Are the "Sleep Disturbing" Pills You Are Taking Actually Worsening Your Sleep?

Do patients with intake of drugs labelled as sleep 

disturbing really sleep worse? A population 

based assessment from the Heinz Nixdorf Recall Study.

1. Anna-Therese Lehnich^1,*, 
2. Bernd Kowall¹,
3. Oliver Kuß², 
4. Andrea Schmidt-Pokrzywniak³, 
5. Gerhard Weinreich⁴, 
6. Nico Dragano⁵,
7. Susanne Moebus¹, 
8. Raimund Erbel¹, 
9. Karl-Heinz Jöckel¹ and
10. Andreas Stang^1,6

DOI: 10.1111/bcp.13015

Abstract from study discussing the efficacy of the claim that drugs labelled as "sleep disturbing" actually worsen sleep. -JR

http://www.helpguide.org/images/sleep/sleeping-pills-350.jpg

Keywords:

• adverse drug reaction;
• drug intake;
• sleep disturbances;
• summary of product characteristics

Aim

The sleep disturbing effect of many drugs is derived from clinical trials with highly selected patient collectives. However, the generalizability of such findings to the general population is questionable. Our aim was to assess the association between intake of drugs labelled as sleep disturbing and self-reported nocturnal sleep disturbances in a population-based study.

Methods

We used data of 4,221 participants (50.0% male) aged 45 to 75 years from the baseline examination of the Heinz Nixdorf Recall Study in Germany. The interview provided information on difficulties falling asleep, difficulties maintaining sleep and early morning arousal. We used the summary of product characteristics (SPC) for each drug taken and assigned the probability of sleep disturbances. Thereafter, we calculated cumulative probabilities of sleep disturbances per subject to account for polypharmacy. We estimated prevalence ratios (PR) using log Poisson regression models with robust variance.

Results

The adjusted PRs of any regular nocturnal sleep disorder per additional sleep disturbing drug were 1.01 (95% confidence interval (CI): 0.97-1.06) and 1.03 (95% CI: 1.00-1.07) for men and women, respectively. Estimates for each regular nocturnal sleep disturbance were similarly close to 1. PRs for regular nocturnal sleep disturbances did not increase with rising cumulative probability for drug-related sleep disturbances.

Conclusions

SPC-based probabilities of drug-related sleep disturbances showed barely any association with self-reported regular nocturnal sleep disturbances. We conclude that SPC-based probability information may lack generalizability to the general population or may be of limited data quality.

FULL STUDY HERE:

Do patients with intake of drugs labelled as sleep disturbing really sleep worse? A population based assessment from the Heinz Nixdorf Recall Study. (n.d.). Retrieved June 20, 2016, from http://onlinelibrary.wiley.com/doi/10.1111/bcp.13015/abstract

Study: Frequent social media use linked to sleep disturbance

A recent study links frequent social media use is linked to sleep disturbances.

Young adults who spend a lot of time on social media during the day or check it frequently throughout the week are more likely to suffer sleep disturbances than their peers who use social media less, according to new research from the University of Pittsburgh School of Medicine.

Published online and scheduled for the April issue of the journal Preventive Medicine, the study indicates that physicians should consider asking young adult patients about social media habits when assessing sleep issues. The research was supported by the National Institutes of Health (NIH).

"This is one of the first pieces of evidence that social media use really can impact your sleep," said lead author Jessica C. Levenson, Ph.D., a postdoctoral researcher in Pitt's Department of Psychiatry. "And it uniquely examines the association between social media use and sleep among young adults who are, arguably, the first generation to grow up with social media."

In 2014, Dr. Levenson and her colleagues sampled 1,788 U.S. adults ages 19 through 32, using questionnaires to determine social media use and an established measurement system to assess sleep disturbances.

The questionnaires asked about the 11 most popular social media platforms at the time: Facebook, YouTube, Twitter, Google Plus, Instagram, Snapchat, Reddit, Tumblr, Pinterest, Vine and LinkedIn.

On average, the participants used social media a total of 61 minutes per day and visited various social media accounts 30 times per week. The assessment showed that nearly 30 percent of the participants had high levels of sleep disturbance.

The participants who reported most frequently checking social media throughout the week had three times the likelihood of sleep disturbances, compared with those who checked least frequently. And participants who spent the most total time on social media throughout the day had twice the risk of sleep disturbance, compared to peers who spent less time on social media.

"This may indicate that frequency of social media visits is a better predictor of sleep difficulty than overall time spent on social media," Dr. Levenson explained. "If this is the case, then interventions that counter obsessive 'checking' behavior may be most effective."

