Tuesday, February 25, 2014

Why Does School Start So Darn Early, and Should it? Wed at 10 PM...Dr. Rotenberg and Terra Ziporyn Snyder on KPFT

ThinkwingRadio: Feb. 26, 2014, 10-11PM, KPFT-FM 90.1 (Houston). TOPIC: Why Does School Start So D*** Early, and Should it?

SHOW AUDIO:  Link is usually posted within about 72 hours of show broadcast.
Welcome to Thinkwing Radio with Mike Honig (@ThinkwingRadio), a listener call-in show (every Wednesday night from 10-11PM CT) on KPFT-FM 90.1 (Houston). My engineer and discussion partner is Egberto Willies (@EgbertoWillies).
For the purposes of this show, I operate on two mottoes:
  • You’re entitled to your own opinion, but not your own facts;
  • An educated electorate is a prerequisite for a democracy.
Thinkwing Radio with Mike Honig is usually a call-in show. Whether you’re listening live on the radio or on the internet from anywhere in the world, you can call in at 713-526-5738. (Long distance charges may apply.) 
GUESTS(Fuller bios can be seen at SOURCES, below the break)
  • Terra Ziporyn Snider (PhD), Executive Director, Co-Founder ofStartSchoolLater
  • Dr. Joshua Rotenberg, MD, is a pediatric neurologist, sleep specialist and epileptologist in Houston, TX.
TOPIC: Why Does School Start So Damn Early, and Should it?
NOTE: This post is subject to update before and after the show.
Some of the links used for this show are BELOW the break:
SOURCES (Below the break):

Monday, February 24, 2014

The Impact of School Daily Schedule on Adolescent Sleep

High school students get 7 hours of sleep per night while they need about 9.2.
What happens if school start times  are delayed?

  • Article

The Impact of School Daily Schedule on Adolescent Sleep

  1. Margarita L. Dubocovich, PhD§
+Author Affiliations
  1. *Science Department, Evanston Township High School, Evanston, Illinois; Departments of
  2. Neurology
  3. §Molecular Pharmacology and Biological Chemistry, and
  4. Psychiatry and Behavioral Science, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  5. Center for Sleep and Circadian Biology, Northwestern University, Evanston, Illinois


Objectives. This study was initiated to examine the impact of starting school on adolescent sleep, to compare weekday and weekend sleep times, and to attempt to normalize the timing of the circadian sleep/wake cycle by administering bright light in the morning. This was a collaborative project involving high school students and their parents, as well as high school and university faculty members, for the purpose of contributing information to the scientific community while educating students about research processes and their own sleep/wake cycles and patterns.
Methods. Sixty incoming high school seniors kept sleep/wake diaries beginning in August and continuing through 2 weeks after the start of school in September. Sleep diaries were also kept for 1 month in November and 1 month in February. Early-morning light treatments were given to 19 students in the last 2 weeks of November and the last 2 weeks of February. Neuropsychologic performance was measured with computer-administered tests. Paper-and-pencil tests were used for assessment of mood and vigor. A testing period consisted of 2 consecutive days at the beginning and end of November and at the beginning and end of February. Tests were given 3 times per day, ie, in the morning before school (6:30–8:00 AM), during midday lunch periods (11:30 AM to 1:00 PM), and in the afternoon (3:00–4:30 PM), on each of the test days.
Results. Adolescents lost as much as 120 minutes of sleep per night during the week after the start of school, and weekend sleep time was also significantly longer (∼30 minutes) than that seen before the start of school (August). No significant differences were found between weekday sleep in the summer and weekend sleep during the school year. Early-morning light treatments did not modify total minutes of sleep per night, mood, or computer-administered vigilance test results. All students performed better in the afternoon than in the morning. Students in early morning classes reported being wearier, being less alert, and having to expend greater effort.
Conclusions. The results of this study demonstrated that current high school start times contribute to sleep deprivation among adolescents. Consistent with a delay in circadian sleep phase, students performed better later in the day than in the early morning. However, exposure to bright light in the morning did not change the sleep/wake cycle or improve daytime performance during weekdays. Both short-term and long-term strategies that address the epidemic of sleep deprivation among adolescents will be necessary to improve health and maximize school performance.
Key Words:

Article about start times here

Study: Asthma and migraine linked admission of self-harm

A study claims that there is a link between having asthma and migraine and a person admitting to self-harm.

