Dr. Michael J. Breus2013-06-19T21:07:53-04:00Dr. Michael J. Breushttp://www.huffingtonpost.co.uk/author/index.php?author=dr-michael-j-breusCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Dr. Michael J. BreusGood old fashioned elbow grease.Asthma: A Risk Factor for Sleep Apnea?tag:www.huffingtonpost.com,2013:/theblog//3.34160602013-06-15T10:30:00-04:002013-06-15T10:30:28-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/associated with obstructive sleep apnea that are long-standing and well-known. They include lifestyle and health factors such as obesity or excess body weight, high-blood pressure, and alcohol and tobacco use, as well as genetic and demographic factors such as family history of the disease, being older, and being male. Now, thanks to new research, we may have a new OSA risk factor to add to this list: asthma.
Researchers at the University of Wisconsin investigated the influence of asthma in the development of obstructive sleep apnea. They found a significantly elevated risk for OSA among people with asthma. Those people who'd developed asthma as children were at particularly elevated risk. Researchers observed 773 adult men and women over a period of eight years. All were participants in the Wisconsin Sleep Cohort study, and were between ages 30-60 at the time the study began. Of the 773 participants, 201 had asthma at the beginning of the study period, and 61 of them had developed asthma during childhood. None of the participants had obstructive sleep apnea. Every four years, the subjects participated in laboratory sleep evaluations, clinical health assessments, and health questionnaires. After adjusting for other risk factors for sleep apnea, including age, gender, body-mass index, smoking, and nasal congestion, researchers found that the presence of asthma significantly increased the risk for sleep apnea:
People with asthma were 1.70 times more likely to develop sleep apnea over the eight-year study period than those without asthma.
Among those in the study who had developed asthma during childhood, the risk was even higher. These people had 2.34 times the risk of developing obstructive sleep apnea, compared to those without asthma.
Researchers found that the longer asthma had been present, the higher the risk for sleep apnea. Every five-year period a person had asthma was associated with a 10 percent increase to their risk of developing obstructive sleep apnea.
Among the participants, 45 developed asthma during the study observation period. Researchers found that these people were 48 percent more likely to develop sleep apnea than those without asthma. The size of this group was too small for researchers to demonstrate a statistical significance to these results. In their discussion of the study's results, researchers pointed to this particular finding as an important one for follow-up investigation.
This latest study is not the first to demonstrate a link between asthma and sleep apnea. Previous research has shown connections between the two conditions:
In a study of more than 4,500 adults ages 20-69, asthma was found associated with symptoms common to sleep apnea, including snoring, apneas, and daytime sleepiness.
Researchers at Israel's Technion-Israel Institute of Technology investigated whether difficult-to-control asthma might influence the onset of sleep apnea. They found that patients with unstable, hard-to-control asthma were at significantly higher risk for obstructive sleep apnea.
Researchers at the University of Wisconsin also looked at the risk of sleep apnea among patients with poorly controlled asthma, and found these patients were at higher risk for obstructive sleep apnea after adjusting for other sleep apnea risk factors, including obesity.
These and other previous studies have identified an association between the two disorders, asthma and sleep apnea. The latest study comes an important step closer to establishing a causal link between the two conditions, by examining specifically the direction of the relationship between the two. The presence of asthma in people later identified as being more likely to develop sleep apnea suggests that asthma may actually contribute to the onset of sleep apnea.
Asthma is a lung disease that causes difficulty breathing, shortness of breath, coughing, and wheezing. Some people can experience these symptoms at night, and they can interfere with sleep. Establishing asthma as a risk factor for OSA is an important public health development. More than 25 million Americans suffer from asthma, including seven million children. If these adults and children are at higher risk for obstructive sleep apnea because of their asthma, they are also at risk for the complications that come with sleep apnea. Obstructive sleep apnea is associated with increased risk for a number of health problems, including heart disease, diabetes, and some cancers. Children can experience apnea and sleep-disordered breathing as well, and children have their own set of health risks associated with the condition, including problems with emotional, social, and cognitive development.
Finding new ways to identify and prevent obstructive sleep apnea is critical to the sleep and overall health of millions of Americans who suffer from this serious sleep disorder. The research into the role of asthma is an important step in this direction.
For more on sleep, click here.]]>Insomnia May Double Risk of Prostate Cancertag:www.huffingtonpost.com,2013:/theblog//3.33855612013-06-06T16:44:48-04:002013-06-09T10:44:04-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/according to the American Cancer Society. Approximately one in six men will be diagnosed with the disease at some point in their lifetime. What if the quality of sleep plays a role in a man's risk for developing the disease?
That's the question posed by a new study examining the link between prostate cancer and disrupted sleep. It's just the latest in a wave of research in recent years that has discovered links between poor sleep and several types of cancer. The results of the latest study suggest that men who have trouble falling asleep and staying asleep -- two common symptoms of insomnia -- may be at twice the risk of developing prostate cancer.
Researchers from the University of Iceland in Reykjavik followed 2,102 men over a period of five years. The men were all part of a large public-health study in Iceland that included more than 2,000 men between the ages 67-96. None of the men had prostate cancer at the time the study began. At the study's outset, researchers asked all the men four questions related to their sleep:
Did they take medication to help them sleep?
Did they have trouble falling asleep?
Did they wake up in the night and have difficulty returning to sleep?
Did they wake up early in the morning and have trouble falling back asleep?
After observing the men for five years, and adjusting for factors such as age, researchers found that poor sleep was associated with elevated risk for prostate cancer:
8.7 percent of men reported experiencing severe sleep problems
5.7 percent of men reported sleep problems classified as "very severe"
During the five-year study period, 6.4 percent of men were diagnosed with prostate cancer.
Difficulty falling asleep and staying asleep was associated with an increased risk for prostate cancer. Men with trouble falling asleep and staying asleep were between 1.7 to 2.1 times as likely to develop prostate cancer as those without these sleep problems
Among men with advanced prostate cancer, the link with disrupted sleep was even stronger. Men with "very severe" sleep problems demonstrated as high as 3.2 times the risk of developing prostate cancer as those who did not experience sleep problems
This study adds to the growing body of research showing evidence of a relationship between poor sleep and risk for prostate cancer and other types of cancer. No direct, causal link has been established between sleep problems and the onset of cancer. But several studies in recent years have shown strong associations between risk levels for cancer and poor, insufficient, and disrupted sleep:
A team of researchers at Harvard University investigated the relationship between sleep duration, snoring, and risk of colorectal cancer. Using data from the Health Professionals Follow Up Study and the Nurses' Health Study, researchers included in their study more than 30,000 men and 70,000 women between ages 40-73. They found that longer sleep duration -- sleeping nine or more hours per night -- was linked to increased risk of colorectal cancer in people who are overweight and who snore regularly. As these are symptoms of obstructive sleep apnea, these results raise the question whether the effects of sleep-disrupted breathing might be a factor in cancer risk.
Researchers at Case Western Reserve University also studied sleep and the risk of colorectal cancer. They found that people who averaged less than six hours of sleep per night had a 50 percent higher risk of colorectal cancer, compared to those who slept at least seven hours nightly. Participants who developed colorectal cancer were also more likely to report having been diagnosed with sleep apnea, and were more likely to have participated in shift work.
Researchers in Japan examined the risk of prostate cancer among shift workers, and found an elevated risk among certain shift workers. Researchers observed more than 14,000 working men in Japan, and found that those who worked rotating shifts were three times as likely to develop prostate cancer as day workers. Men who worked fixed-schedule night shifts showed a very small increase to their risk of developing prostate cancer.
We're still at the early stages of understanding just how significant a role sleep may play as a risk factor in the development of cancer. This is an important area of study that could have a significant impact on prevention and screening, and perhaps even treatment of the disease. The prospect of a connection between sleep and cancer risk is yet another very important reason to maintain healthy sleep habits.
For more on sleep, click here.]]>Sleep Less, Weigh Moretag:www.huffingtonpost.com,2013:/theblog//3.33607912013-06-04T08:28:07-04:002013-06-04T08:28:35-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/
There is a tremendous amount of evidence that sleep plays an important role in weight management. Insufficient sleep is strongly linked to obesity and metabolic disorders, as well as to diabetes. But we're still working to understand the underlying mechanisms by which sleep can influence weight.
