep apnea and night sweats

Night sweats can be common in certain medical illness like cancer and infections. It's also common in peri-menopausal women. Night sweats can also occur with untreated obstructive sleep apnea (OSA). In my experience, this is usually from severe OSA and typically involved the shoulders, neck, and head.

Here is a case report from the Journal of Clinical Sleep Medicine that describes a patient that had severe night sweats from mild OSA. The night sweats were eliminated by use of CPAP. And this patient happened to also have a form of lymphoma, which would make most physicians think that the cancer is the cause of night sweats. The report author suggest sleep evaluation in patients with regular night sweats to look for OSA.

Sleep difficulties may increase stress in relationships

Life stresses, including relationship stress, can disturb sleep. Seems obvious. And many of my patients with chronic sleeping difficulties report irritability, and attribute that to the poor sleep. If you're more irritable, you may fight more with your spouse. Here is an article about a study confirming that.

CPAP may reduce nightmares in post tramautic stress disorder

Post traumatic stress disorder (PTSD) is becoming more frequent among our soldiers. I have had the honor of working with military personnel and their families at several bases in my career - McConnell AFB, Camp Lejune, and most recently at Fox at the Redstone Arsenal. Sleeping problems are common and many report that sleep issues worsen after returning from deployment. In particular, I hear that snoring and breathing problems tend to worsen after returning home.

This article describes an interesting finding. Soldiers diagnosed with PTSD and obstructive sleep apnea (OSA) present to my office regularly. This study showed that CPAP therapy reduces nightmare frequency in those with PTSD. It makes sense as OSA can be more severe in dream sleep. If your dream sleep is disrupted by breathing events, you may experience more dreams, as you may wake up more often in the middle of, or right after a dream. CPAP will reduce the breathing events and may let you sleep right through, so that you don't remember your dreams (and nightmares) as much. There may be other reasons that CPAP reduces dreams too. When someone stops breathing in their sleep, adrenaline surges. This adrenaline surge may increase nightmares, especially in those with PTSD. So CPAP may reduce the adrenaline surges, thereby reducing the nightmares.

Childhood sleep difficulties contribute to medical expenses

Here is an article about a study done in Australian children. The results showed that one in three children have trouble starting or staying asleep. This included infants to elementary school aged children. Of course you have to keep in mind that this is just a survey of parents observations, and it makes me wonder how difficulty sleeping was defined. What was interesting to me was how the parents tended to seek medical care, and more importantly, medications, for their kids perceived sleep problems. Although giving a child a sleep aid seems easy, it doesn't teach them how to sleep on their own. Good sleep tips are provided at the end of the article.

Cognitive behavioral therapy for insomnia in fibromyalgia

Cognitive behavioral therapy (CBT) is a type of psychotherapy used to treat insomnia. I use it in my practice almost daily. Here is an article about a study of CBT vs sleep hygiene education in patients with fibromyalgia. The results showed that sleep hygiene education did improve subjective sleep quality, but that was it. CBT improved several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression.

Electronic devices can disrupt sleeping

Here is another article discussing research that shows that the electronic devices that you use in your bed can disrupt your sleep. Even though the screen is not very bright, it still disrupts secretion of melatonin, the hormone normally released to let your brain know it's time to sleep. Also, the devices tend to be stimulating and may increase alertness, rather than allowing you to relax and get sleepy. Finally, the devices strengthen the association of being awake in your bed. This by itself can fuel insomnia. You should only use your bed for sleep only.

Don't use these devices in your bed. You can use them on the couch in the living room - just get a blue light filter or use a blue light blocking program like f.lux.

Sleep deprivation and anxiety disorders

This article describes research that shows that sleep deprivation fires up areas of the brain associated with emotional processing. This pattern is similar to the abnormal neural activity seen in anxiety disorders. The authors conclude that sleep disruption may be a key factor in anxiety disorders. Maybe. But I'm not sure you can make that statement based on the experiment. The researchers took young healthy people with no anxiety or insomnia disorders and subjected them to images after a night of good sleep and then a sleepless night. But applying the results from these healthy subjects may not be realistic for people with anxiety disorders. The authors also suggest that fixing sleep problems in anxious people may improve their anxiety condition. Perhaps, but usually if what they worry about is related to not sleeping well. I'm not yet convinced that helping people sleep better will eradicate a generalized anxiety disorder, panic disorder, obsessive compulsive disorder, or post-traumatic stress disorder. It is true that many anxiety disorders are associated with difficulty sleeping. However, the difficulty sleeping could be just an effect of the anxiety disorder. Fixing the sleep problem is less likely to help the anxiety disorder. I base this on my own experience with patients with insomnia. Some have anxiety disorders too. When I help them sleep better, their anxiety disorder does not necessarily get better. They worry less about not sleeping, but the other parts of the anxiety disorder remain.

CPAP therapy for obstructive sleep apnea may improve migraines

I often get referrals from headache specialists because they know that sleep disorders and headaches often exist together. In particular, obstructive sleep apnea (OSA) has been associated with headache upon awakening. But any sleep disorder that breaks up sleep could increase risk of regular headaches. This article describes a study showing that CPAP use may improve migraines. In particular, regular CPAP use for OSA decreased the frequency of migraine attacks, their duration, and intensity. CPAP also lowered medication use and lost days from work.

Restless legs syndrome and mortality rate

This study is getting alot of press, so thought I would post it. It is about restless legs syndrome (RLS). RLS is a neurological sleep disorder that causes uncomfortable sensations in the legs at night. It makes you want to move your legs to relieve the sensation. This study showed that men with RLS have a higher chance of dying than those without RLS. I don't have access to the full study in the Neurology Journal, so some details can not be provided. It's not clear how RLS increases mortality rate. However, RLS is often present along with obstructive sleep apnea (OSA), and OSA is known to increase mortality rate. The study authors asked patients if they have OSA, but most won't know if they have OSA unless they have a sleep study. So many of these men could have had undiagnosed OSA and RLS - but the OSA would be the factor in the increased mortality rate, not the RLS.

Obstructive sleep apnea increases risk of sudden cardiac death

Here is a study that offers more support for what we sleep physicians already knew - that moderate or severe obstructive sleep apnea (OSA) can increase risk of sudden cardiac death. The study found this association to be especially true if the OSA resulted in deep oxygen level dropoffs. It makes sense to talk to your doctor about getting tested for OSA, especially if you have existing heart disease.