Senior author Brian A. Primack, M.D., Ph.D., assistant vice chancellor for health and society in Pitt's Schools of the Health Sciences, emphasized that more study is needed, particularly to determine whether social media use contributes to sleep disturbance, whether sleep disturbance contributes to social media use -- or both.

For example, social media may disturb sleep if it is:

• Displacing sleep, such as when a user stays up late posting photos on Instagram.
• Promoting emotional, cognitive or physiological arousal, such as when engaging in a contentious discussion on Facebook.
• Disrupting circadian rhythms through the bright light emitted by the devices used to access social media accounts.

Alternatively, young adults who have difficulty sleeping may subsequently use social media as a pleasurable way to pass the time when they can't fall asleep or return to sleep.

"It also may be that both of these hypotheses are true," said Dr. Primack, also director of Pitt's Center for Research on Media, Technology and Health. "Difficulty sleeping may lead to increased use of social media, which may in turn lead to more problems sleeping. This cycle may be particularly problematic with social media because many forms involve interactive screen time that is stimulating and rewarding and, therefore, potentially detrimental to sleep."

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Sleep disorders are more common in racial/ethic minorities

According to a recent study, sleep disturbances occur more frequently in middle-aged and older adults who are racial or ethnic minorities.

A new study suggests that sleep disturbances and undiagnosed sleep apnea are common among middle-aged and older adults in the U.S., and these sleep problems occur more frequently among racial/ethnic minorities.

Results show that 34 percent of participants had moderate or severe sleep-disordered breathing measured by polysomnography, and 31 percent had short sleep duration with less than 6 hours per night measured by actigraphy. Validated questionnaires also showed that 23 percent reported having insomnia, and 14 percent reported excessive daytime sleepiness. Only 9 percent of participants reported being told by a doctor that they had sleep apnea.

After adjustment for sex, age, and study site, blacks were most likely to have short sleep duration of less than six hours, and they were more likely than whites to have sleep apnea syndrome, poor sleep quality, and daytime sleepiness. Hispanics and Chinese were more likely than whites to have sleep-disordered breathing and short sleep duration, but Chinese were least likely to report having insomnia.

"Our findings underscore the very high prevalence of undiagnosed sleep disturbances in middle-aged and older adults, and identify racial/ethnic disparities that include differences in short sleep duration, sleep apnea and daytime sleepiness," said lead author Dr. Xiaoli Chen, research fellow in the Department of Epidemiology at Harvard T.H. Chan School of Public Health in Boston.

Study results are published in the June issue of the journalSleep.

The study population was recruited from six U.S. communities and comprised 2,230 racially/ethnically diverse men and women who were between the ages of 54 and 93 years. Data gathered by polysomnography, actigraphy and validated questionnaires were obtained between 2010 and 2013.

According to Dr. Chen and her colleagues, this is the first study that has comprehensively evaluated objective measures of sleep apnea, short sleep, and poor sleep, as well as subjective measures of habitual snoring, insomnia, and daytime sleepiness in a multi-ethnic U.S. population that includes Chinese Americans. Results suggest that sleep disturbances may contribute to health disparities among U.S. adults.

"As sleep apnea has been implicated as a risk factor for cardiovascular disease, stroke, diabetes, and mortality, our findings highlight the need to consider undiagnosed sleep apnea in middle-aged and older adults, with potential value in developing strategies to screen and improve recognition in groups such as in Chinese and Hispanic populations," said senior author Dr. Susan Redline, professor of medicine at Harvard Medical School and Division of Sleep Medicine at Brigham and Women's Hospital and Beth Israel Deaconess Medical Center in Boston. The study was supported by grants from the National Institutes of Health (NIH) and an award from the National Center for Advancing Translational Sciences (NCATS).

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Study: Children can experience disturbed sleep after traumatic brain injury

A study indicates that children's sleep can be disturbed following a traumatic brain injury.

Children who sustain traumatic brain injury (TBI) are more likely to experience greater daytime sleepiness, sleep disturbances, and poorer overall sleep quality, and to have impaired emotional, physical, and social functioning, when compared with children without TBI, a small study suggests.

"For clinicians treating children with TBI, it's worth asking children or their parents about their sleep," principal investigator Kimberly Allen, PhD, RN, from the Center for Narcolepsy, Sleep and Health Research, Department of Women Children and Family Health Science, University of Illinois-Chicago, noted in an interview withMedscape Medical News.

She presented the study at SLEEP 2015: the Annual Meeting of the Associated Professional Sleep Societies.