A new study examined the effects of insufficient sleep on weight gain, and looked specifically at energy intake (calories in) and energy expenditure (calories out). Researchers investigated the effects of sleep on these two critical factors in weight management. What did they find? During periods of insufficient sleep, people increased their calorie consumption and, as a result, gained weight. What's more, people who slept too little consumed more of their calories later in the day, which may further contribute to weight gain.
Researchers included 16 adults in a 14- to 15-day inpatient study. All volunteers were in good health, and at a healthy weight. Participants spent the roughly two-week study period in a controlled environment, where researchers could manage and monitor their sleep and eating patterns. Researchers collected baseline health and weight measurements from all 16 volunteers during the study's first three days. During this time, participants were allowed to sleep to a maximum of nine hours per night. Their eating was regulated during this three-day period so they were only consuming what they needed to maintain their initial weight.
Next, researchers split participants into two groups. One group continued to be allowed to sleep for as much as nine hours nightly. The other group was limited to five hours of sleep per night. They slept this way for five consecutive nights, in a sleep pattern designed to mimic a typical workweek. During this five-day period, both groups were allowed the same unrestricted access to food. Participants were allowed to eat larger meals, and were given free access to snacks between meals. Snack foods included both low-calorie options like fresh fruit, and high-calorie, high-fat choices such as chips and ice cream. After five days, the groups switched sleep schedules for another five-day cycle. During both five-day phases, researchers conducted measurements and analysis of participants' sleep and their energy expenditure.
Their results shed light on the relationship of sleep to calorie consumption and output, and on some of the ways that sleep may contribute to weight gain. Researchers found:
Participants whose sleep was restricted to five hours a night for five consecutive nights burned 5 percent more overall calories daily than those who were allowed to sleep up to nine hours per night. However, the daily calorie intake of restricted sleepers was 6 percent higher than longer sleepers. The result? An energy imbalance for restricted sleepers, with more calories consumed than used.
This energy imbalance led to an average weight gain of almost two pounds for those in the restricted sleep phase.
The five-day restricted sleep pattern also resulted in alterations to participants' circadian rhythms: the onset of nighttime melatonin release was delayed, and wake times occurred earlier.
Eating patterns also changed among participants in the five-hour nightly sleep phase. People ate less early in the day, and pushed more of their eating to evening hours. In particular, people whose sleep was restricted snacked more at night. Evening snacks increased to the point where the calories consumed in these late-day snacks exceeded the calories consumed in any single meal during the day.
When people moved from restricted sleep to the longer sleep period, their daily calorie intake reduced. In particular, researchers saw a drop in fat and carbohydrate consumption. The transition resulted in slight weight loss among this group.
Researchers found that men and women responded differently to sleep restriction with regard to weight. Overall, women were able to maintain their weight during the nine-hour nightly sleep phase, during which they had unrestricted access to food. Men, on the other hand, were more likely to gain weight in this phase. But in the restricted-sleep phase, women were more likely to gain weight than men.
These results strongly align with other recent research on the impact of poor sleep on weight. In particular, we've seen other studies suggest the restricted sleep may make it more difficult for people to choose healthful foods, and that lack of sleep may contribute to a shift in calorie consumption to later in the day, to the detriment of our waistlines.
A pair of recent studies indicate that sleep deprivation causes neurological changes that may compromise judgment and trigger desire for unhealthful foods. This study found that lack of sleep is associated with diminished activity in the brain's frontal lobe, an area that's critical to judgment and complex decision-making. Participants who were sleep-deprived made different, less healthful food decisions than those who were not. And in this study, researchers found that in people who were sleep-deprived, the reward center of the brain was more strongly activated by unhealthful foods than in those who had received sufficient sleep.
This 2011 study examined the timing of sleep and of eating, and their impact on weight. Researchers found that "night owls" -- people with late bedtimes -- did more of their daily eating in the evening, compared to those with earlier bedtimes. People with later bedtimes also slept less overall, and had lower-quality sleep. Night owls consumed more calories at dinner and after 8 p.m. than those whose bedtimes were earlier.
A study of mice found that alterations to a circadian-linked gene involved in hunger regulation caused the mice to become obese. Disruptions to this "clock gene" also altered the timing of the mice's eating, causing them to consume more calories during the period normally reserved for rest.
The challenge of maintaining a healthy weight is a daily endeavor, made up of many small choices -- What to eat? How much? When? -- that over time have a powerful cumulative effect. A strong routine of sufficient nightly sleep can aid in this endeavor, helping your body and mind work at its best, every day, for weight control and overall health.
For more on sleep, click here.]]>Challenging Conventional Wisdom About Sleepwalkingtag:www.huffingtonpost.com,2013:/theblog//3.33279662013-05-29T08:22:43-04:002013-05-29T08:22:27-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/research about sleepwalking has raised questions about several common beliefs regarding this frequently misunderstood sleep disorder. Researchers at the University of Montreal conducted a comprehensive review of more than 15 years of study on the topic of sleepwalking. Their analysis produced what may be a clearer picture of the sleep disorder, its possible mechanisms, and its risk factors. Their analysis also challenges some common beliefs about sleepwalking -- beliefs that, if outdated, could interfere with diagnosis and treatment.
What are these views on sleepwalking that researchers say are not supported by data? There are three primary ones, which involve the experience of activities during sleepwalking as well as the daytime effects of the disorder. Researchers say that the cumulative data challenges these three notions:
Sleepwalkers do not remember their episodes
The actions that sleepwalkers take during episodes have no underlying motivation
Sleepwalking has no effect on daytime behavior
Researchers found, in fact, that the memory recall can vary, with some sleepwalkers retaining memories of their episodes and others not. During an episode of sleepwalking, people are in a state that researchers call "dissociated arousal," with parts of the brain in a sleeping state and other parts of the brain in a waking state. This may help to explain why some can remember their experiences while others cannot.
Scientists also found evidence to contradict the common belief that people's actions during sleepwalking are simply irrational, lacking any underlying motivation. The accumulated data, researchers say, suggests otherwise. It is true that episodes of sleepwalking often include strange and seemingly irrational behavior. But researchers found that sleepwalkers who were able to recall their actions during these episodes could also identify a rationale for their behavior, even in circumstances where their actions later seemed strange to them. This led researchers to conclude that sleepwalkers retain motivation for their actions during episodes.
Contrary to the view that the effects of sleepwalking are confined to nighttime episodes, this analysis found that sleepwalkers do experience daytime effects from the disorder. A high percentage of sleepwalkers -- nearly 45 percent -- reported daytime sleepiness. Sleepwalkers perform less well on vigilance tests than those without the disorder. And sleepwalkers who were allowed to nap during the day fell asleep more quickly than those who did not sleepwalk.
Other conclusions that came from this analysis aligned with recent research on sleepwalking. One has to do with genetics. The current review found that nearly 80 percent of sleepwalkers have a family history of the sleep disorder. Researchers identified stress and fatigue as possible causes of sleepwalking, but said that for people who have a genetic predisposition, any disruption to sleep might trigger the disorder.
This conclusion is in line with previous studies, which also found family history linked strongly to the disorder. In this study, researchers at Stanford University investigated sleepwalking and found a strong family connection, with more than 30 percent of the study population able to identify least one other family member with the sleep disorder. The Stanford study, reported in 2012, also found sleepwalking to be significantly more common than often is thought. Stanford researchers found as many as 3.6 percent of U.S. adults may experience some form of nocturnal wandering during any given year. And when sleepwalking is considered over the course of a lifetime, including childhood, as many as 30 percent of the population may have some experience of the disorder.
Sleepwalking is more common during childhood, a conclusion confirmed by this latest research review. Data indicates that sleepwalking is most common in children ages 6-12. Researchers link childhood prevalence of sleepwalking to brain development, and the readiness of a young brain to successfully complete the complicated neurological task of transitioning from wake to sleep. Very often, episodes of sleepwalking will diminish and disappear altogether during adolescence. But as many as 25 percent of adolescent sleepwalkers will continue to have episodes during adulthood, researchers say.
Sleepwalking in adulthood will also decrease with age. This is related to a diminished amount of time spent in the phases of deep sleep, also known as slow-wave sleep. Sleepwalking occurs during periods of slow-wave sleep. As we age, we naturally spend less time in slow-wave sleep, and sleepwalking tends to occur with less frequency. Researchers conducting the review point to evidence of abnormalities in the slow-wave sleep of sleepwalkers, including repeated episodes of "micro-arousals." Further study into the slow-wave sleep of people who experience sleepwalking may shed important light on the underlying causes and triggers for the disorder.
