Monday, September 30, 2013

Negative effects of sleep deprivation

This article discusses how important sleep is for people, and how detrimental sleep deprivation can be.

There's a tendency to see sleep as a giant time suck - some unfortunate biological need to be kept at bay until someone's finished their English paper or beaten a tricky level on Candy Crush Saga.
Robert Wittig sees it differently.
"The only time you cannot possibly waste is when you're sleeping," said Wittig, medical director at the Aspirus Keweenaw Sleep Disorder Center in Laurium.
Perceiving those work, school or social demands as more important than a restful night is the leading cause of sleep deprivation, Wittig said.
A good night's sleep has been redefined downward over the past century as advances in technology and luminosity have extended shopping and recreation to a 24/7 distraction. The average person got nine hours of sleep a night in 1900; now, it's under seven.
"You can see that as a great improvement in human efficiency, or you can see it as a looming disaster," Wittig said. "Personally, as a child of the 60s, I think it might explain the loss of creativity in popular music."
But there's more to fear from drowsiness than Karmin. About two-thirds of single-vehicle accidents on the road are due to falling asleep, Wittig said.
"It probably wasn't a problem when people had horses, because you could fall asleep and the horse would still get you there," he said. "You're going down a highway in a car that's supposed to be comfortable, and a car that's supposed to be quiet and luxurious, you're more likely to fall asleep."
People operating on fewer hours of sleep will also have less initiative and be less efficient, he said.
When people come into the clinic, the first thing Wittig does is take the patient's case history. This can include what drugs they're taking, how often they have substances like alcohol or caffeine and their usual sleep environment.
Wittig once treated a woman from Detroit with terrible insomnia. She was admitted to the sleep center, where she had an uneventful, restful night. They were puzzled until she remarked on how warm it was. As it turns out, her house had no heat.
"That's why you literally have to spend an hour asking these questions, because something simple and obvious can end up being the problem," Wittig said.
About two-thirds of the people who come to the center wind up going through a sleep study. The three main measurements used are electromyography (muscle response), electroencephalography (electrical activity in the brain) and eye movement.
"With those three things, you can tell if a person's awake, asleep, what stage of sleep they're in," Wittig said.
Other tools can include an electrocardiogram, strain gauges on the chest, electrodes to measure restless legs and an oximeter to measure the oxygen saturation of hemoglobin in the blood.
But about a third of patients don't need a sleep study to find the remedy, said Wittig. He cautioned against overtreating patients when simpler solutions exist, using the example of a man who only snores when he drinks.
"As a male, half snore by the age of 50," he said. "It doesn't mean we all need sleep studies."
Some remedies are surgical.sSleep apnea, which causes snoring can be caused by obesity, or by large tonsils or a jaw defect; surgery can be used to open up the throat. Another route is continuous positive airway pressure, in which a machine blows air into a tube connecting to a mask that goes over the nose and mouth.
"Literally, that can be an overnight miracle for someone who got into a problem over years and didn't realize," Wittig said. "Overnight, they're a new person, and they think you're wonderful."
Read more here

Natural treatment for ADHD symptoms

Natural treatments to remedy ADHD, such as fixing sleep issues or monitoring screen time, may help reduce symptoms of ADHD.

I call it the September phenomenon. My practice fills with children getting ready for school, college students grabbing their last-minute prescriptions and everyone questioning whether they should refill their ADD/ADHD medicine of choice.
It is always interesting to see the diversity amongst my ADD population. Many young children and adolescents love the feeling of being "hyper-focused" and are able to accomplish massive amounts of work in a short period of time. Others stare at me, looking pale and fatigued, wanting off their medications.
Medications for ADD have come under increased scrutiny, with recent statistics showing that use of these medications has increased by 50 percent in the last six years. Abuse of Ritalin, one of the most commonly used ADHD medications is also rampant on college campuses. Research continues to debate the effectiveness of the medications for improving grades and helping students "study."
I am always trying to help my patients understand the cause and options for treating their ADD/ADHD. While some patients do need medication, we have seen attention and hyperactivity improve with alternative regimens. Spending time educating patients about prevention of inattention and hyperactivity has proven to be effective in our practice.
ADD and ADHD are the result of neurotransmitter and neuroendocrine imbalances. The four main imbalances include high norepineprine and cortisol, dopamine dysfunction, serotonin deficiency, and insulin irregularity. Each of these imbalances are rooted in nutritional deficiencies that with correction, improve symptoms of hyperactivity and inattention. Food allergies and intolerances also contribute to malabsorption of nutrients.
While my practice goal is to identify each patient's unique ADD/ADHD type, there are general patterns that seem to be consistent for the majority of patients.
Correct Irregular Sleep Cycles
Children with inattention, as well as adolescents, need more sleep than their non-ADD counterparts. Most children require at least 10 hours of uninterrupted sleep. I have noticed that many children become wired at night, fighting sleep and bedtimes. Creating a calming sleep routine that is consistent helps children with ADD/ADHD relax. Reading, journaling, guided imagery tapes and yoga are great pre-bed activities. Warm baths with Epsom salts may also help.
Keep Insulin Stable
Teaching children and parents tips to keep blood sugar and insulin levels stable improve inattention and hyperactivity symptoms. Many children leave their homes with a high-sugar breakfast, followed by sugary snacks and unhealthy lunches. Emphasizing the importance of protein and decreasing total sugar consumption daily to under 40 grams is critical for children with ADD/ADHD. Small servings of protein should be eaten at regular intervals. Convenient protein sources include nuts, yogurt, hummus, protein bars and protein smoothies.
Correct Nutritional Deficiencies
Nutrition is often underplayed in ADHD management, but there are nutritional deficiencies that appear in my patients repeatedly. These deficiencies are also important in neurotransmitter balance. The most common nutritional deficiencies we see in practice include low B vitamin levels, low magnesium, and low levels of amino acids. If you or your child may have ADD/ADHD, have your physician or nutritionist evaluate your potential nutritional deficiencies, prior to supplementation.
Morning Exercise
For many children, serotonin imbalance is the cause of ADD. Beginning a quick morning workout before heading to class gives the brain a serotonin boost. Try running up and down the stairs five times or 10 jumping jacks. A brisk morning walk may also help "wake up" your serotonin.
Create an Electronic Budget
Children and adults with ADD/ADHD often find their symptoms worsen with constant stimulation from iPhones, iPads and other electronics. Most children should have an "electronic budget" that limits use of TV, video games, phones and other gadgets to one hour per day. Adults need an electronic budget as well. While jobs may force us all on the computer for long periods of time, having "electronic-free" hours can help build focus and attention. Turn off your electronics by 10 p.m. and keep four hours at least one day per week gadget/electronic-free.
Although many patients will still need ADD/ADHD medications, trying natural alternatives can keep us all less medication dependent and living healthier. Focus on alternatives in beating your ADD/ADHD, naturally.
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What may be keeping you up at night?

