RxPG News : Sleep Disorders

Sleep loss can cause testosterone levels to plummet

Thu, 02 Jun 2011 17:25:00 PST

( from http://www.rxpgnews.com ) Cutting back on sleep can be quite disastrous for healthy young men - it sends their testosterone levels plummeting, says a study.

Men who slept less than five hours a night for one week in a lab had significantly lower levels of testosterone than when they had a full night's sleep, according to the study.

Significantly, skipping sleep was found to reduce a young man's testosterone levels by the same amount as aging 10 to 15 years, or 10 percent to 15 percent.

Low testosterone has a host of negative consequences for young men, and not just in sexual behaviour and reproduction. It is critical in building strength, muscle mass and bone density.

'Low testosterone levels are associated with reduced well being and vigour, which may also occur as a consequence of sleep loss,' said Eve Van Cauter, professor in medicine, University of Chicago Medical Centre, the US, who led the study, according to a Chicago statement.

At least 15 percent of the adult working population in the US gets less than five hours of sleep a night, and suffers many adverse health effects because of it. Low testosterone is also linked with low energy, reduced libido, poor concentration and fatigue.

The group of young men recruited for the study passed a rigorous battery of tests to screen for endocrine or psychiatric disorders and sleep problems. They were an average of 24 years old, lean and in good health.

They spent three nights in the lab sleeping for up to 10 hours, and then eight nights sleeping less than five hours. Their blood was sampled every 15 to 30 minutes for 24 hours during the last day of the 10-hour sleep phase and the last day of the five-hour sleep phase.

The effects of sleep loss on testosterone levels were apparent after just one week of short sleep. Five hours of sleep decreased their testosterone levels by 10 percent to 15 percent.

The young men had the lowest testosterone levels in the afternoons on their sleep restricted days.

They reported a decline in their sense of well-being as their blood testosterone levels declined. Their mood and vigour fell more every day as the sleep restriction part of the study progressed.

Snoring due to sleep apnea can damage brain severely

Mon, 22 Jun 2009 11:23:57 PST

( from http://www.rxpgnews.com ) Snoring due sleep apnea may impair brain function in a much worse way than previously thought, according to a new study.

Sufferers of Obstructive Sleep Apnea - experience similar changes in brain biochemistry as people who have had a severe stroke or who are dying, the research shows.

OSA is caused by obstruction of the airway, a disorder characterised by pauses in breathing during sleep.

A study by University of New South Wales - Brain Sciences is the first to analyse, in a second-by-second timeframe, what is happening in the brains of sufferers as they sleep.

Previous studies have focussed on recreating oxygen impairment in patients who are awake.

'It used to be thought that apnoeic snoring had absolutely no acute effects on brain function but this is plainly not true,' said study co-author Caroline Rae, professor at Prince of Wales Medical Research Institute.

Sleep apnea affects as many as one in four middle-aged men, with around three percent going on to experience a severe form of the condition characterised by extended pauses in breathing, repetitive asphyxia and sleep fragmentation.

Children with enlarged tonsils and adenoids are also affected, raising concerns of long-term cognitive damage.

Rae and collaborators from Sydney University's Woolcock Institute used magnetic resonance spectroscopy to study the brains of 13 men with severe, untreated, obstructive sleep apnea, said a UNSW release.

They found that even a moderate degree of oxygen desaturation during the patients' sleep had significant effects on the brain's bioenergetic status.

'The findings show that lack of oxygen while asleep may be far more detrimental than when awake, possibly because the normal compensatory mechanisms don't work as well when you are asleep,' said Rae.

These findings were published in the May edition of Journal of Cerebral Blood Flow and Metabolism.

Meditation may be effective for treating insomnia

Thu, 18 Jun 2009 13:01:21 PST

( from http://www.rxpgnews.com ) Meditation may be an effective remedy in treating insomnia, latest research suggests.

According to Ramadevi Gourineni, principal study investigator and director of the insomnia programme at Northwestern Memorial Hospital in Illinois, insomnia is thought to be a 24-hour problem of hyper-arousal. Moreover, elevated measures of arousal are seen throughout the day.

The study collected data from 11 healthy subjects between the ages of 25 and 45 years who suffered from chronic primary insomnia. Participants were divided into two intervention groups for two months.

The first group was taught Kriya Yoga, a form of meditation that is used to focus internalized attention and has been shown to reduce measures of arousal. The second group received health education.

Participants of the health education group also received information about health-related topics and how to improve health through nutrition, exercise, weight loss and stress management.

Results suggested that patients saw improvements in subjective sleep quality and sleep diary parameters while practicing meditation. Patients who practiced meditation saw improvements in sleep latency, total sleep time, total wake time, wake after sleep onset, sleep efficiency and sleep quality.

Findings of this study were presented at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Dr. Ramadevi Gourineni completed her medical school at Kurnool Medical College in Andhra Pradesh, India. She was raised in the United States prior to this. Dr. Gourineni's has a special interest in behavioural treatment of insomnia and currently is involved in research studying the effects of meditation on stress and sleep in individuals with chronic insomnia.

Caffeine may prevent risk taking after sleep deprivation

Fri, 12 Jun 2009 14:36:11 PST

( from http://www.rxpgnews.com ) Washington, June 12 - A dose of caffeine may prevent increased risk taking that occurs after several nights of total sleep deprivation, according to the latest research.

Results suggest that despite extreme sleep deprivation, subjects who consumed caffeine did not exhibit increased risky behaviour on the Balloon Analog Risk Task -, a computerized measure of impulsive risk-taking.

According to William Killgore, principal study investigator and research psychologist at Harvard Medical School, sleep deprivation may not have a simple linear effect on risk taking, but there may be a 'breaking point' during which a person may show a drastic reduction in their ability to control or inhibit behaviour. In this study, caffeine appeared to protect against that breaking point.

'People who were awake for three days straight became more impulsive and acted with less regard for consequences. However, if they had consumed caffeine each night -, they showed no increase in risky behaviour' said Killgore.

Though this study looked at the most extreme range of sleep deprivation and most people may not experience such effects under normal circumstances, results from a previous study have shown that those who were constantly restricted to three hours of sleep per night for a week showed an increase in risk-taking behaviour.

Findings of this study were presented at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Surgical weight loss does not eliminate sleep apnea

Fri, 15 Aug 2008 12:42:48 PST

( from http://www.rxpgnews.com ) Washington, Aug 15 - Weight loss by surgery might not really help those with obstructive sleep apnea that merrily continues in moderate or severe forms even a year later, according to a study.

Results suggest that it is the severity of the condition, rather than a patient's pre-surgical weight, that determines if the condition will be resolved.

Bariatric - surgery reduced body mass index - from an average of 51 to 32 in 24 adults with obstructive sleep apnea -. At the one-year follow-up, however, only one participant experienced its resolution and the majority of the study group - still had moderate to severe OSA.

Patients who have residual OSA after surgery are encouraged to maintain ongoing treatment with continuous positive airway pressure - therapy.

The prevalence of OSA among obese individuals is high and correlates with increasing BMI; among the severely obese, the prevalence of OSA ranges from 55 percent to 90 percent.

OSA itself may promote weight gain through ineffective sleep, impaired glucose metabolism and imbalances of leptin, ghrelin and orexin levels.

'We were surprised by the severity of the residual sleep apnea in postoperative patients,' said principal investigator Christopher J. Lettieri at Walter Reed Army Medical Centre. 'The majority of individuals still had moderate to severe OSA.'

'The second surprising finding of this study was that despite the persistence and severity of the disease, most people thought their sleep apnea was resolved after their weight loss and only a few still used CPAP,' he said.

According to Lettieri, weight loss has many overall benefits; however, most people should not assume their OSA will be resolved after they have lost weight.

The study was published on Friday in the Journal of Clinical Sleep Medicine.

Sleep disturbances among the elderly linked to suicide

Fri, 15 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Self-reported sleep complaints among the elderly serve as a risk factor for completed suicide.

The study, conducted by Rebecca Bernert of Florida State University, focused on data that were collected among 14,456 community elders over a 10-year period. During this time frame, 21 individuals died by suicide. When each suicide was matched to 20 randomly-selected controls, it was discovered that disturbances in sleep, independent of depression, predicted an increased risk for eventual death by suicide.

This suggests that, as a warning sign, poor sleep quality constitutes a significant and modifiable risk factor for completed suicide, said Bernert. Evaluating sleep among at-risk patients may therefore guide and importantly inform both clinical decision-making and suicide risk assessment.

It is recommended that older adults get seven to eight hours of sleep each night for good health and optimum performance. Unfortunately, many older adults often get less sleep than they need. One reason is that they often have more trouble falling asleep.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls, and use more over-the-counter or prescription sleep aids. Poor sleep is also associated with a poorer quality of life. Insomnia, the most common sleep complaint, affects almost half of adults 60 and older.

Those who think they might have a sleep disorder are encouraged to consult with their primary care physician, who will refer them to a sleep specialist.

Slow wave activity during sleep is lower in African-Americans

Thu, 14 Jun 2007 18:00:00 PST

( from http://www.rxpgnews.com ) Slow wave activity (SWA), a stable trait dependent marker of the intensity of non-rapid eye movement (NREM) sleep, is lower in young healthy African-Americans compared to Caucasians who were matched for age, gender and body weight.

Dr. Esra Tasali and colleagues at the University of Chicago collected overnight polysomnographic data from 12 African-Americans and 12 Caucasians, none of whom had any sleep complaints or disorders. The authors found that African-Americans had markedly lower SWA as compared to Caucasians.

The current findings provide evidence for ethnic differences in the intensity of NREM sleep, said Tasali. Lower levels of SWA in African-Americans could be related to their reported poor sleep quality and higher risk for insulin resistance.

The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Extended Shifts for Medical Interns Negatively Impact Patient Safety

Thu, 14 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Working an extended duration shift can pose a risk to not only the safety and well-being of medical interns, but also to that of their patients.

The study, authored by Laura Barger, PhD, of Brigham and Women's Hospital in Boston, was based on 2,737 physicians in their first post-graduate year, who participated in a nationwide Web-based survey, completing a total of 17,003 monthly reports. A regression analysis was performed to determine the relationship between the number of extended duration work shifts (greater than or equal to 24 hours in length), reported medical errors and a self-reported measure of stress.

It was discovered that the reporting of medical errors and the number of extended duration shifts worked in a month were both significant predictors of stress. Compared to months in which no extended duration shifts were worked, interns working five or more extended duration shifts had seven times greater odds of reporting at least one fatigue-related significant medical error that resulted in an adverse patient event and reported 300 percent more fatigue-related preventable adverse events resulting in the death of the patient. Moreover, interns who reported a medical error that resulted in an adverse patient outcome were more than three times as likely to report high stress in that month.

These results suggest that extended duration shifts negatively impact patient safety and the well-being of medical interns. They have important public policy implications for post-graduate medical education and suggest the need for counseling or other care for interns who make medical errors, said Barger.

The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

Imagery rehearsal therapy improves sleep

Thu, 14 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) In a study that insomniacs may find welcoming, imagery rehearsal therapy (IRT) has been shown to subjectively improve their ability to get a good night's sleep.

The study, conducted by Yara Molen of Federal University of S'o Paulo, was focused on 24 chronic insomnia patients, each of whom was divided into one of two groups: experimental or control. The subjects participated in a two-hour meeting over a five-week period on sleep education: hygiene, beliefs and attitudes, and worries. The experimental group received instructions for practicing IRT before sleep, with an audio CD for relaxing and releasing worries, and the control group for reading before sleep, for three weeks.

The results showed that the severity of insomnia in the experimental group diminished, while their beliefs and attitudes about sleep, as well as sleep quality, improved. In the control group, the severity of insomnia also diminished, as well as general worries.

Imagery rehearsal therapy was associated with subjective improvement in insomnia severity, sleep quality, sleep disturbance and functional beliefs and attitudes about sleep, said Molen. Although general worries improved only in the control group, worries about sleep improved in both groups.

Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. These disorders may also be defined by an overall poor quality of sleep. Insomnia is a common sleep disorder. About 30 percent of adults have insomnia. It is more common among elderly people and women. Some medical conditions cause insomnia, or it may be a side effect of a medication.

The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

Reduced sleep quality can aggravate psychological conditions

Thu, 14 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Disturbed sleep is a commonly reported symptom among individuals diagnosed with anxiety disorders. However, the direct cause of disrupted sleep is poorly understood. Proper sleep is critical for cognitive and daily functioning, and reduced quality of sleep has the potential to exacerbate pre-existing psychological conditions.

To effectively evaluate differences in sleep architecture after induced stress, Robert Ross MacLean, of Boston University, utilized an objective measure of anxiety and recorded subsequent sleep-wake behavior in rats. In the rodent model, many previous studies had observed differences in sleep-wake behavior after shock exposure, but the level of anxiety was merely assumed or absent.

MacLean's study exposed naive rats to one of three paradigms: escapable shock, inescapable shock or fear conditioning. Immediately after experimental manipulation, individual level of anxiety was assessed using the elevated-plus maze apparatus, and polygraphic signs of sleep-wake behavior were recorded for six hours.

By measuring individual anxiety level prior to recording sleep, MacLean was able to make comparisons between sleep architecture and level of anxiety. In doing so, MacLean intended to establish a direct link between variation in sleep architecture and heightened anxiety in the rodent model.

These changes could elucidate sleep-wake behavior associated with the subjective complaint of disrupted sleep, thus creating the potential for new diagnostic and assessment criteria for anxiety disorders, said MacLean. This information is relevant given the recent influx of psychological disorders in Iraq war veterans, particularly generalized anxiety and post-traumatic stress disorder.

The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

CBT Workshop Effective for Insomnia in Males

Wed, 13 Jun 2007 16:00:00 PST

( from http://www.rxpgnews.com ) Despite the positive results that it brings in the treatment of insomnia, access to cognitive behavioral therapy (CBT) has been difficult given the limited awareness of CBT services amongst referrers such as primary care providers. In addition to the low capacity among services to provide CBT, there is a gender imbalance, and men tend to seek help less frequently for their insomnia than women. The development and implementation of a CBT workshop is an effective means for getting men to seek help for the sleep disorder, according to a research abstract that was presented on Wednesday at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by June Brown, PhD, of King's College in London, UK, was based on the decision to offer men-only workshops with day-long psychological treatment for insomnia. Men could refer themselves to the workshops, which were run in leisure centers.

The workshops attracted a large number of men during the six-month project, with 111 inquiries. Out of those who attended, just under 50 percent had never consulted their or primary care providers for their insomnia problems. Six weeks after attending the day-long workshop, men reported significant improvements in their sleep, as well as reductions in their depression.

Compared to women, men are usually very reluctant to seek help for their insomnia, said Brown. Even if they do consult, services are not always available. Although effective psychological treatments have been developed, primary care providers often are not aware of these treatments, and psychology services are very stretched. This study shows that CBT workshops are an effective way to get men to come forward and get the treatment they need for their insomnia.

Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. These disorders may also be defined by an overall poor quality of sleep. Insomnia is a common sleep disorder. About 30 percent of adults have insomnia. It is more common among elderly people and women. Some medical conditions cause insomnia, or it may be a side effect of a medication.

CBT is a psychotherapy based on modifying everyday thoughts and behaviors with the aim of positively influencing emotions.

