Insomnia raises risk of fatal injury

Having insomnia can raise a person's risk of death by motor vehicle and other fatal injuries.

New research suggests that insomnia is a major contributor to deaths caused by motor vehicle crashes and other unintentional fatal injuries. The results underscore the importance of the "Sleep Well, Be Well" campaign of the National Healthy Sleep Awareness Project.

Results show that the risk of unintentional fatal injury increased in a dose-dependent manner with the number of insomnia symptoms present. People with all three symptoms of insomnia were 2.8 times more likely to die from a fatal injury than those with no insomnia symptoms, even after adjusting for potential confounders such as alcohol consumption and daily use of sleep medication.

Among the three insomnia symptoms, difficulty falling asleep appeared to have the strongest and most robust association with fatal injuries. People who almost always had difficulty falling asleep were more than two times more likely to die from a motor vehicle injury (hazard ratio = 2.40) and more than 1.5 times more likely to die from any fatal injury (HR = 1.66) than people who never had trouble initiating sleep. Further analysis found that self-reported difficulty falling asleep contributed to 34 percent of motor vehicle deaths and eight percent of all unintentional fatal injuries, which could have been prevented in the absence of insomnia.

"Our results suggest that a large proportion of unintentional fatal injuries and fatal motor vehicle injuries could have been prevented in the absence of insomnia," said lead author Lars Laugsand, MD, PhD, postdoctoral fellow in the department of public health at the Norwegian University of Science in Technology in Trondheim, Norway. "Increasing public health awareness about insomnia and identifying and treating people with insomnia may be important in preventing unintentional fatal injuries."

The study results are published in the November issue of the journal Sleep.

"Healthy sleep is essential for physical health, mental well-being, and personal and public safety," said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. "Sleep is a necessity, not a luxury, and the promotion of healthy sleep should be a fundamental public health priority."

Earlier this year the Healthy Sleep Project launched the "Sleep Well, Be Well" campaign to increase awareness of the importance of sleep as one of the three pillars of a healthy lifestyle. More details are available at http://www.projecthealthysleep.org.

The study involved that analysis of population-based survey data from 54,399 men and women between 20 and 89 years of age. Cause of death was identified using a national registry. During the 13-year follow-up period there were 277 unintentional fatal injuries, including 169 deaths from falls and 57 deaths from motor vehicle crashes.

According to the Centers for Disease Control and Prevention, there are more than 126,000 unintentional injury deaths in the U.S. each year, making it the fifth leading cause of death. There are more than 33,000 motor vehicle traffic fatalities and more than 27,000 unintentional fall deaths annually, as well as 29.3 million emergency department visits related to unintentional injuries.

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Study: Sleep apnea can raise risk of death during pregnancy

A study found that women with sleep apnea have a higher risk of dying during pregnancy than women without sleep apnea.

The risk of dying in the hospital is more than five times higher for pregnant women with obstructive sleep apnea than for those without the sleep disorder, a new study suggests.

People with sleep apnea experience repeated, brief interruptions in their breathing during sleep.

The University of South Florida study authors also found that sleep apnea is associated with higher rates of serious medical conditions that are the leading causes of pregnancy- and childbirth-related death, including an enlarged heart, blood clots in the lungs, and the dangerous blood pressure conditions known as preeclampsia and eclampsia.

The team analyzed data from an estimated 55 million women who were pregnant or gave birth in U.S. hospitals between 1998 and 2009. The study was published online May 1 in the journal Sleep.

"The astounding association with maternal death was surprising," lead author Dr. Judette Louis, assistant professor of obstetrics and gynecology, said in a university news release. "I did not expect to find such a difference in mortality between pregnant women who had sleep apnea and those who did not, especially when we controlled for obesity and other complicating factors."

The increased risk of death may be due to the added stress that sleep apnea places on the normal physical demands of pregnancy, she said.

However, although the study found an association between sleep apnea and an increased risk of pregnancy-related death, it did not prove a cause-and-effect relationship.

The researchers noted that maternal death rates in the United States have increased in recent years, and a rising obesity rate is one suspected cause.

"Our study indicates that sleep apnea may also play a role, whether a woman is obese or not," Louis said. "It's important for obstetricians and primary care practitioners to identify sleep apnea in younger women of reproductive age, convey its risk, and treat the condition before pregnancy."