This article discusses the common issues that keep people from getting a good night's sleep, such as insomnia, sleep apnea, narcolepsy, restless leg syndrome, and periodic limb disorder.

The illusive good night’s sleep. According to the National Center for Sleep Disorders Research at the National Institutes of Health, it’s a national problem. Between stress, problems with your sleeping environment and any number of disorders, 30 to 40 percent of the U.S. adult population reports experiencing symptoms of insomnia each year.
We talked to Marcy Guido-Posey, registered polysomnographic technologist and registered sleep technologist who is a coordinator at Holy Spirit Sleep Centers, and Beverly Azemar, certified nurse practitioner at Penn State Hershey Sleep Research and Treatment Center in Hummelstown, to get the skinny on what’s keeping you from a blissful eight hours.

“Insomnia is defined as the inability to fall asleep, stay asleep or both,” Guido-Posey said. It can lead to impaired daytime functioning.
“When people have trouble sleeping it’s insomnia, which is a symptom and not a disease,” Azemar said. Insomnia symptoms fall into three categories:
• Transient: lasting less than one week
• Short-term: lasting one to three weeks
• Chronic: lasting one month or longer

Sleep apnea
“Sleep apnea is a decrease or total cessation of airflow during sleep,” Guido-Posey said. “Often you will hear loud, rhythmic snoring, followed by a period of silence that ends with a loud snort or gasp as breathing resumes, then stops again. This pattern repeats itself over and over.”
According to the American Sleep Apnea Association, sleep apnea occurs most frequently in men, particularly African Americans and Hispanics. It affects more than 18 million Americans. The three types of sleep apnea are:
• Obstructive sleep apnea: caused by a blockage in the airways
• Central sleep apnea: “That is when the airway is not blocked, but the brain fails to signal the respiratory muscles to breathe,” Azemar said.
• Mixed: a combination of obstructive and central sleep apnea

Narcolepsy is the chronic neurological disorder often depicted in movies by characters falling asleep suddenly during daily activities, which isn’t far from the truth. Excessive daytime sleepiness is the main symptom of narcolepsy and happens because the brain isn’t able to regulate the body’s sleep-wake cycle.
It is estimated that up to 200,000 Americans suffer from narcolepsy. It affects men and women equally. While there is no cure, treatment can involve stimulants, antidepressants and other types of prescription medication. Symptoms include:
• Cataplexy: a sudden loss of muscle control
• Sleep paralysis: the brief inability to talk or move while falling asleep or when waking up
• Hypnagogic hallucinations: scary dreams when falling asleep
• Automatic behavior: performing routine tasks without awareness, or even memory, of performing them

Restless Legs Syndrome
Willis-Ekbom disease, or restless legs syndrome, is a neurological disorder. Its hallmark is a tingling sensation in the legs or arms that results in an irresistible urge to move. The sensation varies from person to person with patients describing a creeping, crawling, or electric feeling, according to the National Sleep Foundation.
RLS is estimated to affect 7 to 10 percent of Americans. Treatments include dopaminergic agents or anticonvulsants combined with behavioral techniques.

Periodic Limb Movement Disorder
PLMD is basically RLS while you’re asleep, explained Guido-Posey. The disorder is characterized by repetitive movements such as twitching or jerking every 20 to 40 seconds. Like sleep apnea, it is often recognized first by bed partners.
PLMD isn’t considered to be a serious medical condition, but it can be a contributing factor in insomnia. The NSF recommends seeking treatment for PLMD when it’s accompanied by RLS and/or daytime sleepiness.

Symptom management with medication
Insomnia sufferers do have over-the-counter and prescription medication options to consider that may help them get a better night’s sleep. OTC drugs such as Benadryl and Tylenol PM can help with occasional sleeplessness, but the Mayo Clinic warns that they aren’t intended for long-term use.
Another issue with OTC sleep aids is the day-after hangover. “Many over-the-counter aids are antihistamines and they can also cause residual daytime drowsiness the next day,” Azemar said. She also warns that while they are fairly safe to use because they are over-the-counter, they can be abused.
Doctors can prescribe medication for their sleep-lacking patients. Common prescription brands of sleeping pills include the sedatives Ambien and Lunesta. These drugs work by relaxing patients and helping them fall asleep and stay asleep.
“When patients are prescribed a sleep aid, they are usually used for 1-2 weeks, but then again some patients need them longer. They just need to be followed and monitored to make sure they are effective and they’re getting the appropriate results,” Azemar said. Some prescription sleep aids help you fall asleep while others can be taken in the middle of the night to help you get back to sleep.
Patients are cautioned that use of prescription sleep aids can come with risks. Side effects can include dizziness, prolonged daytime sleepiness and weight gain. Use can also lead to an increased risk in nighttime falls in older adults.