Research Gaps

Pediatric TBI is common. Each year in the United States over 500,000 children are admitted to the hospital with a TBI. The short- and long-term consequences can include motor and sensory impairments; cognitive, emotional, and psychosocial impairments; and sleep problems, although sleep is less well studied, Dr Allen said.

She and her colleagues assessed the sleep of 15 children with TBI (3 with mild TBI, 5 with moderate TBI, 6 with severe TBI, and 1 with unknown TBI severity) compared with that of 15 healthy children, matched on age, race, and maternal education level. The children were about 11 years of age on average. Those with TBI were an average of 594 days post-injury (range, 26 to 1076 days).

As hypothesized, compared with healthy children, children with TBI demonstrated statistically significant increases in daytime sleepiness on the modified Epworth Sleepiness Scale (P = .03), poorer sleep quality on the Child Sleep Wake Scale (P = .001), and poorer functional status on the Pediatric Quality of Life Inventory (P < .001). Overall, the effect sizes were "high and clinically relevant," the researchers note in their poster.

"Sleep is something physicians need to ask about in children with TBI," Dr Allen said.

She noted that "in most studies of pediatric TBI and sleep, sleep has been a secondary aim, not a primary aim," and they haven't used standardized sleep measures.

"This study," Dr Allen said, "provides a first glance at what children with TBI look like in terms of sleep compared to their peers that are healthy, typically developing children. We need more research in this area."

It should be noted, she added, that most children with TBI were hospitalized for more than 1 week and required rehabilitation, which may play a role in why they experienced daytime sleepiness, poorer sleep quality, and poorer functional status.

"Important" Study

Reached by email for comment, Suresh Kotagal, MD, consultant in neurology, pediatrics and sleep medicine, Mayo Clinic, Rochester, Minnesota, said, "The results are important as they address an important gap in pediatric sleep medicine, i.e., hypersomnia, that develops after head injury."

Dr Kotagal, who wasn't involved in the study, said there are likely "multiple factors underlying excessive daytime sleepiness after head injury. To start with, one has to consider variables prior to trauma that can impact sleep such as hyperactivity and anxiety. The head injury itself could also lead to central neurotransmitter imbalance or hypocretin deficiency that predispose to drowsiness. Medications utilized in head injured children such as antiepileptic drugs and antispasticity agents like baclofen can also contribute to drowsiness."

"Pediatric physical medicine and rehabilitation programs need to pay more attention to post-traumatic hypersomnia as an important treatable symptom that influences cognitive function and the overall quality of life," Dr Kotagal told Medscape Medical News.

Shalini Paruthi, MD, fellow of the American Academy of Sleep Medicine and director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children's Medical Center, St. Louis, Missouri, toldMedscape Medical News that sleep in children with TBI "hasn't been studied enough, so it's great to have this pilot data. Being able to recognize that sleep problems might be part of the TBI effects is very important."

"As part of comprehensive care for our kids who have traumatic brain injuries, we should also be thinking about their sleep. Better sleep may have an impact on healing. We don't know that yet, but it's possible," added Dr Paruthi, who wasn't involved in the study.

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Military members and sleep problems

This article discusses the importance of sleep for members of the military, especially post-deployment.

Improving the quality and quantity of U.S. military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new RAND Corporation study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

The report can be found online at:http://www.rand.org/pubs/research_reports/RR739.html

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Differences in sleep issues between women and men

This article explains the differences in sleep issues faced by women and men.

As a nation we are severely sleep-deprived. According to data from the Centers for Disease Control and Prevention, as much as a third of all Americans do not get the recommended seven hours of sleep a night.

"One of the myths is that we can power through or sleep when we're dead," Dr. Charles Czeisler, chair of the National Sleep Foundation and director of sleep medicine at Harvard Medical School, told "CBS This Morning." "But of coursewe'll get there faster if we don't get enough sleep. "

Women and men run into different roadblocks when it comes to their quest for a good night's sleep.

Women are more likely to toss and turn frequently and fight bouts of insomnia, a result of differences in hormonal regulation. Estrogen tends to shorten the length of the sleep cycle, which is why women often report that they experience sleep troubles around the time of menstruation, pregnancy or menopause.

According to a poll taken by the National Sleep Foundation, 63 percent of women versus 54 percent of men experience insomnia at least few nights a week. Women are also more likely to experience daytime sleepiness.

"One of the things is the internal clock controls the timing of sleep," said Czeisler. "It runs faster in women than it does men. It's only about a tenth of an hour but it adds up so that women, in general, their internal clocks are set to about an hour or an hour and half earlier than men, and that means it wakes them up earlier in the morning and it's harder to stay awake in the evening."

