Health consequences of texting in bed

A study indicates that texting in bed can lead to losing sleep in addition to poor school performance in teens.

Many American teens text in bed, leading to lost sleep, daytime drowsiness and poorer school performance, a new study says.

Researchers from New Jersey looked at nearly 3,200 middle and high school students in the state. They found that nearly 62 percent of the kids used their smartphones in some capacity after bedtime; nearly 57 percent texted, tweeted or messaged in bed; and nearly 21 percent awoke to texts.

"Our study confirms that many teenagers are texting late at night when they should be sleeping. This behavior is more common among older teenagers, especially those in high school, and among girls," said study co-author Vincent DeBari. He is director of research at the Seton Hall University School of Health and Medical Sciences, in South Orange.

"One of the most worrisome aspects of our findings is that in addition to affecting the quality and amount of sleep teenagers are getting, bedtime smartphone use seems to be having a negative impact on their level of alertness during the day and on their grades in school," DeBari said in a university news release.

His study co-author, Dr. Peter Polos, added that teens whose sleep is disrupted by incoming texts may feel compelled to respond to those texts immediately. These exchanges can go on for hours.

"This leads to excessive stimulation at night. Light from electronic devices can suppress the secretion of melatonin, a hormone that promotes sleep. All of these factors combine to make sleep difficult in the face of excessive smartphone use at night," said Polos, a member of the sleep medicine division of the JFK Neuroscience Institute in Edison, N.J.

The researchers also found that smartphone use just before or after bedtime may worsen teens' tendency to go to bed much later and sleep until late morning. This behavior has been linked with depression, anxiety and attention-deficit hyperactivity disorder, the study authors said.

"Repeatedly, studies have shown that today's adolescent students are seriously sleep-deprived, and that it affects their health, their mood and their safety behind the wheel. Our study shows that the unrestricted use of smartphones at night may be a major contributing factor," Dr. Sushanth Bhat, an assistant professor of neuroscience at Seton Hall, said in the news release.

"Since getting the proper amount of sleep is very important for brain development and learning in the teenage years, our study should prompt parents and guardians to consider placing reasonable limitations on adolescent smartphone usage at night," Bhat concluded.

The study findings appear in the October issue of the Journal of Adolescence.

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Health effects of sleep apnea

This article discusses the effects of sleep apnea beyond snoring.

According to the American Sleep Apnea Association, about 22 million Americans have sleep apnea and about 80 percent of those cases are undiagnosed. Sleep apnea is an involuntary sleep disorder in which breathing repeatedly stops and starts.

Sleep apnea can occur when tissue in the back of the throat blocks the airway. If the airway is blocked, the amount of oxygen delivered to the body’s organs is reduced. When blood-oxygen levels drop low enough, the body wakes itself up. Sometimes it happens so fast that it goes unnoticed to the sleeper. People with sleep apnea can stop breathing hundreds of times during the night and often for a minute or longer.

Sleep apnea can have serious and life-shortening consequences if it is not treated. These include high blood pressure, heart disease, stroke, memory problems, diabetes and depression.

Symptoms of sleep apnea:

• loud snoring
• fatigue
• insomnia
• persistent daytime sleepiness
• awakening out of breath during the night
• frequently waking in the morning with a dry mouth or a headache

The most widely used treatment for sleep apnea is a Continuous Positive Airway Pressure (CPAP) machine. The CPAP has a mask that goes over the nose, or sometimes nose and mouth, during sleep and supplies pressurized air that flows into the person’s throat. The increased air pressure keeps the airway open. Sometimes people still struggle with sleep apnea even after they use a CPAP. In those cases, surgery may be needed.

Sleep apnea is sometimes caused by the back of the tongue or tonsils blocking the airway. In these cases, an uvulopalatopharyngoplasty (UVPPP) is required. UVPPP involves shortening the soft palate and removing the tonsils, and it has been the most common sleep apnea surgical procedure performed in the past 25 years. In addition, robotic-assisted resection of the base of tongue is a minimally invasive approach to remove obstructive tongue tissue blocking the airway. After this surgery, sleep apnea is often corrected. At Long Beach Memorial, the da Vinci Si Robotic Surgical System is used to remove redundant tongue tissue and is performed in conjunction with the UVPPP to help our patients get a good night’s rest.