Certain long-term physical disorders, such as asthma and migraine, may boost the risk of self- harm, indicates a comparative study of hospital admissions after an episode of deliberate injury in England, and published in the Journal of the Royal Society of Medicine.
Over 200,000 people are admitted to hospital every year in England as a result of self-harm, and people who self-harm have a substantially increased risk of suicide.
The new National Suicide Prevention Strategy for England includes several priority groups including people with a history of self-harm, young people, and those living with long-term physical health conditions.
The peak age for self-harm is 15–24 years, and suicide is the third leading cause of death in this age group.
While it’s well known that psychiatric illness greatly increases the risk of self-harm, it’s less clear whether physical disorders have a similar impact.
The researchers therefore looked at risk of hospital admission for self-harm among people with different long-term psychiatric and physical disorders across England, using a linked dataset of Hospital Episode Statistics (HES) for 1999–2011.
The psychiatric illnesses studied included depression, bipolar disorder, alcohol abuse, anxiety disorders, eating disorders, schizophrenia and substance abuse.
Unsurprisingly, the analysis showed that patients with these conditions were at much greater risk. They were more than five times as likely to self-harm as those without these conditions, the findings showed.
But certain physical ailments also seemed to be linked to an increased risk of self-harm. Among the physical illnesses studied, patients with epilepsy were around three times more likely to self-harm, while those with asthma or migraine were almost twice as likely to do so.
Patients with psoriasis and diabetes also had a moderately increased risk of self-harm of around 60%, while those with eczema and inflammatory polyarthropathies were around 40% more likely to do so.
Patients with cancers under the age of 65, congenital heart disease, ulcerative colitis, sickle cell anaemia and Down’s syndrome were less likely to self-harm.
“It is important for physicians, general practitioners and mental health workers to be aware of the physical disorders that are associated with an increased risk of self-harm so that at-risk individuals may be better identified and can be monitored for any psychiatric symptoms and mental distress,” write the authors.
Much greater integration of medical and mental health services is needed, they say.
Read more here

Narcolepsy may be responsible for your daytime sleepiness

This article discusses narcolepsy and explains how it could be responsible for daytime sleepiness.

With busy schedules, it’s inevitable to feel sleepy once in a while. But habitually falling asleep during the day while watching TV, reading a book, or in the middle of having a conversation could be a sign of a serious sleep disorder known as narcolepsy.
An underdiagnosed medical condition
Narcolepsy is a sleep disorder that involves the brain’s inability to regulate sleep-wake cycles normally. It affects an estimated one in 2,000 people in the United States, with symptoms typically appearing in early adulthood. Yet it is estimated that 50 percent or more patients with narcolepsy have not been diagnosed. According to a recent survey conducted by Harris Interactive on behalf of Jazz Pharmaceuticals, awareness of narcolepsy is low. One thousand members of the general public and 400 practicing physicians were surveyed about their knowledge of narcolepsy and its symptoms. Only 7 percent of members of the general public who had heard of the condition reported being “very” or “extremely” knowledgeable about it relative to other chronic diseases. That number only increased to 24 percent among primary care physicians. The majority of people surveyed could not identify all five major symptoms of narcolepsy. In fact, studies have shown it may take 10 years or more for people with narcolepsy to receive a correct diagnosis.
“The symptoms of narcolepsy are not well-recognized, which can lead to misdiagnosis,” says Dr. Aatif M. Husain, professor of neurology at Duke University Medical Center.  “By becoming aware of the symptoms of narcolepsy, individuals can have more informed conversations with their doctors, which may help lead to quicker diagnosis.”
The symptoms of narcolepsy: more than daytime sleepiness
A recent study, in which researchers evaluated health care data of more than 9,000 narcolepsy patients compared to 46,000 controls, shows that people with narcolepsy are more likely to suffer from depression, anxiety and other conditions including sleep apnea, stroke and heart failure compared to the general population. There are five major symptoms of narcolepsy. Talk to a doctor if one or more sound familiar.
* Excessive daytime sleepiness (EDS) – EDS, the primary symptom of narcolepsy, is characterized by the inability to stay awake and alert during the day resulting in unplanned lapses into sleep or drowsiness; EDS is present in all people with narcolepsy.
* Cataplexy (muscle weakness with emotions) – A sudden, brief loss of muscle strength triggered by strong emotions like happiness, laughter, surprise, or anger.
* Sleep disruption – Frequent periods of waking up during sleep.
* Sleep paralysis – A brief inability to move or speak while falling asleep or waking up.
* Hypnogogic hallucinations – Vivid, dream-like events that occur when falling asleep or waking up.
These symptoms vary from person to person and not all five symptoms must be present for a narcolepsy diagnosis. It is also important that family and friends understand these symptoms, as they may observe them and encourage their loved ones to seek medical advice sooner.