What about the dangers of sleepwalking? The current research review indicates that sleepwalking overall is not particularly dangerous, that its episodes are brief and usually harmless to sleepwalkers and their bedmates. However, other recent research paints a very different picture, one that suggests sleepwalking poses significant risks for physical harm. Among sleepwalkers in this study, 58 percent experienced some kind of violent sleep-related behavior, and 17 percent had at least one episode that required medical treatment for either the sleepwalker or a bed partner.
We've got a long way to go in our understanding of the causes and behaviors of sleepwalking. I hope this latest review will spur more interest in the questions that remain unanswered by this often-overlooked sleep disorder.
For more on sleep, click here.]]>Insomnia May Triple Risk of Heart Failuretag:www.huffingtonpost.com,2013:/theblog//3.32801912013-05-25T10:12:00-04:002013-05-25T10:12:20-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/research shows a link between insomnia and heart failure. Nearly 6 million adults in the United States suffer from heart failure, according to the Centers for Disease Control. Heart failure is directly responsible for more than 55,000 deaths every year and is a contributing factor to hundreds of thousands more deaths in the U.S. annually.
Researchers in Norway conducted a large-scale study of the relationship between insomnia and heart failure and found that the presence of several symptoms of insomnia is associated with a dramatically elevated risk of developing heart failure. The investigation included more than 54,000 men and women between the ages 20-89. All were participants in a large-scale public health study in Norway. At the study's outset, none of the men and women included had known symptoms or evidence of heart failure. Researchers collected data on participants' sleep, including detailed information on three common symptoms of insomnia:
Difficulty falling asleep
Difficulty staying asleep
Waking feeling un-refreshed -- a sign of non-restorative sleep
Researchers also gathered information on other aspects of health, including risk factors for cardiovascular disease. Participants were then monitored over a period of more than 11 years. Over that period of time, slightly more than 1,400 people developed heart failure. Researchers analyzed data to identify a possible relationship between the incidence of heart failure and insomnia symptoms while controlling for other factors that could influence the risk of heart disease, including age, cholesterol and high blood pressure, body mass index, history of heart problems, and alcohol and tobacco use. They found that insomnia was associated with a higher risk of heart failure:
People who experienced insomnia symptoms had a higher risk of developing heart failure than those who did not experience insomnia symptoms.
The risk increased for people who had multiple symptoms of insomnia.
People who experienced all three insomnia symptoms -- difficulty falling asleep, difficulty staying asleep, and non-restorative sleep -- had more than triple the risk of developing heart failure than those with no insomnia symptoms. People with all three insomnia symptoms also had significantly higher risk of heart failure than those with one or two symptoms of insomnia.
The study results show a strong association between insomnia and heart failure. But they do not provide any evidence to answer the question of whether -- or how -- insomnia might directly cause heart failure. Additional research is necessary to determine if disrupted sleep plays a causal role in the development of heart failure.
Heart failure occurs when the heart is unable to pump blood effectively at levels that meet the body's constant needs. This is a serious cardiovascular disease that has no cure. Other research has shown evidence of a link between sleep problems and heart failure, including studies that indicate an increased risk for heart failure among patients with obstructive sleep apnea.
There is also a great deal of evidence that sleep is critically important to heart health, and that disrupted, poor, and insufficient sleep is associated with elevated risk of cardiovascular disease:
This large-scale investigation, conducted by members of the Norwegian research team responsible for the current study found people with insomnia at elevated risk for heart attacks. People with insomnia had a 27-45 percent greater risk of heart attack than those without insomnia symptoms.
This study showed people who slept fewer than six hours a night had a 48 percent higher risk of heart attack as well as a 15 percent increased risk of stroke.
Sleep disordered breathing -- which commonly manifests as snoring or in obstructive sleep apnea -- is associated with higher risk of heart failure, stroke, and coronary heart disease, according to this research.
Poor sleep is also linked to elevated rates of high blood pressure, an important risk factor for heart attack and heart failure.
Science is still working to get to the root of the relationship between sleep problems and cardiovascular disease. Lack of sleep has been associated with calcium build-up in the arteries, as well as with inflammation and dysfunction of the central nervous system. Definitive answers to the role that sleep plays in cardiovascular disease may well lie in these areas. But the mechanisms by which sleep may influence -- or cause -- diseases of the heart are not yet well understood. Still, there is little question that maintaining healthy sleep habits, and addressing sleep problems promptly with your physician, is beneficial to your overall health and to heart health in particular.
For more on sleep, click here.]]>ADHD or Sleep Disorder: Are We Getting It Wrong?tag:www.huffingtonpost.com,2013:/theblog//3.31935702013-05-20T08:30:42-04:002013-05-24T16:00:33-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/
But what if some of those who've been diagnosed with ADHD are, in fact, suffering from another disorder altogether -- a sleep disorder? That's the provocative and important question posed in this commentary by a practicing psychiatrist with extensive experience treating patients with ADHD. Dr. Vatsal Thakkar, who is also a clinical assistant professor of psychiatry at NYU Langone Medical Center, makes a powerful argument for the need to consider sleep problems as a possible cause when evaluating patients for ADHD.
As Dr. Thakkar points out, many of the symptoms of ADHD are very often similar to symptoms of insufficient and disordered sleep for both children and adults. In children, the symptoms of ADHD and sleep deprivation can be indistinguishable. A diagnosis of ADHD in children frequently comes about after a child exhibits some or all of behavioral symptoms such as these:
Lack of focus: difficulty paying attention, problems listening, forgetfulness, disorganization
Agitated, excitable, impulsive behavior: excessive talking, inability to sit still, difficulty playing quietly, tendency to interrupt, difficulty sharing or waiting for one's turn
These behaviors associated with ADHD interfere with a child's social and intellectual development, causing problems with relationships with peers and adults, at school and at home. But what if ADHD isn't always the underlying cause of these symptoms? Signs of poor quality and insufficient sleep in children can look remarkably like symptoms of ADHD, as a number of recent studies show. There's particularly strong evidence that children with sleep-disordered breathing exhibit many of the same symptoms -- and suffer many of the same behavioral problems -- as children who've been diagnosed with ADHD.
Sleep-disordered breathing in children has been an area of growing interest among sleep scientists -- with good reason. I've written about the dangers of sleep-disordered breathing in children, which is linked to a range of developmental and behavioral problems -- problems that often mirror those associated with ADHD:
This study found that children with obstructive sleep apnea had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness. These children were also more likely to have learning difficulties and low academic performance than those without sleep-disordered breathing.
This large-scale study of more than 11,000 children found that those with sleep-disordered breathing were significantly more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules. The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, 40-100 percent more likely to have behavioral problems similar to those used to diagnose ADHD.
Many adults being treated for ADHD have symptoms that are difficult to distinguish from the effects of poor quality and insufficient sleep. Difficulty concentrating, trouble completing tasks, problems with organization, and memory lapses are all common struggles for adults who've received an ADHD diagnosis. These are also some of the most common problems for adults with sleep problems. I've written about the challenges that lack of sleep and disrupted sleep pose to cognitive function in adults, including problems with memory, learning and focus.
Given the similarities of symptoms between ADHD and poor sleep in children and adults, it's not hard to see how misdiagnosis is possible, even likely. That risk increases when we consider the lack of regular screening that exists for sleep problems. We've made great scientific strides in our understanding of sleep in recent years. But we still struggle with a lack of attention paid to sleep problems by both physicians and patients. For both children and adults, sleep problems continue to be significantly under-diagnosed. This study of members of the American Academy of Pediatrics evaluated sleep-screening practices among pediatricians. Researchers found that fewer than 1 in 5 pediatricians surveyed had received any training in sleep disorders, and fewer than 1 in 6 felt confident about their ability to offer guidance to parents about children's sleep. The study also revealed serious knowledge gaps among pediatricians about sleep, with most unable to answer correctly questions about sleep disorders in children.
The news isn't any better for adults. An analysis of data from the 2005-2006 National Health and Nutrition Examination Survey found that sleep disorders such as insomnia and sleep apnea remain drastically under-diagnosed. What's more, though nearly all of the more than 2,000 adults surveyed reported at least one complaint about their sleep, fewer than 1 in 4 of them had talked with physicians about their sleep problems.
More rigorous and effective screening for sleep problems starts with better training for physicians and medical professionals who must make diagnoses every day. As patients and as parents, we also need to be attentive to symptoms of poor sleep in ourselves and in our children. And we need to take these concerns -- however mild they may appear -- to our physicians.