In order to properly diagnose sleep apnea, a physician must conduct a sleep study in a sleep lab, usually overnight. A sleep study monitors activity during sleep such as measuring brain waves, heart rate and rhythm, breathing patterns and oxygen levels.

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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: Link between depression and sleep disorders in men

A study found a link between depression and sleep disorders in men.

Sleep problems are often caused by various mental illnesses, such as depression or post-traumatic stress disorder, but a new research shows interchangeability between sleep disorders and depression. Apparently, having trouble sleeping can also be a trigger.

Researchers from the University of Adelaide and the Adelaide Institute for Sleep Health examined levels of sleepiness throughout the day in almost 2,000 Australian men aged between 35 and 83.

It turned out that those exhibiting severe daytime sleepiness had 10 percent more chances of becoming depressed than those who felt rested during waking hours. Even after various risk factors were taken into account, the link between the two held up.

At the beginning of the assessment, none of the men entering the study were diagnosed with severe obstructive sleep apnea, but after joining, 856 of them were examined in the light of symptoms related to the condition.

Those receiving this diagnose turned out to be 2.1 times more prone to become depressed than participants who didn’t have the sleep condition.

According to the results, men who struggled with both extreme daytime sleepiness and severe sleep apnea had even more increased chances of depression – 4.2 times more than men with no sleep disorders. Suffering from both conditions also meant 3.5 times more chances of depression when compared with men with only one of them.

Two follow-up tests were involved in the evaluation of depression levels, taken at a five years difference from one another. This period allowed researchers to observe whether it is possible that sleep disorders are linked to a recent diagnosis of depression.

During those five years, men suffering from severe sleep apnea diagnosed during the study turned out to have 2.9 times increased risk of becoming depressed.

However, the study’s design could not help researchers determine whether sleep problems can be considered boosters of depression risk in men. They believe it is possible that depression is a cause of sleep disorders, but the reverse was more difficult to assess.

The team also considered the possibility that a third factor included in the equation could cause both depression and sleep troubles.

Authors of the study are still unsure about the exact relation between a sound sleep and risk of depression, but the results offer enough information doctors can use in their practices. For example, after a patient receives a depression diagnosis, physicians should order a screening for obstructive sleep apnea, even if the patient doesn’t show signs of sleepiness.

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Is my iPad disrupting my sleep?

This article explains how an iPad can disrupt a person's sleep.

Using an iPad or other backlit electronic tablet in the hours before bedtime not only prevents you from falling asleep, it may also affect your alertness the next day, according to a report published in the Proceedings of the National Academy of Sciences, Dec. 22, 2014. Researchers at Harvard-affiliated Brigham and Women’s Hospital found that the light emitted by the devices reset the body’s circadian clock, which synchronizes the daily rhythm of sleep to daylight. As a result, people reading e-books took longer to fall asleep and were less alert the next morning than when they read print books instead.

During the two-week study, 12 men and women read digital books on an iPad for four hours before bedtime each night for five consecutive nights. They also followed the same routine using printed books. When they read the iPad, participants were less sleepy before bedtime but were less alert the following morning, even after eight hours of sleep.

If you’re a bedtime reader who’s addicted to her iPad, don’t despair. The researchers used a 2010
iPad set at maximum brightness. Newer iPads and other e-readers have night-reading modes.

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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: Seniors helped by sleep apnea treatment

A study claims that seniors are helped by sleep apnea treatments such as a CPAP.

A new study finds that continuous positive airway pressure (CPAP) is an effective treatment for seniors with sleep apnea.

CPAP is widely used to treat moderate to severe obstructive sleep apnea, a condition in which the airway relaxes and narrows during sleep, causing breathing problems and interrupted sleep that leads to daytime drowsiness.

CPAP keeps the airway open by pushing a stream of air through a patient's nose via a mask that is worn during sleep. Previous research has shown that CPAP benefits middle-aged adults with sleep apnea, but there had been no studies on whether it was useful and cost-effective in seniors.

This new study of 278 sleep apnea patients aged 65 and older in the United Kingdom found that CPAP reduced their levels of daytime sleepiness and their health care costs.

"Sleep apnea can be hugely damaging to patients' quality of life and increase their risk of road accidents, heart disease and other conditions. Lots of older people might benefit from this treatment," study co-lead author Mary Morrell, a professor at the National Heart and Lung Institute at Imperial College London, said in a college news release.