Many sleep disorders linked with abnormal sexual behaviors

Sun, 03 Jun 2007 04:00:00 PST

( from http://www.rxpgnews.com ) A paper published in the June 1st issue of the journal SLEEP is the first literature review and formal classification of a wide range of documented sleep-related disorders associated with abnormal sexual behaviors and experiences. These abnormal sexual behaviors, which emerge during sleep, are referred to as sleepsex or sexsomnia.

It seems that more and more reports are surfacing of abnormal sexual behaviors emerging during sleep, said Carlos H. Schenck, MD, a senior staff psychiatrist at the Minnesota Regional Sleep Disorders Center in Minneapolis and the lead author of the review. While people may think this type of behavior is humorous, in reality it can be disturbing, annoying, embarrassing and a potentially serious problem for some individuals and couples. Despite their awareness of the condition, many sufferers often delay seeking help, either because they don't know that it's a medical disorder or for fear that others will instead judge it as willful behavior. This paper highlights the expanding set of sleep disorders and other nocturnal disorders known to be associated with abnormal sexual behaviors and experiences, or the misperception of sexual events. The legal consequences are also described and discussed.

Prior to the writing and publication of the review, Dr. Schenck and his colleagues conducted computerized literature searches of peer-reviewed journal articles and looked through textbooks and other sources for information on sexual activity during sleep or sexual behaviors associated with sleep disorders.

Sleep apnea patients have greatly increased risk of severe car crashes

Mon, 21 May 2007 04:00:00 PST

( from http://www.rxpgnews.com ) People with obstructive sleep apnea have a markedly increased risk of severe motor vehicle crashes involving personal injury, according to a study presented at the American Thoracic Society 2007 International Conference, on Sunday, May 20.

The study of 800 people with sleep apnea and 800 without the nighttime breathing disorder found that patients with sleep apnea were twice as likely as people without sleep apnea to have a car crash, and three to five times as likely to have a serious crash involving personal injury. Overall, the sleep apnea group had a total of 250 crashes over three years, compared with 123 crashes in the group without sleep apnea.

While many previous studies have shown that sleep apnea patients are at increased risk of car crashes, this study is the first to look at the severity of those crashes.

We were surprised not only about how many of the sleep apnea patients crashes involved personal injury, but that some patients had fairly mild sleep apnea and were still having serious crashes, says Alan Mulgrew, M.D., of the UBC Sleep Disorders Program in Vancouver, British Columbia.

Patients self-reported feeling of sleepiness was not found to be linked with an increased risk of car crashes, suggesting that patients are unaware of their driving hazard, Dr. Mulgrew says. Even patients with fairly mild sleep apnea were at increased risk of car crashes. Based on these findings, I now consider driving risk when deciding on treatment for patients with mild sleep apnea, he says.

The study is the biggest one to combine validated sleep apnea diagnosis through an overnight sleep study called polysomnography, with data from insurance records to verify motor vehicle crashes and their severity.

In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnea.

The study found that while in the general population men have more vehicle crashes than women, among sleep apnea patients, men and women crash at a similar rate.

Although the issue of treatment is not addressed by this study, Dr. Mulgrew notes that data from other groups suggests that crashes related to sleep apnea are preventable.

Sleep quantity affects morning testosterone levels in older men

Sun, 01 Apr 2007 11:54:41 PST

( from http://www.rxpgnews.com ) The testosterone levels of healthy men decline as they get older. As sleep quality and quantity typically decrease with age, objectively measured differences in the amount of sleep a healthy older man gets can affect his level of testosterone in the morning, according to a study published in the April 1st issue of the journal SLEEP.

The study, conducted by Plamen Penev, MD, PhD, of the University of Chicago, focused on 12 healthy men between the ages of 64 and 74. Three morning blood samples were pooled for the measurement of total and free testosterone. In addition to overnight laboratory polysomnography, wrist activity monitoring for six-to-nine days were used to determine the amount of nighttime sleep of the participants in everyday life settings.

The main outcome levels were total sleep time and morning testosterone levels. Analyses revealed that the amount of nighttime sleep measured by polysomnography was an independent predictor of the subjectsâ morning total and free testosterone levels.

"The results of the study raise the possibility that older men who obtain less actual sleep during the night have lower blood testosterone levels in the morning," said Penev. "Although the findings suggest that how long a person sleeps may be an indicator of age-related changes in important hormone signals in the body, future studies are needed to determine the importance of these relationships for the health of older adults."

Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Sleep disturbance increases spontaneous pain in women

Sun, 01 Apr 2007 11:51:22 PST

( from http://www.rxpgnews.com ) Sleep continuity disturbance impairs endogenous pain-inhibitory function and increases spontaneous pain in women. This supports a possible pathophysiologic role of sleep disturbance in chronic pain, according to a study published in the April 1st issue of the journal SLEEP.

The study, conducted by Michael T. Smith, PhD, and colleagues at Johnâs Hopkins University, focused on 32 healthy females, who were studied polysomnographically for seven nights. On the first two nights, the subjects slept undisturbed for eight hours. Then, the women were assigned to one of three groups: "Control", "Forced Awakening" (FA) and "Restricted Sleep Opportunity" (RSO). From nights three-to-five, the "Control" group continued to sleep undisturbed, while the "Forced Awakening" group underwent eight forced awakenings, one per hour, and the "Restricted Sleep Opportunity" group received partial sleep deprivation by delayed bedtime. On night six, both the FA and RSO groups underwent 36 hours of total sleep deprivation, followed by 11-hour recovery sleep.

In an assessment of the subjectsâ completion of twice-daily psychophysical assessments of mechanical pain thresholds and pain inhibition, it was discovered that the FA group demonstrated an increase in spontaneous pain, while neither the "Control" nor the RSO group showed changes in pain inhibition or spontaneous pain during partial sleep deprivation.

"This study finds that fragmented sleep profiles, akin to individuals suffering from middle of the night insomnia, health care workers on call, and parents caring for infants, alter natural systems that regulate and control pain, and can lead to spontaneous painful symptoms," said Smith. "Our research shows that disrupted sleep, marked by multiple prolonged awakenings, impairs natural pain control mechanisms that are thought to play a key role in the development, maintenance, and exacerbation of chronic pain."

Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Obstructive Sleep Apnoea increasingly associated with cardiovascular disease

Thu, 01 Mar 2007 05:49:05 PST

( from http://www.rxpgnews.com ) Cardiovascular disease can pose a threat to both men and women. While a diet rich in fat and high in cholesterol as well as lack of exercise can contribute to cardiovascular disease, a study published in the March 1st issue of the journal SLEEP finds that people with obstructive sleep apnea (OSA) are at an increased risk of having cardiovascular disease.

The study, which attributes the increased link between OSA and cardiovascular disease to heightened recognition and perhaps a rising prevalence, found mounting data suggesting a potentially important causative role of OSA in cardiovascular disease, particularly systemic hypertension, bolstered by well-described pathophysiologic responses to apnea and hypopneas. Recently published longitudinal cohort studies have strengthened previously recognized associations with stroke and mortality from cardiac events.

"There is abundant physiologic evidence implicating OSA in perpetuating, if not inticing, heart failure. In addition to their association with systemic hypertension, OSA-related stressors, including hypoxemia, increased sympathetic drive, acute surges in blood pressure, and mechanical effects of intrathoracic pressure swings, have varying effects on myocardial oxygen supply and demand, particularly in the already compromised heart," said Sean M. Caples, DO, of the Mayo Clinic College of Medicine in Rochester, Minn., one of the authors of the study.

According to Lawrence Epstein, MD, American Academy of Sleep Medicine (AASM) past president, medical director of Sleep HealthCenters and instructor of medicine at Harvard Medical School, treating sleep disorders and getting an adequate amount of sleep are pillars of good cardiovascular health.

"Sleep apnea is a known risk factor for the development of hypertension, heart disease and stroke," said Epstein. "Also, chronic sleep deprivation has been shown to change metabolic function in a way that promotes weight gain and diabetes, two risk factors for heart disease."

OSA, a sleep related breathing disorder that causes your body to stop breathing during sleep, occurs when the tissue in the back of the throat collapses and blocks the airway, which prevents air from getting into the lungs.

In addition to cardiovascular disease, other effects of OSA include daytime sleepiness, alertness and concentration deficiencies, and an increased risk of hypertension, stroke and diabetes.

OSA can occur in men and women of any age, but it is most common in obese, middle-aged men. The AASM estimates that four percent of men and two percent of women have OSA, and millions more remain undiagnosed.

Safe and effective treatments are available for those with OSA. Scientific evidence shows that continuous positive airway pressure (CPAP) is the best treatment for OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.

Dennis H. Nicholson, MD, medical director of the Sleep Disorders Center at Pomona Valley Hospital Medical Center in Pomona, Calif., says that more public education needs to be done in order to reach out to as many people as possible about cardiovascular disease, and notes that a good night's sleep is critical to maintaining good health.

"Public education is an important and often neglected component in the overall strategy to improve sleep, cardiovascular outcomes and general well being," said Nicholson, who added that reaching out to people about the importance of sleep may result in a decline in the number of reported cardiovascular diseases.

Those who think they might have OSA, or another sleep disorder, are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Sleep deprivation affects moral judgment

Thu, 01 Mar 2007 05:45:29 PST

( from http://www.rxpgnews.com ) Research has shown that bad sleep can adversely affect a person's physical health and emotional well-being. However, the amount of sleep one gets can also influence his or her decision-making. A study published in the March 1st issue of the journal SLEEP finds that sleep deprivation impairs the ability to integrate emotion and cognition to guide moral judgments.

The study, conducted by William D.S. Killgore, PhD, and colleagues at the Walter Reed Army Institute of Research, was focused on 26 healthy adults, who made judgments about the "appropriateness" of various courses of action in response to three types of moral dilemmas on two separate occasions: at rested baseline and again following 53 hours of continuous wakefulness.

Compared to baseline, sleep deprivation resulted in significantly longer response latencies (suggesting greater difficulty deciding upon a course of action) for moral personal dilemmas.

The findings suggest that continuous wakefulness has a particularly debilitating effect on judgment and decision making processes that depend heavily upon the integration of emotion with cognition, said Killgore, adding that the results provide further support to the hypothesis that sleep loss is particularly disruptive to the ventromedial prefrontal regions of the brain, which are important for the integration of affect and cognition in the service of judgment and decision making.

"Most of us are confronted with moral dilemmas nearly every day, although the majority of these choices are minor and of little consequence," said Killgore. "Although such decisions are inextricably steeped in social, emotional, religious and moral values, and their correct courses of action cannot be determined through scientific inquiry, it is well within the realm of science to ask how the brain goes about solving such dilemmas and what factors, whether internal or external to the individual, contribute to the judgments and decisions that are ultimately reached."

According to Dr. Killgore, these findings do not suggest that sleep deprivation leads to a decline in "morality" or in the quality of moral beliefs, but a latency to respond and the change in the leniency or permissiveness of response style as evidenced by the tendency to decide that particular courses of action were "appropriate" before and after sleep loss.

"Our results simply suggest that when sleep deprived, individuals appear to be selectively slower in their deliberations about moral personal dilemmas relative to other types of dilemmas," said Killgore.

The present findings may have implications for those in occupations that frequently require periods of extended sleep loss and in which real-world moral dilemmas may be encountered (e.g., emergency medical services, military personnel in combat, fire/rescue workers), noted Killgore. When sleep deprived, such personnel may experience greater difficulty reaching morally based decisions under emotionally evocative circumstances and may be prone to choosing courses of action that differ from those that they would have chosen in a fully rested state, added Killgore.

Experts recommend that adults get seven-to-eight hours of sleep on a nightly basis.

Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Sleepy driver near-misses may predict accident risks

Thu, 01 Mar 2007 05:42:02 PST

( from http://www.rxpgnews.com ) Getting behind the wheel on an insufficient amount of sleep poses a significant risk to not only the driver, but to others sharing the road. Sleep deprivation may affect a driver's awareness of his or her surroundings, as well as reduce one's ability to react to situations in time. As a result, this endangers the lives of themselves and others by increasing the likelihood of causing an accident. In the first known scientific study into the important question of near-miss sleepy accidents and their association with actual accidents, a study published in the March 1st issue of the journal SLEEP finds that sleepy near-misses may be dangerous precursors to an actual accident.

The study focused on a study sample of 35,217 individuals. The results obtained showed that a total of 1.3 percent of all participants reported at least one accident associated with being sleepy over the preceding three years. Near-miss accidents associated with sleepiness were reported in 18.3 percent of the sample (10.6 percent with one sleepy near-miss, 5.9 percent with two-to-three sleepy near misses and 1.8 percent with four or more sleepy near-misses).

"Little attention has been given to sleepy near-miss driving accidents up to now despite their likely relationship with actual driving accidents," said Nelson B. Powell, DDS, MD, of Stanford University, one of the authors of the study. "Although there have been investigations that included near-miss accidents and/or sleepy near-misses, these data were limited and not used to predict a sleepy accident. This study indicates that near-miss sleepy accidents are common and dangerous. "The near-miss sleepy accidents occur in 14 times more people than actual sleepy accidents, and the near-misses appear to predict who is at risk for any type of actual accidents in a dose-response fashion."

Drowsy driving, the dangerous combination of sleepiness and driving, or driving while fatigued, while operating a motor vehicle, is becoming a growing problem in the United States.

In a sense, drowsy driving is similar to driving under the influence, as sleepiness results in a slower reaction time, decreased awareness, impaired judgment and an increased risk of getting involved in an accident, resulting in unnecessary deaths or injuries to innocent people. Nearly nine out of every ten police officers responding to an AAA Foundation for Traffic Safety Internet survey reported they had stopped a driver who they believed was drunk, but turned out to be drowsy. The survey was coordinated with the National Highway Traffic Safety Administration.

Sleep is an essential component of our everyday lives. When you sleep, your body recharges itself so that you wake up feeling refreshed. The amount of sleep you get affects everything else you do: how you think, how you feel, how you perform, and even how you drive.

The American Academy of Sleep Medicine (AASM) offers the following tips for people to avoid sleepiness while driving:

Get enough sleep
AASM recommends that adults get seven-to-eight hours of sleep each night in order to maintain good health and optimum performance.

Take breaks while driving

If you become drowsy while driving, pull off to a rest area and take a short nap, preferably 15-20 minutes in length.

Consume caffeine

Caffeine improves alertness in people who are fatigued.

Do not drink alcohol
Alcohol can further impair a person's ability to stay awake and make good decisions. Taking the wheel after having just one glass of alcohol can affect your level of fatigue while driving.

Do not drive late at night

Avoid driving after midnight, which is a natural period of sleepiness.

Those who think they might have a sleep disorder are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Treating insomnia is far less costly than ignoring it

Thu, 01 Mar 2007 05:38:21 PST

( from http://www.rxpgnews.com ) Insomniacs are advised to get early treatment for their sleep disorder not only so they can start feeling better faster, but it can also save them and their employers money in the long run. A study published in the March 1st issue of the journal SLEEP finds that, as opposed to treating insomnia, failure to treat it is much more costly.

The study, conducted by Ronald J. Ozminkowski, PhD, director of health and productivity research at Thomson Medstat in Ann Arbor, Mich., and James K. Walsh, PhD, director of the Sleep Medicine and Research Center in Chesterfield, Mo., addresses the cost of untreated insomnia for over 210,000 patients.