Diabetics and those with high blood pressure should be tested for obstructive sleep apnea

Here is an article from the annual sleep meeting last week. The American Academy of Sleep Medicine recommends evaluation for patients with high blood pressure and type 2 diabetes, since they are at increased risk of having obstructive sleep apnea.

Sleep apnea and alzheimer's

Obstructive sleep apnea (OSA) and Alzheimer's dementia get more common as we age. This article discusses research that shows that markers of Alzheimers increase as the severity of OSA increases. And this was more true for lean patients than for obese ones. In other words, the more severe your OSA, the more likely you are to have these markers for Alzheimer's. The authors of the study speculate that obesity may somehow be protective of alheimer's, and that's why they were less likely to have the markers even if the have OSA. Maybe. But perhaps the lean people had OSA much longer, and had more time to damage the brain, resulting in changes seen in Alzheimers.

12 interesting sleep facts

This article from discusses facts learned at the Harvard University for the Medical School's Corporate Sleep Health Summit. It's a collection of tidbits of interesting info about sleep.

Red lighting may improve alertness

Here is an article demonstrating a misleading title. Humans have a normal dip in alertness in the afternoon - hence the siesta in Spain for example. The study cited in this article showed that having people stare at a red light for almost an hour improved alertness as measured by brainwaves. However, the subjects did not report feeling more alert. So thinking that getting red light bulbs will stave off sleepiness is misleading and more studies are needed. Getting enough sleep and treating any sleep disorders will help more than the color of the lights in your office.

Graph that demonstrates effects of sleep loss on performance

This article has a graph showing the effects of sleep loss on performance, and how it is similar to being intoxicated with alcohol.

Diet and sleepiness

This article discusses research showing a link between diet and sleepiness. The results showed that fat intake made subjects sleepier while carbohydrate intake caused alertness. Protein had no affect on sleepiness. This is confusing and contradicts some other studies showing carbohydrates increase sleepiness and protein causes alertness.

Sleep problems may increase risk of prostate cancer

The study findings reported about in this article have been getting lots of press. The study showed that those that report regular sleep difficulties have a higher risk of being diagnosed with prostate cancer. Remember correlation does not equal causation - meaning the study results do not mean insomnia causes prostate cancer. It may be that men with prostate cancer have more insomnia, perhaps from pain or frequent urination.

Gene becomes more active with sleep loss

It's been said that an objective measurement of sleep loss could like finding the Holy Grail. It's been elusive. Here is an article that discusses research showing that a particular gene is expressed more during sleep deprivation. And this gene product could be tested in saliva samples of humans someday. It is not a measurement of sleepiness, but could indicate if a person is sleep deprived. More testing will be needed to see if the gene would be more active in people who get enough sleep, but have an untreated sleep disorder like sleep apnea.

Sleep complaints common in older population

This article discusses research showing how frequent insomnia symptoms occur in older people. The article does not define how old the study population was - I assume it's 65 years or older. The results showed that over 90% of those surveyed reported insomnia symptoms. And over half reported using some form of treatment to help them sleep better - whether that was prescription medications, over-the-counter medications, alcohol, or behavioral treatment. Sleep apnea is not discussed, and it's known that sleep apnea worsens with age and can cause insomnia.

Training the mind may improve insomnia in older persons

This article discusses research showing how training older person's minds (called cognitive training) can improve sleep quality. Effects were modest but were not seen in the control population. This could be a non-drug way to help older persons with chronic insomnia.

Sleep disorders and schizophrenia

Schizophrenia is a mental illness that impacts a persons thinking and behavior. It's hard to treat and there is no cure. Sleep problems are common. This article discusses that point - in particular insomnia, obstructive sleep apnea (OSA), and sleep-related movement disorders. This is what I see in my practice when patients with schizophrenia are referred to me. OSA is common due to obesity, and obesity can be worsened by the medications used to treat schizophrenia. Also, movement disorders when asleep can be more common due to the medications used for schizophrenia.

Restless legs syndrome linked to erectile dysfunction

Restless legs syndrome (RLS) is a neurological sleep disorder characterized by an overwhelming urge to move the legs at night. This study showed a link between RLS and erectile dysfunction (ED). Men with RLS had a 38% increased risk of ED compared with men without RLS, after adjusting for age, smoking status, and other potential confounders. What's not known, is if the men had obstructive sleep apnea (OSA). RLS is often seen in OSA. The OSA could have attributed to the ED, not the RLS.

Sleep loss may impact blood vessels

Sleep loss has been linked to cardiovascular disease. Researchers think that the sleep loss my cause inflammation that negatively affects blood vessels. This study showed that short term sleep loss did negatively affect blood vessels. Researchers took 8 people and had them sleep only 4 hours a night for 3 nights. By second night of sleep loss, there was significant impact on blood vessels. But by the third night of sleep loss, things had returned to normal. So chronic, nightly sleep loss may allow for compensation. But if people lose sleep for 1-2 nights, then sleep normally a few nights, followed by another 1-2 nights of poor sleep may be at increased risk due to the effects on blood vessels.

Hotels focus on giving good night's sleep

Many of you may have trouble falling asleep, at least on the first night, in a hotel. It's a phenomenon we sleep doctors call the first night effect. Typically this short term sleep problem resolves by second or third night. It's due to being unfamiliar with the sleep environment. Now, hotels are trying to improve their customers sleep. Some chains have "sleep ambassodors" whatever that means. They offer massages, aroma therapy, supplements, or wide choice of pillows. Of course, like the article points out, many of the things offered in these hotels can be done at your home. Maybe I should higher a sleep ambassador for my practice?!

How sleep loss may help depression

Psychiatrists know that short term sleep loss can improve mood in depressed people. In fact, in those with bipolar disorder, which used to be called manic depression, sleep loss can trigger a manic event. Sleep deprivation is not used anymore as a treatment because it's so difficult to maintain. The effect only lasts until the person sleeps.

Adenosine is the chemical that builds up in our brain the longer we stay awake. The higher the levels, the more sleepy we get. Adenosine levels rapidly diminish with sleep. Researchers think that the build up of adenosine is responsible for the mood elevating effects of sleep loss. This article discusses how researchers studied mice with depression. They gave the mice a chemical that mimics high adenosine levels. The mice slept normally but they showed improved mood and behavior.

