New mothers sleepy for many months

A study from Australia shows that new mothers are still very sleepy four months after giving birth and should be cautious about returning to work too quickly.

New mothers are being urged to be cautious about returning to work too quickly, after a study found one in two were still excessively sleepy four months after giving birth.

Dr Ashleigh Filtness, from QUT's Centre for Accident Research & Road Safety -- Queensland (CARRS-Q), studied the sleep patterns and tiredness of postpartum mums and found despite new mums recording stable night sleep times at 18 weeks, they continued to report being excessively tired.

The CARRS-Q study, published in PLoS One, followed 33 healthy new mums who recorded their postpartum sleep patterns in 15 minute increments during weeks 6, 12 and 18.

"Sleep disruption strongly influences daytime function, with sleepiness recognized as a risk-factor for people performing critical and dangerous tasks," she said.

Dr Filtness said the study had significant implications for decisions-makers about when women should return to work, with current government paid parental leave entitlements ceasing at 18 weeks.

"This brings into question whether four months parental leave is sufficient to ensure daytime sleepiness has diminished to a manageable level before returning to work," she said.

"It is important when developing regulations for parental leave entitlements that policy makers take into account the high prevalence of excessive daytime sleepiness experienced by new mothers.

"With the birth of every baby the new mother must adjust to the demands of parenting and one aspect of that is to remain functional while experiencing potentially severe sleep disruption.

"To put this into context, the assessment tool used to determine new mums' sleepiness is also used by GPs to determine clinically relevant levels of sleepiness.

"If any other otherwise healthy person presented to a doctor with this degree of sleepiness they would likely have been offered advice regarding implications for daytime impairment including the impact on sustaining attention and decision making."

Dr Filtness said the study also found while new mums were still waking on average twice a night to attend to their babies at 6, 12 and 18 weeks -- their total sleep time was about 7 hours and 20 minutes.

She said Australian new mothers actually slept more than the average American worker (6h 53mins).

"So while postpartum women experienced disturbed sleep, they didn't necessarily experience total reduced sleep time," she said.

"What we found was that inevitably, new mothers will wake in the night to attend to their infant and the number of times they wake remains consistent during the first 18 postpartum weeks.

"Sleep disruption reduced over time and it appears this was driven by a reduction in the time it took for new mums to return to sleep, suggesting improved efficiency by mothers at settling their infant or the development of the infant's circadian rhythm.

"These findings highlight the importance of sleep quality as opposed to sleep quantity, especially during the first 12 weeks."

"Soon-to-be mums should be aware of the importance of their own sleep and consider how they are going to preserve their own sleep during the first few months of caring for a baby," she said.

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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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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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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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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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Sleep patterns in people with epilepsy

A Brazilian study claims that people with epilepsy (PWE) had generally worse sleep quality than those without epilepsy.

The aim of this study was to assess excessive daytime sleepiness (EDS), sleep quality, and sleep disorders in a cohort of patients with epilepsy in the city of Florianopolis in southern Brazil. The authors concluded that PWE had more EDS, daytime dysfunction, and sleep disorders compared to a control group.

Methods

• One hundred and forty patients diagnosed with epilepsy were assessed by questionnaires that included demographic and clinical variables, the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Stanford Sleepiness Scale (SSS), and the Fletcher & Luckett Adapted Questionnaire (FLAQ).
• These data were then compared to data from a control group (n = 85).

Results

• Compared to controls, patients with epilepsy (PWE) had significantly higher scores on the ESS (p = 0.003), higher scores on the “daytime dysfunction” domain of the PSQI (p = 0.002), and more symptoms that suggested obstructive sleep apnea in the FLAQ (p < 0.001).
• By performing multiple linear regression models, the authors demonstrated that age, male gender, the presence of secondarily generalized seizures, and phenobarbital use were slightly to moderately correlated with PSQI (r = 0.38) and FLAQ (r = 0.51) but not with SSS scores.

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Chronic Fatigue Syndrome and How It Affects Sleep

This article discusses what chronic fatigue syndrome is, its negative effect on sleep, and research that is being done on this syndrome.

For people with chronic fatigue syndrome, sleep problems are common. Sleep disorders and disruptive and non-refreshing sleep are some of the most frequent complaints from people suffering from chronic fatigue. Chronic fatigue syndrome is a debilitating medical condition. It's also a mysterious -- and historically controversial -- illness.

The basic characteristics of chronic fatigue syndrome include ongoing fatigue that interferes with daily activities, problems with memory and concentration, muscle pain and headaches, and other physical symptoms such as sore throat and tender lymph nodes. People with chronic fatigue also experience feelings of malaise after periods of mental and physical exertion.