The authors discovered that, in contrast to many other disorders, insomnia is relatively inexpensive to treat. Even the most expensive medications cost less than $200 per year for the typical insomnia patient, noted the authors, adding that the major costs of insomnia occur before diagnosis is made and before treatment begins.

In comparison, the authors found that untreated insomnia led to $924 to $1,143 more in medical expenditures, depending on the patients' age, for just the six months before treatment began.

In the U.S., employers pay for about 80 percent of all health expenditures for the employees and dependents covered in their health plans. Employers also pay for all of the lost absenteeism via lower worker productivity. For a typical employee with untreated insomnia, these costs would be about $1,059 for just the six months prior to treatment, said the authors.

Insomnia leads to a substantial increase in health care expenditures and absenteeism from work. About 10 percent of the adults in the U.S. (i.e., about 25 to 30 million people) have chronic insomnia, so the cost of failure to treat is huge for the U.S. population.

"Our study suggests that it costs far less to treat insomnia than to ignore it," said Ozminkowski, the study's lead author. "Untreated insomnia affects individuals' health, quality of life, and job performance and increases their use of healthcare services substantially."

"Approximately 25 to 30 million Americans have chronic insomnia, so this issue has huge implications for employers, health plans, government insurance programs and individuals," said Walsh, co-author of the study.

Insomnia is a common sleep complaint that occurs when you have one or more of these problems:

You have a hard time initiating sleep.

You struggle to maintain sleep, waking up frequently during the night.

You tend to wake up too early and are unable to go back to sleep.

Your sleep is non-restorative or of a poor quality.

About 30 percent of adults suffer from some form of insomnia. It is more common among elderly people and women. Some medical conditions cause insomnia, or it may be a side effect of a medication.

Those who think they might have insomnia, or another sleep disorder, are urged to discuss their problem with their primary care physician, who will issue a referral to a sleep specialist.

Resemblance between cataplexy during status cataplecticus, normal REM sleep

Sun, 04 Feb 2007 23:19:10 PST

( from http://www.rxpgnews.com ) The first efforts to identify the neural structures and pathways underlying cataplexy during status cataplecticus in a narcoleptic patient, with the use of brain perfusion single photon emission computed tomography (SPECT), have led to the discovery that cataplexy during status cataplecticus, a case of prolonged cataplexy, partially resembles normal rapid eye movement (REM) sleep but without the other imaging characteristics of this state, according to a study published in the February 1st issue of the journal SLEEP.

The study, conducted by Dorothée Chabas, MD, PhD, of Université Pierre et Marie Curie-Paris, and Assistance Publique Hôpitaux de Paris, focused on a 68-year-old woman with hypocretin-deficient narcolepsy-cataplexy, who suffered status cataplecticus after having stopped clomipramine. The woman underwent a 99mTc-ethylcysteinate dimmer brain SPECT during an episode of cataplexy. This image was compared with her brain SPECT during an intervening asymptomatic period. Subtraction SPECT coregistered to magnetic resonance imaging (MRI)-determined anatomic areas differentially perfused during cataplexy and basal wakefulness state.

According to the results, the areas hyperactivated during cataplexy correspond on brain MRI with the cingular area, the left and right orbitofrontal cortex, the right temporal cortex and the right putamen, which are all activated during normal REM sleep. There was, however, no hyperactivation of the pons, amygdale or occipital cortex, other imaging characteristics of normal REM sleep.

"To my knowledge, this report is the first of imaging analysis comparing brain activation during a cataplectic episode with a nonsymptomatic state in the same subject," said Chabas. "Previous imaging studies have failed to show structural changes in the brain of narcoleptic patients, but functional changes could be demonstrated. The method used in this particular study analyzed functional features specifically related to the mechanisms of cataplexy. Picturing brain activity during cataplexy, a transient and unpredictable neurologic state, is challenging. It is, however, easier to study cataplexy during status cataplecticus."

Risk Factors For Developing Complications From Sleep Apnea Surgery

Tue, 17 Oct 2006 14:30:00 PST

( from http://www.rxpgnews.com ) Patients undergoing surgery to correct sleep apnea are more likely to have complications if their condition is severe, they have a high body mass index, they have other medical problems or they are undergoing certain other surgical procedures at the same time, according to a report in the October issue of Archives of OtolaryngologyHead & Neck Surgery, one of the JAMA/Archives journals.

Individuals with sleep apnea repeatedly stop breathing during the night due to upper airway obstruction, according to background information in the article. Sleep apnea contributes to an increased risk of cardiovascular disease, poor quality of life and death. A procedure known as uvulopalatopharyngoplasty (UPPP), during which surgeons remove the uvula and other soft tissues at the back of the throat to help clear the airway, is the most common operation performed to alleviate sleep apnea. About 1.6 percent of all patients undergoing such procedures have serious complications, including .2 percent who die within 30 days. Previous reports about the risk factors for complications have been conflicting.

Eric J. Kezirian, M.D., M.P.H., University of California, San Francisco, and colleagues studied 3,130 consecutive adults (97 percent men, average age 50) in patients who underwent UPPP between 1991 and 2001 at the United States Veterans Affairs medical centers. The researchers gathered data about participants surgeries and characteristics from medical records. Data on body mass index (BMI), other illnesses and the severity of sleep apnea was collected from medical charts for a smaller group of patients, including all 51 (1.6 percent) of the original group who had serious complications and 212 others who did not have serious complications but were the same sex and age, had the same number of procedures performed at the same time and had surgery the same year as those who did.

In the larger group of 3,130 patients, those who had more severe sleep apnea, who had additional non-nasal surgeries at the same time and had other medical conditions were more likely to have serious complications following surgery. For each additional illness besides sleep apnea that a patient had, his or her risk for complications almost doubled. In the smaller group of patients, more severe sleep apnea, higher body mass index and the presence of other illnesses were associated with a higher risk for complications when they were all considered together. However, based on the small number of participants with complications, the researchers could not determine if each was an risk factor on its own. Having retrolingual surgery (certain procedures involving the tongue, epiglottis or jaw) at the same time as UPPP was independently associated with having complications following the operation. Lowest oxygen saturation, a measure of how much oxygen red blood cells are carrying, also was not associated with complications.

Apnea-hypopnea index [a measure of sleep apnea severity], body mass index and medical comorbidity [other illness] were each associated with serious complication; however, the low complication rate precluded demonstration of associations independent of each other, the authors conclude. Concurrent retrolingual procedures were also associated with serious complication, but the cumulative risk of separate retrolingual procedures is unknown.

Studying sleep deprivation's effect on decisions

Tue, 08 Aug 2006 04:23:00 PST

( from http://www.rxpgnews.com ) Everyone needs sleep, but temporary periods with no sleep can be a reality of military operations. To get answers on sleep questions for the military as well as civilians, for nearly four years Dr. Sean Drummond, a Department of Defense-funded researcher, has studied the effects of sleep deprivation on the brain, namely in decision making, as well as how long it takes to recover from periods of no sleep.

"We can't keep as many things online at any one time when we're sleep deprived. Sleep deprivation significantly impairs attention, working memory performance, our ability to drive. It has the same effect as alcohol does," said Drummond, who works with the University of California San Diego and the Veterans Affairs San Diego Healthcare System.

In the May issue of Flying Safety Magazine, Capt. Brain Drummond, a pilot in a KC-135 air refueling tanker in Iraq recounted a potentially accident-causing mistake he made in March during a refueling mission when he let too much fuel out of a tank, causing an imbalance in the aircraft. He believes the mistake resulted from too many missions with too little sleep. After flying 12 six- to seven-hour missions and fulfilling all the briefing, debriefing and aircraft pre- and post-flight requirements, he recalled that he and the crew looked like "the walking dead."

"I don't think you really know the fatigue that sets into your body until you are finally able to rest," he said. "Even though I was getting enough rest at night during the 11 straight sorties, my body and senses became very numb. I truly believe, because of the demand for the missions in OIF (Operation Iraqi Freedom), our crew had become so tired that we forgot the little things, which can add up to big things."

Because of incidents like Drummond's the DoD's Peer Reviewed Medical Research Program funds research like Drummond's. Congress created the program in 1999 to promote research in health issues the military faces. Since its inception through 2005, the program has spent almost $300 million to fund nearly 200 projects in a range of medical topics, including combat casualty care and technology and infectious disease research.

The researcher and his team recruited 40 volunteers with good sleep habits who agreed to live in a lab for six days. For their stay, volunteers lived two normal days and nights, stayed awake for 64 hours and then were allowed again to sleep so the team could observe the recovery process.

During the volunteers' awake hours, they underwent half-hour long learning, memory and decision-making tests every two hours to see how well they fared at different stages of sleep deprivation. One test, for example, had the volunteers memorize lists of nouns. Drummond and his team also used functional magnetic resonance imaging in the morning and evening to map the brain's reaction. The imaging technique looks at oxygen use in the brain, so whatever part of the brain is being used, it needs more oxygen.

"The brain is a system, a network of areas, all of which work together to get a task done," he said.

The researcher found that volunteers' working memory wasn't affected after 36 hours without sleep, not because they were all healthy and had an average age of 24 years, but because other regions of the brain jumped in to help.

"The brain can actually compensate for this level of sleep deprivation. Areas that don't normally turn on when a person is well rested came online when the person was sleep deprived," Drummond said. "The better they're able to engage them, the better they're able to do after sleep deprivation."

After 60 hours, though, most volunteers didn't fare as well on their tests as they had at the 36-hour mark. After two and a half days without sleep, their brains could not recruit help.

"I think it will be important to use these data to try to better predict and understand who is going to be resilient to sleep loss and who is going to be vulnerable," Drummond said. "The benefits will come in better understanding the consequences of sleep deprivation for more complex types of cognitive functions -- as opposed to simple attention, for example -- as well as better understanding how long the recovery process takes."

Drummond's team also found that recovering from 64 hours of sleep loss wasn't as simple as getting a few good nights' rest.

"We found on some tasks that people aren't back at the baseline level even after two full nights of sleep, given that they only lost two nights of sleep," he said. "Given the pervasiveness of inadequate sleep in the military and civilian worlds alike, there is clearly a need to understand what this is doing and can it be counteracted."

New sleep gene discovery wakes up scientists

Tue, 04 Jul 2006 21:51:00 PST

( from http://www.rxpgnews.com ) Proteins that regulate sleep and biological timing in the body work much differently than previously thought, meaning drug makers must change their approach to making drugs for sleep disorders and depression and other timing-related illnesses.

The surprise finding is an about-face from previous research, said Daniel Forger, assistant professor of math at the University of Michigan. Forger and his collaborators from the University of Utah's Huntsman Cancer Institute have written a paper on the topic, which will appear on in the July 11 issue of the Proceedings of the National Academy of Science.

Scientists studied two proteins (one called CKIe and another called PERIOD) that help regulate timing in the body, and looked at how those proteins function in cells, said Forger. One of the proteins causes the other protein to degrade, and the body knows what time it is by how much or how little PERIOD protein is present at any one time in the body. The body's clock is called a circadian rhythm.

Drug makers spend billions to develop drugs to help people with sleep disorders, and other disorders impacted by our biological clocks. Drugs to restore a healthy circadian rhythm by manipulating the levels of PERIOD proteins are currently under development.

One such sleep disorder is called Familial Advanced Sleep Phase Syndrome and this is caused by a gene mutation, Forger said. Patients suffering from the disease routinely wake very early, say at 4 a.m. and must go to bed early, at say 7 p.m. said Forger.

If put in a cave with no light, these people should have a shortened day, Forger said. This means that on our time, they would wake the first day at say, 6 a.m. then at 4 a.m. then at 2 a.m. on subsequent days.

"When they have light and dark cycles in the normal world, they pretty much have to live in a 24-hour day," Forger said. "They were able to adjust but the price they have to pay is their body wakes up early, and they have to go to bed earlier than we do."

"The theory was that the mutation caused (more of the PERIOD protein) so you get a short day so you want to get up very early in the morning," Forger said. But, during testing they found the opposite is true: the mutation actually caused the PERIOD to degrade more quickly so that less is present in the body.

The finding wasn't a complete surprise to Forger, who develops math models of the circadian rhythms. Forger's computer models always said that the opposite of the prevailing thinking should be true---that the PERIOD protein should degrade more quickly when the mutation is present.

"I had this prediction for a year or two," Forger said. "Basically, people said this is ridiculous, you're a mathematician, what do you know"

Then he met David Virshup, M.D., while giving an invited talk at the University of Utah. Virshup's previous research was on the gene involved in circadian rhythms and its role in cancer development. Their experiments had also suggested that genetic mutation caused the protein to degrade more quickly. Virshup suggested they test Forger's simulation.

The researchers took cell cultures and observed that for those with the mutated gene, the protein only took a couple hours to degrade. For the normal gene, it took 8-10 hours.

Next, Virshup said, his team will begin testing ways to regulate the circadian rhythm in mice, a necessary step before new drugs can be developed.

Diphenhydramine Does Not Improve Infant Sleep

Tue, 04 Jul 2006 13:18:00 PST

( from http://www.rxpgnews.com ) An antihistamine often recommended to parents whose infants do not sleep through the night may not be effective in reducing nighttime awakenings or improving parents' happiness with their children's sleep, according to a report in the July issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Between 20 and 46 percent of parents have reported that their infants have trouble sleeping, according to background information in the article. Some parents let their children cry for extended periods at night-this method, known as crying out, is popular but controversial among parents and health care professionals. Another commonly used method is to give children medications-such as antihistamines, normally used to treat allergies-to sedate them at bedtime. Diphenhydramine hydrochloride, sold as Benadryl, is often used by parents and recommended by physicians despite the fact that it has not been studied in children younger than age 2 years.

Dan Merenstein, M.D., then at The Johns Hopkins School of Medicine, Baltimore, and now at Georgetown University, Washington, D.C., and colleagues conducted a trial of diphenhydramine in 44 children ages 6 to 15 months who slept in cribs. Parents in the study had all reported that their children woke up two or more times per night. The participating infants were randomly assigned to receive 100 mL of diphenhydramine or placebo (inactive medication) in a cherry-flavored liquid 30 minutes before bedtime for one week between May 2004 and May 2005. Parents reported whether the child had fewer awakenings that required parental intervention during that week and also tracked their child's sleep in a diary for the first 28 days. At four points during the first 43 days of the study, parents were asked to rate their happiness with their children's sleep on a scale of one to 10.

Three of 22 participants in the placebo group and one of 22 participants in the diphenhydramine group had fewer nighttime awakenings during the week in which the infants were taking medication. Two additional parents in the placebo group reported improvement in nighttime awakenings four weeks and six weeks later. There was no difference between the two groups in parents' reports of how happy they were with their children's sleep at any point during the study. On June 6, 2005, the trial was stopped because of the apparent lack of effectiveness of diphenhydramine.

"Many in the medical and lay community accept diphenhydramine as effective treatment for sleep problems," the authors write. "Unfortunately, this attitude is based on anecdote and studies of adult physiological interactions." The results of this study "demonstrated that at the most commonly used dose, diphenhydramine may play no role in treating infant sleep problems."

More rigorous studies are needed regarding effective treatment for sleep problems in children, the authors conclude. "Important aspects of a young child's health care, such as proper food intake and sleep routine, often are based on assumptions," they write. "Our study results illustrate that such assumptions may be wrong and should be subjected to study in life laboratories."