Another thing we can do? Protect our sleep, and our children's sleep, by setting sleep-friendly limits against the nonstop, perpetually wired, always "on" culture we live in today. As Dr. Thakkar points out, the escalation of ADHD cases in the 1990s and 2000s coincided with the rise of the digital age, and the widespread use of personal technology that now pervades our daily lives. These devices -- our laptops and tablets and cell phones -- that enable so much convenience and connection, also threaten the quality and quantity of sleep. The nighttime exposure to light they emit interferes with the body's release of melatonin, disrupting sleep cycles and diminishing time spent in the deepest, most restorative phases of sleep. More than ever before in history, we must work to create the darkness that is so essential to sleep. Keeping our bedrooms, and our children's bedrooms, gadget-free sanctuaries for sleep is one important way to guard against chronic sleep deprivation.
To raise the possibility that some cases of ADHD in children and adults may actually be un-diagnosed sleep disorders does not call into question the seriousness of ADHD, the difficulties it poses, and the importance of effective treatment for this very real disorder. Additional research is critical to determine whether, and how often, sleep disorders are being misdiagnosed as ADHD. The goal is to make the right diagnosis -- whether ADHD or sleep problems -- and pursue the most effective treatment. All patients, whatever their condition, deserve no less. Pursuing the question of a link between disrupted sleep and symptoms of ADHD is a matter of public health, one that deserves prompt and sustained attention.
For more on sleep, click here.]]>Zolpidem-Related ER Visits Have Increased Sharplytag:www.huffingtonpost.com,2013:/theblog//3.32384502013-05-10T17:05:49-04:002013-05-10T17:05:56-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/news about complications that can arise from prescription sleep medication: Side effects from a common prescription sleep aid are sending increasing numbers of people to emergency departments.
The number of people seeking emergency medical treatment for the adverse effects of sleep medications containing zolpidem has risen dramatically in recent years, according to a new federal report. Zolpidem is the active ingredient in several of the most commonly prescribed sleep medications, including Ambien, Ambien CR, Edluar, and Zolpimist.
The report was issued by the Substance Abuse and Mental Health Services Administration's Drug Abuse Action Network (DAWN), which collects information about drug-related visits to emergency departments nationwide. Their analysis included all emergency-department visits that involved adverse effects of zolpidem during the years 2005-2010. During this five-year period, visits to emergency departments involving adverse effects of zolpidem increased significantly, rising by more than 200 percent. Women and older adults sought emergency treatment for adverse zolpidem effects in greater numbers overall than men and younger adults. According to the report:
In 2010, there were 64,175 emergency-department visits involving zolpidem. Of these, 19,487 -- or 30 percent -- specifically involved adverse reactions to the sleep medication.
In 2005, there were just 6,111 emergency-room visits involving adverse reactions to the sleep drug. During the period 2005-2010, emergency-department visits involving adverse reactions to zolpidem rose almost 220 percent.
The analysis found women were significantly more likely to seek emergency treatment for problems with zolpidem than men:
Women accounted for 68 percent of emergency-department visits related to adverse reactions to zolpidem in 2010. The differences between men and women fluctuated during the five-year period, but overall women made up a greater number of the zolpidem-related emergency visits in every year but 2008.
The number of emergency-department visits made by women involving adverse effects of zolpidem increased by 274 percent during the years 2005-2010. Visits by men increased 144 percent.
Age also was a factor, with greater numbers of cases involving older adults:
Adults ages 45 and older accounted for 74 percent of all emergency-department visits involving adverse reactions to zolpidem. As a comparison: this same age group accounted for 56% percent of emergency-room visits involving adverse effects of any drug.
Patients ages 65 and older were the single most common age group to seek emergency treatment for adverse reactions to the sleep medication: Thirty-two percent of all emergency-department visits related to adverse effects of zolpidem were undertaken by people in this age group.
Patients ages 45-54 were the next largest group, accounting for 22 percent of all visits.
Other pharmaceutical drugs often were involved in emergency treatments related to zolpidem. Half of the emergency-department visits related to adverse effects of zolpidem involved other medications as well:
Of the total visits to emergency departments related to adverse effects of zolpidem, 40 percent involved the sleep drug alone.
In 50 percent of the cases, one or more additional prescription drugs were involved.
The most common prescription drugs seen in combination with zolpidem's adverse effects included narcotic pain relievers, antidepressants, anti-anxiety medications and other insomnia medications.
The side effects associated with zolpidem can be disorienting, scary, and at times dangerous. These side effects include hallucinations, problems with memory, excessive daytime tiredness, sleepwalking and engaging in other behaviors such as eating and even driving while not fully awake and alert. The adverse effects of zolpidem can be exacerbated when the sleep medication is combined in the body with other common prescription drugs, including narcotic pain relievers, antidepressants and anti-anxiety medications. Alcohol, too, can have a magnifying effect on the body's reaction to zolpidem.
Medications containing zolpidem are prescribed to millions of Americans with sleep problems, in numbers that have been rising dramatically in recent years. The SAMHSA report does not discuss reasons for the spike in zolpidem-related emergency department visits, but it's certainly likely that the rise in the number of prescriptions may play a significant role. For all their frequent usage, we still don't know a great deal about the health and side effects of zolpidem medications. Stories about strange and erratic behavior associated with these sleep medications have been widely reported, but research into the effects of zolpidem is just starting to accumulate.
In January of this year, the Food and Drug Administration issued a safety alert including changes to its regulations regarding zolpidem. The FDA announced it would require drug makers to cut in half the recommended dosages for women taking zolpidem, and suggested that the recommended dosage for men be lowered as well. The alert also urged medical professionals to warn all patients taking zolpidem about early-in-the-day drowsiness and impairment. The FDA's action came about as a result of research indicating that patients -- especially women -- who take zolpidem at night may have concentrations of the medication in their bloodstream high enough to cause impairment in the morning for activities such as driving. The research showed that women's bodies take significantly longer to metabolize the drug, leaving them particularly vulnerable to excessive drowsiness and impairment in the morning.
Research also has shown that older adults are at greater risk for adverse effects from sleep medications, including those containing zolpidem. The elevated numbers of both women and older adults seeking emergency treatment for problems with zolpidem appears to align with other research suggesting these groups are at elevated risk for complications from these medications. We must continue to learn more about the short-term and long-term effects of zolpidem and other sleep medications on patient safety and health.
Sleep medications containing zolpidem can be an effective short-term treatment for disordered sleep. But these medications must be prescribed with care and caution by doctors, and used correctly by patients. Prescription sleep medications such as those with zolpidem are not intended for long-term use. For most patients with sleep problems, the best long-term prescription for healthy sleep isn't found in a pill bottle. It's found in the fundamentals of strong daily sleep habits, and a lifestyle that promotes good sleep hygiene.
For more on sleep, click here.]]>Low Melatonin Level Means High Risk for Diabetes?tag:www.huffingtonpost.com,2013:/theblog//3.31797182013-05-06T10:25:04-04:002013-05-06T10:25:11-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/estimates, 1 in 10 American adults currently has diabetes. And, if the CDC projections are correct, those numbers will double or even triple over the next 40 years.
There are well-established links between disrupted sleep and risk of Type 2 diabetes. But the exact relationship between the two is not fully understood. In the ongoing effort to better understand the causes and risk factors for diabetes, research in recent years has increasingly focused on the role of melatonin. Now, new research indicates that low levels of melatonin are associated with elevated risk for Type 2 diabetes. The study, led by researchers at Boston's Brigham and Women's Hospital, found that women with the lowest levels of melatonin secretion had more than two times the risk of developing Type 2 diabetes as those with higher melatonin levels.
Researchers used data from the Nurses' Health Study, a long-term, large-scale project investigating a broad array of women's health issues. Since its inception in 1976, the Nurses' Health Study has collected information from more than 200,000 female nurses. For this study, researchers used information from women who provided blood and urine samples in 2000. First, researchers selected the women without diabetes, and monitored their health for the next 12 years. During the period of 2000-2012, 370 of the women developed diabetes. Using this sub-group, researchers analyzed melatonin levels. In their analysis, they controlled for other risk factors for Type 2 diabetes, including body mass index, family history, high blood pressure, and lifestyle habits. They found:
Lower melatonin levels associated with higher risk of diabetes
Those with the very lowest levels of melatonin secretion had 2.17 times the risk for diabetes than those with the highest levels of melatonin
Women with the highest levels of melatonin developed diabetes at a rate of 4.27 cases per 1,000. For women with the lowest levels of melatonin, the incidence of diabetes was 9.27 cases per 1,000.