On the other hand, anatomical differences in men mean they're more likely to have sleep apnea -- a result of more fat deposit around the neck. Approximately 17 percent of men and 9 percent of women are diagnosed with sleep apnea, a type of sleep disorder that is caused by infrequent or paused breathing.

"If you crowd out the airway then you're going to have trouble when you sleep," said Czeisler. "One out of 3 men and about 1 out of 6 women suffer from disturbed sleep disordered breathing. But unfortunately, because it tends to be viewed as a male dominated disease women are much less likely to be diagnosed. Only 1 out of 10 women compared with men get diagnosed for sleep apnea."

Regardless of these challenges, everyone can take a number of measures to avoid sleep deprivation. Czeisler says good sleep hygiene is essential, such as going to bed at the same time each night to regulate your circadian rhythm. Some people find it helpful to set an alarm for bedtime. Creating a bedroom that's conducive to sleeping is also essential: remove all electronics from the bedroom and keep your room cool and dark.

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Study: Self-reported sleep issues increase Alzheimer's riskhttp://i.dailymail.co.uk/i/pix/2012/03/01/article-2108664-11FCB218000005DC-905_468x338.jpg

According to a study, older males self-reporting sleep issues increases his risk of developing Alzheimer's disease.

In a new study, researchers from Uppsala University demonstrate that elderly men with self-reported sleep disturbances run a higher risk of developing Alzheimer's disease than men without self-reported sleep disturbances. The results are published in the scientific journal Alzheimer's & Dementia.

The researchers followed more than 1,000 men, who were initially 50 year old, between the years 1970 and 2010. The results of the study show that self-reported sleep disturbances were linked to an increased risk for Alzheimer's disease during the 40-year follow-up period, particularly if they occurred late in life. The data suggest that a regular good night's sleep could support brain health in men.

'We demonstrate that men with self-reported sleep disturbances run a 1.5-fold higher risk to develop Alzheimer's disease than those without reports of sleep disturbances during a 40-year follow-up period. The later the self-reported sleep disturbance was found the higher the risk was for developing Alzheimer's disease. These findings suggest that strategies aimed at improving sleep quality in late life may help reduce the risk to develop Alzheimer's disease', says Christian Benedict, sleep researcher at Uppsala University, who led the study.

"Importantly, there are several lifestyle factors, such as exercise, that can influence your brain's health. Thus, it must be borne in mind that a multifaceted lifestyle approach comprising good sleep habits is essential for maintaining brain health as you age," says Christian Benedict.

In an earlier article published in the journal Sleep, Christian Benedict and colleagues showed that a single night of total sleep deprivation increased blood concentrations of brain molecules in young men that typically rise in blood upon acute brain damage.

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Do weighted blankets help children with autism sleep?

This article discusses a study about the effect of weighted blankets and if they help children's sleep who have autism. While no clinical differences were found, the children and their parents did notice a positive difference.

Children with autism spectrum disorders (ASDs) have much higher rates of sleep disturbance than do typically developing children. Weighted blankets are an intervention widely accepted by families to improve sleep quality for children with ASDs, but the evidence supporting their use is limited. This study was conducted at three clinical sites in England, enrolling children aged 5-16 years with a diagnosis of ASD. All children had a reported disturbance in sleep for at least 5 months prior to enrollment. Sleep disturbances included sleep latency (delay of falling asleep of at least 1 hour after "lights out") and receiving fewer than 7 hours of continuous sleep.

The investigators chose a single manufacturer to make both the weighted and the "placebo" blankets. Two different sizes were used, depending on the age and size of the child. The small weighted blanket weighed 2.25 kg, and the larger blanket weighed 4.5 kg. Control blankets were made of the same material, but plastic beads were inserted into the blanket instead of the typical steel shot. This controlled for the insulating effect of a blanket during sleep, and the embedded beads provided similar tactile stimulation but without the inclusion of the weight.

The children were randomly assigned 1:1 to begin with either the intervention or placebo blanket. During the treatment phases, the children used the blanket for 12-16 nights. After completion of one treatment phase, the children then crossed over to using the other blanket for another 12-16 nights of monitoring. During each treatment phase, parents and children (if old enough) completed sleep diaries that measured sleep latency, duration of sleep, and parental perceptions of sleep quality. Children also wore electronic devices (accelerometers) on the nondominant hand that measured movement, with still times being considered "sleep" and times of movement above predesignated thresholds being labeled as "awake." This allowed the investigators to calculate the total sleep time, which was the primary outcome of interest. The parental measures of sleep duration and quality were secondary outcomes. The parents and children also completed subjective evaluations of the acceptability of the blankets.