To me this is fascinating because it points to a novel way to treat depression. I also wonder if it would be a way to help insomniacs sleep better.

Sleep loss may impact male fertility

This article discusses how sleep problems may be associated with male fertility problems. Researchers surveyed young men around 18 years old and tested a sample of their sperm. Those that had disturbed sleep (not defined in the article) or slept less than 6 hours had 29% reduced sperm concentrations. They also had reduced sperm quality and smaller testicles. What's not clear is why these men had disturbed sleep - was it from a sleep disorder or voluntary sleep deprivation? If it's the latter, than more sleep may help couples that have trouble conceiving.

Nasal allergies can contribute to sleep difficulties according to survey

This article discusses a survey showing that 59 percent of nasal allergy sufferers surveyed said they have sleep issues as a result of their allergy symptoms, but only 35% take medicine to prevent the allergy symptoms. Nasal allergies can reduce airflow through the nose, which can make snoring and sleep apnea worse. This is particularly true for children. Sometimes, I send my patients to allergists or ear / nose / throat specialists for evaluation of their nasal symptoms.

Weight loss in obese type 2 diabetics with obstructive sleep apnea

Obesity, type 2 diabetes, and obstructive sleep apnea (OSA) occur together commonly. Weight reduction has been shown to improve both blood sugar control and OSA severity. There is a study that looked at intensive lifestyle intervention (ILI) versus usual diabetic support (DS) in OSA severity. After one year, the ILI group had greater weight reductions and less severe OSA than the DS group. The researchers then looked at the results after 3 more years, as reported in this paper.

So after the first year, the intensive lifestyle intervention was provided on an individual basis and included one on-site visit per month. There was a second contact by telephone, regular mail, or email. At each session, participants were weighed, self-monitoring records reviewed, and a new lesson presented. The usual diabetes support group had three annual sessions, with each one focusing on diet, physical activity, and social support. Information on behavioral strategies was not presented and participants were not weighed, like in the ILI group.

Results showed that at year 4, >5 times as many participants in the ILI group had total remission of their OSA. The prevalence of severe OSA among ILI group was half that of the diabetes support group. OSA remission occurred in those with mild to moderate OSA at baseline. But in those with severe OSA at baseline, none achieved remission and few changed to mild severity. And in both groups, a similar prportion had a worsening of OSA severity at year 4. Some had mild OSA at baseline and then severe OSA at year 4! A limitation of this study is that almost 38% of participants dropped out by year 4, primarily due to not wanting to repeat PSG.

So what does all this mean? That if you have severe OSA, weight reduction alone is unlikely to get rid of the OSA. However, weight reduction alone may eliminate OSA that is mild to moderate.

Exercise and diet can prevent obstructive sleep apnea from worsening.

Here is a study about obstructive sleep apnea (OSA), exercise, and diet. As you may know, OSA is associated with obesity. Weight loss can reduce the severity, and weight gain can worsen OSA over time. This study is out of Finland. Researchers followed 81 adults with mild OSA and had some follow a diet and exercise program for one year. The others did not. After 4 more years, researchers checked their weight and OSA level. Those that did the diet and exercise program lost an average of 12 pounds. Six had OSA that progressed to moderate, but none were severe. The other group gained one pound on average over the 4 years. 12 worsened to moderate OSA and two had severe OSA.

The researchers concluded that weight loss may lessen the chance of OSA worsening. This is good, as the more severe the OSA, the higher the risk of cardiovascular consequences.

Women are more tired than men

This article discusses research from the CDC showing about 15% of women reported they are very tired or exhausted, while only 10% of men said they were. And the difference was most pronounced in younger women, ages 18 to 44. Now, the article author speculates that the tiredness is related somehow to sleep. It is a fact that women suffer from insomnia at a greater rate than men. But women could be tired for other reasons - thyroid disease, anemia, depression, all of which are more common in women too.

A desk you can sleep in

I loved the show Seinfeld. There was one episode, called the nap, where George had his desk remodeled so that he could take a nap in it, and not be caught. Here is an article showing a real desk that doubles as a bed. It could be used by students who need to study and nap in the same space.

How astronauts sleep in space

This is one of the coolest videos about sleep! I never even thought about how an astronaut would sleep in space. Watch the video to learn what they do.

Sleep apnea impairs driving ability

Obstructive sleep apnea (OSA) can increase sleepiness, which can impair your ability to safely drive. Here is an article about two studies showing just that. Both studies involve longer distances on a driving simulator. So keep that in mind, as driving for real may be different. People with untreated OSA were more likely to fail the simulator test than those without OSA. Also, those with untreated OSA were more likely to admit to nodding off behind the wheel than those without OSA. Neither study tested the drivers after they received OSA treatment - those studies will be interesting to see.

Whether you have OSA or not, always use precaution when driving. Do not drive if you feel sleepy. If you get sleepy while driving, pull over to a safe area and take a brief nap. Or if you are with someone else, let them drive so you can nap in the car.

CPAP can boost worker productivity

Obstructive sleep apnea (OSA) can reduce worker productivity if untreated. This study showed that workers that regularly used a CPAP when they slept were more productive. And productivity did not improve in those with OSA that did not use their CPAP.

Slow frequency sounds heard during sleep may improve memory

Slow wave sleep is the deepest level of sleep, occurring mostly in the first half of the night. It's called slow wave sleep because the waveforms 1-3 times per second - contrast this with non-deep sleep, where the waveforms occur 4-7 times per second. This article discusses research showing that sounds produced at the same frequency as slow wave sleep, and listened to while asleep, can enhance word associations. Sounds produced at different frequencies did not improve word associations.

The researchers also think these sounds may improve the overall quality of sleep - more studies are needed though.

Sleep duration and adolescent obesity

Another story about sleep duration and obesity. This study looked at 1390 kids from age 14 to 18 years old. They asked them to report their height, weight, number of hours they sleep per night, physical activity level, and amount of time spent in front of a screen (TV / video games / computer) every 6 months. The average amount of sleep per day was about 8 hours and this decreased to 7.5 hours by the time the kids reached age 18. When the researchers crunched the numbers, they saw that longer sleep duration was associated with a lower body mass index (BMI), a ratio of height to weight. The higher the BMI, the more overweight the kid. The association between BMI and sleep duration was stronger as the BMI increased - for each additional hour of sleep past 8 hours, the BMI was lower than the average. This means that more sleep seemed to help the most overweight kids.