"Many patients feel rejuvenated after using CPAP because they're able to sleep much better, and it may even improve their brain function," Morrell added.

"We think low oxygen levels at night [because of interrupted breathing] might accelerate cognitive [mental] decline in old people, and studies have found that sleep apnea causes changes in the gray matter in the brain. We're currently researching whether treatment can prevent or reverse those changes," she noted.

CPAP should be offered to seniors with sleep apnea, and more needs to be done to raise awareness of the condition, the study authors said. The study is published in the Aug. 27 online edition of The Lancet Respiratory Medicine.

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Signs it's time for a sleep study

This article discusses different types of sleep disorders, and tells signs that may indicate it's time for a sleep study.

There are a number of sleep disorders that keep us from getting the rest we need. While poor sleep can be devastating to our quality of life, some sleep disorders — such as sleep apnea — can actually be life-threatening. The most common sleep disorders are:

• Sleep apnea — interrupted breathing while sleeping
• Insomnia — inability to get to sleep or stay asleep
• Daytime sleepiness disorder (hypersomnia) — feeling sleepy all day, unable to stay awake, difficulty focusing
• Restless leg syndrome — uncomfortable urge to move legs while at rest
• Narcolepsy — sudden sleep attacks

A sleep study is typically the quickest and best way to find out whether you have a sleep disorder. It's time for a sleep study if:

• Your bed partner complains of loud snoring and has witnessed you not breathing.
• You wake up with a dry mouth or sore throat, coughing, choking or unable to catch your breath.
• You have excessive daytime sleepiness and decreased energy during the day.
• You are unable to remain awake while driving.

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Is sleep apnea harmful for health?

This article describes in what ways sleep apnea is harmful to a person's health.

Sleep apnea is a sleeping disorder that occurs when a person’s breathing is interrupted during sleep. These breathing pauses typically last between 10 to 20 seconds and can occur up to hundreds of times at night. This chronic sleep deprivation results in daytime sleepiness, slow reflexes, poor concentration, and an increased risk of accidents.

Sleep apnea can also lead to serious health problems over time, including diabetes, high blood pressure, heart disease, stroke, and weight gain. But with treatment you can control the symptoms, get your sleep back on track, and start enjoy being refreshed and alert every day.

Sleep apnea Symptoms:

l If pauses occur while you snore, and if choking or gasping follows the pauses, these are major signs that you have sleep apnea.

l Morning headaches

l Memory or learning problems and not being able to concentrate

l Feeling irritable, depressed, or having mood swings or personality changes

l Waking up frequently to urinate

l Dry mouth or sore throat when you wake up

Treatment of sleep apnea:

l Weight loss: People who are overweight have extra tissue in the back of their throat, which can fall down over the airway and block the flow of air into the lungs while they sleep. Losing just 10% of body weight can have a big effect on sleep apnea symptoms. In some cases, losing a significant amount of weight can even cure Sleep Apnoea.

l Quitting smoking.

l Avoiding alcohol, sleeping pills, and sedatives,

l Avoiding caffeine and heavy meals within two hours of going to bed.

l Maintaining regular sleep hours.

l Bariatric Surgery: Choosing Surgery is not a simple decision and it is not for everyone who struggles with sleep apnea. It is for individuals who have exhausted other options for treatment and have got excess weight.

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Smoking marijuana can lead to poor sleep quality, study claims

According to a study, smoking marijuana can lead to impaired sleep and poor sleep quality.

Smoking pot can lead to poor sleep quality, a new research shows.

Researchers found that marijuana abuse was linked to increased chances of difficulty in falling asleep, struggling to maintain sleep, experiencing non-restorative sleep and feeling daytime sleepiness.

The effect was strongly seen in people who began smoking weed before the age of 15. They were nearly twice more likely to have severe problems falling asleep, experiencing non-restorative sleep and feeling overly sleepy during the day.

"Current and past marijuana users are more likely to experience sleep problems," said lead author Jilesh Chheda, research assistant at the University of Pennsylvania in Philadelphia. "The most surprising finding was that there was a strong relationship with age of first use, no matter how often people were currently using marijuana. People who started using early were more likely to have sleep problems as an adult," he said in a news release.