Previous, smaller studies have found that sleep apnea increases the risk for problems during pregnancy, but this is the first large-scale analysis linking sleep apnea with increased risk of maternal death.

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Insomnia symptoms can raise risk of death

Both insomnia, and the symptoms of insomnia such as issues falling asleep or staying asleep, have been shown to risk a person's risk of death.

With our busy lives, it can be tempting to shrug off -- or ignore altogether -- difficulties with sleep. Trouble falling asleep, difficulty staying asleep throughout the night, waking feeling tired and unrefreshed: These are commonly experienced disruptions to sleep for millions of adults. Too often, these sleep problems aren't taken seriously, or are considered the less-than-ideal price to pay for living full and sometimes hectic lives.

Difficulty falling asleep, waking during the night, waking very early in the morning, and experiencing un-restorative sleep are all symptoms of insomnia, a serious sleep disorder. People may experience these symptoms all at once, or some of them and not others. They may experience them chronically or every so often. They are signs of disrupted, poor quality sleep and they should never be ignored.

New research indicates how high a price we may pay for overlooking signs of insomnia. Scientists at Massachusetts' Brigham & Women's Hospital have identified a link between insomnia symptoms and elevated risk of death. Their study, which included more than 23,000 men, found certain symptoms of insomnia associated with higher mortality risk from cardiovascular disease. The men were all participants in the Health Professionals' Follow-Up Study, a long-term, ongoing research endeavor that investigates issues related to men's health. In 2004, 23,447 men reported to researchers about their sleep and any insomnia symptoms. Researchers followed up with the men over a period of six years, during which time 2,025 of the men died. After adjusting for other mortality-influencing factors including age, lifestyle habits, and other health problems, researchers analyzed data on men's mortality as related to the presence of the following insomnia symptoms:

• Trouble falling asleep
• Difficulty maintaining sleep
• Waking in the early morning
• Experiencing non-restorative sleep

They found that several symptoms of insomnia were associated with higher rates of cardiovascular death among the men. In particular:

• Men who reported having difficulty falling asleep had a 55 percent increased risk of death from cardiovascular disease as compared to those men who did not experience this sleep difficulty.
• Men who reported experiencing un-refreshing sleep most of the time were at 32 percent higher risk for cardiovascular death than men who did not report this symptom.

Poor sleep is well understood to have a serious, negative impact on heart health. Not sleeping well, or enough, raises the risks for a number of cardiovascular problems, includinghigh blood pressure, heart attack, heart failure, and stroke. Protecting the quality of sleep as we age is a critical component of protecting long-term cardiovascular health.

This isn't the first scientific evidence of a link between poor sleep and increased mortality risk. But the news is particularly worrisome because these symptoms are quite common, particularly as we age. Estimates suggest that 30 percent or more of American adults experience some insomnia symptoms at least periodically, and for 10-15 percent, insomnia is chronic. Insomnia grows increasingly common with age: More than half of adults over the age of 65 experience symptoms of insomnia. Women are at higher risk than men for insomnia, due in part to hormonal cycles during childbearing years and to the hormonal changes associated with menopause. This current study included only men, but other research has shown higher risks of mortality associated with poor sleep in both men and women:

• In a number of studies that included both men and women, sleeping fewer than six hours and more than eight hours per night has been associated with increased mortality risk.
• Obstructive sleep apnea in men and in women is linked to significantly highercardiovascular and overall mortality risks. Studies have shown that mortality risksfrom cardiovascular problems are two or more times greater for adults with obstructive sleep apnea. The more severe the obstructive sleep apnea, the greater the mortality risks.
• Research has also linked use of sleeping pills to increased mortality risk. The link between higher rates of mortality and sleeping pill use exists even after factoring out other possible contributors to death risk, including health problems, age, and gender.

Ready for some good news? While sleep problems left untreated may shorten longevity, improving sleep can have powerful positive health benefits. A study conducted recently in the Netherlands found that a regular routine of 7-8 hours of sleep may have as significant an impact on risk for cardiovascular death as not smoking.Regular, sufficient amounts of high-quality sleep have also been linked to reduced risk for Type 2 diabetes, largely because of the positive effect that sleep can have on improving insulin sensitivity.