From these results, the authors suggest that kids who sleep at least 10 hours per day could reduce their BMI. Interestingly, the association between BMI and sleep duration persisted even when accounting for physical activity and screen time. So even if overweight kids watch TV as much as normal weight kids, increased sleep duration may reduce obesity.

One important limitation in this study is that they did not monitor calorie consumption. So, like I've mentioned in other posts, longer sleep may be associated with less weight because of decreased calorie consumption, not from longer sleep itself.

The authors point out that telling kids to sleep more does not work. But delaying school start time in the morning may allow kids to sleep more. Also, getting all electronic devices out of the bedroom at night may increase sleep duration.

Overnight diet claims to lose weight in your sleep

This article is about a new diet book. Ordinarily, I don't post about diet books. This one caught my attention because of it's claim that weight loss is related to sleep. Beware, I am only giving my opinion here about the article. I haven't read the book.

The diet plan consists of 6 days of high protein meals followed by 1 day of liquid meal. Specifics are not given. The book author claims that you will lose two pounds the first night while you sleep. The author also says that you need to get enough sleep, 8 hours, because lack of sleep is what makes you hungry.

If you read the article, there is some criticism about the rapid weight loss. I agree with the statement that the 2 pounds of overnight weight loss is almost entirely water. Basically, this diet is low carb. Of course you will lose weight - but it's mostly water in the beginning. Also, sleep deprivation is not why we get hungry. It's more complicated than that.

MRI scanners may be able to detect visual images in dreams

During sleep studies, I can tell when someone is in dream sleep. However, I can't determine what they dreaming about. Here is an article about research done in Japan showing that an MRI may be able to predict what you are dreaming about. They studied three men in early stages of sleep with an MRI. This showed the researchers what area of the brain was activated during dreaming. The researchers woke the subjects up and had them describe what they were dreaming about. They correlated the visual dream description with the location that lit up on the MRI. Then, when the men dreamed again in the MRI, researchers were able to predict about 70% of the time, what the person was dreaming about by noting the location of the brain that had lit up on the MRI. Pretty cool, huh?

Type 2 diabetes linked to low melatonin levels

Melatonin is the hormone produced in your brain when the sun goes down. It is the signal that says it's time for sleep soon. This article talks about a study that showed that people with low amounts of melatonin at night were twice as likely to develop type 2 diabetes.

It will be interesting to see if taking melatonin would prevent people who are at risk from developing diabetes. Research also needs to be done to figure out how and why melatonin is related to diabetes. I wonder if people with type 1 diabetes also have low melatonin levels at night.

Sleep apnea may impair kids behavior and adaptive functioning

Studies have shown that kids with obstructive sleep apnea (OSA) can have behavioral difficulties that affect school and home. Some will present to their pediatrician with symptoms of attention deficit-hyperactivity disorder (ADHD) - but in reality, the cause is underlying OSA. This study in the Journal Sleep looked at how kids with OSA have increased risk of behavior and adaptive functioning difficulties. Adaptive functioning refers to how these kids "negotiate social situations, engage in self-care to meet his or her own needs, and apply skills learned in school."

Researchers studied 263 kids starting at ages 6-11 years old. They had the kids and parents fill out questionnaires about behavior and functioning. They had the kids do home sleep studies. Then 5 years later, they repeated the questionnaires and sleep studies.

The results showed that the highest rate of impairment occurred in those kids diagnosed with OSA, particularly those that had it on both sleep studies (5 years apart). Researchers note, however, that some behaviors, like aggression and conduct problems, were accounted for by sociodemographic variables, rather than the OSA. And kids who had OSA on both sleep studies were 3-7 times more likely to have learning problems and lower grades than in kids who never had OSA.

CPAP may reduce inflammation associated with sleep apnea

Obstructive sleep apnea (OSA) causes inflammation - both local and systemic. Researchers think that the local inflammation is from trauma from snoring. Systemic inflammation may occur because of repetitive drops in blood oxygen levels and / or sleep fragmentation from OSA. This study did a meta-analysis to see if CPAP reduces three markers of systemic inflammation - CRP, IL-6, and TNF-alpha. The data showed that CPAP use did significantly reduce levels of CRP and TNF-alpha. It lowered levels of IL-6, but not enough to be statistically significant.

The bottom line is that untreated OSA is associated with systemic inflammation, which may raise the risk for cardiovascular disease. Treating OSA with CPAP can reduce some of the markers of inflammation - this may lower the risk of developing cardiovascular disease.

Sleep apnea may increase risk of brain tumor

Obstructive sleep apnea (OSA) can cause repetitive dips in blood oxygen levels, which can then cause chronic inflammation. Some researchers think this chronic inflammation may increase risk of cardiovascular disease, lowered immunity, and increased risk of tumors. This study showed an increase risk of brain tumors in patients with sleep apnea. The article does not describe the OSA severity - is it only in severe OSA sufferers? Or is there risk increased even with mild OSA? Does it depend on how the researchers defined apnea events - with oxygen level dip and/or arousal in brain wave monitoring? More questions than answers at this point.

Sleeping position may affect pregnancy outcome

I was always taught that pregnant women should avoid sleeping on their back. This is especially true as you get closer to term date. As the baby gets bigger, it and the uterus can compress the inferior vena cava, the main vein that brings blood back to the mom's heart. Less blood into the heart means less blood out of the heart, which can harm the baby.

Here is a article about a study that showed that sleeping on the back while pregnant was associated with stillbirth. Researchers think that the stillbirths occurred because the babies were low birth weight - possibly due to reduced blood flow to the placenta during back sleeping. Researchers speculate that sleeping on the sides may reduce rates of stillbirth.

Kids can sleep right through a fire alarm

Here is a video story about how kids can sleep through a fire alarm. Most parents know that kids sleep deeply. In this video story, the reporter set up an experiment demonstrating that three young boys slept right through the ear-piercing fire alarm in their home. But there is hope - one company is trying to improve the fire alarm but changing the noise it produces - instead of the beeping, it will be the parents voice telling the kids to get up.