They enrolled 67 children in the trial, approximately 80% of whom were boys. At enrollment, more than 80% of the children experienced sleep latency, 53% experienced poor sleep maintenance, and 43% experienced both sleep problems. The final analytic cohort included 64 children; dropout was similar in both groups. The average sleep latency during treatment phases was 77.1 minutes, and the average total sleep time was 453 minutes (7.5 hours). There were no significant differences when looking at within-subject differences in total sleep time during weighted blanket vs unweighted blanket intervention periods. The total sleep time was 454.4 minutes when the children used weighted blankets compared with 457.7 minutes when using placebo blankets. Mean sleep latency was 74.3 minutes with the weighted blanket compared with 69.9 minutes with the control blanket, a difference that did not reach statistical significance. The average time awake after sleep onset (84 minutes) was virtually identical between the two groups. Parental estimates of sleep duration during weighted and unweighted blanket treatment phases did not differ. Children clearly favored the weighted blanket over the unweighted blanket when asked about general likability (48% vs 31%), and the parents believed that sleep was improved using the weighted blanket compared with the unweighted blanket (51% vs 16%). Moreover, parents judged that the weighted blanket made their child calmer (35% vs 14%) than the unweighted blanket. The investigators concluded that the weighted blankets provided no clinically measurable benefit for sleep measurements in these children, including parental assessments of sleep duration and sleep latency. However, parents and children both reported preferring the weighted blankets.

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Study: Sleep issues common for children with psychiatric disorders

A study found that sleep issues are more common for children with a psychiatric disorder.

John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties - particularly problems with falling asleep - were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings – collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschooladjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization," said Boekamp.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp. "Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment."

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What causes sleep issues for Parkinson's patients?

This article discusses the link between Parkinson's disease and sleep issues, and what may cause sleep issues for people with Parkinson's disease.

Up to 70% of Parkinson’s disease (PD) patients experience sleep problems that negatively impact their quality of life. Some patients have disturbed sleep/wake patterns such as difficulty falling asleep or staying asleep, while other patients may be subject to sudden and involuntary daytime sleep “attacks.” In the extreme, PD patients may exhibit REM-sleep behavior disorder (RBD), characterized by vivid, violent dreams or dream re-enactment, even before motor symptoms appear. A review in the Journal of Parkinson’s Disease discusses the underlying causes of sleep problems in PD, as well as medications, disease pathology, and comorbidities, and describes the most appropriate diagnostic tools and treatment options.

Sleep problems in PD patients can have wide-ranging adverse effects and can worsen in later stages of the disease. Sleepiness socially isolates patients and excessive sleepiness can put patients at risk of falls or injury, and can mean patients must give up driving. Sleepiness can impair cognition and concentration, exacerbate depression, and interfere with employment. Wakefulness at night impairs daytime wakefulness and may also cause mood instabilities and can exhaust caregivers.

“Diagnosis and effective treatment and management of these problems are essential for improving the quality of life and reducing institutionalization of these patients,” says lead author Wiebke Schrempf, MD, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Neurology, Division of Neurodegenerative Diseases, Dresden, Germany.

Dr. Schrempf and colleagues describe some of the complexities associated with treating sleep problems in PD patients, such as the worsening of sleep problems by dopaminergic medications used to treat motor symptoms. Lower doses of levodopa or dopamine agonists are able to improve sleep quality partly by reducing motor symptoms such as nighttime hypokinesia (decreased body movement), dyskinesia (abnormal voluntary movements), or tremor (involuntary shaking), which interfere with normal sleep. However, the same medications may also cause excessive daytime sleepiness. The report describes how changing medication, dose, duration of treatment, or timing of administration can improve outcomes.

The presence of other conditions common in PD patients such as depression, dementia, hallucinations, and psychosis may interfere with sleep. Unfortunately, some antidepressants can also impair sleep.

Sleep problems may also be harbingers of future neurodegenerative disease. Patients with RBD exhibit intermittent loss of normal muscle relaxation during REM sleep and engage in dream enactment behavior during which they may shout, laugh, or exhibit movements like kicking and boxing. “RBD seems to be a good clinical predictor of emerging neurodegenerative diseases with a high specificity and low sensitivity, whereas other early clinical features of PD, such as olfactory dysfunction and constipation, are less specific,” says Dr. Schrempf. “These early clues may help identify PD patients before motor symptoms appear, when disease-modifying therapies may be most beneficial.”