If you have symptoms of insomnia, don't ignore them. Share them with your doctor. Make an honest assessment of your sleep habits and make a commitment to taking simple steps to improve your sleep routine and your overall sleep hygiene. Taking steps to improve the quality and quantity of your sleep is one important way to protect your cardiovascular and overall health for the duration of your life. And sleeping well may actually help you extend that duration.

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Study claims insufficient sleep is more likely in African Americans

A study shows that African Americans are more likely than whites to get insufficient sleep.

Black Americans are more likely than whites to get too little sleep and this disparity is greatest among people in professional occupations, a new study shows.

Lack of sleep has been linked with increased risk of health problems, such as obesity, high blood pressure, diabetes, heart disease and even death.

For the study, researchers analyzed data collected from nearly 137,000 American adults between 2004 and 2011, and found that 30 percent of them were short sleepers (getting less than seven hours of sleep a night), 31 percent were optimal sleepers (getting about seven hours of sleep a night), and 39 percent were long sleepers (getting more than seven hours of sleep a night).

Further analysis revealed that 37 percent of black participants were short sleepers, compared with 28 percent of white participants. Among people in professional or management positions, blacks were much more likely than whites to be short sleepers (42 percent versus 26 percent), according to the Harvard School of Public Health researchers.

Blacks working in support services or as laborers were also more likely than whites to be short sleepers, 37 percent versus 26 percent and 35 percent versus 32 percent, respectively. The only job sectors in which blacks and whites had similar rates of short sleep were the retail and food industries.

The findings were published online Sept. 9 in the American Journal of Epidemiology.

"With increasing numbers of blacks entering professional and management roles in numerous industries, it is important to investigate and address the social factors contributing to the short sleep disparities in blacks compared with whites in general, and particularly in professional settings," study author Chandra Jackson, a postdoctoral research fellow in the department of nutrition, said in a Harvard news release.

Possible sleep-disrupting factors that affect blacks more than whites include: job stress; workplace discrimination or harassment that can increase job stress; limited control over job demands or prestige; long work hours; stress at home; and limited access to professional and social networks that provide emotional or financial support.

In addition, blacks are more likely than whites to do shift work and are also more likely to live in city neighborhoods with high noise levels at night, the researchers noted.

And, the study authors pointed out, it's also possible that a high work ethic among blacks -- a strong desire to succeed against all odds -- could lead to stress, disrupted sleep and harmful health effects.

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Study: Epilepsy indicates a person is 11 times more likely to die prematurely

A study from the UK claims that a person with epilepsy is 11 times more likely to die prematurely than a person without epilepsy. A person with epilepsy is also more likely to commit suicide than a person without epilepsy.

Nine per cent of people with epilepsy died young compared with just 0.7 per cent of those without the condition, the 41-year research discovered.

And the findings, published in The Lancet, showed that people with both epilepsy and alcohol or drug disorders were 22 times more likely to die than someone who did not have either.

Someone who has epilepsy is also four times more likely to commit suicide than someone who does not, the team from Oxford University said.

Only half of the UK’s 600,000 epilepsy sufferers are seizure-free, and one in 20 people will have an epileptic seizure at some point in their life.

Dr Seena Fazel from Oxford University, who led the study, said standard checks could help reduce the risk of premature deaths in people with epilepsy.

Dr Fazel commented: "Our results have significant public health implications as around 70 million people worldwide have epilepsy, and emphasise that carefully assessing and treating psychiatric disorders as part as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients.

"Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy."

The study, which tracked 69,995 people with epilepsy born in Sweden between 1954 and 2009 for a 41-year period, found suicides and accidents accounted for almost 16 per cent of all deaths in people with epilepsy.

Of these, three-quarters also had been diagnosed with a psychiatric condition such as depression. They were the most common cause of death not linked to the underlying disease process.

The researchers also found that the risk of premature death in people with epilepsy compared similarly to their unaffected siblings and the general population. This suggests that epilepsy is an independent cause of early deaths, the academics said.

Simon Wigglesworth, deputy chief executive of Epilepsy Action, said the study was cause for concern.

"The findings of this research are concerning and highlight the need for excellent healthcare for people with epilepsy", Mr Wigglesworth said.

"Getting the best possible support and treatment is important to help to reduce the likelihood of people with epilepsy experiencing mental illness. And a holistic approach to managing the condition should help ensure that people with epilepsy get the best possible treatment for both their epilepsy and any associated conditions.”