Dr. Oz gets sued for insomnia treatment recommendation

This has received lots of press. Here is an article that discusses what happened. Apparently, Dr. Oz recommended a home remedy to sleep better - putting heated rice in your socks at night to warm your feet. This makes no sense to me. It sounds like Dr. Oz is trying to cool the body by drawing blood to the feet, which then loses the heat. One of his viewers has diabetic neuropathy, and has reduced sensation in his feet. The viewer put on socks with rice in them and suffered 3rd degree burns. That viewer is suing Dr. Oz's show, saying he should have warned viewers about the risk of getting burned.

I understand what Dr. Oz was trying to accomplish - people find it easier to sleep when their bodies are cooler. However, there are safer ways to do that than the heated-rice-in-your-socks method.

Home schooled teens get more sleep

There has been much criticism of school start times. Elementary school children start the latest and high school students start the earliest. But this goes against our sleep biology - young children get up earliest and teenagers sleep later. Here is a study showing that home schooled teens get about 1.5 hours more sleep per night than those students in public or private schools. In fact 55% of home schooled teens got enough sleep versus 25% of public / private school teens.

Sleep deprivation may lead to overeating

Another study about eating behavior and sleep. This time, researchers studied young, healthy people in a controlled sleep lab for two weeks straight. They restricted half of them to 5 hours per night for 5 nights, then let them sleep up to 9 hours per night. The other half slept up to 9 hours per night for 5 nights, then were restricted to 5 hours per night. When the participants were only sleeping 5 hours per night, they burned more calories, but they also ate more. And the tended to eat more of their calories closer to bedtime than the well-rested group. Interestingly, appetite controlling hormone levels were not altered as expected during the sleep deprivation phase. The researchers concluded that sleep loss does not make you overweight and getting more sleep will not make you lose weight. I wish weight loss was that easy. It still boils down to eating less calories, regardless of how many hours you sleep.

Some sleep aids may boost memory by changing sleep

When I perform sleep studies on my patients, one way I have of knowing that a patient is in a certain stage of sleep is by one of their brain wave patterns. One such pattern that is commonly associated with light, non-dream sleep is sleep spindles. Sleep researchers have discovered that certain disorders that can affect memory, like Alzheimer's and schizophrenia, have a reduce amount of sleep spindles. And certain medications can increase the number of spindles. So researchers did a test to see if taking one of these medicine to increase the spindle frequency improved memory. One of the medications was Ambien. The results showed an increase in spindles and an improvement in verbal memory. And the improvement was better than plain sleep. This is exciting, as it may allow us to improve memory in certain people.

Sleep disruption may signal future Alzheimer's Disease

Alzheimer's patients sleep poorly at night and often nap multiple times in the daytime. They can get their days and nights so mixed up, they end up sleeping only in the daytime and are up all night wandering. Sleep problems are a common reason for putting people with Alzheimer's Disease in nursing homes. Here is a study showing that broken up sleep and daytime napping were more likely in people with pre-clinical Alzheimer's Disease - meaning before there is any memory loss. Researchers determined their sleep quality with home based sleep testing and sleep diaries. They determined pre-clinical Alzheimer's Disease with results from a spinal tap. These findings are interesting as a disruption in sleep quality may mean that the person is at risk for developing a cognitive disorder.

Insomnia can increase risk of developing heart failure

Here is a study that got lots of press. Researchers studied over 54,000 Norwegians who were initially free of heart failure. The researchers asked the respondents how many times per week they have difficulty falling asleep, staying asleep, or woke unrefreshed. The results showed that in those that reported difficulty falling and staying asleep almost every night, and waking unrefreshed at least once a week, had a three fold increase in chance of developing heart failure. The researchers adjusted for factors that could affect the results, such as age, sex, marital status, education, shift work, blood pressure, cholesterol, diabetes, body mass index, physical activity, smoking, alcohol, any previous heart attack, depression and anxiety.

Now, before you panic, step back for a minute. These results support an association between insomnia and heart failure, but not that insomnia causes heart failure. Also, these patients were not examined before by sleep physicians and did not have sleep studies. Obstructive sleep apnea (OSA) could cause insomnia, and OSA is known to increase the risk of heart failure. So the insomnia reported by these study participants could be just a marker for undiagnosed OSA. This could explain the increased risk of heart failure, not the insomnia itself. And the study researchers did not adjust for OSA or other sleep related breathing disorders.

The authors theorize that if insomnia is linked to heart failure, then treating the insomnia may reduce risk of developing heart failure. I agree, as long as the cause of the insomnia is evaluated first.

Withdrawal of CPAP for two days in patients with obstructive sleep apnea

In patients with obstructive sleep apnea (OSA), no matter the severity, I tell them to use their CPAP every time they sleep. This provides the best results of their therapy. Of course, not everyone can or will use it EVERY night. I explain that the CPAP is not curing their OSA. However, using CPAP nightly for weeks or months on end can mildly reduce the severity, especially if they already have severe OSA. Here is a study demonstrating just that effect. They studied patients initially in the lab to make the diagnosis. Then they used the CPAP continuously for 4 months on average. Then they went two nights without the CPAP and had repeat sleep studies. The results showed that for those with mild to moderate OSA, there was no difference in OSA severity, objective sleepiness, subjective sleepiness, or sleep architecture when off the CPAP. However, in the ones with severe OSA, there was a mild improvement in OSA severity - but they still had severe OSA! But subjective and objective sleepiness levels were no different. The authors think (and I agree) that treating severe OSA for a few months may reduce inflammation in the upper airway enough to mildly reduce the OSA severity. But, because they still have severe OSA, they continue to feel sleepy when not using their CPAP. So use your CPAP every time you sleep if you want to feel as good as you can.

Mattress buying tips and myths

I don't know much about mattresses. But someone told me that buying a mattress is like buying shoes. You get what you pay for. You may sleep better on a more expensive mattress, just like your feet may be more comfortable in more expensive shoes. And since you spend about one-third of your life on a mattress, better make it a good and comfortable one. This article discusses how to buy a mattress. One interesting thing is that the author says mattresses double in weight every 10 years from dust mites - living and dead ones. That's enough to give someone insomnia!