PD is the second most common neurodegenerative disorder in the United States, affecting approximately one million Americans and five million people worldwide. Its prevalence is projected to double by 2030. The most characteristic symptoms are movement-related, such as involuntary shaking and muscle stiffness. Non-motor symptoms, such as worsening depression, cognition, and anxiety, olfactory dysfunction, and sleep disturbances, can appear prior to the onset of motor symptoms.

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How to treat sleep problems following a concussion

New clinical guidelines have been released regarding how to treat sleep problems in people following a concussion.

The Defense and Veterans Brain Injury Center has released new clinical recommendations and support tools to assist in the identification and treatment of a sleep disturbance occurring in patients after a concussion (mild traumatic brain injury or mTBI). The suite of products assists health care providers in the identification of a sleep problem and provides recommendations for its treatment.
"Sleep disorders are common after a person sustains a concussion," said Col. Sidney Hinds, II, M.D., Defense and Veterans Brain Injury Center's, or DVBIC's, national director. "The prompt identification and treatment of sleep disorders are an important part of the recovery process for concussion. Sleep is critical to the brain's healing and recovery processes. Research shows that if sleep is regular and adequate, restorative processes are promoted." 

Since 2000, more than 300,000 U.S. service members have sustained a traumatic brain injury.

Common sleep disorders associated with traumatic brain injury, referred to as TBI, include insomnia, circadian rhythm sleep wake disorder and obstructive sleep apnea. Insomnia is the most common sleep disturbance after concussion.

The new Management of Sleep Disturbances following Acute Concussion/Mild TBI Clinical Recommendations suite is composed of clinical recommendations, a clinical support tool, a provider education slide deck and a patient education fact sheet.

"These clinical recommendations advise that all patients with concussion symptoms should be screened for the presence of a sleep disorder," said U.S. Public Health Service Capt. Cynthia Spells, DVBIC's clinical affairs officer. "Patients should be asked if they are experiencing frequent difficulty in falling or staying asleep, excessive daytime sleepiness or unusual events during sleep. The initial step in the diagnosis of a sleep disorder includes a focused sleep assessment."

Non-pharmacological measures to treat insomnia that focus on stimulus control and good sleep hygiene are the preferred methods of treatment. Short-term use of sleep medication may be necessary in addition to these measures if they are not effective by themselves.

Spells said stimulus control means controlling your environment to help promote sleep. Examples of stimulus control measures include relaxing before bedtime, going to bed only when sleepy, getting out of bed when unable to sleep, removing electronics (TV, smart phone, computer) from the bedroom and using the bedroom only for sleep and intimacy.

Sleep hygiene habits include avoiding caffeine and other stimulants close to bedtime, daily physical activity but not exercising close to bedtime, arising at the same time every morning, getting natural light exposure every day, and avoiding alcohol, nicotine and large meals close to bedtime.

Spells said the new sleep disturbance clinical recommendations and support tool product suite was developed by the Department of Defense in collaboration with the Department of Veterans Affairs and civilian medical professionals.

"Although tailored for the military and VA health care systems, these recommendations may be used by civilian health care providers treating concussion associated sleep disorders," Spells said. "Many service members and veterans, especially those serving in the National Guard and Reserve, receive care from civilian health care specialists." 

DVBIC serves as the Department of Defense subject matter expert on TBI and manager of the TBI pathway of care.
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Kids who are bullied can have nightmares years later

A study looked into kids who were bullied and found they have nightmares and night terrors years after being bullied.

New research suggests that kids who are bullied when they're younger may be more likely to suffer from nightmares and night terrors a few years later.

However, bullies themselves don't appear to face any higher risk of disturbed sleep.

"They sleep solidly," said study author Dieter Wolke, a professor of developmental psychology and individual differences at the University of Warwick in England. "That is clearly different than what most people think. They are not disturbed thugs, but calculated manipulators."

The study has weaknesses. Its design doesn't allow researchers to compare the percentages of children -- bullied or not-bullied -- who have bad dreams. And researchers can't be certain that being bullied at a younger age directly causes nightmares a few years later. It's possible that some other factor is responsible.

Still, "there is a clear association" between being bullied and having nightmares and night terrors, the researchers found.

What's a night terror? It's when a child gets "stuck" between stages of sleep and may scream and thrash around. "They're nearly impossible to wake and won't remember the episode the next morning," Wolke said.

For the study, the researchers examined surveys of over 6,400 children in the United Kingdom. The children answered questions about bullying at ages 8 and 10, and about sleep problems at age 12.