Sleep hygiene
One of the most important factors in a good night’s sleep is your hygiene. Sleep hygiene is the collection of practices necessary to developing a healthy sleep schedule.
Factors in sleep hygiene include:
• Creating a sleep-promoting environment
• Maintaining a regular sleep schedule
• Sticking to healthy eating habits
• Lowering your stress level
If you are maintaining healthy sleep hygiene and still experiencing insomnia or symptoms of a sleep disorder, talk to your doctor about scheduling a sleep study and treatment options.

Read more here

There's no such thing as a concussion-proof helmet

This article explains why parents should be weary of helmets claiming to be "concussion-proof"and what to do about concussions in their children.

Football season is upon us and many parents of young players may be swayed by helmets claiming to be "concussion-proof." There is no such thing, experts warn.
Some manufacturers are promoting aftermarket add-ons for football helmets – such as liners, bumpers, pads and electronic devices – that promise to reduce the risk of concussion. However, there is little research evaluating the effect of physical impact on young athletes, and risk-reduction claims about helmets designed for adult players may not be relevant to younger players, New York Attorney General Eric Scheiderman warned. 
“It’s important to remember that no helmet can fully prevent a concussion,” Schneiderman said, as he cautioned manufacturers against making claims they can't back up. “Ensuring that manufacturers don’t mislead the public and endanger young New Yorkers is a key concern for my office."
Head injuries, including concussions, can happen at any time on the field of play, regardless of the type of helmet being worn. False claims may give players and parents a false sense of security. Instead, parents, coaches and young football players should rely on a number of tips and strategies to help reduce the risk of head injury, including: learning and recognizing symptoms of a concussion; minimizing head-to-head hits on the field, and enforcing stronger and stricter penalties against such behavior.

What to do

Although the age, condition, type and fit of the helmet are important factors, reducing the risk of concussion is not “all about the helmet.” Schneiderman issued these tips to reduce the risk of concussion and head injury in youth football:
  • Players, parents and coaches must be trained on the symptoms and risks of concussion.
  • Recognizing the signs of concussion and removing a player immediately is extremely important.
  • New York State law requires that players be removed from play until they are asymptomatic for a minimum of 24 hours and have written approval from their physician to return to play. Many other states have similar laws.
  • The number of concussions can be significantly reduced with modifications to practice format and an emphasis on penalty enforcement.
  • Reducing the number of hits is instrumental to reducing the risk of concussion because of the cumulative risk from repeated hits. Limit the amount of contact in practice and forbid drills that involve full-speed, head-on blocking and tackling that begins with players lined up more than three yards apart.
  • Players need to be trained to focus on techniques that minimize head-to-head hits. Coaches and referees must strictly enforce penalties against such behavior.
Read more here

Tips for Parents to get Bedtime Right

This article discusses tips to help parents get their children back on a regular bedtime schedule.

There’s nothing like back-to-school schedules to knock parents on our heels in a public way. The dog days – and late bedtimes – of summer are gone. Parents are left crying in their coffee at 7 a.m. after late nights spent barricading children in their rooms, caving in and crawling into bed with them or any one of a number of other jury-rigged solutions to avert sleep deprivation.