Yoga may improve restless legs syndrome

This article demonstrates in a small group of women with restless legs syndrome (RLS) improved with regular yoga. There is no control group, so it's not clear that the yoga itself improved their RLS. In many patients, RLS symptoms wax and wane, so some of the improvement may be regression toward the mean - the RLS may have gotten better with time alone, and the yoga may not have anything to do with it. Also, exercise has been shown to help RLS - not just yoga.

Exercising close to bedtime may not disturb sleep

This article discusses results of a National Sleep Foundation poll showing that exercise close to bedtime does not interfere with sleep. The article discusses that it is not true that exercise close to bedtime will disrupt sleep. I completely agree. I used to be a long distance runner. In high school and high school, I would run late at night after work. I slept like a baby. But the article misses the important point about exercise and insomnia. For those with chronic insomnia, exercise close to bedtime can worsen insomnia.

This article could be about anything you hear about sleep - don't drink caffeine before bedtime, watch TV in bed, sleep in on the weekends, take naps. All of these are fine to do...IF you don't have insomnia. If you do have insomnia, than the above activities can worsen the insomnia. So in you "good" sleepers, go ahead and workout close to bedtime. For you chronic insomniacs, you also need to exercise, but do it in the morning, or no later than late afternoon.

Swine Flu Vaccine and Narcolepsy

Narcolepsy is a sleep disorder that causes excess sleepiness. It's not a common disorder, and can be hard to diagnose. There have been several news reports about the link between a flu vaccine given in Europe and narcolepsy. This report shows that there may be a link between the two. Researchers think that the immune system may be involved in development of narcolepsy, and that the vaccine tricks the immune system in predisposed individuals. However, correlation does not equal causation. More, larger studies are needed to show that narcolepsy may have been caused by this vaccine.

Obstructive sleep apnea, stroke, and atrial fibrillation

Obstructive sleep apnea (OSA), stroke, and atrial fibrillation are related. OSA can increase risk of stroke. So can atrial fibrillation. OSA can make it harder for cardiologists to control atrial fibrillation. Here is a study that studied these three conditions. They monitored people with OSA to see if they had a stroke. In those that did have a stroke, atrial fibrillation was much more common. This suggests a relationship between atrial fibrillation and OSA in stroke development. And this relationship was true after adjusting for common conditions like age, diabetes, body mass index, etc.

Sleep loss can affect gene expression

This article got some press, so I thought I would comment on it. Researchers took 26 healthy people, and allowed them six or less hours of sleep per night for a week. They then kept them up for 40 hours straight and then let them sleep as much as they want, up to 10 hours per night for another week. I can only see the abstract, so some of the details are unknown. From blood samples, researchers determined that 711 different genes were altered during the sleep deprivation period. The blood samples were taken 3 hours apart as the participants stayed up for 40 hours straight. It's not clear why they did this - it could alter the results. The genes that were affected play a part in metabolism and our internal body clock. However, some of the genes affected have no known function. From the abstract, it's not clear that the genes were altered by the week of deprivation or the 40 hour total sleep loss.

Chemicals involved in the sleep of seals

Apparently, seals are able to sleep in the water. But only half their brain sleeps at a time in the water. On land, their whole brain sleeps. This article discusses research findings involving two chemicals in the brain involved in seal sleep. Acetylcholine is high in the side of the brain still awake whereas serotonin is equal on both sides. Unfortunately, sleep in humans is still more complex than just these two neurochemicals. Other important ones are orexins, histamine, norepinephrine, and dopamine. But this research may allow sleep scientists to help figure out how the neurochemicals are related and involved in sleep, so that one day we may be able to better understand and treat sleep disorders.

Simple changes in the ICU can reduce delirium

This article discusses research showing that better sleep can reduce delirium in ICU patients. Many patients in an intensive care unit get delirious - a brain disorder that leaves the patient confused, sleepy, inattentive. It can be dangerous and hard to treat. Getting too little sleep can exacerbate delirium. ICU's are not known for their good sleep environment with constant interruptions by staff to assess these really sick patients. This research showed that simple environmental changes were able to reduce delirium by 54%. The interventions included turning off televisions, turning off room and hallway lights, limiting the number of staff visits to patient rooms overnight for drawing blood and giving medications to reduce interruptions, reducing overhead pages and minimizing unnecessary equipment alarms. The patients also were offered eye masks, ear plugs, and tranquil music. In the final stage, a new medication guideline was introduced that discouraged giving patients certain commonly prescribed drugs for sleep, such as benzodiazepines, that are known to cause delirium.

One night of complete sleep loss can affect eating behavior

Here is another study about eating and sleep. Researchers continue to try to blame sleep loss on the obesity epidemic, and I continue to be skeptical. Sleep loss may be a small factor, but eating habits and lack of exercise are much bigger contributors. In this study, researchers took healthy young men and monitored their eating habits after a normal night of sleep and then after staying up entirely for a single night. The results showed that the men who were sleep deprived tended to eat greater proportions of energy dense snacks. Their meal portions were the same. The authors conclude that total sleep deprivation can increase food intake, especially energy dense food. This may be true, but it's a long stretch to say this is responsible for obesity. These were non-obese men with only one night of sleep deprivation. We need larger studies in people who are chronically, but partially sleep deprived. This study of only one night of total sleep deprivation does not add much to the discussion of sleep deprivation and obesity.

Should you get enough sleep? Of course. Is more sleep going to help you lose weight? Only if you change what you eat and exercise.

Periodic limb movements in sleep, heart abnormalities, and hemodialysis

Periodic limb movements in sleep (PLMS) are repetitive, small leg jerks that occur during sleep, usually without any memory of it happening. However, PLMS can fragment sleep and have been linked to increased cardiovascular risk factors. Restless legs syndrome (RLS) is linked to PLMS - most RLS patients have PLMS. RLS and PLMS are common in hemodialysis patients. And hemodialysis itself is linked to cardiovascular disease. This study sought to determine if patients with RLS and PLMS on hemodialysis had a deterioration in heart structure and function compared to those RLS patients without PLMS.

Researchers used a cutoff value for the PLMS that puts them in the moderate to severe amount - this is most likely to be clinically significant. Results showed that resting heart rate and blood pressure (BP) were similar in those with and without PLMS. The minimum systolic BP (referring to the 120 in "120 over 80" for example) was higher in the PLMS group. Also, the percent reduction of BP during sleep, compared to being awake, was 50% smaller in the PLMS group. This means that those with PLMS did not experience as much a dip in BP during sleep - something that could lead to high blood pressure in the daytime. The mass of the left side of the heart was greater in PLMS group, but both groups had hearts that could pump out the same amount of blood per beat.