Read more here

Smartphones hurting our ability to sleep and work

An article from the Wall Street Journal discusses how smartphones make us tired which can both hurt our ability to sleep at night and to be productive during the day.

For a productive day at work tomorrow, give the smartphone a rest tonight.
Reading and sending work email on a smartphone late into the evening doesn’t just make it harder to get a decent night’s sleep. New research findings show it also exhausts workers by morning and leaves them disengaged by the next afternoon.
That means the way most knowledge workers do their jobs—monitoring their iPhones for notes from the boss long after the office day is done and responding to colleagues at all hours—ultimately makes them less effective, posit researchers from University of Florida, Michigan State University and University of Washington.
The scholars conducted two studies of workers’ nighttime technology habits, sleep duration and quality, energy and workplace engagement. In the first study, 82 mid- to high-level managers were asked every morning how many minutes they used their smartphone after 9:00 pm the night before and how many hours they slept. Then, they were asked to rate their agreement with statements like “I feel drained” and “Right now, it would take a lot of effort for me to concentrate on something.”
In the afternoon, they had to assess statements about work engagement, such as “Today while working, I forgot everything else around me.”
Prior studies have shown that staying focused and resisting distractions takes a lot of effort, so when smartphone use interferes with sleep, it takes a toll the next day.
“The benefit of smartphone use may…be offset by the inability of employees to fully recover from work activities while away from the office,” the researchers write.
After accounting for sleep quality, the researchers found that work-related smartphone use in the evening was associated with fewer hours of sleep. The subjects who recorded shorter nights also reported depleted reserves of self-control, and those who felt morning exhaustion also indicated they were less engaged during the day, a domino effect that shows how an unending workday ultimately leads to poorer work.
The second study, which involved 161 workers, measured how late-night tech use—on smartphones, laptops, tablets and TV—can disrupt sleep and next-day work engagement.
In her book, “Sleeping With Your Smartphone,” Harvard Business School professor Leslie Perlow studied executives at Boston Consulting Group who were given a chance to disconnect on a regular basis. The executives became more excited about their work, felt more satisfied about their professional and personal lives and even became more collaborative and efficient.
Using any kind of electronic device affects sleep quantity and focus the following day, but smartphones are especially draining. That’s partly because the always-on, always-handy phone the first device we turn to, says Christopher M. Barnes, an assistant professor of management at University of Washington’s Michael G. Foster School of Business and a co-author of the paper. Having a screen so close to our faces probably doesn’t help us prepare for sleep, he adds.
The researchers don’t yet know if there’s a particular threshold at which smartphone use begins to affect sleep habits, but even 30 minutes before bedtime can take a toll, Barnes says.
The fix, researchers say, is to put down the phone and enjoy the evening. But that’s easier said than done, so long as managers send emails at 10:30 p.m. and expect responses by 10:31 pm. Barnes says real change will have to come from the top, with managers setting an example by not sending those messages in the first place, or at least toning down expectations on response time.
Read more here

Autism may be due to specific chemical switch

A study shows that autism may be caused by a specific faulty chemical switch that does not get turned on causing the brain to not develop normally.

Autism may result from a faulty chemical switch that doesn't get flipped in time to help the brain develop normally, a new research study suggests.

Building on what they hope will be an important insight into the cause of autism, French researchers are testing a high blood pressure medication on dozens of European children with autism.

The team, which has a financial stake in the drug, has tried it on 30 children with autism; now they are testing it in more, hoping to improve core characteristics of autism for the first time.

There are drugs to treat some of autism's symptoms, but none that address the underlying social and communication difficulties and repetitive behaviors, which define the condition. Previous attempts to develop an effective drug against the condition, which affects at least one in 88 U.S. schoolchildren, have either failed or are also still experimental.