Getting kids to sleep is one of the dominant parenting woes of our times – just ask author Adam Mansbach, who scored a roaring bestseller with his ode to bedtime defeat, 2011’s Go the F–– To Sleep. Scientific researchers are refining what we know about sleep and its crucial function in memory, cognition and general health for all of us. And as they increasingly turn their focus to children and the relationship between sleep, biology and development, the reasons to get it right are only proliferating. It’s no wonder modern parents are whining about their perceived failures and grasping for sleep solutions from professionals.
“My phone has not stopped ringing this week,” says Tracey Ruiz, a respected Toronto sleep consultant. Ruiz, who goes by the professional handle Sleep Doula, started her business focused on babies, but now says her biggest growth area is the under-10 set. Clients have been desperate enough to fly her across the continent for bedtime triage.
Maybe they read about studies like the one released in July that looked at 9,000 four-year-olds. It found that those who had shorter-than-average sleep times have increasing rates of “externalizing” behavior such as anger, overactivity, aggression and impulsivity.
“It’s becoming a bigger issue because we’re all more scheduled, even the kids,” says Rachel Y. Moon, the sleep expert who has written the newest book on the subject, Sleep: What Every Parent Needs to Know. “In my practice, I see so many parents making decisions based on emotion and desperation,” the Washington, D.C.-based pediatrician says.
Shalini Roy feels my pain. The Toronto mother is in the midst of trying to dial bedtime back to 7:45 for her seven-year-old son, who needs more sleep for his big Grade 3 days.
“It’s kind of a stretch – he’s moving around, getting his PJs on,” she says. “The problem is this year he’s into chapter books. It just doesn’t end. ‘Just a few more words, just till the end of the chapter.’”
Admittedly, she says she often finds herself playing timekeeper while her husband, who oversees bedtime when the deadline gets pushed toward 8:30 or 9. There may be yelling, she allows.
Most experts recommend an average of 12 hours for toddlers and school-age kids. Ruiz says that can mean 10½ for some kids and 13 for others. And all experts stress consistency in sleep and wake times as a way to maintain circadian rhythms – not to mention consistency in how parents approach sleep setbacks.
Valerie Kirk, the medical director of the Pediatric Sleep Service at the Alberta Children’s Hospital in Calgary, says about half of her clinic’s families are experiencing non-medical sleep problems .
“One person’s problem is another person’s crisis,” she says. “The spectrum of what we see, on the mild side would be a child getting up two or three times a week to one getting up many, many times a night or simply refusing to go to bed.”
Kirk says that regardless of the methods out there to get bedtime back on track – from reward-based sticker charts to timers and cut-the-apron-strings techniques – the key is that bedtime become non-negotiable, much like bad-tasting medicine for a sick child or a car seat.
What’s more, she says, if your can get bedtime right, other disturbances like nighttime waking will become less likely.
“Non-negotiable” doesn’t have to mean they retreat to their rooms and you close the door and ignore them, Ruiz says. Nor does it mean favouring consistency over an extra cuddle. “Your child is not a robot.”
And forget laying down the law through gritted teeth when you’re frustrated – such as: “You are melting down. You’re tired. You have to go to bed earlier.”
Instead, Moon suggests talking with your child at dinner or on the way to school about any new rules – when everyone can be more rational.
Many parents I’ve heard from have summoned up enough rational reserves and enforce an ironclad 6 or 6:30 bedtime.
Burlington mother Jennifer Cushing is one of them. Bedtime for her five- and 2½-year-old is 6:30 sharp (wake-up is 6:30 or 7). Dinner is at 4:15 or 4:30.
“I was getting up with them at night when my second was a newborn,” she says. She tried the “extinction method,” also known as a “modified cry-it-out” approach, advocated by pediatrician and author Marc Weissbluth.
“It’s a rush to get home, make dinner, bath them, get them ready for bed,” she says, adding that her husband gets home early enough to get the process under way. “But you have to find what works for you.”
In our house, we’re getting there, 10 minutes at a time. I’m consoling myself with Moon’s reassurance: “You are not the first parent of a kindergartener who fell asleep on the bus. It’s a big transition.”
My son even started waking up five minutes before the alarm this week. We should all get a sticker for that.
Read more here

What are the NFL players being told about concussions by their own Players' Association?

I think its fascinating that the teams have physicians but that the Players' Association is advocating the use of IMPARTIAL specialists: neurologists. JR

What is a concussion?

A concussion is a type of brain injury. It occurs when the brain moves quickly enough to interrupt its function. Most concussions result in full recovery, but some can lead to more severe injuries if not recognized and treated properly.

The source of the injury is not always clear. It can come from a blow to the head or even from a blow to the body. It can come from one big hit  or from several smaller ones.

You may not always be aware that you are concussed. It is common that  concussed people do not know they are injured. Look out for the health of your teammates. Be aware of these signs and symptoms in yourself  and fellow players:
What is interesting is that the NFL plaers' association is teaming up with neurologists (the American Academy of Neurologists)


• Disorientation or confusion
• Memory loss
• Behavior or personality change
• Trouble concentrating
• Feeling sleepy or groggy
• Sensitive to light or sound
• Dizziness or nausea
• Headache

If you or a teammate have any of these symptoms, tell your medical staff immediately. Trying to play with a concussion puts  you at serious risk for further injury

If a concussion is suspected (in either a game or practice), you should
be evaluated immediately. There is an NFL protocol for this evaluation
that can be done in under 10 minutes. If you think you may have a
concussion, report your symptoms and request this exam. DO NOT


Not every hit that causes symptoms is a concussion and  only medical personnel can make the diagnosis. You should be evaluated  with a comprehensive neurological evaluation, ideally in a quiet, distractionfree place.

RETURN TO WORK. If you have a concussion, you should not participate  in a game or practice until you are (1) symptom free at rest and during physical exertion and (2) cleared by your team physician AND the team’s  independent neurological consultant.

 The return to work protocol should
involve several steps of increasing exertion – from a stationary bike, to
jogging, to agility work, to non-contact drills. With each step, a player must
be symptom free to move to the next step. You should never play football
after a concussion if you have not been evaluated appropriately or are still  experiencing symptoms.


You have the right to a second opinion.

It is your health and your brain. If  you are unsure about your medical condition and/or your medical care,
do not hesitate to seek additional care. There are many experts in sports  concussion that can provide the care you need.

Don’t let any question go unasked. You and your family deserve the best  information. If you would like help getting a second opinion, or have a question, call

Thursday, September 26, 2013

Insight into the brain and Alzheimer's disease

This article discusses research into the functioning of the brain associated with Alzheimer's disease.