The authors concluded that PLMS can alter the structure of the heart, but not necessarily its function. They feel that PLMS do this by raising blood pressure during sleep. The heart gets larger when it has to pump against a higher blood pressure, which can lead to the results obtained in this study. Of note, the RLS itself was not associated with the heart structure changes.

What does this mean? It means that patients with RLS on hemodialysis may need to be studied for PLMS. More studies will be needed though to find out if treating PLMS improves results.

Oral appliances for obstructive sleep apnea lower blood pressure

Oral appliances are a type of mouth guard worn at night when asleep to treat obstructive sleep apnea (OSA). I use them in patients with mild to moderate OSA, and in those with severe OSA but who don't respond to CPAP. OSA is strongly associated with high blood pressure (HTN), and CPAP has been shown to help reduce HTN by treating OSA. There have not been many studies showing that oral appliances reduce blood pressure when used to treat OSA. This paper pooled data from 7 studies that measured blood pressure changes in OSA patients using an oral appliance. The results showed that in those with mild to moderate OSA, an oral appliance modestly improved blood pressure, and results were comparable to CPAP.

Nightmares and beliefs about sleep are related to suicidal thoughts

This article in the Journal of Clinical Sleep Medicine discusses the relationship between nightmares, beliefs about sleep and insomnia, and suicidal thoughts. Apparently, studies have shown that insomnia symptoms are related to near lethal suicide attempts. Nightmares are also linked to suicidal thoughts and completions.

This study gave questionnaires to patients that presented with suicidal thoughts or attempts. Insomnia symptoms were common in these patients. Nightmares were also present. These symptoms remained significant even after adjusting for the effects of depression - which can increase risk of suicide and insomnia. The researchers analyzed these patients thoughts and beliefs about sleep and insomnia - such as, "if I don't sleep well, I will not be able to function at all the next day."

The findings suggest that the insomnia symptoms themselves were not the determining factor for suicidal thoughts - it was the thoughts about the consequences and causes of insomnia that was related to suicidal thoughts. Nightmares also increased the risk of being suicidal. This makes sense. Many people wouldn't mind insomnia as much if they felt it didn't impact their daytime functioning or possibly affect their health. The researchers noted a sense of hopelessness about insomnia - meaning these insomniacs did not think they ever would sleep better. And therefore, their daytime functioning and how they felt in the daytime would never improve. It reminds me of patients that deal with chronic, unrelenting pain - they can become hopeless about ever living a life without pain.

Unlike chronic pain, however, insomnia can get better with behavioral therapy. Recognizing this is important for physicians and mental health workers, so that they can refer their at risk patients with insomnia for appropriate treatment.

Diseases that are more common in people with obstructive sleep apnea

Here is a study in the Journal of Clinical Sleep Medicine out of Denmark that analyzed which diseases were more common in patients later diagnosed with obstructive sleep apnea (OSA). The researchers used 1% as the cutoff off for inclusion. The results showed that in those diagnosed with OSA, their was an increased risk of the person having already been diagnosed with diabetes, hearing loss, high blood pressure, angina, atrial fibrillation, pneumonia, emphysema, asthma, deviated nasal septum, and prostate enlargement. These make sense clinically, and many of the conditions co-exist. Obesity is a common factor in OSA, and this could link some of the conditions listed.

The hearing loss is interesting, and may be related to loud snoring. Deviated nasal septum could impact airflow through the nose, increasing snoring and OSA. OSA can increase night time urination. In men, they might get diagnosed more with prostate enlargement when they report this nighttime urination. But their doctor may not think about OSA as a cause until later.

Teens and sleep texting

This article discusses the problem of teenagers and texting while asleep. It can be a form of sleepwalking. These teens leave their phone on next to them and will text without fully waking up. They have no recollection of the texting. Sometimes the texted content is bizarre or inappropriate. The answer, of course, is to turn off the phone or just not have it in the bedroom when trying to sleep.

Bed bugs on the rise (at least in Central Nebraska)

This article discusses bed bugs, which are apparently on the rise in central Nebraska. I've never seen a bed bug or had a patient come in because of bed bugs. But this article does a nice job of discussing most things you would want to know about the little guys.

The bed bugs are small and live in tight spaces in and around a bed. They feed at night - and their food is blood. Some people have more severe reactions to bed bug bites, so you can't tell if you bed bugs by how your skin may look after a feeding.

The article mentioned that you should be careful in hotels - and advised to inspect for bed bugs. If there were bed bugs in your hotel room, what would you do? I'd go to a different hotel if there was availability. Hotel bedspreads are bad enough - don't need blood sucking bugs added to the mix!

Hotel lets you sleep as if you are homeless

At first, I thought this could not be true. But this is a real hotel in Sweden that is trying to raise awareness for people that are really homeless. For $14 a night, you can sleep in what looks like a run down park bench - I guess to mimic what sleeping on the street may be like. I assume the experience would be unpleasant, motivating the sleeper to donate to homelessness charities.

Treating REM sleep behavior disorder

This article discusses REM sleep behavior disorder (RBD). It's a type of sleepwalking disorder, most commonly seen in older men with neurodegenerative disorders like Parkinsons Disease. It's not curable, but can be treated. Sometimes, untreated obstructive sleep apnea drives the RBD. Certain medications, like antidepressants, can worsen RBD. I sometimes use Klonopin, but have used melatonin or a medicine for Restless legs syndrome.

The study compared melatonin and klonopin, and both seemed to be effective. Patients stopped the medications at about the same rate, but for different reasons - melatonin for lack of efficacy and klonopin for side effects.

For some patients, medications just do not help. It's important to make sure the bedroom environment is safe. Some patients need bed rails to prevent falling out of bed. I have even had some patients sleep in a sleeping bag so they wont be able to move that much! It works like swaddling a baby helps keep the baby from moving around in a crib.

February worst month for sleeping?