A separate study published last week warned that children whose mothers take anti-epilepsy drugs during their pregnancy face an increased risk of developing autism.

By the age of three, children were four times more likely to show traits associated with autism if their mothers had taken drugs to control their epileptic seizures.

According to Epilepsy Research UK, around two-thirds of epileptic seizures can be successfully treated with anti-epileptic drugs.

In the latest study, the causes of death were compared with 660,869 people of the same age and sex from the general population, and 81,396 unaffected siblings of people with epilepsy, to account for the potential influence of genetic or environmental factors.

While in some 60 per cent of cases the cause for epilepsy is not known, some types are inherited and common causes are brain damage, scarring of the brain tissue, a tumour, or chemical and hormonal imbalances in the body.

Epilepsy is a neurological condition defined as the tendency to have recurrent seizures. There are around 40 different sorts of seizure and a person can suffer from more than one type.

Every day 87 people in the UK are diagnosed with epilepsy, and many people who develop epilepsy when they are below the age of 20 will “grow out of it” in adult life, according to Epilepsy Action.

While only 52 per cent of people with epilepsy in this country are seizure-free, the charity estimates that with the right treatment seven in 10 could avoid seizures.

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Information on SUDEP (Sudden Unexpected Death in Epilepsy)

The following information on SUDEP (Sudden Unexpected Death in Epilepsy) was provided by the CDC and gives risk factors of SUDEP and how to lower your risk.

For some people living with epilepsy, the risk of Sudden Unexpected Death in Epilepsy (SUDEP) is an important concern. SUDEP refers to such deaths in people with epilepsy that are not caused by injury, drowning, or other known causes.1

It is likely that most, but not all, cases of SUDEP occur during or immediately after a seizure.  The exact cause is not fully known or understood, but theories exist as to why SUDEP occurs.1-4

• Breathing. A seizure may cause a person to have pauses in breathing (apnea).  If these pauses last too long, they can reduce the oxygen in the blood to a life-threatening level.  In addition, during a convulsive seizure a person’s airway sometimes may get covered or obstructed, leading to suffocation.
• Heart Rhythm. Rarely, a seizure may cause a dangerous heart rhythm or even cardiac arrest.
• Other Causes and Mixed Causes. SUDEP may result from more than one cause or a combination involving both breathing difficulty and abnormal heart rhythm.

Risk Factors for SUDEP

Estimates of SUDEP risk vary, but general population studies suggests that each year there is about 1 case of SUDEP for every 1,000 people with epilepsy.2 For some, this risk can be considerably higher, depending on several factors identified by researchers such as:

• Uncontrolled or frequent seizures.1
• Generalized convulsive (tonic-clonic or “grand mal”) seizures.1

Other possible risk factors may include the following:

• Long duration of epilepsy and young age when seizures started.2
• Not taking antiepileptic medication regularly as prescribed.4
• Alcohol use.1

Steps to Reduce the Risk of SUDEP

If you have epilepsy, ask your doctor to discuss your risk of SUDEP with you. The first and most important step to reduce your risk of SUDEP is to regularly take your seizure medication as prescribed. If you are taking seizure medication and are still having seizures, discuss options for adjusting the medication with your doctor. If seizures continue, consider consulting an epilepsy specialist, if you are not already seeing a specialist. Other possible steps to reduce the risk of SUDEP might include:

• Avoid seizure triggers, if these are known.2 Read more information about seizure triggers.
• Avoid excessive alcohol use.1
• Avoid sleep deprivation.1

If you have uncontrolled epilepsy, talk with your doctor about other possible ways to reduce your risk of SUDEP. If necessary, other ways to reduce risk might include having adults in the household trained in first aid for epilepsy seizures.

How Do I Talk to My Doctor About SUDEP?

When you decide to talk with your doctor about SUDEP, possible questions to ask the following:

• What is my risk for SUDEP?
• If my risk of SUDEP is increased, what can I do to reduce my risk?
• What should I do if I forget to take my anti-epileptic drug (AED)?
• What steps should I take if it is decided to change my seizure medication?
• What medications provide the best seizure control for me?
• Are there any specific activities I should avoid?
• What instructions should I give my family and friends if I have a seizure?

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