The study involved adults ranging in age from 20-59 years who responded to the 2007-2008 National Health and Nutrition Examination Survey (NHANES). A history of drug use was reported by 1,811 participants. Cannabis use was assessed as any history of use, age at first use and number of times used in the past month. Sleep-related problems were considered severe if they occurred at least 15 days per month.

The findings show that weed abuse in the early years of adolescence might pose a higher risk for subsequent insomnia symptoms.

"Marijuana use is common, with about half of adults having reported using it at some point in their life," said Chheda. "As it becomes legal in many states, it will be important to understand the impact of marijuana use on public health, as its impact on sleep in the 'real world' is not well known."

The research abstract was published in the journal 'Sleep' and will be presented Wednesday, June 4, in Minneapolis, Minnesota, at SLEEP 2014, the 28th annual meeting of the Associated Professional Sleep Societies LLC.

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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.

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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.

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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.

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Study shows that narcolepsy is an autoimmune disorder

A study claims that narcolepsy is actually an autoimmune disorder which has important impacts for treatment options.

A recent study confirms long-held suspicions that the sleep disorder narcolepsy -- a condition where a person feels uncontrollably sleepy during the daytime and can experience muscle weakness -- is actually an autoimmune disorder. The findings also help to explain why narcolepsy was linked to the Pandemrix H1N1 flu vaccine.

Nearly all people with narcolepsy have a specific genetic signature -- called the HLA signature, where HLA stands for human leukocyte antigens -- but not everyone with this genetic signature goes on to develop narcolepsy (20 percent of the general population is thought to possess this signature). A type of immune cell, called the CD4+ T cell, is associated with this HLA signature; immune cells, like this type of T cell, are responsible for recognizing and eradicating foreign invaders in the body.

Previously, researchers had found evidence to suggest that the immune system was responsible for narcolepsy by attacking neurons that produce a neurotransmitter called hypocretin, which promotes wakefulness. (People with narcolepsy are known to have low levels of hypocretin).

In the new study, published in December in the journal Science Translational Medicine, researchers found that only people with narcolepsy have these CD4+ T cells that react to portions of the hypocretin protein, while people without narcolepsy do not have these T cells. WebMD reported that this discovery was based on examinationof 39 people with narcolepsy, and 35 people without the sleep disorder.

However, Nature News also pointed out that the study did not prove that these T cells themselves kill neurons that produce hypocretin -- there could be something else that's going on causing the death of these neurons.

The researchers also found that CD4+ T cells react strongly to a portion of the H1N1 hemagglutinin protein because it strongly resembles that of two portions of hypocretin -- which could help to explain the link between narcolepsy and the H1N1 Pandemrix vaccine, which actually contained parts of viral protein.

Reuters reported that 900 cases of narcolepsy, if not more, were linked with the Pandemrix vaccine, which was administered in the 2009/2010 flu pandemic in Europe but not the United States. (It is no longer being administered in Europe.)

"The relationship between H1N1 infection, vaccination and narcolepsygave us some very interesting insight into possible causes of the condition," study researcher Dr. Emmanuel Mignot, M.D., Ph.D., a professor of psychiatry and behavioral sciences at Stanford University School of Medicine, as well as director of the Stanford Center for Sleep Sciences and Medicine, said in a statement. "In particular, it strongly suggested to us that T cells of the immune system primed to attack H1N1 can occasionally also cross-react with hypocretin and somehow cause the destruction of hypocretin-producing neurons."

The new findings mean that researchers now have a target to set their sights on -- finding ways to stop the loss of brain cells by the body's own immune system.

"By giving us a new way to think about how neurons in these patients die, it alsosuggests new therapeutic approaches that we would not have considered if we hadn’t learned that this is an autoimmune disease," study researcher Dr. Elizabeth Mellins, M.D., an immunology researcher at Stanford, said in the statement.

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Sleep loss can raise teenager's blood pressure

Sleep loss in teenagers has many negative health outcomes, such as daytime sleepiness and raising their blood pressure, which can lead to serious health conditions later in life.

Beyond making teens sleepy during the day, staying up late may be raising their blood pressure, setting them up for later heart troubles, say Chinese researchers.

"Sleep is an essential part of everyone's life. However, with continuous advancement of technology, the portion of sleep in each day is diminishing," the study's lead author Chun-Ting Au told Reuters Health in an email.