This article discusses a UK survey showing that people surveyed reported taking 8 minutes longer to fall asleep and sleeping 10 minutes per night less than in March. The reasons are not clear, but it is thought perhaps due to longer nights, darker days, and centrally heated homes. I would think January would be even worse, as the days are shorter in that month. But no mention of January.

iPAD use close to bedtime could worsen sleep

This article is about a study showing that iPAD use within two hours of bedtime at the brightest setting could suppress melatonin secretion, resulting in difficulty falling asleep. I agree and suspect this is a problem for lots of insomniacs. It's not just ipads, but any electronic device with a screen that you hold close to your face. The article recommends turning down the brightness. You can do that or get a blue light filter to put over the screen. There is software from f.lux that could also reduce blue light emission from your screen.

Older age people may have memory problems from lack of deep sleep

This article discusses research about our aging brain, sleep quality, and memory. As we age, there is a reduction in volume in a part of our brain behind the middle of our forehead - the medial pre-frontal cortex (PFC). Sleep researchers think this area helps generate the deepest levels of sleep. As we age, the amount of deep sleep is reduced gradually. Many older people have little deep sleep. In this study, the researchers think that the older people who had less deep sleep than younger people, had reduced ability to remember new things. They think this effect is not so much about the volume reduction in the PFC, and more about the loss of deep sleep. Unfortunately, not much can be done to increase the level of deep sleep, whether you are old or young. Some medications have been shown to mildly increase deep sleep levels. Some researchers are apparently working with electrical stimulation of the brain - sounds interesting but I don't know more about it.

About one-third of US workers are sleep deprived

This video discusses research showing that about 1/3 of workers are sleep deprived, costing about $63 billion in lost productivity.

Alcohol is not a good sleep aid

Here is another study showing what we already knew about the effect of alcohol on sleep. It may help some fall asleep faster, but it leads to sleep disruption in the second half of the night. The article rightly cautions people not to rely on alcohol to help them sleep. In addition to being addictive, alcohol suppresses REM or dream sleep.

Split sleep schedule better than consolidated daytime sleep in truck drivers

This article discusses a study about sleep times in truck drivers. Drivers that work at night usually sleep during the day. This study showed that splitting up sleep into two 5 hour blocks was better than trying to get sleep all in one block during the day.

Poor sleep can impair gratitdue towards romantic partner

This article discusses research showing that poor sleep quality can impair your ability to show gratitude to your romantic partner. Seems self evident to me. I wonder, though, if a lack of gratitude is really just a part of the persons personality, and not just a function of sleep quality. Perhaps poor sleep quality just accentuates the problem. But selfish people are going to be selfish - good sleep or not.

One in 24 people report drowsy driving

This link describes research showing that 1 in 24 people report driving while drowsy. Insufficient sleep and sleep disorders like obstructive sleep apnea are to blame. Drowsy driving was more common in young and older drivers. I imagine the younger ones were sleepy from too little sleep and the older ones from sleep disorders and perhaps sedating medications.

This study highlights the importance of safe driving. Don't drive if you feel drowsy. If you get sleepy while driving, pull over and take a brief nap. Or if your traveling with another person, switch drivers.

Sleeping positions

Here is an article from the Wall Street Journal about sleep positions. There is a part about obstructive sleep apnea and one of the sleep doctors recommends sewing a tennis ball into the back of your pajama shirt to keep from sleeping on your back. That may work, but it may be easier to put pillows behind you to keep you sleeping on your sides.

TV before bedtime can reduce kids sleep duration

This article discusses research showing that increased TV time before bed can reduce total amount of sleep time in children. The study is based on a survey, so has biases but still points to some commonsense things parents need to remember about their children's bedtime rituals. Limiting screen time, especially around bedtime can help kids sleep better and longer. It's not just the content of the TV program that is the problem, but just the light from the screen itself can suppress melatonin.

Insomnia subtype affects daytime functioning

This article discusses research about insomnia. It follows revision of the mental health classification manual (DSM-V) that emphasizes insomnia as a disorder, rather than as a symptom of another mental, medical, or sleep disorder. Researchers surveyed people with insomnia. Results showed that in those with the most sleep disruption - both onset and maintenance problems, coexisting mental health problems, and if it started in childhood, have the most daytime impact. This makes sense to me and fits what I see in my chronic insomnia patients.

FDA recommends lower dose of Ambien for women

This article discusses recent news release that the FDA is lowering its recommended dosage of Zolpidem in women. Zolpidem is active ingredient in Ambien. FDA says women can not metabolize the medicine at full strength quick enough, and still have high levels in their bloodstream when waking in the morning. This could lead to motor vehicle accidents. The FDA is not saying women on full strength Ambien have to have their dose reduced, or that women will not be allowed to take full strength. Just that these patients on Ambien should give themselves plenty of time in bed so that the medicine is fully metabolized and they are safe to drive.

Sleep problems common on simulated space mission

Here is an article about an experiment done to simulate space travel. Astronauts were confined to a pressurized spacecraft in Moscow for 520 days straight. Their sleep was monitored with an actigraph, a type of accelerometer. After a month, some of the crew members began to have sleep problems. It seems that one of the issues is that the low light levels on the spacecraft are not strong enough to simulate the day-night cycle we experience daily. Since our brain's clock depends on light to keep our rhythms regular, exposure to stronger light sources on the spaceship may help in actual space flight.

Pre-eclampsia, fetal activity levels, sleep-disordered breathing, and CPAP

Pre-eclampsia occurs high blood pressure and protein in the urine develops in a woman at least 20 weeks pregnant. It is associated with maternal death and fetal growth restriction. Some studies have shown an association of sleep disordered breathing (SDB), like obstructive sleep apnea (OSA), with pregnancy-induced high blood pressure. Pre-eclampsia goes away with delivery. However, if it's too early, delivery is delayed as long as possible.

Fetal movements are a normal part of pregnancy. Frequent movements are good, lack of movements is bad. In the Journal Sleep is a study where researchers quantified fetal movements in pregant patients with and without pre-eclampsia. They then did sleep studies on those with moderate to severe pre-eclampsia and observed some of them on CPAP for one night.

The results showed that pre-eclampsi reduced fetal movements. CPAP also raised fetal activity in women with pre-eclampsia, even thought the pre-eclampsia did not go away. The results are a little hard to interpret, because both pre-eclamptic and control patients had OSA based on the charts in the study, and the controls did not receive CPAP.

But if the results hold up in larger, better defined studies, treating women with pre-eclampsia with CPAP if they have sleep disordered breathing may allow obstetricians to delay delivery until a safer time.