This is the latest in a series of research breakthroughs that suggest melatonin plays an important role in metabolic functions and risk of diabetes. I wrote recently about studies that have found that mutations to the body's melatonin receptor gene are associated with significantly heightened risk for Type 2 diabetes. Other research has also found evidence of a relationship between melatonin levels on the onset of diabetes:
Several studies involving mice and other animals have found melatonin secretion has an effect on insulin sensitivity and other markers of diabetes. This study showed improvements to insulin sensitivity and glucose tolerance in mice given supplemental melatonin. And in this study, blood pressure and blood glucose levels dropped in hamsters given melatonin. On the other hand, mice deprived of melatonin experienced diminished ability to metabolized glucose, likely as a result of increased resistance to insulin.
Studies involving people have also shown links between insulin resistance and melatonin. This study of patients with metabolic syndrome found a strong association between melatonin levels and insulin levels in the human body. Many people with metabolic syndrome very often go on to develop diabetes.
How does melatonin work in the body to influence the onset of diabetes? We don't yet have a definitive answer to that question. The current study, and other studies of melatonin and diabetes, have not identified the mechanism by which melatonin influences the development of diabetes. In discussing their results, researchers indicate that they believe evidence points strongly to melatonin's role in the secretion of insulin.
Melatonin, best known as "the sleep hormone," is critical to regulating the body's 24-hour biological clock and sleep-wake cycle. Melatonin release is triggered by the absence of light. As night approaches, melatonin levels rise, preparing the body for sleep. Melatonin levels fall back as daytime arrives, and the body becomes alert and prepared for a waking day. Over years of scientific inquiry, our understanding of melatonin's role in the body has broadened. We're still learning about the range of melatonin's influence. But the hormone is now recognized as having influence in several important biological functions, including the immune system and metabolic system.
So, does this mean people at risk for Type 2 diabetes should start taking melatonin supplements? Definitely not.
We don't know enough yet about melatonin as a factor in diabetes. Studies such as this latest one strongly point to a relationship, but it's one that is not yet well understood. These and other research findings do not indicate that an increase of melatonin through supplements would work effectively to reduce the risk of Type 2 diabetes. And supplemental melatonin comes with its own set of possible complications. Our bodies are expert at creating and regulating melatonin naturally. Introducing supplementation of the hormone into the body at an inappropriate dose, or at the wrong time of day, can interfere with the proper functioning of the body's circadian clock. Melatonin should only be used when specifically recommended by a doctor after careful determination that it is an appropriate treatment.
That said, these results are yet another step forward in our understanding of the importance of melatonin, and in particular, its relationship to diabetes risk. Building on discoveries such as this may lead to new and more effective treatment and prevention strategies to combat this dangerous and all-too-common disease.
For more on sleep, click here.]]>Have You Considered a 'Sleep Divorce'?tag:www.huffingtonpost.com,2013:/theblog//3.31557782013-05-02T08:14:38-04:002013-05-24T16:06:44-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/this news story with great interest, as it covers a topic I get asked about a lot: whether it's a good idea for couples to sleep apart to improve their individual sleep.
This is an issue that seems to come up with increasing frequency as more couples appear to be sleeping in separate bedrooms. It's estimated that 25 percent of couples in the U.S. are sleeping apart. This is a number that has been on the rise in recent years. What's more, the residential construction industry in recent years has reported a substantial uptick in requests for two separate master bedrooms in new homes.
What's behind the drive to sleep separately? There are a number of reasons that couples find themselves considering separate bedrooms. Here are some of the most common:
Different schedules: Early birds and night owls can disrupt each other's sleep at either or both ends of the night and grow to feel incompatible as sleep partners.
Disrupted sleep: People who experience symptoms of disrupted sleep, such as snoring, or tossing and turning from insomnia, can keep their partners from sleeping well.
Poor sleep equipment and sleep environment: A too-small mattress can make couples' sleep challenging. A room that's too bright, or too warm, can be disruptive to sleep.
Divergent sleep habits: One person likes to watch TV late into the night or surf the Web from bed. Partners can disturb each other with their non-sleep bedroom habits.
Conflicts over co-sleeping: Parents who don't sleep well with children in bed, or who disagree about whether or not to co-sleep, can find themselves seeking separate sleeping spaces.
With sleep disorders like insomnia and obstructive sleep apnea all too common and on the rise, it is understandable how couples might opt for separate bedrooms. There is no question that it is critically important for both partners to achieve restful and sufficient sleep on a regular basis. Disrupted sleep can increase risk for a range of serious illnesses, including cardiovascular problems, obesity, and diabetes. Poor sleep also can have negative effects on relationships. This recent study suggests that lack of sleep may diminish the positive feelings we have for our partners. Researchers found people with lower quality sleep demonstrated lower levels of gratitude and were more likely to have feelings of selfishness, than those who slept well. People who slept poorly showed less of a sense of appreciation for their partners. What's more, poor sleep on the part of one person in the relationship had a negative effect on feelings of appreciation and gratitude for both partners.
So, sleep is important for individual health and also for the health of relationships.
But is sleeping apart really the best remedy for couples whose sleep needs improvement? I'm not convinced it is. For some couples, sleeping apart may indeed be the right choice. But couples who want to sleep together can and should consider addressing their sleep issues from within their shared bedroom before making the jump to separate sleeping quarters.
Often, discussions of the merits and pitfalls of bed sharing will separate the issue of individual sleep quality from the psychological and emotional desire to sleep with a partner. For couples who sleep together, this time can be one of deep closeness and intimacy, sexual and emotional. The intimacy established by sleeping together is for many a cherished and valuable aspect of being a couple. The challenge is to create and maintain strong, healthy, and compatible sleep habits for a shared sleeping space.
Here are some questions to consider before you set up separate bedrooms:
Have you addressed any sleep issues with your doctor? Anyone who experiences symptoms of disrupted or poor sleep should consult their physician. Undiagnosed, disordered sleep can wreak havoc with an individual's rest and a couple's sleep. But effective treatments are available. And evidence suggests that people being treated for sleep disorders can benefit from having a partner continue to sleep with them. This study found that sleep apnea patients using CPAP therapy were 60 percent more likely to stay with their treatment plan if their partners remained in bed with them.
Is your bedroom sufficiently sleep friendly? Several factors in your bedroom can enhance -- or hinder -- couples' sleep. Having the right sleep equipment is critical, starting with a good mattress. Squeezing two adults onto a traditional full or queen-size bed will not give most couples enough room to sleep comfortably. Invest in a mattress that is large enough for both partners to claim their own space -- and still meet up in the middle. Memory-foam mattresses can lessen the impact of a partner's nighttime movements. Does one of you like a firm bed and the other prefers a softer one? Mattresses can be customized so each side has the right level of cushioning for both partners.
Creating a comfortable bedroom environment is also important. Darkness, a moderate room temperature, and cleanliness all can affect sleep quality. Clean sheets and a dark and quiet bedroom can make a big difference to couples sleeping together well.
Can you marry your sleep habits? Maybe you're an early riser, and your partner likes to stay up into the wee hours. You like to read late into the night, and your spouse prefers lights out at 10 o'clock. Rather than simply trying to tolerate your differences -- or moving to the spare bedroom -- can you find middle ground? This kind of compromise can actually help improve everyone's sleep habits, by moderating extreme tendencies and removing extraneous activity from the bedroom. If you get up much earlier than your partner, agree that you'll take care of your morning routine -- getting dressed, making a first check of email -- outside the bedroom. If you're in the habit of reading as the clock rounds midnight, consider opening your book earlier in the evening so you can move up your bedtime.
Here's one great way to simplify your bedroom habits: Remove the electronics. Televisions, computers, and cell phones have no place in a restful bedroom. Both the light they emit and the stimulation they provide are disruptive for sleep. Bedrooms are for sleep and sex.
Like so many aspects of a relationship, sleeping together well as a couple is a dynamic process. By paying attention to sleep problems and sleep hygiene, many couples may find they can work out their sleep differences, avoid the "sleep divorce," and stay together in bed.
For more on sleep, click here.]]>Exercise Gives a Big Boost to Sleeptag:www.huffingtonpost.com,2013:/theblog//3.30711002013-04-15T08:08:04-04:002013-06-15T05:12:02-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/shown that exercise can improve sleep, including for people with sleep disorders and other sleep-related illnesses. And now there's even more evidence of the sleep benefits that can come with regular physical activity.