Au is a research associate in the Department of Pediatrics at the Faculty of Medicine of the Chinese University of Hong Kong.

He and his team wanted to examine the relationship between sleep and blood pressure in teens without other potential causes of high blood pressure, such as obesity or sleep apnea.

"Scientifically, as the association between sleep duration and blood pressure was still uncertain, we decided to conduct this study to examine the association in a more precise way," Au said.

The researchers invited adolescents who had participated in a previous study on obstructive sleep apnea. All participants in the new study were healthy and not overweight or obese for their ages, and none had sleep apnea or recent surgery involving the airways.

A total of 143 kids between the ages of 10 and 18 completed the study. The kids filled out sleep diaries for seven days before they entered a sleep lab for 24-hour sleep studies, where they were monitored for blood pressure, sleep duration and the quality of their sleep.

In general, the children who had less total sleep during the week had slightly higher blood pressure measurements. On average, each hour of nightly lost sleep was associated with an increase of 2 mm Hg in systolic blood pressure (the top number) and 1 mm Hg in diastolic blood pressure.

The study did not prove that short sleep duration would cause high blood pressure in adolescents. Some other cause could be behind both the higher blood pressure readings and reduced sleep times.

The researchers point out that previous studies have found that kids with short sleep times had higher levels of the stress hormone cortisol in the morning, and that sleep deprivation may blunt the ability of blood vessels to respond to changes in pressure.

In the current study, researchers also found that kids who got the least amount of sleep based on their sleep diaries generally had later bedtimes and woke up earlier every day. But during the 24-hour sleep study, those kids fell asleep sooner and had longer total sleep times than the rest of the kids.

This change in sleep patterns might signal a rebound from sleep deprivation in the preceding week and suggests that kids might be able to make up for some lost sleep, Au's team writes in the journal Pediatrics.

"Our results found that blood pressure was sensitive to changes in sleep pattern, implicating that having longer sleep may have beneficial effects on blood pressure and thus cardiovascular health," Au said.

"On the other hand, although blood pressure was more closely associated with the sleep time on the night before, the carryover effect of the ‘sleep debt' accumulated over the past few days remained significant," he said.

"This suggests that occasional adequate sleep, as what we commonly do during weekends, may improve the situation a little bit, but does not completely reverse the detrimental effects of long-term sleep deprivation on blood pressure," Au said.

Dr. Judith Owens, director of Sleep Medicine at the Children's National Medical Center in Washington, DC, said there's not much published research in this area.

"As the authors point out, a lot of what's been done previously was confounded by this issue of obesity and obstructive sleep apnea. I think this was a very important and innovative step to eliminate those confounding variables, and look at this issue in otherwise healthy adolescents," she told Reuters Health.

Owens, a professor of Pediatrics at George Washington University School of Medicine and Health Sciences, was not involved in the new study.

She said this is an issue that affects all teenagers, not just kids who have sleep problems.

"This is something that goes on for at least 9 months of the year, for years, for the average adolescent, so the implication that this may have measurable cardiovascular effects is so important," Owens said.

Owens also said she hopes reports like this lead to long-term studies following sleep-deprived teens into their adult years.

"If we can see these short term kinds of effects, maybe we'll see more funding to do these very expensive studies where we're measuring these same kinds of issues in adults who were adolescents undergoing this sleep deprivation," she said.

Owens also told Reuters Health that disruptions in circadian rhythms might also contribute to cardiovascular risk.

Adolescents are often sleep deprived during the school year because their circadian rhythms don't match up with school schedules and they often can't fall asleep early enough to meet their sleep needs.

Au says parents can help their kids get the sleep they need.

"Be consistent and perseverant," he wrote in an email. "There are several techniques (e.g. developing a nightly bedtime routine) that can help children establish a regular sleep pattern. You may easily obtain a list of them from the Internet. No matter what technique you use, consistency and perseverance is the key to success."

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Study: Narcolepsy could be caused by the immune system

According to a recent study, narcolepsy might be caused by an immune system attack, meaning it could be tested for by a blood test, and treatment may center around the immune system.

A new study has uncovered evidence that most cases of narcolepsy are caused by a misguided immune system attack -- something that has been long suspected but unproven.