People sleep even less than they think

Tue, 04 Jul 2006 13:07:00 PST

( from http://www.rxpgnews.com ) A study of the sleep characteristics of 669 middle-aged adults found that people sleep much less than they should, and even less than they think. Published in the July issue in the American Journal of Epidemiology, the study also found that blacks sleep less than whites, men sleep less than women, and the poor sleep less than the wealthy.

Although participants spent an average of 7.5 hour a night in bed, they spent only 6.1 hours asleep. White women slept the most, 6.7 hours a night, followed by white men at 6.1 hours, black women at 5.9 hours and black men at 5.1 hours. Higher income also was associated with more sleep.

"People don't think they get enough sleep and they get less sleep than they think," said study author Diane Lauderdale, Ph.D., associate professor of health studies at the University of Chicago. "As we learn more and more about the importance of sleep for health, we find evidence that people seem to be sleeping less and less."

Studies suggest that average sleep times have declined since 1900, when people reported sleeping nine hours a night. Studies from the 1970s reported average sleep times closer to seven hours a night.

"Our study tells that we can't entirely trust those earlier surveys," Lauderdale said, "because people do not know how much they sleep."

This was one of the first large studies to combine sleep diaries with a technique called wrist actigraphy that uses a motion sensor -- worn like a watch -- to measure not just when people go to bed but when they fall asleep. Participants wore the device in the home for three days and nights. They also kept a log of their hours in bed.

Using the Actiwatch and nightly logs, Lauderdale and colleagues recorded how long people spent in bed (on average, 7.5 hours), how long it took them to fall asleep (22 minutes), how long they slept (6.1 hours), and their total sleep "efficiency" -- time asleep divided by time in bed (81 percent).

They found that sleep duration and sleep efficiency were "remarkably lower" than values reported in most previous studies, noted Stuart F. Quan of the University of Arizona in a commentary.

The researchers were particularly surprised by the short span and poor quality of sleep among African-American men -- 5.1 hours a night and 73 percent sleep efficiency.

"Although sleep scientists have generally accepted that the average sleep duration of Americans has been declining in parallel with our transformation to a frenetic 24-hour society," Quan wrote, "most sleep clinicians would consider those values indicative of sleep deprivation even by current standards."

Lack of sleep has long been connected with reduced ability to concentrate, trouble learning, decreased attention to detail and increased risk of motor vehicle accidents. More recent studies have tied chronic partial sleep deprivation to medical problems, including obesity, diabetes and hypertension.

This study may someday connect sleep loss to coronary artery disease. The 669 volunteers, aged 38 to 50, were recruited from the Chicago site (based at Northwestern University) of the CARDIA study, an ongoing project, begun in 1985, designed to assess long-term cardiovascular risk factors.

Although the study found significant variation based on race, sex and income it was not designed to get at the causes of those differences.

"People who make more money may have fewer worries," Lauderdale suggested, "or they may have more control over their sleep environment."

The findings, however, are "consistent with sleep being on the causal pathway between socioeconomic status (or race) and disease risk," the authors conclude.

"There are many temptations to sleep less," said Lauderdale, "but there is a growing body of evidence that this would be unwise."

"I try to get at least seven hours a night," she said. "I can't function the next day without it."

Computer models may reveal what makes human body clock tick

Tue, 04 Jul 2006 00:54:00 PST

( from http://www.rxpgnews.com ) Scientists at the University of Edinburgh are using digital technology to develop an artificial body clock which can tell them more about the causes of sleeplessness. The computer-designed clock, which mimics the workings of key genes and proteins in the brain, can shed new light on the complex biological processes which influence our internal rhythms. The study is part of major Europe-wide investigation into sleep disturbance, which is a growing problem in the EU where one in every five employees now works shifts.

Understanding the subtleties of the human body clock is a hugely challenging task and, so far, attempts to explain its workings have met with only limited success. In order to build a clearer picture of the complex processes involved, the Edinburgh team has adopted a novel approach. Rather than observing how the clock functions in humans, and trying to discern what each 'part' does, scientists have begun building their own artificial clock from scratch.

Researchers are using leading edge technology to replicate the behaviour of a few, well-understood genes and proteins. These functions - in effect, the cogs and wheels of the human body clock - are reproduced in the laboratory using computer models. Once the team has developed a number of these key components, a prototype clock will be assembled by researchers in Szeged, Hungary.

Researchers will then test the new clock in simple yeast samples. Yeast is the perfect testing ground because it has no 24-hour clock of its own to upset the experiment, giving the scientists complete control over experiments. The new clock can be manipulated easily and analysed rapidly. The team will then test whether these artificial clocks can trigger in yeast cells the same rhythmic signals that produce the time-keeping function in the human clock.

Professor Andrew Millar, of the University of Edinburgh's School of Biological Sciences, said: Our aim is to build basic clocks and make them progressively more complicated. We will use the genetic information which we have at our disposal - and leading edge technologies - to introduce our synthetic 'clockwork' on to the blank canvas which yeast provides.

This novel way of 'learning by doing' will test how much we currently understand about the biological clock and suggest ways in which we can adapt these circuits for other purposes in the future.

The Edinburgh study is part of the EUCLOCK project, which involves researchers at 29 sites in 11 countries. Scientists will carry out a range of research projects, each designed to find out more about how genes and proteins are connected in humans, mice and flies to influence the workings of biological clocks.

Also playing a key role in the 16 million Euro project is an Edinburgh based start-up company, LUX biotechnology. The company will provide EUCLOCK scientists with innovative research tools which will monitor gene activity to assess the success of the various experimental approaches.

LUX's innovative technology, based on the light-emitting enzymes (luciferases), will provide researchers with a continuous read-out of the activity of the clock genes which will help scientists monitor how their artificial clocks are functioning.

New fruit fly protein JET illuminates circadian response to light

Fri, 30 Jun 2006 02:26:00 PST

( from http://www.rxpgnews.com ) Researchers at the University of Pennsylvania School of Medicine have identified a new protein required for the circadian response to light in fruit flies. The discovery of this protein named JET brings investigators one step closer to understanding the process by which the body's internal clock synchronizes to light. Understanding how light affects circadian (24-hour) rhythms will likely open doors to future treatments of jetlag.

The body's 24-hour clock controls a multitude of internal functions such as periods of sleep and wakefulness, body temperature, and metabolism. Although circadian function produces a stable rhythm in the body, the biological clock will reset in response to light. The human condition known as jet lag takes place during the period when the body is attempting to resynchronize to the environmental light changes brought on by travel, namely from one time zone to another.

A mutant fruit fly that possesses jetlag-like behaviors enabled senior author Amita Sehgal, PhD, Professor of Neuroscience at Penn and a Howard Hughes Medical Institute (HHMI) Investigator, and colleagues to identify the gene and subsequent protein that aids in the response of the internal biological clock to light. The researchers report their findings in most recent issue of Science.

To test the circadian rhythm of fruit flies, Sehgal and others exposed wild type (control) and mutant flies to several light and dark settings constant darkness, constant light, and equal periods of light and darkness (a light-dark cycle). During exposure to constant light for one week, the controls developed a disrupted sleep pattern after a few days, while the mutants maintained a regular circadian rhythm. The mutant and control flies displayed no behavioral differences during their exposure to constant darkness and the light-dark cycle. However, when the fruit flies were shifted from one light-dark cycle to another, the mutant flies took two days longer to adjust their sleep-wake cycle to the new light-dark schedule.

"The behavior of the mutant flies is similar to that displayed in a person who has prolonged jetlag," notes Sehgal. In search of answers to the mutant's defective circadian response to light, Sehgal and colleagues looked to the molecular details of the clock cells in the jetlag flies.

When a fruit fly is exposed to light, a photoreceptor called cryptochrome (CRY) transduces the light signal and kicks off a series of reactions within the clock cells of the brain. Under normal conditions, CRY will respond to light by binding to a protein called timeless (TIM). A second protein, a member of the F-box protein family, also binds to TIM, signaling TIM for cellular destruction.

Genetic analysis revealed that the jetlag flies possess a mutation in a gene that encodes a member of the F-box protein family. A closer examination of the protein produced by the mutated sequence led researchers to JET, a new protein within the F-box protein family.

"Since the degradation of TIM always happens in the presence of light, the animal associates the absence of TIM with daytime hours," explains Sehgal. The mutated JET protein reduces the light-dependent degradation of TIM and the circadian response to light.

Sehgal and others were able to reverse the behaviors in the jetlag flies by genetically replacing the mutated gene sequence with the normal sequence, which led to the production of the wild-type (control) JET protein. When the jetlag flies acquired the normal JET protein, regular TIM degradation took place and the fruit fly was better able to adjust to shifts in the light-dark cycle.

Future studies in the Sehgal lab will focus on continuing to identify other molecules required for the circadian response to light. "Some of the molecules required for the circadian light response in flies may be conserved in humans. Over time, we will have a better understanding of how the human clock responds to light and may be able to design drugs to treat jetlag," concludes Sehgal.

CBT More Effective Than Zopiclone in Insomnia

Thu, 29 Jun 2006 02:48:00 PST

( from http://www.rxpgnews.com ) Patients with insomnia who implemented cognitive behavioral therapy interventions such as relaxation techniques had greater improvement in their sleep than patients who received the sleep medication zopiclone, according to a study in the June 28 issue of JAMA.

Insomnia is usually defined as subjective complaints of poor sleep accompanied by impairment in daytime function. It is common in people aged older than 55 years (9 percent-25 percent are affected) and is associated with reduced quality of life, depression, and more physician visits. Despite these links to individuals lives and societal costs, most people with chronic insomniaup to 85 percentremain untreated, according to background information in the article. Two-thirds of individuals with insomnia report having poor knowledge of available treatment options, and as many as one fifth resort to either untested over-the-counter medications or alcohol in attempts to improve their condition. Among primary care physicians, the treatment of choice for insomnia has commonly been prescription medication. Cognitive behavioral therapy (CBT) is the most widely used psychological intervention for insomnia. No studies have compared the newer non-benzodiazepine sleep medications with nonpharmacological treatments.

Borge Sivertsen, Psy.D., of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between January 2004 and December 2005 to compare the short- and long-term clinical efficacy of CBT and the non-benzodiazepine sleep medication zopiclone. The trial included 46 adults (average age 60.8 years; 22 women) with chronic primary insomnia. The participants received either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation technique; n = 18), sleep medication (7.5 mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. Clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography [PSG; monitoring of physiological activity during sleep]).

Using PSG testing, the total time spent awake during the night for the CBT group improved significantly more than both the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the placebo group. Total wake time at 6 weeks was reduced 52 percent in the CBT group compared with 4 percent and 16 percent in the zopiclone and placebo groups on PSG testing, respectively. On average, participants receiving CBT improved their PSG-registered sleep efficiency by 9 percent at posttreatment, compared with a decline of 1 percent in the zopiclone group, a difference that the authors stated was both statistically and clinically significant.

Total sleep time measured using both PSG and sleep diary increased significantly in the CBT group at 6 months compared with 6 weeks. The zopiclone group showed no significant change at 6 months on PSG, maintaining improvements seen at 6 weeks. Comparing the 2 active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the CBT group than in the zopiclone group as assessed using PSG; total sleep time was not significantly different .

...the present findings have important implications for the clinical management of chronic primary insomnia in older adults. Given the increasing amount of evidence of the lasting clinical effects of CBT and lack of evidence of long-term efficacy of hypnotics, clinicians should consider prescribing hypnotics only for acute insomnia. At present, CBT-based interventions for insomnia are not widely available in clinical practice, and future research should focus on implementing low-threshold treatment options for insomnia in primary care settings. As recently demonstrated by Bastien et al, telephone consultations and CBT-based group therapy for younger patients with insomnia produced equally significant improvements as individual therapy sessions. In another study, CBT delivered via the Internet in a self-help format showed significant improvements in individuals with chronic insomnia, the authors write. Finally, future research should seek to identify which single factors in the CBT regimen produce the best results and to what extent booster sessions at 1 to 2 years after initial treatment may be necessary to maintain improvements.

Severe hot flashes associated with chronic insomnia

Tue, 27 Jun 2006 03:57:00 PST

( from http://www.rxpgnews.com ) Women who have severe hot flashes may have more chronic sleep problems than women who do not, according to a report in the June 26 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

As many as 85 percent of menopausal women experience hot flashes, sensations of heat that may also involve sweating, according to background information in the article. Hot flashes often occur during the night and have been associated with insomnia, or difficulty sleeping. The symptoms of insomnia include problems falling asleep and/or staying asleep, sleep that is not restful and an overall dissatisfaction with sleep quantity or quality. Because many other factors also influence sleep in menopausal women, the exact link between hot flashes and insomnia has been difficult to establish.

Maurice M. Ohayon, M.D., D.Sc., Ph.D., Stanford University School of Medicine, Palo Alto, Calif., conducted telephone interviews with 3,243 individuals in California, including 982 women ages 35 to 65 years, between June 2003 and April 2004. Of the women, 562 (57.2 percent) were premenopausal; 219 (22.3 percent) were perimenopausal, meaning that they had irregular menstrual cycles with at least one period in the previous year; and 201 (20.5 percent) were postmenopausal, or had reported no menstrual bleeding in the previous year. Hot flashes were defined as mild if they usually did not involve sweating, moderate if they mostly involved sweating but did not require a woman to stop the activity she was pursuing and severe if they typically involved sweating and did require a woman to stop an activity.

About 33 percent of the women reported having hot flashes, including 12.5 percent of the premenopausal women, 79 percent of perimenopausal women and 39.3 percent of postmenopausal women. Of those who had hot flashes, about half reported that they were typically mild, while about one-third had moderate and about 15 percent had severe hot flashes. More than 81 percent of women with regular severe hot flashes had symptoms of chronic insomnia. These women reported difficulty falling asleep, non-restful sleep and overall dissatisfaction with their sleep patterns on a regular basis (at least three nights a week for at least the past six months). Women with mild hot flashes did not report these problems any more frequently than did women with no hot flashes. Women were also more likely to have problems staying asleep as their hot flashes became more severe.

The researchers also examined how insomnia related to women's menopausal status and found that women in perimenopause were more likely to have difficulty falling asleep, non-restful sleep and overall dissatisfaction with sleep. One-third of perimenopausal and postmenopausal women reported that they believed insomnia was related to the development of menopause.

"This study provides evidence that severe hot flashes are associated with chronic insomnia in women aged 35 to 65 years," the authors write. "The dramatic increase in insomnia in women with severe hot flashes indicates that severity of hot flashes should be routinely assessed in all studies of menopause.

"Treating hot flashes could improve sleep quality and minimize the deleterious consequences of chronic insomnia," they conclude.

Acting out vivid dreams may forewarn of more serious illness

Mon, 19 Jun 2006 13:08:00 PST

( from http://www.rxpgnews.com ) Mayo Clinic sleep medicine specialists have found that almost two-thirds of patients with REM sleep behavior disorder (RBD) develop degenerative brain diseases by approximately 11 years after diagnosis of RBD.

"This study found RBD most frequently led to neurodegenerative diseases called the synucleinopathies: Parkinson's disease or dementia with Lewy bodies," says Maja Tippmann-Peikert, M.D., Mayo Clinic sleep medicine specialist, neurologist and the study's lead researcher. "From our findings, I would consider those with RBD at increased risk for these diseases."