Scientists of the Charité -- Universitätsmedizin Berlin and the German Center for Neurodegenerative Diseases (DZNE) have managed to acquire new insights into the functioning of a region in the brain that normally is involved in spatial orientation, but is damaged by the Alzheimer's disease. They investigated how nerve signals are suppressed inside the so-called entorhinal cortex. According to the researchers, this neuronal inhibition leads nerve cells to synchronize their activity. The results of this study are now published in Neuron.
The entorhinal cortex is a link between the brain's memory centre, the hippocampus, and the other areas of the brain. It is, however, more than an interface that only transfers nervous impulses. The entorhinal cortex also has an independent role in learning and thinking processes. This is particularly applicable for spatial navigation. "We know precious little about how this happens," says Prof. Dietmar Schmitz, a researcher at the Cluster of Excellence NeuroCure at the Charité -- Universitätsmedizin Berlin and Site Speaker for the DZNE in Berlin. "This is why we are investigating in animal models how the nerve cells within the entorhinal cortex are connected with each other."
Signals wander inside the brain as electrical impulses from nerve cell to nerve cell. In general, signals are not merely forwarded. Rather, operation of the brain critically depends on the fact that the nerve impulses in some situations are activated and in other cases suppressed. A correct balance between suppression and excitation is decisive for all brain processes. "Until now research has mainly concentrated on signal excitation within the entorhinal cortex. This is why we looked into inhibition and detected a gradient inside the entorhinal cortex," explains Dr. Prateep Beed, lead author of the study. "This means that nerve signals are not suppressed equally. The blockage of the nerve signals is weaker in certain parts of the entorhinal cortex and stronger in others. The inhibition has, so to speak, a spatial profile."
When the brain is busy, nerve cells often coordinate their operation. In an electroencephalogram (EEG) -- a recording of the brain's electrical activity -- the synchronous rhythm of the nerve cells manifests as a periodic pattern. "It is a moot question as to how nerve cells synchronize their behavior and how they bring about such rhythms," says Beed. As he explains, it is also unclear whether these oscillations are only just a side effect or whether they trigger other phenomena. "But it has been demonstrated that neuronal oscillations accompany learning processes and even happen during sleep. They are a typical feature of the brain's activity," describes the scientist. "In our opinion, the inhibitory gradient, which we detected, plays an important role in creating the synchronous rhythm of the nerve cells and the related oscillations."
In the case of Alzheimer's, the entorhinal cortex is among the regions of the brain that are the first to be affected. "In recent times, studies related to this brain structure have increased. Here, already in the early stages of Alzheimer's, one finds the protein deposits that are typical of this disease," explains Schmitz, who headed the research. "It is also known that patients affected by Alzheimer's have a striking EEG. Our studies help us to understand how the nerve cells in the entorhinal cortex operate and how electrical activities might get interrupted in this area of the brain."
Read more here

Study: Sleep Apnea and Kidney Disease Linked

A study claims that obstructive sleep apnea and kidney disease are linked disorders.

Severe hypoxic events in obstructive sleep apnea (OSA) might lead to kidney damage, though the sleep disorder appeared to be only a minor contributor overall, an observational study showed.
The lowest oxygen saturation level reached at night modestly but significantly predicted chronic kidney disease as indicated by a below-normal estimated glomerular filtration rate (eGFR), Oreste Marrone, MD, of the Institute of Biomedicine and Molecular Immunology of the National Research Council in Palermo, Italy, and colleagues found.
Mean oxygen saturation wasn't a significant predictor overall in the multivariate analysis, nor were there consistent correlations between eGFR and Apnea-Hypopnea Index, the researchers reported here at the European Respiratory Society meeting.
"We don't have to expect a major effect on kidney function," Marrone told MedPage Today. "But we can expect that if a patient has very important drops in oxygen saturation, it may in some way worsen his kidney function, especially if he has comorbidities."
Predictors of a low estimated glomerular filtration rate (eGFR) included older age, female gender, and higher body mass index across most models, while diabetes was significant in polysomnography-tested patients, and hypertension was significant in nocturnal cardiorespiratory polygraphy-tested patients.
In such more susceptible patients, "OSA could give a minor contribution to reduce eGFR by means of nocturnal hypoxia," the researchers noted in the poster presentation.
Potential mechanisms for a causal link to kidney damage could be intermittent hypoxia, metabolic abnormalities, hypertension, and sympathetic hyperactivity, Marrone noted.
The most likely explanation is via vascular damage in the kidneys from hypoxic events, Jan Hedner, MD, of the University of Gothenburg, Sweden, noted in an interview with MedPage Today at the poster discussion session he chaired.
"It's a vulnerable area of the body," he said. "If you already have comorbid conditions like diabetes and hypertension, it could well be that you accelerate the deleterious effect on the renal system."
Marrone's group analyzed 8,112 patients in the European Sleep Apnea Database (ESADA)seen for suspected OSA at 24 centers with polysomnography or cardiorespiratory polygraphy and who had data available to calculate eGFR.
Overall, 8.5% of the cohort had an eGFR below 60 ml/min/1.73 m2, all in the range of stage 3 kidney disease. Participants with the highest creatinine levels -- indicating severe kidney disease -- were excluded from the study, as their condition was unlikely to have been caused by sleep disordered breathing.
That measure of kidney function correlated with Apnea-Hypopnea Index by home polygraphy (P=0.008) but not by the more rigorous sleep study.
The opposite was true for oxygen desaturation index, which correlated with eGFR on polysomnography (P=0.013) but not polygraphy.
Mean and lowest oxygen saturation were significantly linked with eGFR by both types of sleep study.
"The strength of this data is that it represents the biggest studied cohort so far of patients addressing renal function, so from that perspective I think it's useful and important work," Hedner noted. Hedner was involved in ESADA as a sleep medicine specialist but not in Marrone's analysis.
However, the study couldn't determine causality, and Hedner pointed out that it couldn't answer questions that require a longitudinal approach either.
Read more here

Sleep disorders in children may be caused by winter viruses

Sleep disorders in children related to breathing during sleep may be due to winter viruses.