In a study out today in the journal Science, the researchers offer an explanation for the promise of their drug, bumetanide, a generic diuretic long used to treat the fluid retention of high blood pressure.

The researchers found that the drug, given during pregnancy, could reverse autism symptoms in newborn mice bred with a genetic condition that often causes autism in people, and in rats exposed to the epilepsy drug valproic acid, which is known to trigger autism.

They suspect that bumetanide is flipping a chemical switch in the brain — changing the chemical GABA from stimulating electrical activity in the brain to tamping it down. This switch needs to be flipped during or near birth for the brain to develop normally, says lead researcher Yehezkel Ben-Ari of the French Institut National de la Santé et de la Recherche Médicale, in Marseilles, France.

Because this switch fails to flip in rodents with two very different triggers of autism, the researchers say they may have found an underlying cause of the condition.

That is a "pretty incredible finding and really great," says Andrew Zimmerman, a pediatric neurologist and autism expert at the University of Massachusetts Medical School in Worcester, Mass.

He and other researchers note that it's too early for people to try the drug outside of carefully watched clinical trials. There are just so many unknowns, from what the drug will do to the developing brain to how much of the drug to give and when.

"So many things cure cancer in mice and rats, and so many things cure all kinds of things and then when we give them to humans they have adverse affects and don't fix the problems we thought they could fix," says Gary Goldstein, president and CEO of the Kennedy Krieger Institute, a Baltimore-based clinic and research center. "I wouldn't give it to my child, I can tell you that."

Ben-Ari and his colleagues have patented a version of bumetanide and formed a company, Neurochlore, in Marseilles, to test the drug in children. He says bumetanide should not be given to pregnant women — despite his success with rodents — because it is impossible to determine which children will go on to develop autism and unethical to test on healthy ones.

It should be used as early in childhood as possible, Ben-Ari says, and his team is testing the drug in children as young as 2. Autism is typically diagnosed around age 4, but experts are working to push that diagnosis earlier. It is widely believed that the sooner treatment begins, the more effective it is likely to be.

Ben-Ari says he is hopeful that the drug will show benefits across a broad spectrum of children with autism, but behavioral therapy and possibly other pharmaceutical treatments will likely still be needed, too, he says.

"It's important for people to understand there is no drug to cure a medical disease as complicated as autism," he says.

Read more here

Sunday, February 23, 2014

Sleep apnea in MS patients

Recent findings show that sleep apnea can increase fatigue in  multiple sclerosis (MS) patients.

Sleep apnea is common in people with multiple sclerosis and may contribute to their fatigue, a new study shows.
Fatigue is one of the most frequent and debilitating symptoms experienced by MS patients.
The study included 195 people with MS who completed a sleep questionnaire and were assessed for daytime sleepiness, insomnia, fatigue severity and sleep apnea.
One-fifth of the patients had been diagnosed with sleep apnea and more than half were found to have an elevated risk for the condition. The researchers also found that sleep apnea risk was a significant predictor of fatigue severity.
According to the American Academy of Sleep Medicine (AASM), sleep apnea involves decreased or periodic stoppage of airflow during sleep. As muscles relax, soft tissue at the back of the throat may collapse and block the upper airway. Most people with the condition snore loudly.
MS is a chronic, frequently disabling disease that attacks the central nervous system, according to the National Multiple Sclerosis Society. Symptoms range widely, from mild signs such as numbness in the limbs to severe symptoms including paralysis or loss of vision.
The new findings suggest that sleep apnea may be a common but under-recognized contributor to fatigue in MS patients, and doctors should not hesitate to check these patients for sleep problems, study author Dr. Tiffany Braley, an assistant professor of neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers, said in an AASM news release.
"Obstructive sleep apnea is a chronic illness that can have a destructive impact on your health and quality of life," and MS patients at high risk for sleep apnea should undergo a comprehensive sleep evaluation, academy president Dr. M. Safwan Badr said in the news release.
The study appears in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, an AASM publication.
About 400,000 people in the United States have MS, according to the National Multiple Sclerosis Society. Up to 7 percent of men and 5 percent of women have sleep apnea, according to the AASM.
Read more here

Seizures caused by fevers alleviated by epilepsy drug

A study shows that seizures caused by fevers in children can be alleviated by antiepileptic drugs.