RBD is a sleep disorder in which patients act out their dreams, which are often unpleasant and violent, according to Dr. Tippmann-Peikert. This acting out results from a loss of normal muscle paralysis in REM (rapid eye movement) sleep, the dream stage, which ordinarily prevents enacting one's dreams.

"The danger with RBD is that patients can hurt themselves or their spouses during the acting out behaviors -- bruises, lacerations, bone fractures and even subdural hematomas have been reported," says Dr. Tippmann-Peikert.

In this study, the investigators mailed questionnaires to 39 patients diagnosed with RBD at the Mayo Clinic Sleep Disorders Center between 1988 and 1995. If a patient had died, the questionnaire was mailed to surviving relatives. Of the 23 patients who agreed to participate, five had developed dementia or Parkinson's disease, and 10 reported neurological symptoms highly suggestive of dementia or Parkinson's disease. The patients in this study were an average of 11.2 years beyond their diagnoses of RBD.

This study is the second long-term follow-up study following patients with idiopathic, or inexplicable, RBD, confirming previous findings by Carlos Schenck, M.D., and Mark Mahowald, M.D., of Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center in Minneapolis.

Other studies are under way to determine whether RBD is a state of pre-Parkinson's, pre-dementia or pre-multiple system atrophy (another type of synucleinopathy), according to the Mayo Clinic researchers.

Researchers have reported that as the brain-degenerating disease progresses, RBD may decrease in frequency and intensity or resolve completely, says Dr. Tippmann-Peikert.

There is no intervention to prevent those with RBD from progressing to Parkinson's disease, dementia or multiple system atrophy, says Dr. Tippmann-Peikert, as the origin of RBD is not clear enough to develop an appropriate therapy. Even though no preventive treatment exists yet, she says RBD patients can use safety precautions in their bedrooms to prevent injury (e.g., move nightstands away from the bed, use extra pillows or pillows on the floor next to the bed for extra padding, remove dangerous objects such as weapons from the bedroom, lock all windows and doors to walk-out decks); See a sleep specialist and, if prescribed, take medications to suppress RBD symptoms; Become familiar with the signs and symptoms of Parkinson's disease, dementia or multiple system atrophy; Follow up regularly with a sleep specialist to monitor for signs of brain-degenerating illnesses, and consider a referral to a neurologist if any signs appear

Dr. Tippmann-Peikert also stresses the importance of diagnosing RBD as early as possible.

"Awareness of excessive nocturnal behaviors and dream enactment and bringing it to the attention of a physician could lead to an early diagnosis of Parkinson's disease, dementia or multiple system atrophy," she says. "Hopefully, early identification of patients with idiopathic RBD will lead to close monitoring and early treatment of any developing neurological disorders."

Mushroom bodies regulate sleep like a snooze button

Thu, 08 Jun 2006 05:37:00 PST

( from http://www.rxpgnews.com ) With help from some drowsy fruit flies, a team of researchers from the Howard Hughes Medical Institute (HHMI) at the University of Pennsylvania School of Medicine has identified a region of the fruit fly's brain that is crucial to controlling sleep.

The finding, reported in the June 8, 2006, issue of the journal Nature, is important because it identifies a new role for brain structures, called mushroom bodies, which have now been shown to control fruit fly slumber. Mushroom bodies were known to be involved in processing sensory information and memory. Thus, the new studies lend support to the idea that sleep helps the brain consolidate learning and memory.

We spend one-third of our lives sleeping, but we know very little about sleep and how it is regulated, explained Amita Sehgal, the senior author of the new Nature paper and an HHMI investigator at the University of Pennsylvania School of Medicine. The research actually doesn't tell us much directly about the purpose of sleep, said Sehgal. But one of the things suggested (from past research) is that sleep helps consolidate memory.

Consequently, the finding by Sehgal and her colleagues showing that sleep and memory share a common locus in the brain may begin to substantiate why our brains must routinely descend into the idling metabolic and electrical state that defines sleep.

Sehgal's group conducted a series of experiments with sleeping flies that fingered mushroom bodies as at least one of the brain's primary snooze buttons.

Mushroom bodies are an anatomical structure in the fly brain, mostly associated with learning and memory, said Sehgal, who conducted the research at Penn's Center for Sleep and Respiratory Neurobiology. They also process olfactory cues and locomotor activity.

It is possible, Sehgal and her colleagues speculate, that the mushroom bodies constitute a gate to fly dreamland: sleep occurs when the stream of sensory information processed by the structure an elaborate net of neural cells is inhibited.

In humans and other higher animals, sleep has been associated with several different structures in the brain, mostly by looking at brain waves, the patterns of electrical signals generated during sleep or wakefulness. There are no structures analogous to mushroom bodies in vertebrates, but the hippocampus and/or thalamus may harbor a similar control center for human sleep, Sehgal noted.

In the fly, the mushroom bodies are probably not the only thing associated with sleep.

Once you have (linked sleep to an anatomical structure), you can figure out changes taking place at the molecular level in that region of the brain, Sehgal explained. It allows us to shift our efforts to see what happens during sleep and what happens when we're awake that leads to sleep.

The HHMI team was able to home in on mushroom bodies' role in regulating sleep in flies by using the drug RU-486 in their studies. RU-486 is a steroid that acts on steroid-regulated promoters, she explained. We used RU-484-responsive sequences to control our gene of interest and once we had done that in the fly, we could feed the fly RU-486 to turn that gene on.

Sehgal and her team were then able to induce large changes in sleep by using RU-486 to manipulate a critical gene known as protein kinase (PKA), which makes a protein that, in the brain, activates other proteins and switches other genes on or off.

In flies, the duration of sleep is inversely related to PKA activity. By expressing the gene in different regions of the brain, including mushroom bodies, it was possible to assess the roles of those structures in the phenomenon of sleep.

Sehgal said that a fly is sleeping if it remains motionless for extended periods. At the moment, our definition of fly sleep is five minutes of immobility, she explained. In addition to identifying the structure that governs sleep in invertebrates, the new HHMI work promises to help researchers zero in on the anatomical structures in the brains of higher animals, including humans, which govern sleep.

Melatonin Most Effective For Sleep When Taken For Off-Hour Sleeping

Sun, 07 May 2006 19:43:00 PST

( from http://www.rxpgnews.com ) Researchers from the Divisions of Sleep Medicine at Brigham and Womens Hospital and Harvard Medical School have found in a double-blind placebo-controlled clinical study, that melatonin, taken orally during non-typical sleep times, significantly improves an individuals ability to sleep.

This finding is particularly important for rotating or night-shift workers, travelers with jet lag and individuals with advanced or delayed sleep phase syndrome.

Melatonin is a hormone produced by the body at night in darkness, which helps the brain determine day and night to help regulate sleep cycles and circadian timing. Retinal light exposure inhibits the release of the hormone.

Millions of Americans take melatonin supplements to improve their sleep, yet the results of prior studies on the efficacy of melatonin as a sleep-promoting agent have been mixed, according to the Agency of Healthcare Research and Quality, which carried out an extensive review of this topic two years ago. The present study, conducted at the Brigham and Womens Hospital, sought to address this question.

Thirty-six participants (21 men and 15 women), between the ages of 18 and 30 with no significant past or current medical disorders, sleep disorders, or psychological disorders were chosen for the study from a pool of applicants.

The participants refrained from alcohol, caffeine, nicotine, illicit substances and prescription and non-prescription medications for three weeks prior to the start of the study. They were studied in sound-proof suites free of time clues. Participants were first studied for three days and nights in the lab on their traditional sleep schedules to measure their normal sleep structure and melatonin production.

Participants were then kept on a 20-hour sleep-wake schedule, simulating a traveler crossing four time zones eastward every day, explained Dr. Charles Czeisler, Chief of the Division of Sleep Medicine at Brigham and Womens Hospital and senior author of the study. For the next three weeks, thirty minutes before each sleep episode, participants ingested either a placebo, 0.3milligrams (mg), or 5.0mg of pharmaceutical grade melatonin.

The researchers found that sleep efficiency during the six hour, 40 minute episodes was significantly higher in the groups that took melatonin during times when the body was not producing melatonin. At those times, participants taking 5.0mg of melatonin had a sleep efficiency of 83 percent and those taking 0.3mg melatonin had a sleep efficiency of 84 percent.

Sleep efficiency in both of these groups was significantly greater than that in participants taking placebo, who had a sleep efficiency of 77 percent. There was no significant difference in sleep efficiency among all participants during times when melatonin was being produced in the body.

James K. Wyatt, Ph.D., lead author of the study, Diplomate, American Board of Sleep Medicine and now acting Co-Director of the Sleep Disorders Service and Research Center at Rush University Medical Center in Chicago stated, A landmark feature of this comprehensive research was the study of 24 successive sleep episodes in the same participants, including over 1,000 sleep recordings, across a full range if circadian phases the bodys internal 24-hour timing system. We were able to definitively show in these healthy young adults that the use of melatonin as a sleep-aid was only beneficial for sleeping when the body wasnt already releasing its own supply of melatonin.

These data leave little doubt about the effectiveness of melatonin in alleviating sleep disturbances when attempting to sleep at the wrong time of day, at least under laboratory conditions, continued co-author Derk-Jan Dijk, now Director of the Surrey Sleep Research Centre, Surrey, England.

Czeisler concluded: Melatonin enabled these participants to obtain an extra half hour of sleep when they attempted to do so during the day, at a time when they were not producing melatonin themselves. Melatonin did not help these young adults sleep at night, when their body was already producing melatonin. These finding have implications for millions of people who attempt to sleep at a time that is out of synch with the brains internal clock.

Children with fetal alcohol spectrum disorders exhibit altered sleeping and eating patterns

Sun, 07 May 2006 19:08:00 PST

( from http://www.rxpgnews.com ) Children with fetal alcohol spectrum disorders (FASD) suffer from a variety of behavioral alterations. For example, they may exhibit alterations in sleeping and eating patterns, which may indicate that their circadian systems which control biological rhythms have been affected by alcohol exposure during development. A rodent study in the May issue of Alcoholism: Clinical & Experimental Research confirms that alcohol exposure during a period equivalent to the third human trimester influences the ability to synchronize circadian rhythms to light cues.

"Human infants with FASD may suffer from sleep disorders, including a reduced amount of sleep, abnormal brain wave activity, and fragmented rapid eye movement and slow-wave sleep, which may be related, in part, to circadian dysregulation," explained Jennifer D. Thomas, associate professor of psychology at San Diego State University and corresponding author for the study. "Disruptions in circadian rhythms can also influence other behaviors, including attention and mood regulation. In fact, individuals with FASD may suffer from depression and other psychopathologies." Although sleeping, eating and mood can be influenced by many factors, she said, the circadian systems are responsible for coordinating multiple physiological systems with environmental cues.

"Most of our body processes are regulated in the circadian fashion," concurred David Earnest, a professor in the department of neuroscience and experimental therapeutics at Texas A&M University Health Sciences Center. "We know that these circadian rhythms are important in human health, although we still need to fully determine how alterations in circadian rhythmicity are linked to human mental and physical disorders."

For this study, researchers exposed male Sprague-Dawley rats to 6.0 g/kg of alcohol per day (n = 8), using an artificial rearing procedure, from postnatal days four through nine. The alcohol level represented heavy binge drinking. An artificially reared control group (n = 8) and a normally reared control group (n = 8) were also included in the study design. At 10 to 12 weeks of age, wheel-running behavior was continuously measured for eight days under a 12-hour light/12-hour dark (LD) cycle. Then the cycle was delayed by six hours and the rats were exposed to a new LD cycle for an additional six days. Their adjustment to the new cycle was evaluated.

"Our study demonstrated that exposure to alcohol during the third trimester, when components of the circadian system in the brain are developing, can lead to long-lasting alterations in the ability to entrain the cycles to environmental cues, like light/dark cycle," said Thomas. "These data suggest that dysfunction of circadian systems may contribute to some of the behavioral problems observed in children with FASD."

"This is the equivalent to a person undergoing exposure to 'jet lag,'" noted Earnest. "Basically, if you take a human and go across a number of time zones from east to west, similar to the light/dark cycle of these animals, some people will shift quickly, and some will not, and may even experience some physical problems or illness because of effects on their immune system. The responses of the alcohol-treated animals indicated that they resynchronized to the shifted light/dark cycle more slowly than the control animals."

The implications of these results for humans, added Earnest, are much broader than the term "jet lag" might indicate. "These individuals are going to have difficulties, in terms of their ability to function, while traveling across time zones and also during shift work," he said. "There are a couple of prominent examples in history regarding this: the Exxon Valdez and Chernobyl. The captain of the Exxon Valdez was not only working shift work, but he was drinking too, and unable to maintain a normal, necessary performance. With Chernobyl, the shift-work schedules were inappropriate and, at the time that the accident happened, poor mental and physical performances contributed to the disaster."

The underlying message, said Thomas, is that drinking alcohol during pregnancy can have long-lasting damaging effects to the offspring. "There is currently no known safe amount of alcohol that can be consumed during pregnancy, so it is best to abstain from alcohol drinking during pregnancy. We need to better understand the mechanisms of this dysfunction to determine if there are ways to mitigate the circadian dysfunction and behavioral dysregulation associated with developmental alcohol exposure."

Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem

Thu, 06 Apr 2006 05:36:00 PST

( from http://www.rxpgnews.com ) It is estimated that 50 to 70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting health and longevity. The cumulative long-term effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.

Hundreds of billions of dollars a year are spent on direct medical costs associated with doctor visits, hospital services, prescriptions, and over-the-counter medications. Almost 20 percent of all serious car crash injuries in the general population are associated with driver sleepiness, independent of alcohol effects.
Despite such huge societal consequences and costs, the Institute of Medicine (IOM) finds that the cumulative effects of sleep loss and sleep disorders are "under- recognized" and "awareness among the general public and health care professionals is low given the magnitude of the burden

The Sleep Research Society applauds the Institute of Medicine (IOM) of the National Academy of Sciences for recognizing the adverse impact of sleep disorders and sleep deprivation on public health in its report entitled "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem" (IOM Report), which was released on April 4, 2006. The 2006 IOM Report updates and reinforces the prior recommendations of the National Commission on Sleep Disorders Research that was chaired by William C. Dement, MD, PhD. The Sleep Research Society, which was one of the sponsoring organizations for the IOM Report, strongly supports the Institute of Medicine's conclusion that additional investment is needed to address this serious unmet public health problem by Recognizing that sleep disorders and sleep deprivation are significant public health problems that have a wide range of deleterious health and safety consequences

A multi-media education program to foster increased awareness among the general public (including children, young adults, middle age adults, and older adults) and health care professionals about the physiology of healthy sleep across the lifespan, and of the importance of sleep to health, performance, learning and safety and of the tremendous societal costs associated with sleep loss and sleep disorders should be developed

Programs to promote the early diagnosis and treatment of sleep disorders should be Instituted

Surveillance and monitoring of sleep patterns in the U.S. population and of the public health burden of sleep loss and sleep disorders by the Centers for Disease Control and Prevention should be Improved

Sleep medicine should be recognised as an independent specialty of medicine that is interdisciplinary in nature but requires specialized training

More research scientists in the fields of sleep science and sleep medicine and more clinicians in the field of sleep medicine should be trained

The number of trained scientists in other disciplines who focus on sleep-related researchIntegrating the teaching of sleep science and sleep medicine into undergraduate, graduate and professional education programs should be increased

Investment in basic research in sleep science and in research in sleep medicine on the causes and treatments of inadequate sleep and sleep disorders should be increased

The sleep research community through initiatives to attract new investigators to the fields of sleep science and sleep medicine should be strengthened

Interdisciplinary sleep programs in all academic health centers should be established. The Sleep Research Society further recommends that clinical revenues generated by these programs be reinvested in sleep science and sleep medicine through these interdisciplinary sleep programs.