Overall, 24 percent of the kids had nightmares and 9 percent had night terrors. Even after the investigators adjusted the statistics in the study so they wouldn't be thrown off by high or low numbers of children who had issues such as psychiatric problems, those who'd been bullied when they were younger were still more likely to have these kinds of sleep problems at age 12.

Not all kids who have nightmares or other sleep problems are being bullied. However, among those who do, the level of extra risk of bullying is "moderate," Wolke said.

Could the nightmares be the problem that contributes to bullying by, say, causing kids to be more anxious and seen as vulnerable? Wolke said the study findings don't suggest that possibility.

Robert Faris, an associate professor of sociology at the University of California, Davis, said the study appears to be valid and fits in with previous research that has linked bullying to stress, anxiety and depression. "It does seem likely that anxiety would play a role in nightmares," he said.

What to do? "It is important for pediatricians and doctors to be aware of this relationship," study author Wolke said, and ask about bullying when kids have sleep problems. "Identifying and helping children who are being bullied would eliminate potential mental health problems in the future," he said.

But Faris pointed out that many victims of bullying -- perhaps more than half -- don't feel comfortable telling their parents about what's going on, often because they feel their parents can't do anything about it.

That may indeed be the case, he said. Still, this study suggests that parents of kids who have chronic nightmares should be aware that this behavior may be a sign that their child is being bullied, Faris said.

What if a parent doesn't think their child will open up? "Don't ask directly about whether they're being bullied, but engage in some more subtle conversations instead," Faris suggested. "And pay attention to what's going on with their interactions with friends."

The findings are to be presented Saturday at the annual meeting of the Pediatric Academic Societies in Vancouver. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Chronic sleep disturbance could mean early Alzheimer's or dementia

A study shows that chronic sleep disturbance could indicate an early onset of Alzheimer's or dementia.

People who experience chronic sleep disturbance -- either through their work, insomnia or other reasons -- could face an earlier onset of dementia and Alzheimer's, according to a new pre-clinical study by researchers at Temple University.

"The big biological question that we tried to address in this study is whether sleep disturbance is a risk factor to develop Alzheimer's or is it something that manifests with the disease," said Domenico Praticò, professor of pharmacology and microbiology/immunology in Temple's School of Medicine, who led the study.

Initially, the researchers looked at longitudinal studies which indicated that people who reported chronic sleep disturbances often developed Alzheimer's disease.

For the study, they used a transgenic Alzheimer's mouse model that begins developing memory and learning impairment at about one year -- the equivalent of a human that is mid-50-60 years in age -- and at 14-15 months have the typical human brain pathology of Alzheimer's, including amyloid plaques and tau protein tangles, the two major brain pathological/lesion signatures for the disease.

The eight week study began when the mice were approximately six months old, or the equivalent of an adult human in their 40s. One group of mice was kept on a schedule of 12 hours of light and 12 hours of darkness, while a second group was subjected to 20 hours of light and only four hours of darkness, greatly reducing their amount of sleep.

"At the end of the eight weeks, we didn't initially observe anything that was obviously different between the two groups," said Praticὸ, who is also a member of Temple's Center for Translational Medicine. "However, when we tested the mice for memory, the group which had the reduced sleep demonstrated significant impairment in their working and retention memory, as well as their learning ability."

The researchers then examined the mice's brains to look at the different aspects of the Alzheimer's pathology -- mainly the amyloid plaques and tau protein tangles.

"Surprisingly, we didn't see any difference between the two groups in the amyloid plaques," noted Praticὸ. "However, we did observe that the sleep disturbance group had a significant increase in the amount of tau protein that became phosphorylated and formed the tangles inside the brain's neuronal cells."

Tau protein acts as an important component for neuronal cell health, but elevated levels of phosphorylated tau can disrupt the cells' synaptic connection or ability to transport a nutrient/chemical or transmit an electrical signal from one cell to another, said Praticò.

"Because of the tau's abnormal phosphorylation, the sleep deprived mice had a huge disruption of this synaptic connection," he said. "This disruption will eventually impair the brain's ability for learning, forming new memory and other cognitive functions, and contributes to Alzheimer's disease."

Praticὸ said that since the sleep deprived mice developed the Alzheimer's brain pathology earlier than the mice who were not deprived, sleep disturbance acts as a trigger that accelerates the pathological process of tau becoming phosphorylated and irreversibly damaging the synaptic connection.

"We can conclude from this study that chronic sleep disturbance is an environmental risk factor for Alzheimer's disease," he said. "But the good news is that sleep disturbances can be easily treated, which would hopefully reduce the Alzheimer's risk."