Experts said the finding, reported Dec. 18 in Science Translational Medicine, could lead to a blood test for the sleep disorder, which can be difficult to diagnose.

It also lays out the possibility that treatments that focus on the immune system could be used against the disease.

"That would be a long way out," said Thomas Roth, director of the Sleep Disorders and Research Center at Henry Ford Hospital, in Detroit.

"If you're a narcolepsy patient now, this isn't going to change your clinical care tomorrow," added Roth, who was not involved in the study.

Still, he said, the findings are "exciting," and advance the understanding of narcolepsy.

Narcolepsy causes a range of symptoms, the most common being excessive sleepiness during the day. But it may be best known for triggering potentially dangerous "sleep attacks." In these, people fall asleep without warning, for anywhere from a few seconds to a few minutes.

About 70 percent of people with narcolepsy have a symptom called cataplexy -- sudden bouts of muscle weakness. That's known as type 1 narcolepsy, and it affects roughly one in 3,000 people, according to the U.S. National Institute of Neurological Disorders and Stroke.

Research shows that those people have low levels of a brain chemical called hypocretin, which helps you stay awake. And experts have believed the deficiency is probably caused by an abnormal immune system attack on the brain cells that produce hypocretin.

"Narcolepsy has been suspected of being an autoimmune disease," said Dr. Elizabeth Mellins, a senior author of the study and an immunology researcher at Stanford University School of Medicine, in California.

"But," she said, "there's never really been proof of immune system activity that's any different from normal activity."

Mellins thinks her team has uncovered "very strong evidence" of just such an underlying problem.

The researchers found that people with narcolepsy have a subgroup of T cells in their blood that react to particular portions of the hypocretin protein -- but narcolepsy-free people do not. T cells are a key part of immune system defenses against infection.

That finding was based on 39 people with type 1 narcolepsy, and 35 people without the disorder -- including four sets of twins in which one twin was affected and the other was not.

It's known that genetic susceptibility plays a role in narcolepsy. And the theory, Mellins explained, is that in people with that inherent risk, certain environmental triggers may cause an autoimmune reaction against the body's own hypocretin.

Infections are the main culprit, and there is already evidence that the H1N1 "swine" flu is one trigger. In China, Mellins noted, there was an upswing in childhood narcolepsy cases after the H1N1 flu pandemic of 2009.

And in 2010, a cluster of narcolepsy cases in Europe was linked to a particular H1N1 vaccine that contained an "adjuvant" designed to induce a stronger immune system response. That vaccine, called Pandemrix, is no longer in use.

All of that led experts to speculate that in some genetically vulnerable people, the H1N1 virus could cause T cells to mistakenly attack hypocretin-producing brain cells.

And in the current study, Mellins's team found that segments of the H1N1 virus were similar to portions of the hypocretin protein -- the same portions that activated narcolepsy patients' T cells. They say that supports the idea that certain infections confuse T cells into attacking hypocretin-producing cells.

An expert on sleep welcomed the new study.

"They're providing more-compelling evidence that this is an autoimmune disease," said Dr. Nathaniel Watson, an associate professor of neurology at the University of Washington in Seattle, and a member of the board of directors for the American Academy of Sleep Medicine.

He and Mellins both said the results could have practical use, too. For one, researchers may be able to develop a blood test to help objectively diagnose narcolepsy.

Right now, Watson said, narcolepsy can be difficult to pinpoint, because the most common symptom -- daytime sleepiness -- has far more common causes. The most common, he noted, is simple: Not going to bed early enough.

So to diagnose narcolepsy, people may have to spend 24 hours in a sleep lab or, in some cases, have a lumbar puncture (spinal tap) to measure hypocretin in the spinal fluid.

Mellins said that if an autoimmune reaction is the cause of type 1 narcolepsy, it might be possible to treat with an immune-suppressing therapy.

The problem, though, is that once people develop full-blown symptoms, their hypocretin-producing cells have already been knocked off.

"We'd need some kind of pre-clinical marker of the disease to be able to intervene," said Watson at the University of Seattle.

Roth of Henry Ford Hospital agreed. "The big challenge is, how will you identify the people to treat?"

Three of the study authors reported they are inventors on a patent to use the hypocretin protein segments to diagnose narcolepsy. Stanford owns the intellectual property rights for this use.

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