A national sleep science and sleep medicine research and clinical network should be created

The research agencies in the National Institutes of Health (NIH) that are responsible for supporting research in sleep science and sleep medicine should be Reinvigorated

According to NSF CEO Richard L. Gelula, "The IOM report should be read by everyone concerned about sleepiness and fatigue in our society, whether it is in the classroom, at work or on the road. The report complements what NSF has been finding in its annual Sleep in America polls - namely, that too many Americans are getting too little sleep, that sleep problems and symptoms of sleep disorders are widespread in our population, that too few people ever talk to their doctor about sleep and, importantly, that too few doctors ask their patients about sleep when assessing health. The IOM report shows there are achievable solutions to these problems, but that Americans must be re- educated about sleep, all doctors should be trained to understand the contribution of sleep to health as well as to be able to recognize and effectively respond to sleep disorders, and the nation should increase investment in sleep research to learn how to best prevent and most effectively treat sleep disorders."
The American Academy of Sleep Medicine, the National Center on Sleep Disorders Research at the NIH, the National Sleep Foundation, and the Sleep Research Society requested that the IOM conduct a study that would examine the public health significance of sleep, sleep loss, and sleep disorders, gaps in the public health system and adequacy of the current resources and infrastructures for addressing the gaps, barriers and opportunities for improving interdisciplinary research and medical education and training in the area of sleep and sleep medicine, and, develop a comprehensive plan for enhancing sleep medicine and sleep research.

NSF congratulates the IOM committee on sleep medicine and research for its great effort to review the scientific evidence linking sleep to health and safety and for calling on all of those involved in healthcare - from research to delivery of patient care - to recognize and embrace how sleep contributes to health, and how untreated sleep disorders are robbing our patients of their well-being and our society of the productivity of otherwise strong and effective people. It is now up to the sleep community to create strategic partnerships and redouble its efforts to carry these findings forward and to translate them into better sleep health for patients, workers and the population at large."

The report, which was independently produced by IOM, proposes specific strategies for increasing the medical focus on sleep, awareness of sleep and sleep research. These strategies are built on the recognition that sleep-related issues span areas of medical practice and require an interdisciplinary approach. For instance, sleep concerns range from pediatrics to geriatrics, from primary care to specialties such as pulmonology, cardiology, endocrinology, and psychiatry. Research investigations into the nature of sleep and the causes and consequences of sleep disorders are similarly interdisciplinary.

While the Sleep Research Society supports these initiatives recommended by the IOM panel, the Sleep Research Society believes that the IOM Report should also have been broad enough to cover additional health policy initiatives, the urgent need for which are implied but largely unaddressed in the IOM Report. Despite extensive evidence cataloged in the 461-page IOM Report, there were no recommendations calling for health policy initiatives addressing either:
drowsy driving, which the IOM Report identified as being associated with nearly 20 percent of all serious car crash injuries in the United States; or
the extended duration (30 consecutive hour) work shifts to which medical and surgical residents (who "work longer hours than virtually all other occupational groups" according to the IOM Report) are scheduled twice per week for years during their training.

After reviewing the evidence demonstrating that forced repetitive sleep deprivation of young physicians significantly increases their risk of making serious medical errors, more than doubles their risk of having a motor vehicle crash while driving home from work, and induces performance decrements comparable to legal intoxication, the IOM Report merely recommends education of resident physicians about the adverse health effects and safety hazards of sleep loss

. To do so without addressing physician work hours or drowsy driving invites the rejoinder: "Physician, heal thyself." The Sleep Research Society calls upon the IOM and organizations involved in medical education to lead in recognizing the importance of sleep to health, performance and safety by undertaking a health policy initiative related to physician work hours so that physicians -- with their ever- increasing knowledge of the importance of adequate sleep -- can lead the nation by example.

The Sleep Research Society also calls for a health policy initiative to address the issue of drowsy driving, since the National Highway Transportation Safety Administration estimates that at least 15 million drivers nationwide have nodded off or fallen asleep while driving in the past six months. That equates to more than 80,000 drivers in the nation falling asleep at the wheel every day, or about one every second throughout day and night, endangering themselves, their families, and their fellow citizens. The outcome of those fall-asleep episodes is sobering. More than half of those drowsy drivers wandered into another lane, drifted onto the shoulder, or drove across the centerline during the incident. In another 10 percent of these incidents, the driver ran off the road. In fact, an estimated 1,350,000 drivers nationwide were involved in a drowsy-driving-related crash in the past five years -- that is 30 drowsy driver crashes per hour or one every 2 minutes. Yet this nation, which spends over $300 million annually on education regarding the hazards of drinking and driving, spends about 0.1 percent of that amount on education related to drowsy driving. Education and regulation restricting driving privileges of drivers impaired by sleep loss or sleep disorders is urgently needed.

The IOM report sheds more light on the problem of large numbers of people with unrecognized and undiagnosed sleep disorders that adversely affect health and performance. The major obstacles to people getting the care they need is the public's lack of awareness of the importance of avoiding sleep deprivation and detecting sleep disorders and the lack of recognition by primary care health professionals of the signs and symptoms of sleep disorders. Sleep specialists are trained to diagnose sleep disorders and provide high quality, effective treatment. The number of sleep specialists grows by over 350 a year and the number of accredited sleep centers increases by over 200 per year. Though more are needed, the limitation to care is that not enough people are recognized as having a possible sleep disorder and sent to a specialist trained in sleep medicine. As more people are recognized with sleep disorders we need to increase the number of sleep specialists to care for them. First, we need to increase identification of people with sleep disorders. Primary care health care professionals needed to be educated about sleep loss and sleep disorders and evaluation of sleep patterns should be part of every routine evaluation. This report can help bring this about.
However, the AASM believes the IOM did not go far enough in some of its recommendations to ensure the appropriate growth and development of the fields of sleep science and sleep medicine. Currently, research and financial policy for most sleep centers and academic units are not controlled by those units but rather by other agencies and departments. In order to truly promote the development of this field, the National Centers for Sleep Disorders Research (NCSDR) and academic and private sleep centers need to be empowered as independent entities on par with other subspecialties of medicine. For NCSDR this could mean a line item budget or movement into its own division within one of the existing Institutes. For academic sleep centers this would require establishing sleep medicine divisions or departments. These steps would enhance the attractiveness of the field to new investigators and clinicians from a wide variety of other disciplines and create a career path in sleep science and sleep medicine.

Children who sleep less are three times more likely to be overweight

Wed, 29 Mar 2006 13:15:00 PST

( from http://www.rxpgnews.com ) The less a child sleeps, the more likely he or she is to become overweight, according to researchers from Université Laval's Faculty of Medicine in an article published in the latest edition of the International Journal of Obesity. The risk of becoming overweight is 3.5 times higher in children who get less sleep than in those who sleep a lot, according to researchers Jean-Philippe Chaput, Marc Brunet, and Angelo Tremblay.

These results come from data collected among 422 grade school students aged 5 to 10. The scientists measured the weight, height, and waist size of each participant. Information on the children's lifestyle and socioeconomic status was obtained through phone interviews with their parents.

Through body mass index measurement, the researchers determined that 20% of the boys and 24% of the girls were overweight. Children who slept less than 10 hours a night were 3.5 times more at risk of being overweight than those who slept 12 or more hours. No other factor analyzed in the study--parental obesity, parents' level of education, family income, time spent in front of the TV or computer, regular physical activity--had as much of an impact on obesity than time spent sleeping.

Hormone production is currently the researchers' prime hypothesis to explain the relationship between sleep and obesity. "Lack of sleep lowers the level of leptin, a hormone that stimulates metabolism and decreases hunger. In addition, short nights of sleep boost the concentration of ghrelin, a hormone that increases hunger," explains Professor Angelo Tremblay.

The progression of obesity and the decrease in the number of hours devoted to sleep, two phenomena that have become increasingly important social issues over the last few decades, could thus be more closely related than it would appear at first glance. Between 1960 and 2000, the prevalence of obesity doubled in the population while the average night of sleep lost one to two hours. During the same period, the percentage of young adults who slept less than seven hours went from 16% to 37%.

"It's ironic that part of the solution to obesity might lie in sleep, the most sedentary of all human activities. In light of this study's results, my best prescription against obesity in children would be to encourage them to move more and to make sure they get enough sleep," concludes Tremblay.

Studies by Brown, Lifespan scientists are at cutting edge of sleep research

Tue, 28 Mar 2006 22:23:00 PST

( from http://www.rxpgnews.com ) A new poll of teenagers across the US finds that many of them are losing out on quality of life because of a lack of sleep. The results, announced today by the National Sleep Foundation (NSF), cite sleeping in class, lack of energy to exercise, feelings of depression, and driving while drowsy as only some of the consequences for insufficient sleep.

The poll data support previous work by three Rhode Island researchers who are at the forefront of sleep research. Previous studies from Brown Medical School, and Lifespan affiliates Bradley Hospital and Hasbro Children's Hospital, have found that adolescents are not getting enough sleep, and suggest that this can lead to a number of physical and emotional impairments.

Mary A. Carskadon, PhD, with Bradley Hospital and Brown Medical School, chaired the National Sleep Foundation poll taskforce and has been a leading authority on teen sleep for more than a decade. Her research on adolescent circadian rhythms indicates that the internal clocks of adolescents undergo maturational changes making them different from those of children or adults. Nevertheless, teens must adhere to increasingly earlier school start times that make it nearly impossible for them to get enough sleep.

"Our results show that the adage 'early to bed, early to rise' presents a real challenge for adolescents," says Carskadon, who directs the Bradley Hospital Sleep and Chronobiology Sleep Laboratory and is a professor of psychiatry and human behavior at Brown Medical School.

Carskadon's work has been instrumental in influencing school start times across the country. Regionally, the North Kingstown School Department in Rhode Island, North Reading Public Schools in Massachusetts, and West Hartford Public Schools in Connecticut are considering school start time changes due, in part, to research on teens and sleep.

In a study published in the November 2005 issue of the journal Sleep, Carskadon found that the "sleep pressure" rate the biological trigger that causes sleepiness slows down in adolescence and is one more explanation for why teens can't fall asleep until later at night. Carskadon's newest finding indicates that, in addition to the changes in their internal clocks, adolescents experience slower sleep pressure, which may contribute to an overall shift in teen sleep cycles to later hours.

Judy Owens, MD, a national authority on children and sleep, is the director of the pediatric sleep disorders center at Hasbro Children's Hospital and an associate professor of pediatrics at Brown Medical School. Her latest book, "Take Charge of Your Child's Sleep: The All-in-One Resource for Solving Sleep Problems in Children and Teens," is especially important in light of the fact that 90% of the parents polled believed that their adolescents were getting enough sleep during the week.

"This poll sends a clear message to parents: Teens are tired," says Owens. "Parents can help get a handle on the problem by eliminating sleep stealers such as caffeinated drinks in the fridge or a TV or computer in the teen's bedroom as well as enforcing reasonable bed times."

Last June, a major report in the journal Pediatrics merged a review of more than two decades of basic research with clinical advice for physicians. Rhode Island authors included Carskadon, Owens, and lead author, Richard Millman, MD, professor of medicine at Brown Medical School and director of the Sleep Disorders Center of Lifespan Hospitals, a Rhode Island sleep research and treatment center that is one of the largest in the country.

The report indicated that adolescents aged 13 to 22 need nine to 10 hours of sleep each night. It also discussed the hormonal changes that conspire against them. When puberty hits, the body's production of sleep-inducing melatonin is delayed, making an early bedtime biologically impossible for most teens. At the same time, the report notes, external forces such as after-school sports and jobs and early school start times put the squeeze on a full night's sleep.

The result: A "profound negative effect" on mood, school performance and cognitive function. Studies also show that young people between 16 and 29 years of age were the most likely to be involved in crashes caused by the driver falling asleep.

"Some of our kids are literally sleep-walking through life, with some potentially serious consequences," Millman said. "As clinicians and researchers, we know more now than ever about the biological and behavioral issues that prevent kids from getting enough sleep. But the National Sleep Foundation did something powerful: They asked teens themselves about their sleep. The results are startling and should be a wake-up call to any parent or pediatrician."

Body clock could be re-set: Research

Thu, 23 Mar 2006 17:53:00 PST

( from http://www.rxpgnews.com ) The body clock that plays a major role in our metal and physical health could be re-set to help people working in swing shifts, experiencing jet lag or facing depression, says a new study.

Everyone is equipped with a biological clock, a region in the brain of the size of a corn kernel, which dictates our sleep-wake cycles. A research conducted by Kent State professor David Glass has shown that this clock can be re-set, reported science portal EurekAlert.

The body clock is an internal mechanism in organisms that controls the periodicity of various functions or activities, such as metabolic changes, sleep cycles or photosynthesis.

Glass, known internationally as the first researcher to measure serotonin release from the brain's biological clock region, has become the first to extract, identify and measure a neuropeptide, a protein crucial to the regulation of the body's clock.

Glass found that neuropeptide could be used to re-set the biological clock when it has been disrupted.

Association noted between sleep apnea and cardiovascular disease

Thu, 10 Nov 2005 17:43:00 PST

( from http://www.rxpgnews.com ) In the current issue of the New England Journal of Medicine, two studies draw attention to the newly recognized association between sleep disorders and heart trouble. The relevance of these studies to patients with sleep apnea is discussed in an accompanying editorial by Virend Somers, M.D., Ph.D., a Mayo Clinic cardiologist.

The first study, on the use of continuous positive airway pressure (CPAP) for patients with central sleep apnea and heart failure, was led by T. Douglas Bradley, M.D., of Toronto General Hospital. The other study on obstructive sleep apnea as a risk factor for stroke and death was led by H. Klar Yaggi, M.D., of Yale Center for Sleep Medicine.

In his editorial, Dr. Somers notes that central sleep apnea is characterized by intermittent loss of respiratory drive, while obstructive sleep apnea results in a narrowing or collapse of the airway. While they differ, both sleep apneas are "linked to the modern-day epidemics of obesity, cardiovascular disease, and heart failure," he says.

The results of the first study -- also referred to as the Canadian Positive Airway Pressure trial -- were disappointing because, even though the treatment was carefully applied, it was not sufficiently effective, Dr. Somers says. Patients with both heart failure and central sleep apnea received either CPAP -- a mask worn during sleep that delivers air through the airway -- or no treatment to see if CPAP improved survival.

In the end, mortality was similar in both groups. "Unfortunately, the study doesn't tell us for certain whether or not we should treat central sleep apnea in our heart failure patients," Dr. Somers says.

Because of limited effectiveness of the treatment, the study points to a need to "rethink what we are treating and how we are treating it," he says, adding that the CPAP device was intended to treat obstructive sleep apnea, not central sleep apnea. "This suggests we need to find better treatments and devices for central sleep apnea."