A good night's sleep is important to our children's development. But with the first day of school just passed, many children are at increased risk for sleep breathing disorders that can impair their mental and physical development and hurt their academic performance.
A study conducted in North America in 2011 showed that the frequency of sleep-disordered breathing increases in the winter and spring. Until now, researchers believed asthma, allergies and viral respiratory infections like the flu contributed to disorders that affect children's breathing during sleep.
Now, in a new study conducted at the Pediatric Sleep Center at the Tel Aviv Sourasky Medical Center and published in the journal Sleep Medicine, Riva Tauman and her fellow researchers of the Sackler Faculty of Medicine at Tel Aviv Univ. have shown that asthma and allergies do not contribute to pediatric sleep-disordered breathing. Viruses alone, they say, may be responsible for the seasonal variation seen in children.
The researchers say the study has broad implications for the treatment of sleep-breathing disorders in children, bolstering the idea that the time of year is relevant when treating children for sleep-disordered breathing in borderline cases.
Blowing hot and cold
"We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months," Tauman says. "What we didn't expect is that the trend has nothing to do with asthma or allergies."
"Sleep-disordered breathing" is a blanket term for a group of disorders. One of the common disorders is obstructive sleep apnea, in which the upper airway becomes blocked, usually by enlarged tonsils or adenoids, causing snoring and, in more severe cases, breathing pauses that lead to poor-quality and fragmented sleep and decreased oxygen and elevated carbon dioxide levels in the bloodstream.
In the long term, sleep-disordered breathing in children can cause stunted growth, heart disease and neurocognitive problems associated with diminished school performance, impaired language development and behavioral issues.
In their study, Tauman and her Sackler Faculty of Medicine colleagues Michal Greenfeld and Yakov Sivan statistically analyzed the cases of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010. Confirming earlier results of a 2011 study of five- to nine-year-olds, the researchers found that pediatric sleep-disordered breathing is worse in the winter — which in Israel they defined as from November to March — than in the summer. The seasonal variability is most apparent in children less than five years old, they found.
The researchers also found that wheezing and asthma do not contribute to the trend.
Based on their findings, the researchers speculate that viral respiratory infections — which are more prevalent in younger children and during colder months — are the major contributor to the seasonal variability seen in pediatric sleep-disordered breathing.
Taking the long view
If the sleep clinic tests had all been conducted in the winter, the researchers estimate that seven percent more children would have been diagnosed with sleep-disordered breathing. Seven percent fewer would have been diagnosed if all the tests had been done in the summer, they estimate.
"Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer," says Tauman. "But if he has only mild symptoms in the summer, I can assume they are more severe in the winter."
Read more here

Australian vitamin treatment can significantly reduce migraine severity and frequency

A treatment developed in Australia claims to significantly reduce migraine severity and frequency by using vitamins that work with gene mutations.

AUSTRALIAN migraine sufferers won't have to live in the dark much longer.
Queensland-led genetics researchers have just launched a final, phase three clinical trial for a treatment that could drastically reduce symptoms in 20% of sufferers.
The trial is headed by Professor Lyn Griffiths, the new Executive Director of QUT's Institute for Health and Biomedical Innovation.
She and her world-leading team have identified several genes implicated in migraine and are translating that genetic information into new diagnostics and treatments.
Professor Griffiths said one of those genes causes a mutation in a particular enzyme, which stops the enzyme from working properly.
"We're trialling a specific combination of vitamins that can make that enzyme work better and make the gene then function properly," she said.
"Results so far have shown that, taken preventatively, the treatment has a very big impact on migraine - significantly reducing how severe they are, how frequent they are and the pain associated with any migraines.
"That can be very beneficial to sufferers with that gene mutation.
"This last phase in the trial is focused on dosage levels and, if it proves successful, we expect to have a tablet on the market in just over a year."
This week is Headache and Migraine Week, an initiative of the Brain Foundation.
Roughly 12 per cent of Australians suffer from migraine. It affects around 18 per cent of woman, six per cent of men and four per cent of children.
And there is a strong genetic link - about 90 per cent of people who experience migraines are not the only one in their family.
Professor Griffiths was one of the first scientists in the world to study the DNA links for migraine.
"I suffered from migraine as a teenager, my mum suffered from migraine, but as a geneticist looking at genes for various disorders I didn't even think about migraine until my son at about the age of four started suffering from migraine, including visual disturbances.
"So when you have someone close in your family who you really care about, you realize just how debilitating, how severe, it is; and I thought something needed to be done.
"We haven't identified all the genes yet. There's still a lot more research needed to identify all of them."
Professor Griffiths is urging people who suffer from migraine to join the Headache Register
There, sufferers can access the latest in migraine news and research, learn about current and upcoming treatment trials and download a Headache Diary to help them manage their disorder.
Professor Griffiths is confident researchers will find more targeted treatments in the future.
"You can't do this sort of research unless you have people in the public helping you," she said.
"I don't think people realise just how common migraine really is - it's a really common disorder, extremely debilitating and there's a real need to develop new treatments for it.
"We believe there are a number of different gene mutations that play a role in migraine and those different gene mutations need different treatments."
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Saturday, September 21, 2013

Sleepy teenagers are at greater risk of pedestrian accident

Pedestrian teenagers who are sleepy due to sleep deprivation are more likely to be hit by a car.