The National Sleep Foundation devoted its annual "Sleep in America" poll to exploring the relationship between exercise and sleep. Their results found that people who exercise regularly experience better quality and more consistent sleep than those who do not. People who exercise are also significantly less likely to feel sleepy during the day, and to experience symptoms of sleep disorders such as insomnia and obstructive sleep apnea. And the news gets better: While more vigorous exercise is best, people participating in light exercise -- as little as 10 minutes of walking a day -- reported substantially better sleep than non-exercisers.
The NSF interviewed a nationally representative sample of 1,000 adults between the ages of 23 and 60. Participants were asked to report on their physical activity in the past week, providing details on the frequency, duration, and intensity of their exercise. They also were asked to report on the quantity and quality of their sleep, as well as sleep problems including symptoms of disordered sleep and daytime drowsiness. Participants provided information about their overall health, and personal habits including alcohol and smoking.
Based on the reports of physical activity, respondents were divided into four categories, according to their exercise habits:
Vigorous: These people participated in activities like running, biking, swimming, and other pursuits that require significant physical exertion.
Moderate: Respondents in this category spent time doing activities that included higher-than-normal levels of physical exertion, including yoga and weight training.
Light: People in this category were physical active at normal levels of exertion, getting their exercise primarily by walking.
No activity: The respondents in this category did not engage in exercise.
The results were striking. All respondents -- from vigorous exercisers to non-exercisers -- reported getting roughly the same amount of sleep on a nightly basis, an average of six hours and 51 minutes on workdays, and seven hours and 37 minutes on non-workdays. All groups also reported needing about the same amount of sleep to meet the demands of their daily lives: an average of 7 hours and 17 minutes. But exercisers at all levels reported sleeping substantially better than those who did not exercise:
More than half of exercisers (56-67 percent) reported getting a good night's sleep every night or almost every night, compared to 39 percent of non-exercisers.
Exercisers at all levels also reported higher quality of sleep than non-exercisers. More than three-quarters (76-83 percent) said their sleep was "very good" or "fairly good," compared to 56 percent of non-exercisers.
More than half of exercisers at all levels also reported feeling their quality of sleep improve on days they engaged in physical activity.
While all exercisers reported significantly better sleep, the highest-quality sleep was reported by those who engaged in the most vigorous physical activity. Vigorous exercisers reported the highest sleep quality, and the most robust daytime energy levels. And they were least likely to have problems with their sleep:
Twenty-six percent of vigorous exercisers said their quality of sleep was "very good," compared to 16 percent of light exercisers.
Sixty-six percent of vigorous exercisers said they got more sleep than they needed, compared to 53 percent of moderate and light exercisers.
Vigorous exercisers had fewer sleep problems than moderate and light exercisers, including less difficulty falling asleep and staying asleep, waking too early and not being able to fall back asleep. All exercisers reported fewer of these problems than people who did not exercise at all.
Fifty percent of vigorous exercisers said they had no problems maintaining enthusiasm for the demands of their daily lives, compared to 40 percent of moderate and light exercisers and 33 percent of non-exercisers.
People who engaged in no exercise didn't just report lower quality sleep, they also reported in greater numbers a range of difficulties with their health and their daily lives:
Non-exercisers were significantly more likely to say they experienced "very bad" sleep than exercisers. Fourteen percent of non-exercisers categorized their sleep as very bad, compared to 3-4 percent of exercisers.
More than half -- 61 percent -- of non-exercisers reported "rarely" or "never" getting a good night's sleep on workdays, compared to 29 percent of vigorous exercisers.
Non-exercisers were more likely to feel sleepy during the day. Nearly twice as many non-exercisers reported daytime sleepiness as exercisers.
Daytime sleepiness interfered with non-exercisers daily activities and their safety more often than for those who exercised. Fourteen percent of non-exercisers reported having trouble staying awake while driving, eating, or engaging in social activity one or more times in the previous two weeks, compared to 4-6 percent of exercisers.
Non-exercisers were significantly more likely to have symptoms of sleep disorders, including obstructive sleep apnea. Forty-four percent of non-exercisers demonstrated a moderate risk for sleep apnea, based on standard clinical indications for the sleep disorder. This number was more than twice as high as for vigorous exercisers, only 19 percent of whom indicated a moderate risk of sleep apnea.
The message here is clear: Put some time every day toward exercise, and when bedtime comes around you'll sleep better. For those trying to juggle a regular exercise routine amid busy schedules, there's some more good news in these poll results. The survey found that exercise at any time of day was good for sleep, including within four hours of bedtime. It's been a common recommendation -- including from the National Sleep Foundation itself -- to avoid exercise during the final four hours of the waking day, in order to prevent physical exertion from interfering with sleep. Based on these results, the NSF has revised its recommendation, and encourages normal sleepers to exercise at any time of day, provided that their exercise does not interfere with their sleep. People with insomnia and other sleep disorders should continue to schedule their exercise earlier in the day. And anyone who finds their sleep diminished by late-day exercise should do the same.
So, where do you fit in the sleep-exercise picture that these survey results illustrate? Are you sleeping as much, and as well, as you need? If you're looking for ways to improve your sleep, your daily exercise routine is a great place to start.
For more on fitness and exercise, click here.]]>NHL Wakes Up to Sleep Problemstag:www.huffingtonpost.com,2013:/theblog//3.30538702013-04-13T10:00:20-04:002013-06-13T05:12:01-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/
In response to reports of widespread use, the NHL and the NHL Players' Association are working together to study the use of Ambien by players in the league. The results of the study are expected later this spring, when the league is expected to issue its findings and make recommendations about use of the prescription sleep medication.
The issue of sports-related drug use -- particularly the performance-enhancing kind -- is of course widespread in professional sports these days, and has been for some time. For many years, rightly or wrongly, hockey has been thought of as a sport less riddled with performance-enhancing drugs. But steroids and other performance-enhancing drugs are only part of the drug problem in sports. Prescription drug use -- including excessive or inadvisable use of sleep medications -- is also a problem in the world of competitive athletics.
And the NHL is no exception. The death of NHL player Derek Boogaard is a sad and sobering example: The 27-year-old died of a drug and alcohol overdose in 2011. Investigations into his death revealed that he was in possession of a frightening array of drugs, including a dozen or more prescriptions for Ambien, which he'd received from several different doctors.
Sleep problems are a serious issue for professional athletes, whose intense training, rigorous schedules, and frequent travel across time zones put them at high risk for disrupted and insufficient sleep. Pro athletes crisscrossing the country, often flying overnight before waking up to an early-morning practice or next-day game, share risks for sleep problems with other high-frequency travelers and people who work non-traditional schedules. People in these jobs -- from law enforcement to doctors and nurses to airline personnel and air-traffic controllers -- are at higher risk for sleep disorders such as insomnia and obstructive sleep apnea. They also can be at elevated risk for health problems associated with poor sleep, including obesity, Type 2 diabetes, and cardiovascular disease.
In addition to studying the use of Ambien, the NHL has also taken other steps to address sleep issues among its players. In its most recent agreement with the NHL Players' Association, the NHL made changes to league policies that are intended to provide players with better rest during the season. The new rules include a minimum of four days off per month during the season, and a minimum nine-hour break between flight touchdown and the beginning of the next practice when players are on the road. While these changes may seem modest, they do appear to reflect a growing awareness of the need to protect athletes' ability to sleep. It is my hope that they also reflect an understanding that sleep medication is not the first -- nor always the best -- recourse for improving sleep.
I wrote last fall about the New York Jets' decision to hire sleep specialists to work with players on improving their sleep habits, and the sleep-friendly adjustments made to the team's practice schedule. This is exactly the kind of attention I like to see being put toward improving sleep -- the kind that addresses lifestyle changes in manageable, sustainable ways rather than jumping right to sleep medication as the catch-all solution to sleep problems. I hope we see more of these sorts of strategies implemented by professional sports teams and leagues.
The study of sleep's effects on sports is relatively new, but there is a growing body of evidence to show that sleep can boost athletes' performance on their field of play. There is also research that shows how lack of sleep may have negative consequences for athletes:
Research at Stanford University's Center for Sleep Sciences and Medicine has shown sleep linked to measurable improvements to performance across a range of sports. From swimming to basketball to football, collegiate players in these studies improved speed, accuracy, and reaction times when they increased their nightly sleep.