The second study provides strong support that obstructive sleep apnea is likely involved in causing strokes, transient ischemic attack or sudden death, he says.

The troubling part of this study is that most people in it were already receiving treatment for obstructive sleep apnea, Dr. Somers says. "So is the stroke risk even higher for people not being treated, and how much do patients benefit from treatment?" he asks.

The goal for treating sleep apnea -- central and obstructive -- is to enable patients to be less sleepy, feel better and live longer, he says. He believes treatment is important because he has seen many patients, especially those with heart disease, do well with effective treatment, which can reduce sleepiness and lower blood pressure. However, Dr. Somers cautions that it remains to be proven that treating sleep apnea prevents deaths from heart disease.

These studies remind us to consider how and why we are treating sleep apnea in our heart disease patients, he says.

Avoid jet lag by resetting body clock

Wed, 02 Nov 2005 11:53:00 PST

( from http://www.rxpgnews.com ) A simple, at-home treatment -- a single light box and the over-the-counter drug melatonin -- allows travelers to avoid jet lag by resetting their circadian body clock before crossing several time zones, according to new research being published in The Endocrine Society's Journal of Clinical Endocrinology and Metabolism. This treatment can also help those with delayed sleep phase syndrome (DSPS), a persistent condition that results from a misalignment between a person's internal biological clock and the external social environment.

Both bright light and melatonin have successfully been used in laboratory and field settings to "phase advance" (resetting the circadian clock earlier in time so that all the circadian rhythms of the body occur earlier) thereby helping people adapt to night shift work or to a new time zone following rapid transmeridian jet travel. Melatonin alone has been shown to synchronize the circadian clock of the blind to the 24-hour day.

"However, this is the first study to show that melatonin and bright light can both help to advance the circadian clock, and the combination of bright light and melatonin produces a larger phase advance than bright light alone," said Senior Author Charmane Eastman, Ph.D., Director of the Biological Rhythms Research Lab and Professor of the Behavioral Sciences Department at Rush University Medical Center in Chicago. Phase advance is the resetting of the circadian clock earlier in time so that all the circadian rhythms of the body occur earlier.

Dr. Eastman and colleagues at Rush's Biological Rhythms Research Lab studied 44 healthy adults -- 24 men and 19 women -- between the ages of 19 and 45 years old. The participants were randomly divided into three groups and assigned one of three treatments -- placebo, 0.5 mg melatonin, or 3.0 mg melatonin.

Each participant was assigned a strict eight hour sleep schedule that was similar to their typical sleep schedule. In addition, they had to remain in bed, in the dark, trying to sleep throughout the eight hour scheduled sleep/dark period. On the seventh day, each person was given a baseline phase assessment, starting seven hours before and ending three hours after their beginning bedtime. They then slept in the lab and were awakened at their scheduled wake time. The participants continued on this sleep schedule through day 10 of the study.

Days 11 through 13 marked the treatment period of the study, during which the participants slept in the lab in individual, dark, temperature-controlled bedrooms. Each afternoon, each person received either 0.5 or 3.0 mg of melatonin or matching placebo. The study ended with a final phase assessment on day 14.

The researchers found that those given melatonin experienced significantly larger phase advances -- the 0.5 mg group at 2.5 hours and the 3.0 mg group at 2.6 hours versus the placebo group at 1.7 hours. Moreover, the participants did not experience jet lagtype symptoms. There was a slightly larger phase shift with the 3.0 mg dose compared to the 0.5 dose; however, the difference was not statistically significant. In addition, the higher melatonin dose made the participants slightly more sleepy in the evenings after taking the pill. Therefore, the researchers recommend using the 0.5 dose in combination with morning intermittent bright light to advance their sleep schedule.

"The findings are very practical," said Dr. Eastman. "A business person could go to a pharmacy and buy 0.5 mg of melatonin over the counter. He or she would also have to buy or rent a light box. Then before flying east, he or she could go to bed and wake up earlier each day while using the light box in the morning and taking melatonin in the evening. If they did this for the number of days equivalent to the number of time zones crossed, then they should be completely adjusted to the new time zone before they fly," she added. "However, even following the schedule for a few days before flying would reduce the jet lag experienced upon arrival at the destination. The more days a person follows this procedure the less jet lag they will have on landing and the sooner they will adjust and feel no jet lag."

Thousands of Australians are dangerously sleepy at work

Thu, 08 Sep 2005 00:22:00 PST

( from http://www.rxpgnews.com ) The two cognitive neuroscientists, who are studying the problem of excessive daytime sleepiness, believe that up to 770,000 people in Australia may experience drowsiness during crucial, everyday tasks.

"Many of these people are at double jeopardy - as drivers and as machinery operators or farm workers," said Psychology department researcher Dr John Reid.

"Overseas studies show that between five and nine percent of the adult population experiences periods of irresistible sleepiness at least three times a week," he said.

"It is interesting to note that in countries where people take an afternoon siesta, that percentage falls dramatically to about one per cent."

Dr Reid and Professor Stuart Armstrong of the Epworth Sleep Centre, have conducted initial research and they have now joined the Faculty of Medicine, Nursing and Health Sciences to continue their study.

"Many people, including health professionals are surprised to find that such a high percentage of people are sleepy such a lot of the time," Dr Reid said.

Sleepiness - not just going to sleep - is a significant risk factor that is under-recognised, particularly by many doctors, the researchers claim.

They stress that excessive sleepiness is not the same as fatigue. "You can be fatigued without being sleepy, and you can be sleepy without having done anything to make you tired," Dr Reid said.

Excessive sleepiness may be caused by sleep disorders such as insomnia, medical conditions including diabetes and sleep apnoea, neurological conditions such as narcolepsy, or through lifestyle factors.

The scientists are about to do a further study into the prevalence and causes of wake-time sleepiness in adults in Victoria.

Clocking in Pillow Time without the Pillow

Wed, 24 Aug 2005 04:10:00 PST

( from http://www.rxpgnews.com ) If you snooze, you lose those uncomely grayish-brown crescents below your eyes. If you dont snooze, you lose a lot more. The body cant fight off infection, the muscles cant regenerate as quickly, the mind cant learn new words, and the eyes cant focus on the road. You also gain things: a bad mood and increased risk for diabetes, high blood pressure, and heart problems. Indeed, the effects of sleep deprivation can be so serious that some sleep scientists liken lifetime sleep debt to a heavy backpack: every sleep hour missed adds an extra pound to your pack until it weighs you down.

For people without time for a daily eight hours in the sack, drugs that counteract the effects of sleep deprivation could serve as substitutes. In a new study, Sam Deadwyler and colleagues have explored this possibility by giving dog-tired rhesus monkeys a drug shown to improve the functioning of alert brains. They found that sleepy monkeys taking the drug performed tasks better and had increased metabolic activity in several regions of their brains. This suggests that the cognitive effects of sleep deprivation can be reduced chemically.

The researchers kept the monkeys awake for 30 to 36 hours by playing music and videos, keeping the lights on, and interacting with them: all the annoyances that can also keep humans from sleeping. To determine the drugs effect on drowsy monkeys, Deadwyler and colleagues used a behavioral test called Match-To-Sample, which measured both accuracy of memory and speed of recall. In the behavioral test, the monkeys saw a simple image flash on a screen. For a variable amount of time, the monkeys had to remember the image. Then, they had to select the correct image from a group of others shown on the monitor simultaneously. When monkeys correctly selected the original image with a cursor, they got a squirt of juice in their mouth as reward. The researchers measured how long they could keep the screen blank between the first and second images without affecting the monkeys performance. They found that if the monkeys were tired, they couldnt remember the first image for long as they could when they were alert. But with the drug, the sleep-deprived monkeys did at least as well as alert monkeys.

The drug, labeled CX717 (Cortex Pharmaceuticals), acts on AMPA receptors, protein structures on the surface of neurons. When these receptors bind to the neurotransmitter glutamate, they transduce excitatory signals by opening an ion channel. Ampakines including CX717 make the activated channel stay open longer when glutamate binds. More ions pass through the channel, creating a stronger signal when nerve cells are activated. The ubiquity of these receptors makes them good targets for drugs that increase general cognitive functioning.

The researchers used a technique called positron emission tomography, or PET, to gain insight into CX717s neurobiological role. The PET signal reflected the distribution and rate of metabolism of ingested radioactively labeled glucose in the monkeys brain cells. By measuring regional brain glucose metabolism, the researchers determined that for sleep-deprived monkeys, glucose metabolism drops off in brain areas previously associated with memory tasksnamely, the prefrontal cortex, the dorsal striatum, and the medial temporal lobe. However, when sleep-deprived monkeys took the drug, they showed heightened glucose metabolism in these same brain regions. The researchers compared these results to suggest a biological basis for the drugs effects.

Previous studies have shown that caffeine and amphetamine can reduce the deleterious cognitive effects of sleep deprivation. But as anybody who has indulged one latte too many knows, caffeine and other powerful stimulants have limited usefulness. These potentially addictive chemicals can distort thinking just as they can enhance it. Because CX717 has a different biochemical action, it may be more beneficial than stimulants for counteracting the cognitive effects of sleep deprivation. But that doesnt mean we should throw away our pillows and blankets just yet: sleep deprivation affects both body and mind.

Genetic disease offers clues to SIDS, sleep apnea

Tue, 12 Jul 2005 13:02:00 PST

( from http://www.rxpgnews.com ) Imagine raising a child who stops breathing when falling asleep and has to be reminded to visit the bathroom after drinking a Big Gulp. That's the dilemma faced by parents of children born with congenital central hypoventilation syndrome (CCHS). Afflicting about 250 children in the United States, the genetic disease wreaks havoc in areas of the brain that control involuntary actions such as breathing, fluid regulation and heart function.

Now an MRI study by UCLA scientists reveals that these children's brains display stroke-like damage in regions that regulate the cardiovascular system, body temperature and urination. Published July 11 in the Journal of Comparative Neurology, the research holds important clues for unraveling the mysteries of sudden infant death syndrome (SIDS), sleep apnea and numerous other conditions.

"For a breathing researcher, this syndrome represents a rare opportunity from Mother Nature," explained Ronald Harper, Ph.D., principal investigator and professor of neurobiology at the David Geffen School of Medicine at UCLA. "By using CCHS as a model to study how the brain controls breathing, we hope not only to help children born with the disease, but also provide insights into SIDS and sleep apnea.

"These children's brains don't respond to the same cues as the rest of us, which prevents a host of involuntary mechanisms from kicking in," he added. "Younger children have to be reminded to breathe and to go to the bathroom. They will plop down to relax in front of the TV or a video game, start turning blue and not realize they are passing out."

Some children show disruption of the sympathetic nervous system, which regulates cardiovascular function. They have disturbed heart rates and blood pressure, often profusely sweat or shiver, especially at night, and sometimes faint during strenuous bowel movements. A mild fever can worsen breathing problems and quickly grow life-threatening. The pupil of one eye may constrict, while the other remains dilated.

Harper and his colleagues performed MRI brain scans on 12 children with CCHS and compared their scans to those of 28 healthy children matched by age and gender.

"We were startled to see severe tissue injury in multiple regions of the brains of children with CCHS," said Dr. Rajesh Kumar, first author and UCLA neurobiology researcher. "This damage prevents different parts of the brain from communicating with each other and blocks the nervous system from responding to involuntary reflexes."

Located primarily on the right side of the brain, the damage proved extensive. Tissue loss centered in the brain's emotion areas, which may explain the children's lack of fear to the feeling of suffocation. Damage also appeared in the anterior cingulate, which helps regulate cardiovascular function, blood pressure, heart rate and pain. This region also is involved in recognizing the urge to urinate.

The basal forebrain showed damage, as well. This area contains sensors for carbon dioxide, regulates thirst and body temperature, and plays a role in maintaining sleep.

"Now that we know where the damage exists, scientists can focus on new strategies to help the brain compensate for the injury," said Harper. "For example, we may be able to inject injured areas with nerve growth factors to stimulate the regrowth of lost nerve fibers and recover some functions."

At least 70 percent of CCHS children tested possess a mutation of PHOX2B, a gene related to brain structures that control blood vessel diameter. Harper hypothesizes that the mutated gene prevents normal development of these regions, resulting in narrowing of the blood vessels and inadequate blood flow to the brain sites that control breathing

"We think that insufficient blood flow starves cells of oxygen in the brain structures that regulate breathing," said Harper. "The breathing disorder results from the brain's inability to develop completely."

Parents of children with CCHS are desperate to call attention to the need for research of the mysterious syndrome. The condition forces most young patients to undergo a tracheotomy, an opening in the windpipe, which enables parents to quickly connect children to ventilators at bedtime. A family vacation requires lugging the ventilator on planes and to hotel rooms.

A few years ago, ventilators weren't available, and CCHS children died young. Now ventilators are enabling these children to live past adolescence, when they often unwittingly kill themselves by falling asleep after drinking alcohol. With proper care, CCHS children are now living into their 30s, marrying and having children of their own.

Serotonin appears to modulate circardian rhythm

Sun, 10 Jul 2005 15:41:00 PST

( from http://www.rxpgnews.com ) Researchers at the University of Pennsylvania School of Medicine have determined how serotonin decreases the bodys sensitivity to light and that exposure to constant darkness leads to a decrease in serotonin levels in the brain of fruit flies. These findings suggest that serotonin may play a role in maintaining circadian rhythm, as well as modulating light-related disorders such as seasonal affective disorder (SAD). Senior author Amita Sehgal, PhD, Professor of Neuroscience at Penn and a Howard Hughes Medical Institute (HHMI) Investigator, and colleagues report their findings in the July 7 issue of Neuron.

The bodys 24-hour (circadian) clock controls cycles of wakefulness and sleep, as well as the rhythm of other physiological functions, such as body temperature and blood pressure. Although the body functions on roughly a 24-hour schedule, this cycle is capable of being reset by environmental disturbances. In Sehgals lab, fruit flies provide the model system for examining entrainment, the synchronization of the internal clock to the environment.

In humans, a light pulse in the early evening delays rhythm-if it stays light later, you stay up later, says Sehgal. Disturbances in the late evening advance the body clock-an early dawn leads to an early rise.

Entrainment was tested in flies by exposing them to a pulse of light during the dark period. Closely resembling the body clock adjustment seen in humans, Sehgals flies reset their body clock following the night-time disturbances. However, this adjustment was lessened when the flies were treated with serotonin prior to the test.

Sehgal speculates that serotonin is acting to protect the body clock from being over-responsive to light disturbances. You do not want your clock to be so supersensitive to light that small fluctuations are going to throw it out of whack, she explains. Serotonin appears to modulate the response of the body clock to light.

In flies, a protein called cryptochrome drives the response of the body clock to light. Under normal circumstances, light excites cryptochrome located within the brain, which in turn, interacts directly with the clock protein to reset the clock. Sehgal and colleagues discovered that serotonin works by attaching to the serotonin 1B receptor, altering the activity of another protein, GSK3bß, which further changes the cascade of events leading to the resetting of the clock.

Sehgal points to the clinical implications for understanding the interaction between GSK3ß and serotonin. Lithium, a drug commonly prescribed to treat bipolar disorder, targets GSK3ß. Lithium resets the clock in all organisms that have been examined, explains Sehgal. Assuming that the mechanism works the same way for mammals, the implication would be that antidepressants other than Lithium can also affect the clock.