The researchers published their findings, "Sleep deprivation impairs memory, tau metabolism and synaptic integrity of a mouse model of Alzheimer's disease with plaques and tangles," in the journal Neurobiology of Aging.

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Too much computer time makes autistic children sleep less

Autistic children are prone to sleep disorders, and excess screen time could add to the likelihood of sleep disorders in these children.

Kids with autism and related disorders are prone to sleep disturbances but a new study finds that screen time, especially in the bedroom, may make their sleep problems worse.

When researchers compared boys with autism spectrum disorders (ASD) to other boys, they found that all the kids with bedroom access to media slept fewer hours, but the relationship was twice as strong for the boys with autism.

"In-room media access was associated with about 1.5 fewer hours of sleep per night in the group with autism," said Christopher R. Engelhardt, who led the study at the University of Missouri-Columbia.

"This association can potentially be problematic, particularly if the reduction in sleep interferes with other daily activities, such as school, homework, interactions with other people, or driving," he told Reuters Health in an email.

Past studies suggest that up to 80% of kids with autism, and related conditions like Asperger's disease, experience sleep troubles, including difficulty falling asleep or staying asleep through the night.

Hormone melatonin

Children with attention deficit hyperactivity disorder (ADHD) also are known to have a high rate of sleep disturbances. With both conditions, it's unclear why sleep is so difficult.

Theories include a disruption in sleep-wake cycles that are regulated by the hormone melatonin, which is often deficient in kids with ASDs, Engelhardt and his colleagues write in Paediatrics.  Because kids with autism spectrum disorders, like those with ADHD, also tend to spend a lot of time watching TV and playing video or computer games, the researchers wondered whether that could be contributing to their sleep problems.

So they recruited the parents of 49 boys with autism spectrum disorders, 38 with ADHD and 41 comparison boys with typical development to fill out questionnaires about their children's bedroom screen access and sleep patterns.

 All the kids were between ages eight and 17. Boys with autism who had TV, computers or video games in their bedrooms got less sleep than all the other boys, including boys with autism who didn't have media in their bedrooms.

Limiting electronics

Without a TV in their room, boys with autism spent an average of about nine hours sleeping, compared to less than eight hours among kids with an ASD and a bedroom TV.

In contrast, bedroom TVs didn't seem to make a difference for boys with ADHD or typical development. Boys with autism with computers in their rooms slept nearly two hours less than boys with autism and no bedroom computer.

A lot of time spent playing video games, regardless of where they were located, was also linked to shorter sleep times among boys with ASDs. Even for typical children, too much time with TV or video games has been linked to attention problems, hyperactivity, arguments and physical fights, Engelhardt said. "We can't say that access to a TV causes less sleep," only that the two are linked for some kids, he said.

Last month, the American Academy of Paediatrics called for limiting screen time for all kids to one or two hours per day. ”This is a good recommendation for all children," Dr Beth Marlow, Burry Chair in Cognitive Childhood Development and director of the Sleep Disorders Division at Vanderbilt University Medical Centre in Nashville, Tennessee.

"Following this recommendation for kids with (autism spectrum) and ADHD is good, although children with (autism spectrum) or ADHD who are still having difficulty with sleep despite limiting electronics really deserve a sleep evaluation by their paediatrician or sleep specialist.

Time distortion

"Sleep troubles can also stem from anxiety, sleep apnoea, pain that the child might not be able to express, gastrointestinal problems or seizures, she said.

For typically developing kids, bedroom TV access doesn't usually seem to cut into sleep. "However, (Engelhardt's) finding for teens with ASD concurs with our clinical impressions – that these teens have difficulty 'switching off'' videogames," Michael Gradisar said.

Gradisar is a clinical psychologist who studies technology use and sleep, especially among teens, at Flinders University in Adelaide, South Australia. "Many teens have a distorted sense of time passing when playing videogames, however, it may be that this time distortion is stronger for teens with ASD," he said.

Parents can have a tough time managing how much their children play games or watch TV, he said. "It may take quite some time to do, but one option is for parents to introduce other hobbies and activities into their teens lives, so that video gaming eventually occupies less time."

Engaging features

"People with autism tend to spend more time with media outlets, researchers think, because the electronic worlds have engaging audio and visual features and their social interactions are easy relative to real life interactions."

This doesn't necessarily mean that parents should take TVs or video games out of their autistic children's rooms, but might consider limiting or monitoring media consumption, he said. "Screen media can certainly be good for kids with autism," he said.

"Scientists have long known that video games are great at teaching and reinforcing certain behaviours, so it's possible that these games can be used to adjust and shape the types of behaviours generally valued by society, such as behaviours intended to help others."

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