There is also research that indicates sleep may play an important role in post-exercise recovery, which is considered a critical to maintaining athletic performance over the course of a season and a career.
When professional athletes don't get enough sleep, they may be shortening the overall lengths of their careers. That's the message from a pair of studies that found that low sleep was associated with shorter career spans and more frequent trades, in both professional football and professional baseball.
It's not that sleep medications like Ambien don't have any place in the treatment of disordered sleep. They do. But prescription sleep medications need to be carefully prescribed and monitored, and they are rarely, if ever, the best first step in a treatment plan to improve sleep. This is true for the men and women of professional sports. It's also true for the rest of us, who want to be at the top of our game in our daily lives.
For more on sleep, click here.]]>Insomnia Increases Suicide Risktag:www.huffingtonpost.com,2013:/theblog//3.30218522013-04-06T11:01:16-04:002013-06-06T05:12:01-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/common among people with depression and other mental health problems. Research indicates that people with depression are significantly more likely to experience insomnia symptoms. Insomnia also has been linked to an elevated risk for suicide. A recent study offers new details about the relationship between insomnia and suicidal thoughts among people with depression.
Researchers at Georgia Regents University examined the possible influence of insomnia and disturbed sleep among patients with a history of depression and suicide. Their analysis revealed that the connection between insomnia and suicidal thoughts may be influenced by nightmares, and also by the presence of negative attitudes and beliefs about sleep in patients who are suffering from depression.
Their study included 50 patients between the ages 20-84. All had received treatment for depression either as inpatients or outpatients, or in the emergency room. Seventy-two percent of the participants were women, and a majority -- 56 percent -- had attempted suicide at least once. Researchers measured levels of depression and insomnia, feelings of hopelessness, as well as the presence and severity of nightmares and attitudes and beliefs about sleep.
Participants experienced moderate insomnia, on average.
As expected, their analysis showed an association between the presence and severity of insomnia and suicidal thoughts.
Researchers also analyzed data to examine the possible relationship between nightmares and attitudes about sleep with suicidal thoughts, and found significant associations. When these additional sleep problems were included in the analysis, insomnia itself was no longer directly associated with suicidal thoughts. This suggests that insomnia may have an indirect effect on suicidal thoughts, through the presence of these other symptoms, in patients who are depressed.
Among people with depression, insomnia contributes to a sense of hopelessness about sleep, according to researchers. These negative feelings about sleep, as well as nightmares experienced by people with depression and insomnia, may be critical predictors for suicidal thoughts.
This is important new information in our understanding of the link between insomnia and suicide. The presence of these symptoms -- nightmares and feelings of hopelessness about sleep -- may be a more specific predictor of suicide risk among people with depression than insomnia in general.
Earlier work by some of the same researchers explored the relationship between insomnia and suicide. Their study included 60 patients between the ages 18-70. Two thirds were women, and all suffered from major depression and insomnia symptoms. Researchers found that the severity of insomnia among these patients was linked to degree of suicidal thoughts. More severe insomnia was associated with higher intensity of suicidal thoughts. In their analysis, researchers isolated insomnia from other symptoms of depression, such as low mood and inability to experience pleasure. They determined that insomnia is an independent predictor of suicidal thinking. This latest study built on those findings, looking with greater depth and specificity at how insomnia and related attitudes and behaviors of disrupted sleep may influence suicidal thoughts.
Other research has shown a strong association between insomnia and disrupted sleep and suicide for people with depression and other psychiatric disorders:
This study examined the relationship of nighttime sleep disturbances -- including insomnia and nightmares -- and the risk of suicide among psychiatric outpatients. Researchers found that both insomnia and nightmares were linked to an elevated risk of suicide.
This study also investigated sleep disturbances and nightmares as risk factors for suicide. Rather than including only participants with depression or other psychiatric disorders, Hungarian researchers used a broad sample of data, representative of the general population of Hungary. They found that sleep disturbances and nightmares elevated the risk of suicide by as much as four times among men, and as much as three times among women. In this study, frequent nightmares and sleep disorders were associated with a higher risk of suicide than depression.
Sleep problems have been shown to be strong predictors of suicidal behavior for adolescents. This research reported that sleep problems in early adolescence (ages 12-14) were a significant predictor of suicidal thoughts and self-harming behaviors by later adolescence (ages 15-17). And this study of young adults in the military revealed sleep problems to be a stronger predictor of suicidal thinking than depression or feelings of hopelessness.
In addition to risks for young adults, there also appear to be particular risks for older adults, in the connection between suicide and insomnia and disrupted sleep. This research showed that older adults with sleep problems were at greater risk for suicide than those in their age group who maintained healthy sleep patterns.
Understanding how insomnia and other sleep problems contribute to hopelessness and thoughts of suicide can provide important new options for suicide prevention and treatment of depression and suicidal thoughts. By identifying nightmares and dysfunctional, negative attitudes about sleep as important predictors of suicidal thinking in people with depression, we may be better able to identify those who are at greater risk for self-harm.
For more on sleep, click here.]]>Lack of Sleep Disrupts Our Genestag:www.huffingtonpost.com,2013:/theblog//3.29256682013-03-27T08:13:58-04:002013-05-27T05:12:01-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/
New research may offer some important insight into how sleep affects heath. A new study indicates that poor sleep can significantly disrupt and inhibit normal gene activity in hundreds of genes. The genes affected help to govern broad and important biological functions, including stress, the immune system, inflammation, metabolism, and circadian rhythms. A team of researchers led by scientists at England's University of Surrey examined the influence of sleep on gene function and found that a week of low sleep altered the activity of more than 700 genes. The study was collaborative effort among specialists in sleep science, genomics, physiology, and bioinformatics.
The study included 26 adults whose sleep was monitored for two weeks. During the first week, participants sleep slightly fewer than six hours per night, less than the recommended seven to eight hours. During the second week, they slept 8.5 hours nightly. After the conclusion of each week, researchers took blood samples and analyzed them to identify any changes in genetic activity. After controlling for other factors, including exposure to light, activity levels, and food, the results showed that a single week of insufficient sleep had a dramatic effect on gene activity:
Low sleep altered the activity of 711 genes.
The total number of genes affected by sleep increased by seven times after one week of sleep deprivation.
Many of our genes rise and fall in activity in accordance with our body's 24-hour circadian clock. A week of insufficient sleep reduced the total number of genes that rise and fall in line with circadian rhythms from 1,855 to 1,481.
Sleep deprivation also diminished the amplitude of the rise and fall of some of these circadian-aligned genes.
The genes affected by sleep deprivation help govern circadian rhythms, metabolic functions, and sleep homeostasis -- the regulation of sleep itself. These are genes connected to immune system functioning, inflammation levels, and stress responses. Previous research has shown that disrupted sleep is indeed strongly associated with health problems related to these biological functions:
Circadian rhythms. In recent years, we've learned a great deal about the importance of our circadian rhythms to health. Sleep itself is one of the many essential biological functions governed by our 24-hour circadian clock. Disruptions to circadian function are associated with a range of health problems, including psychiatric disorders, dementia, metabolic disorders such as diabetes, autoimmune disorders such as rheumatoid arthritis, and cancer.
Metabolism. Disrupted sleep is also strongly associated with metabolic diseases, including obesity, metabolic syndrome, and diabetes. Studies have shown that sleep problems can predict the future development of metabolic syndrome, a disorder that is associated with higher risk for diabetes and cardiovascular disease. Sleep is a critical factor in healthy weight control, and sleep deprivation is strongly linked to obesity. And there is a great deal of research to indicate that poor sleep increases the risk of diabetes, perhaps by contributing to insulin resistance.
Inflammation.Inflammation in the body is linked to a long list of health problems, including cardiovascular disease, chronic pain, diabetes, and cancer. Insufficient sleep has been linked to an increase in inflammation. This study showed people who slept six or fewer hours per night had higher levels of inflammation than those who slept between six and nine hours nightly.
Immune system. Research has also shown that sleep plays a role in immune system functioning. Numerous studies in recent years indicate that disrupted sleep, as well as too little sleep, may compromise healthy immune activity. This recent research found poor sleep to be as damaging to the immune system as stress.
Stress. Stress response is another biological process affected by the gene disruption found in this latest study. The relationship between sleep and stress is complicated. Stress can interfere with both the quantity and quality of sleep, as this study shows. And insufficient sleep can have negative effects on the way we respond to stress. Research shows that low sleep is linked to hormonal changes that can affect stress response. Studies also show that healthy sleep works to ease the emotional sting of difficult memories. Lack of sleep may inhibit our ability to process difficult emotional experiences, prolonging periods of stress and anxiety.