Sehgal and colleagues also studied the role of serotonin in dark adaptation, the experience of increased sensitivity to light following long periods of darkness. After seven days in constant darkness, flies demonstrated significantly reduced levels of serotonin compared to flies exposed to the normal light-dark cycle. Interpreting the relationship of serotonin as it influences circadian rhythm, Sehgal suggests, In situations of dark adaptation, you may become more sensitive to light because serotonin goes down.

The reduction of serotonin levels in flies kept in constant darkness may provide scientists with insight into the etiology and treatment of SAD, a mood disorder related to reduced sunlight during winter. People with seasonal affective disorder will respond to medications such as Prozac to increase serotonin, says Sehgal. Patients also respond to light therapy. We now believe that light is also increasing serotonin-perhaps this is why both of these treatments are effective.

By identifying the mechanism of interaction between serotonin and the body clock, as well as the environmental factors influencing the levels of serotonin in the brain, Sehgal and colleagues hope to be able to shed light on the possible role of circadian activity on affective disorders. The interplay of serotonin, light, and the circadian system suggests a close relationship between circadian regulation and mental health.

Ramelteon demonstrates no abuse potential

Tue, 24 May 2005 12:42:00 PST

( from http://www.rxpgnews.com ) Results of a clinical study indicated that ramelteon, an investigational compound currently under review by the FDA for insomnia treatment, had no more potential for abuse than placebo in individuals with a history of polydrug abuse. These results, presented at the 2005 American Psychiatric Association Annual Meeting, showed that patients exhibited no abuse potential or behavioral impairment at up to 20 times the proposed therapeutic dose of ramelteon compared to placebo.

"In the treatment of insomnia, drug abuse potential is a significant concern to patients as well as to prescribing physicians," said Roland Griffiths, PhD, Professor in the departments of Psychiatry and Neuroscience, Johns Hopkins Bayview Medical Center, Baltimore, MD. "The chronic nature of some types of insomnia may necessitate treatment for an extended period, underscoring the need for sleep medications with little or no abuse potential."

It is estimated that 60 million Americans suffer from insomnia at least a few nights per week. Most currently prescribed sleep agents and some investigational drugs work by targeting gamma-aminobutyric acid (GABA) receptors, which are located throughout the brain. In pre-clinical studies, ramelteon has shown no affinity for GABA or opiate receptors.

This study was a placebo-controlled, crossover clinical study of fourteen adults with a history of polydrug or multiple-drug abuse. These subjects were entered into a 7-day double-blind treatment period, comparing behavioral effects and abuse potential of ramelteon and triazolam, a benzodiazepine sedative-hypnotic.

During the treatment period, study medication was administered to patients in a randomly-assigned sequence and included:

* ramelteon (16 mg, 80 mg, 160 mg);
* triazolam (0.25 mg, 0.50 mg, 0.75 mg); and,
* placebo.

Measures of "drug-liking," were assessed each day using questionnaires completed at intervals between 0.5 hours pre-dose, up to 24 hours after dose administration. Memory, reaction time and standing balance tasks were also performed at each of these time intervals. Analysis of peak drug-liking scores showed a dose-response effect in patients receiving triazolam, with significantly greater peak liking reported at the higher doses (0.50 mg, 0.75 mg) as compared with placebo. Ramelteon showed no statistically significant dose-related effect compared to placebo.

Results also showed that triazolam treatment (0.50 mg, 0.75 mg) produced a dose related impairment of task performance as compared to that of placebo. Ramelteon did not produce any significant changes in task performance comparative to that of placebo at any dose.

"Obtaining abuse potential results similar to that of placebo is an important step in establishing a safety profile for ramelteon," said Steve Sainati, MD, PhD, vice president of Clinical Research, Takeda Global Research & Development, Lincolnshire, Ill. "Comparing ramelteon's effects versus a benzodiazepine sedative-hypnotic provides information that is valuable scientifically, as well as clinically relevant."

Ramelteon offers a completely new mechanism of action, specifically targeting two receptors in the brain, MT1 and MT2. The MT1 and MT2 receptors are located in the brain's suprachiasmatic nuclei (SCN). The SCN is known as the body's "master clock" because it regulates the 24-hour sleep-wake cycle.

Overworked brains release adenosine to trigger sleep process

Thu, 21 Apr 2005 20:14:00 PST

( from http://www.rxpgnews.com ) Why people get drowsy and fall asleep, and how caffeine blocks that process, are the subjects of a new study by researchers at UT Southwestern Medical Center.

When cells in a certain part of the brain become overworked, a compound in the brain kicks in, telling them to shut down. This causes people to become drowsy and fall asleep. Alter that natural process by adding coffee or tea, and the brain compound called adenosine is blocked, and people stay awake.

These findings, available online and in the April 21 issue of the journal Neuron, offer new clues regarding the function of the brain in the bodys natural sleep process, as well as potential targets for future treatments for insomnia and other sleep problems.

Prolonged increased neural activity in the brains arousal centers triggers the release of adenosine, which in turn slows down neural activity in the arousal center areas. Because the arousal centers control activity throughout the entire brain, the process expands outward and causes neural activity to slow down everywhere in the brain.

Insomnia and chronic sleep loss are very common problems, said Dr. Robert W. Greene, professor of psychiatry and senior author of the study. In addition, all the major psychiatric disorders, including depression, schizophrenia and post-traumatic stress disorder have sleep disruption as a prominent symptom.

If we can understand better some of the factors involved in what makes us normally fall asleep, we can start to understand what might be going wrong when we dont.

Showing that increased brain cell activity triggers drowsiness also explains how caffeine works in helping people fight sleep.

We knew that coffee kept us awake, Dr. Greene said. Now we know why: Coffee and tea are blocking the link between the prolonged neural activity of waking and increased levels of adenosine in cells, which is why they prevent us from getting drowsy.

Past studies by Dr. Greene and his colleagues have shown that adenosine may act as a fatigue factor. When adenosine levels increase in the arousal centers -- as happens with prolonged waking -- mammals tend to fall asleep. But what hasnt been known before is what triggers the release of adenosine to induce sleep.

Neurons in the brain do things -- such as talk to each other, process information and coordinate body activities which are called neural activity, said Dr. Greene. When they do this over a long period of time, more and more adenosine is released and feeds back onto the cells to quiet them down. Its like telling them: You guys have worked too hard; take it easy, and refresh yourselves. "

What we have shown in our study is that its this prolonged neural activity of being awake that causes adenosine levels to go up, which in turn makes a person feel drowsy. Its the brains way of achieving a proper balance between the neural activity of waking and the need for sleep. If something goes wrong with this adenosine system, you may end up with insomnia.

Infant Sleep: A Precursor to Adult Sleep?

Tue, 19 Apr 2005 17:12:00 PST

( from http://www.rxpgnews.com ) Sleep is absolutely essential for well-being. Just ask one of the 40 million Americans with sleep disorders who suffer crippling fatigue, impaired judgment, irritability, moodiness, and myriad health problems. Still, its precise function remains unclear. An intriguing role for REM sleepthe stage most closely associated with dreamingwas suggested almost 40 years ago when sleep researchers Howard Roffwarg and William Dement discovered that babies spend far more time in REM sleep than adultsprompting their hypothesis that infant REM sleep plays a role in central nervous system development.

A central element of their hypothesis revolves around the nature of infant sleep and whether the neural mechanisms of infant sleep differ significantly from those of adult sleep. Infant rats, like the offspring of other altricial species (born naked, helpless, and blind), spend most of their time in whats now called active sleep, indicated by intermittent muscle twitching and low muscle tone (atonia)behaviors characteristic of adult REM sleep. At issue is whether infant mechanisms are primitive, undifferentiated, and distinct from adult mechanisms or whether they contain elementary components that are integrated into the developing sleep system.

In a new study, Karl Karlsson, Mark Blumberg, and their colleagues tackle the technical difficulties involved in studying the tiny neonatal brain to investigate the neural activity associated with infant sleep states. The active sleep of week-old rats, they show, bears a striking resemblance to the conventional definitions of adult sleep. Whats more, the neural mechanisms underlying the infant sleep state contain the primary components of adult sleep.

In previous studies, Karlsson and Blumberg discovered a brainstem region in the ventromedial medulla, which they called the medullary inhibitory area (MIA), that appears functionally equivalent to the region that generates REM atonia in adults. They also found that the MIA doesnt generate infant sleep on its own but depends on a network that spans both lower brainstem and midbrain regions. In this study, the authors set out to identify the neural structures that project to the MIA and better characterize the network.

Karlsson et al. first established that there are neurons that connect to the MIA from areas in the medulla and pons. Then, by recording from neurons in these areas, they found neurons that are active only during sleep or wakefulness and that appear to control muscle tone and twitching. Neurons active mostly during atoniaindicating sleepconcentrated in the subcoeruleus (SubLC) region of the pons; those active mostly during wakefulness clustered in an area within the dorsolateral pontine tegmentum (DLPT) in the midbrain. The authors went on to link different sets of neurons with specific behaviors and brain regions. A group of neurons within the DLPT, for example, showed distinct bursts of activity just before muscle twitching. And a subset of SubLC neurons fired at much higher rates when atonia was accompanied by bouts of tail and neck muscle twitching.

Introducing lesions in the SubLC and another pontine nucleus, called the pontis oralis, caused significant changes in muscle tone and twitching. Lesions in the two pontine nuclei reduced periods of atonia but not the number of muscle twitchesin effect decoupling the key components of REM sleep, twitching and atonia. Lesions in the DLPT had the opposite effect: increased atonia and significantly less muscle twitching.

Altogether, the authors argue, these results show that sleep development elaborates on elementary components already in place soon after birth. If the neural mechanisms of infant and adult sleep were entirely different, then sleep might serve different purposes in infancy and adulthood. But the striking parallels outlined in this study suggest a developmental continuity between the two states. They also chart a course for future study that might even test Roffwargs view that the neonatal brainstem primes the central nervous system for the sensory challenges that lie aheadand could even be the stuff that dreams are made of.

Possible clues to Obesity's association with Insomnia

Tue, 12 Apr 2005 23:31:00 PST

( from http://www.rxpgnews.com ) Unconventional wiring of the brain circuits that govern sleep and waking might explain the prevalence of insomnia and the condition's association with obesity, according to new work published in the April issue of Cell Metabolism. Characterized by a chronic inability to fall asleep or remain sleeping, insomnia is estimated to affect one in every eight Americans.

By finding ways to interfere with that unconventional wiring, scientists may advance on new treatments for insomnia, the researchers said. Natural variation in this brain system might also explain differences among people in their susceptibility to sleep disturbances.

The researchers found that so-called hypocretin neurons--having important roles in both arousal and appetite--lack the ability of most neurons to filter "noise" from signal, reported Tamas Horvath and Xiao-Bing Gao of Yale University School of Medicine. The neurons also rapidly reorganize themselves, becoming even more excitable, in response to stresses such as food deprivation, they found.

"The cell bodies of most neurons act as a filter," sorting through a multitude of signals to eliminate noise and generate an appropriate response, Horvath said. "In contrast, it appears that the basic wiring of hypocretin neurons allows noise to become the major signal."

As obesity has reached epidemic proportions, the incidence of insomnia and sleep deprivation has also risen. Studies of this apparent insomnia-obesity association have suggested a causal link between the two, but the underlying mechanism has remained unclear. The new findings of hypocretin neurons offer some possible clues, Horvath said.

Scientists discovered hypocretin neurons while studying narcolepsy, a condition marked by sudden bouts of deep sleep. Narcolepsy generally stems from a shortage or malfunction of hypocretin neurons. The neurons also induce appetite, an important activity for the control of food intake. Yet the integration of the brain cells' roles in arousal and appetite remains largely unexplored, Horvath said.

In a series of experiments in brain slices and in mice, the researchers examined the organization and stability of inputs to hypocretin cell bodies, which act as filters in other brain cells. They found that hypocretin neurons have an "unorthodox" organization in which excitatory currents exert control on nerve cell bodies with minimal inhibitory inputs to filter them.

Overnight food deprivation promoted the formation of more excitatory inputs. Those new inputs were reversed upon refeeding, they reported, an indication of the extreme plasticity of the hypocretin system to prevailing conditions.

That sensitivity and adaptability makes sense, given the neurons' role as the body's natural alarm, rousing one from slumber in response to external cues, Horvath said. However, the structure of the system might also explain the prevalence of sleep disorders and, perhaps, the associated rise in obesity.

"In an evolutionary sense, the response of the hypocretin system to small stimuli would have been necessary for survival," he said. "But in today's chronically stressful environment, the circuitry may also be an underlying cause of insomnia and associated metabolic disturbances, including obesity."

Music improves sleep quality in older adults

Thu, 07 Apr 2005 18:17:00 PST

( from http://www.rxpgnews.com ) Sleep, a vital ingredient in life, can sometimes become difficult as humans get older. But a recent study by researchers at Case Western Reserve University's Frances Payne Bolton School of Nursing and the Buddhist Tzu-Chi General Hospital in Taiwan shows that listening to soft music at bedtime will help older adults sleep better and longer.

The research, published in the February 2005 edition of The Journal of Advanced Nursing, found that older people with sleep problems reported a 35 percent improvement after they started listening to 45 minutes of soft music before bedtime. Researchers Hui-Ling Lai, director of the Community Health Center at the Buddhist Tzu-Chi General Hospital, an assistant professor at Tzu Chi University in Taiwan and Case alumna, and Marion Good, professor of nursing at Case, studied the sleeping patterns of 60 people aged 60-83, randomly designating them in equal numbers into a music group and a control group. They discovered that the 30 who had listened to carefully selected music experienced physical changes that aided restful sleep. These included lower heart and respiratory rates.

"The difference between the music group and the control group was clinically significant," said Lai, lead author of the study. "The music group reported a 26 percent overall improvement in the first week and this figure continued to rise as they mastered the technique of relaxing to the sedative music."

Participants in the study were older adults with sleep difficulties who lived in central Taiwan. Those with certain medical conditions were excluded, as were people taking sleep medication, drinking high levels of caffeine or using existing relaxation techniques such as meditation.

The music group was able to choose from six tapes that featured soft, slow music. These included one tape of Chinese folk music and five that had been found effective for reducing postoperative pain in research conducted by Good.

Good, one of the country's leading researchers of drug-free methods to reduce postoperative pain, has found in previous studies that the combination of relaxation and music relieved postoperative abdominal pain significantly more than painkillers.

Sleep quality was measured in the music group before they started using the technique and then monitored over the three-week study period. The sleep quality of the control group, who did not use the music tapes, also was assessed over the same period.

People in the music group showed significantly better scores in overall sleep quality and in five of the six subcategories used to measure sleep quality. These included better and longer nighttime sleep and less dysfunction during the day. The only element that did not improve after listening to music was sleep disturbance.

"Music is pleasant and safe and the technique we used in our study is quick and easy to learn is low cost, and could be used readily by nurses," Good said. "It is easy to use and does not cause side effects."

Sleep disorders can result in tiredness, fatigue, depression, greater anxiety, irritability, pain sensitivity, muscle tremors and lack of daytime alertness. Lai and Good explain that although there is much research about sleep, few studies have focused on the effects of music in improving sleep quality, particularly in older adults.