Sleep-deprived teens are at increased risk of getting hit by a vehicle while crossing the street, researchers warn.
The new study included 55 teens, aged 14 and 15, whose ability to cross a street safely was tested in a virtual-reality setting in the Youth Safety Lab at the University of Alabama at Birmingham.
Teens whose sleep was restricted to four hours the night before the test took more time to begin crossing a street, crossed with less time before contact with vehicles and had more close calls than those who slept for eight and a half hours. Four hours of sleep is half the amount considered adequate for 14- and 15-year-olds.
The sleep-deprived teens averaged 2.2 close calls or hits by vehicles on 25 of the simulated street crossings, compared with 1.42 close calls or hits for those who had an adequate amount of sleep, according to the study, which was published Sept. 3 in the Journal of Adolescent Health.
The findings suggest that teens' ability to cross the street safely can be compromised after only one night of too little sleep, said study author Aaron Davis, a psychology post-doctoral fellow in the Leadership Education in Adolescent Health program at the university.
"It is easy to discount the idea that this loss of sleep could have a significant impact if it occurs rarely, but this study demonstrates that adolescents' safety could be put at risk after just one night of inadequate sleep," Davis said in a university news release.
An estimated 8,000 teens aged 14 and 15 require medical attention for pedestrian-related injuries each year in the United States, according to background information in the news release.
Study co-author David Schwebel, director of the Youth Safety Lab, said the study "demonstrates the importance of sleep for human functioning. Our results show clearly that insufficient sleep influences adolescent safety; without sufficient sleep, they are inattentive, distractible and poor decision-makers."
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Sleep apnea can worsen skin cancer outcomes

A recent study showed that people with sleep apnea had significantly worse melanoma and skin cancer outcomes.

A bad night’s sleep can be the result of stress, poor diet, or simply not getting enough hours of rest. If you begin to fall into a pattern of back-to-back sleepless nights and find yourself experiencing daytime sleepiness, slow reflexes, and poor concentration, you may be suffering from a common sleep disorder — sleep apnea. The common yet underrecognized condition affects the way that approximately 22 million Americans breathe when they sleep at night, according to the American Sleep Apnea Association. Eighty percent of moderate and severe cases of obstructive sleep apnea (OSA) are undiagnosed, putting patients at risk for high blood pressure, chronic heart failure, and other cardiovascular problems.
The sleep disorder has also been linked to a higher prevalence of cancer mortality. In sleep apnea, there is a lack of adequate air flow traveling into the lungs through the mouth and nose, causing a reduction in oxygen levels in the blood. This common trait in sleep apnea is known to play an important role during the various stages of tumor formation and progression. In fact, the severity of the sleep disorder may predict the risk of malignant skin melanoma, according to a new study.
Findings presented at the European Respiratory Society (ERS) Annual Congress in Barcelona unveiled the link between skin cancer and sleep apnea in humans. Previous studies have examined the link between the sleep disorder and both mortality and incidence rates from cancer. However, this is the first study to analyze the relationship between a specific cancer — skin melanoma — and sleep apnea in humans. The researchers measured the aggressiveness of melanoma, along with the presence and severity of sleep apnea, in 56 patients diagnosed with malignant skin melanomas.
Sixty-one percent of patients with malignant skin melanomas had sleep apnea, while 14.3 percent had severe sleep apnea. The results of the study revealed that as the severity of sleep apnea increased, the progression of skin melanoma also increased. Extreme sleep apnea was also associated with a higher growth rate or depth of invasion of the tumor, reports Science Daily.
"This is the first study in a human sample to show that sleep apnea can worsen the outcomes of melanoma." said lead author of the study, Dr. Francisco Campos-Rodriguez, from the Hospital de Valme in Seville, Spain.
While most patients with sleep apnea suffer specifically from OSA, central sleep apnea is the second most common type of sleep apnea diagnosed. This type of sleep disorder happens when the brain doesn’t send the right signals to the muscles that are responsible for controlling breathing, according to the University of Maryland Medical Center. Some people even suffer from a combination of the two types of sleep apneas — known as complex sleep apnea.
The research findings by Campos-Rodriguez and his colleagues could have important clinical implications, if applied to a larger sample size. "If the results are confirmed in larger studies, this would have important clinical implications, particularly as sleep apnea can be easily treated and this could open up new therapeutic possibilities for people with both conditions,” Campos-Rodriguez said. The researchers have begun a bigger trial that will further analyze the link between the sleep disorder and skin melanoma, involving 450 patients with cutaneous melanoma. This study could provide a breakthrough in the treatment of skin cancer patients with sleep apnea.
According to the American Cancer Society, approximately 120,000 new cases of melanoma will be diagnosed in the United States in a year. The most preventable cause of skin melanoma is exposure to the sun.
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Study: Obesity increases migraine risk

A study claims that obesity increases the risk for episodic migraines and explains why this link may exist.