There's an abundance of scientific evidence linking sleep to these and other health problems. But we're just scratching the surface of understanding the underlying pathways by which sleep influences health. Understanding more about how sleep affects genetic function holds great promise in illuminating these pathways and could open important new avenues for both treatment and prevention of illness and disease.
For more on sleep, click here.]]>Less Sleep Means More Caloriestag:www.huffingtonpost.com,2013:/theblog//3.28065452013-03-20T08:29:00-04:002013-05-20T05:12:02-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/
Researchers at the Perelman School of Medicine at the University of Pennsylvania examined the dietary differences among people with different sleep patterns, and found that people who reported sleeping the recommended seven to eight hours per night consumed fewer calories than those who reported sleeping five to six hours per night. People who slept between seven and eight hours nightly also had more diverse diets than those who slept both less and more than this recommended nightly amount. Eating a wide range of foods is considered an indicator of a healthy diet.
Researchers used data from the National Health and Nutrition Survey (NHANES), a population-based survey of the health and nutrition habits of adults and children in the U.S., conducted annually by the Centers for Disease Control. As part of the survey, participants report their nightly sleep amounts. Researchers used this information to create four sleep categories:
Very short sleep: Those who slept fewer than five hours per night
Short sleep: People who slept five to six hours nightly
Standard sleep: Those who slept seven to eight hours per night
Long sleep: People who slept for nine or more hours nightly
The NHANES data also included detailed information about participants' daily eating habits. Using this information, researchers analyzed how the diets of short and long sleepers differed from standard sleepers, in terms of the range of foods and nutrients, and also calorie intake. They found that calorie consumption differed among the four groups:
Short sleepers, those who slept between five and six hours nightly, consumed more calories than any other group.
Short sleepers were followed by standard sleepers, very short sleepers, and long sleepers, in the overall amount of calories consumed daily.
Researchers also found differences in the makeup and quality of diets across the four groups:
Standard sleepers, those who slept seven to eight hours, had the most broadly varied diet of all the groups.
Very short sleep was associated with lower consumption of tap water, as well as carbohydrates and lycopene, a nutrient found in red and orange vegetables such as tomatoes. Lycopene is an antioxidant, and may protect against cancer and heart disease.
Short sleep was associated with lower amounts of Vitamin C, tap water and selenium, a mineral found in fish, meat, and nuts. Selenium helps to protect heart health, and may reduce the risk of some cancers.
Long sleep was linked to lower carbohydrate consumption, as well as lesser amounts of theobromine. Theobromine is a stimulant, similar to caffeine but much weaker, which is found in chocolate and tea. Theobromide also has relaxing effects, and may help to lower blood pressure. Long sleep was also associated with greater alcohol consumption.
We don't know from this study whether diet is influencing sleep or sleep is influencing food choice, or both. But the evidence is abundant that these two pillars of health -- sleep and diet -- affect each other in a number of ways. We've seen a great deal of research that diet and weight control are strongly influenced by sleep, and that too little sleep can make eating healthfully more challenging:
Sleep deprivation disrupts hormones that regulate appetite, according to a number of recent studies. Being low on sleep increases feelings of hunger, a result of imbalances to the levels of hormones ghrelin and leptin, which work to regulate appetite.
Other research has also shown that too little sleep is linked to increased calorie intake and to eating more high-fat foods. This study found that men who were sleep deprived consumed an average of an additional 263 calories daily, compared to men who got sufficient sleep. Women who were sleep deprived consumed an average 329 extra calories daily. Both men and women also ate greater proportions of high-fat and high-protein foods. And this study concluded that people short on sleep were more likely to consume more of their overall calories from snacks, with higher carbohydrate amounts.
Sleep has a powerful effect on diet and weight control. There is also evidence that diet can help or hinder sleep, depending on what foods you choose:
A high-fat diet may contribute to disrupted sleep and excessive daytime tiredness, according to studies like this one.
On the other hand, a vitamin and mineral-rich diet can both keep weight in check and promote healthy, restful sleep. Foods rich in magnesium and potassium -- including many fruits, vegetables, grains, and nuts -- improve circulation, and relax the muscles of the body. Research has shown that the gene that regulates potassium in the body may also be responsible for generating slow-wave sleep, the deepest and most restorative phase of sleep. Foods with calcium aid in the body's production of melatonin, a hormone critical to maintaining a healthy sleep-wake cycle.
And it's not just what you eat, but when: the timing of meals and snacks relative to sleep can also have an effect on the quality of your eating and sleeping. People who have later bedtimes and eat more of their calories later in the day sleep less, consume more calories and have less healthful diets, according to this research.
Want your diet and your sleep to work together, each strengthening the other? Adopt a varied, nutrient-rich diet and a sleep routine that allows for seven to eight hours of nightly rest. Now that's a recipe for long-term health.
For more on sleep, click here.]]>Soldiers Short on Sleeptag:www.huffingtonpost.com,2013:/theblog//3.27606212013-03-08T08:16:52-05:002013-05-08T05:12:01-04:00Dr. Michael J. Breushttp://www.huffingtonpost.com/dr-michael-j-breus/significantly elevated risk for sleep problems, and sleep-related health issues.
A new study shows high rates of sleep disorders among active duty military personnel. The study also found that a majority of the soldiers suffering from sleep problems are also coping with one or more additional illnesses, including depression, anxiety, post-traumatic stress disorder (PTSD), and brain injuries.
Researchers at Madigan Army Medical Center in Washington examined the sleep of 725 active duty military personnel from the US Army, Navy and Air Force. Most of those who participated -- 93.2 percent -- were male. And the majority -- 85.2 percent -- had served in combat positions. All had been referred for sleep evaluation using polysomnography, a standard test used in the diagnosis of sleep disorders.
Researchers looked to determine the frequency of sleep disorders among these active duty soldiers, and also to identify other potentially sleep-related health problems. They found most soldiers suffering some type of disrupted sleep and having insufficient levels of sleep. Many of these soldiers were also coping with other medical conditions that are influenced and exacerbated by sleep problems.
85 percent of the soldiers had some type of sleep disorder
Obstructive sleep apnea was diagnosed in 51.2 percent of the participants. This was the most common sleep disorder among the soldiers in the study
24.7 percent of soldiers were found to be suffering from insomnia
On average, soldiers were sleeping 5.7 hours per night.
42 percent reported sleeping fewer than five hours per night
A majority of soldiers were coping with some type of health issue:
58 percent had at least one other medical condition
23 percent were suffering from depression
17 percent had anxiety
13 percent were suffering from PTSD
13 percent had mild traumatic brain injuries
25 percent were taking medications for pain
The soldiers with these medical problems were more likely to also have sleep problems, according to the study results. Military personnel with depression or chronic pain were 1.5 times as likely to have a sleep disorder. Those with PTSD were twice as likely to have disrupted sleep. The health problems common among the active-duty military personnel are all conditions that have a complicated relationship to sleep:
There is a substantial body of research showing links among depression, anxiety and sleep. Sleep problems are widespread among people with depression and anxiety. More than three-quarters of patients with depression also experience disrupted sleep, according to research. And among patients with major depression, suicide rates are higher for those who also suffer from sleep problems.
The relationship between sleep and pain is an important and growing area of research. As is the case with all of these health problems, the association between pain and sleep is complex, with influence running in both directions. Research shows that sleep deprivation reduces tolerance for pain, and also that pain itself can cause sleep problems.
PTSD is a complicated and all-too-common health risk for combat soldiers. Sleep problems are also common among those who suffer from PTSD. Studies show that two-thirds of patients with PTSD also have sleep problems. And research indicates that disrupted and insufficient sleep can exacerbate the anxiety that is often present with PTSD.
These conditions are dangerous to health and can be profoundly disruptive to life and relationships. Combat soldiers are at particular risk for these types of medical conditions, given the intense, prolonged and dangerous conditions under which they work. Lack of sleep can elevate their risk even further, and can complicate these health problems once they've begun.
As researchers in this current study suggest, we need further investigation into the sleep problems associated with military duty, and also the health and safety risks associated with sleep deprivation and sleep disorders. Our military personnel do our nation a great service. It's our duty to do all that we can to protect their health on the battlefield and when they come home. Paying greater attention to soldiers' sleep is one important way to do that.