Early treatment with antiepileptic drugs reduces the length of fever-related seizures in children, according to a new study.
Published Feb. 6 in the journal Epilepsia, the study also found that a standard emergency medical services treatment guideline for prolonged fever-related seizures is needed in the United States.
Most fever-related seizures, also called febrile seizures, are brief, but up to 10 percent can last more than 30 minutes. These prolonged seizures can put children at risk for short- and long-term complications, including developing epilepsy, according to a journal news release.
The new study included nearly 200 children, aged 1 month to 6 years, who had one seizure or a group of seizures that lasted more than 30 minutes. The researchers examined the connection between time to treatment and length of the seizure.
About 90 percent of the children were given at least one antiepileptic drug, and the first dose was given by EMS crews or emergency-room staff an average of 30 minutes after the seizure began, the study found.
The average length of seizure was 81 minutes among children who received an antiepileptic drug before they arrived at the emergency room and 95 minutes for those who did not. On average, seizures ended about 38 minutes after a child received the first dose of an antiepileptic drug.
"The time from the start of the seizure to treatment is crucial to improving patient outcomes," study lead author Dr. Syndi Seinfeld, an assistant professor in the division of child neurology at Children's Hospital of Richmond, at Virginia Commonwealth University, said in the news release.
"Our study is the first to examine the treatment of [febrile seizures] by EMS, which currently does not have a standard therapy protocol for prolonged seizures," Seinfeld said.
"Our findings clearly show that early [antiepileptic drug] initiation results in shorter seizure duration," she said. "A standard [prolonged seizure] treatment protocol prior to arrival at the hospital, along with training for EMS staff, is needed across the United States to help improve outcomes for children with prolonged seizures."
Read more here

Friday, February 21, 2014

Medicine instead of tonsillectomy for children with mild obstructive sleep apnea - Ask a Pediatric Sleep Specialist

This article claims that a specific drug combination can replace the need for a tonsillectomy for children who have mild obstructive sleep apnea.

The anti-inflammatory asthma drug montelukast (Singulair) plus intranasal corticosteroids was an effective initial alternative to surgery for mild obstructive sleep apnea (OSA) in children, a retrospective study showed.
That strategy was associated with normalization of sleep findings in 62%,David Gozal, MD, of Chicago's Comer Children's Hospital, and colleagues found.
Overall, taking into account nonadherence and parents refusing the strategy, 81% were able to avoid surgery, the researchers reported online in Chest.
With "the absence of significant side effects and overall favorable safety profile associated with the use of either intranasal corticosteroids, or of oral montelukast," the combination "may ultimately replace adenotonsillectomy as the first line of treatment in mild OSA," they suggested.
Pediatric sleep apnea can resolve on its own, and that might have accounted for some of the results, Gozal's group acknowledged.
However, "the combined evidence from in vitro experiments showing marked reductions in tonsillar and adenoid tissue proliferation with application of corticosteroids or montelukast, and the experience garnered from clinical trials using either intranasal corticosteroids alone or oral montelukast alone," support a real effect.
Prospective randomized controlled trial evidence is "sorely" needed, the group concluded.
Until such a trial is done, it would be premature to offer the drug combo routinely,Christopher Carroll, MD, medical director of surgical critical care at Connecticut Childrens Medical Center in Hartford, commented in an interview with MedPage Today.
Nevertheless, "I don't think there's any problem with trying this before going to surgery," he suggested, noting that its OSA resolution rate was fairly competitive with the 75% rate found for surgery in a recent review.
"We tend to think that surgery is definitive and is curative 100% of the time, but that's just not true," he said. "And it carries a significant risk."
The retrospective review included 836 otherwise healthy children ages 2 to 14 who were clinically and polysomnographically diagnosed with mild OSA at three centers.
Among them, 752 accepted open-label treatment with a combination of oral montelukast and an intranasal corticosteroid for 12 weeks, with continued montelukast for 6 to 12 months if symptoms persisted at subsequent polysomnographs or a recommendation for surgery if they worsened.
Predictors of nonresponse were older age (odds ratio 2.3 for age older than 7, 95% CI 1.43-4.13) and obesity (OR 6.3 with BMI z score over 1.65, 95% CI 4.23-11.18).
Read more here