Obese people may be at higher risk for episodic migraines, a new study suggests.
Episodic migraines -- the more common type of migraine -- occur 14 days or fewer per month, while chronic migraines occur at least 15 days per month.
Migraines involve intense pulsing or throbbing pain in one area of the head, according to the American Academy of Neurology. Symptoms can include nausea, vomiting and sensitivity to light and sound. Migraines affect more than 10 percent of the population.
In the study of more than 3,800 adults, those with a high body-mass index (BMI) -- a measure of body fat determined using height and weight -- were 81 percent more likely to have episodic migraines than those with a lower BMI. This was particularly true among women, whites and those under the age of 50.
The cross-sectional study doesn't prove that obesity causes episodic migraines, but it does demonstrate that people who are obese have an increased risk of having more of them, even low-frequency ones, said lead author Dr. Barbara Lee Peterlin, director of headache research at Johns Hopkins University School of Medicine, in Baltimore.
"These results suggest that doctors should promote healthy lifestyle choices for diet and exercise in people with episodic migraine," Peterlin said in a statement. "More research is needed to evaluate whether weight-loss programs can be helpful in overweight and obese people with episodic migraine."
The study was published in the Sept. 11 issue of the journal Neurology. The researchers also presented the findings in June at the International Headache Congress in Boston.
Dr. Gretchen Tietjen, director of the headache treatment and research program at the University of Toledo, in Ohio, said she found the findings interesting because previous studies had looked for connections between obesity and chronic migraines.
"That the researchers were able to show an association between obesity and episodic migraine lends more credence to some of the earlier studies that found similar things," she said.
She pointed out, however, that it still isn't known which came first -- the obesity or the migraine. There are many possible scenarios, Tietjen said. "Maybe the person had the migraines first and then started taking medications like amitriptyline or valproic acid," she said. "Those medications are associated with weight gain."
The possible connection between obesity and migraines is still under debate. One theory supporting the link centers on inflammatory substances from fat tissue (adipose) that are released into the system, Tietjen said.
Premenopausal women have more total adipose tissue in general than men, and women have more superficial and less deep adipose tissue, Peterlin said. But after menopause, adipose tissue is more similar between the two sexes.
Adipose tissue secretes different inflammatory proteins based on how much tissue there is and where it is located. Since younger women and obese people have more adipose tissue, this could, at least in part, explain why they get more headaches.
On the other hand, Peterlin also suggested that a possible connection may be related to the brain. "Previous imaging data in migraine patients have shown activation of the hypothalamus, a part of the brain that controls the drive to feed," she said. Alternatively, it could be that people who have migraines may be more inclined to behaviors associated with weight gain, such as being less active.
Would losing weight mean migraines will decrease in frequency? Although weight loss is generally encouraged for people who are obese, that won't necessarily result in migraine relief, Peterlin and Tietjen said.
At least two small studies have evaluated migraines in people who were obese and underwent bariatric surgery to lose weight, Peterlin said. Although these studies did find that some patients experienced fewer headaches, the studies were small and more research needs to be done to see if this is consistent.

It's possible that the lifestyle changes needed for weight loss cut the migraine frequency, rather than the weight loss itself, the experts said. People who eliminate processed foods, high-calorie foods and alcohol -- all of which can be migraine triggers -- could end up experiencing fewer headaches.
Unfortunately, the opposite could also be true if dieters introduce new foods that are migraine triggers. Some people may develop migraines when they consume certain sugar substitutes, for example. There also is limited data suggesting that people with severe obesity who exercise may have fewer migraines, Peterlin said.
"Our data and previous research serve as a call to researchers in the headache field to identify safe and appropriate treatment options for obese [people with] episodic migraines of all classifications and not just those who qualify for [weight-loss] surgery," she said.
Peterlin also suggested that physicians, in addition to providing lifestyle education to their obese patients with episodic migraines, take into account the weight-gain or weight-loss effect that migraine medications may have on their patients.
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Tuesday, September 17, 2013

Genetics may influence children's school anxiety

A study discusses how parents' anxiety genetically passes to children and can influence the child's back to school attitude and anxiety level.

Many parents may have noticed their children seemed on edge during their first week of school. They may have been agitated, withdrawn or more focused on themselves, rather than what was going on around them. Such behaviours are classic symptoms of high anxiety, says Université de Montréal researcher Richard Tremblay.
Tremblay is a professor emeritus whose area of expertise is childhood psychology and psychiatry, particularly antisocial behaviour. In 1984, he launched a longitudinal study that focused on the development of children from conception on. Many of the original participants are now in their mid-30s. Thanks in part to funding from the Canada Foundation for Innovation, Tremblay was able to build a mobile lab in 2005 that allowed him to park this study at participants' front door -- a convenience that helped ensure their cooperation over decades.
He says the longer timelines of his study gave him the chance to better understand the hereditary and environmental factors that lead a child to become aggressive, depressed or anxious.
Tremblay says the anxiety young students feel as they return to school is often related to the uncertainties they feel about their new teacher and classroom environment, the kids they'll interact with and whether their bullies will hunt them down during recess.
"It's a big change in the rhythm of life for everybody, especially children," says Tremblay. "Those who have problems with anxiety often create worst-case scenarios, almost like horror stories in their minds."
But Tremblay adds that being prone to such back to school horrors is not isolated to the imaginations of young students. Rather, their sky-is-falling tendencies may have been inherited from their parents, he says.
"There is a big genetic effect in terms of anxiety behaviours," says Tremblay. "The best predictors of anxiety or depression among children are their parents' own struggles with the same disorders. In other words, if you have a very anxious mother or father, you are at high risk of being an anxious child."
Parents pass their anxious tendencies to children through their genes, predisposing the next generation to bouts of apprehension, says Tremblay. "But a child's anxiety can be amplified by their environment," he adds. "If you're brought up by an anxious mother or father and you're genetically predisposed to these conditions, you will have a difficult time learning how to control your anxiety."
Tremblay outlines the consequences of this increased on-edge behaviour, suggesting the tightly-wound types are more likely to become depressed. They may have serious problems paying attention in school which could eventually affect their scholastic achievement and social relations.
And jittery students often have an additional worry to deal with. Not only are they nervous about going back to school but they tend to be anxious about being anxious once they get there. "It's a meta problem," says Tremblay, referring to how anxiety about one thing can generate anxiety about another.
To deal with such concerns, Tremblay encourages parents to monitor their children's behaviour in the first week of school. "Parents need to think about who their child is, how they're child has coped in the past and what worked and what didn't," says Tremblay.
He suggests parents who've suffered from anxiety watch for any behavioural similarities reflected in their children. Once identified, they can use their own memories of how they coped to guide their children through nerve-wracking encounters.
If children aren't able to relax within the first few weeks of school, Tremblay recommends parents seek help from the school, from counsellors or even from the young child's grandparents. He believes they can offer grounded insight into what it's like raising a high-strung kid who then has an anxious child of their own.
"Grandmama knows things that can be very helpful," says Tremblay. "People imagine that new psychological knowledge will solve all their problems but those old experiences are very good."
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