The causes of chronic fatigue are unknown. There is no test to determine the presence of the illness. Physicians make a diagnosis based on the presence of a cluster of symptoms over an extended period of time, at least six months, and by ruling out other conditions. For many years, chronic fatigue was considered with skepticism by some in the medical community. There were those who questioned whether chronic fatigue was an illness at all, rather than the consequence of a sleep disorder or a mental health issue. Over the past two decades, chronic fatigue syndrome has won acceptance by the medical establishment. But much about the disorder -- its causes, its mechanisms in the body -- remain largely unknown.

Disrupted sleep is a hallmark of chronic fatigue syndrome. Chronic fatigue is associated with a range of sleep problems, including:

• Excessive daytime sleepiness
• Non-restorative sleep (waking feeling tired even after sufficient or prolonged periods of rest)
• Difficulty falling asleep and staying asleep
• Sleep disorders such as obstructive sleep apnea, insomnia, and narcolepsy

Despite the frequency with which people with chronic fatigue syndrome experience sleep disturbances, the connection between sleep and chronic fatigue -- like so much else about the disorder -- is not well understood.

Researchers at Australia's Victoria University have conducted a review of research related to sleep and chronic fatigue. Their analysis sheds some light on possible reasons for poor sleep among patients with chronic fatigue.

Sleep complaints are common among chronic fatigue patients, but there is no single or typical sleep experience for people with this disorder. For the past two decades, research has shown high levels of sleep disorders among adults with this condition:

• Several studies, including this one, have found that more than half of chronic fatigue patients have some type of sleep disorder.
• This study showed chronic fatigue patients experience greater levels of disrupted sleep than patients with multiple sclerosis.
• More than 50 percent of chronic fatigue patients in this study had obstructive sleep apnea or sleep-related movement disorders, such as restless leg syndrome.
• A similar study showed 46 percent of chronic fatigue patients suffered from obstructive sleep apnea
• This large, population-based study showed nearly 80 percent of chronic fatigue patients experienced un-refreshing sleep, and 20 percent had obstructive sleep apnea or narcolepsy.

An important area of research into the connection between sleep and chronic fatigue looks at the role of pain. The physical pain associated with chronic fatigue may be a significant factor in the sleep problems experienced by people with chronic fatigue. We know that pain and sleep influence each other in multiple ways. Pain can make sleep difficult to achieve and sustain. Lack of sleep, in turn, can make us more sensitive to pain. Studies like this one have shown that pain causes chronic fatigue patients to wake more often throughout the night than either healthy people or those with depression. And one study found that disruption to slow wave sleep in healthy people triggered physical pain and fatigue similar to people with chronic fatigue syndrome. As researchers themselves note, the role of muscle pain in sleep disorders among chronic fatigue sufferers is an area of research that warrants more attention and further study.

There's another body of research that suggests that people with chronic fatigue experience changes to their sleep cycles that could result in less restorative sleep. Studies have shown that people with chronic fatigue may spend less time in slow wave sleep than healthy people. Slow wave sleep occurs during the sleep stages three and four and is the most restorative sleep we can experience. Studies have shown that chronic fatigue patients spend a reduced amount of time in slow wave sleep and in REM sleep than healthy people. To date, there is less evidence for the reduction in REM sleep than in slow wave sleep. The cause of this disturbance to sleep cycles is unclear. However, there is evidence of a possible link between systematic inflammation and disruptions to sleep cycles, particularly to time spent in slow wave sleep. Systemic inflammation in the body is common among chronic fatigue patients and may play a role in the persistent problem of non-refreshing sleep.

Still another area of study suggests that changes to the body's nervous system activity may play a role in the sleep disruptions experienced by people with chronic fatigue. Chronic fatigue patients experience alterations to the functioning of their nervous systems during waking hours, and these can continue during sleep. Several studies have shown that chronic fatigue patients are more likely to experience disruptions to normal nervous system activity during sleep, and this may be affecting the quality of sleep they experience.

There are so many questions that remain unanswered about the relationship between sleep and chronic fatigue syndrome. Why and how does non-restorative sleep occur so frequently? What is the cause -- or effect -- of sleep disorders such as obstructive sleep apnea and restless leg syndrome among people with chronic fatigue? Do the standard measurements of sleep quality work accurately for this group of people?

Here's one thing we do know: Sleep disruptions are a critical component of chronic fatigue syndrome. Answering these and other questions about the role that sleep plays in chronic fatigue could provide some much needed insight into this debilitating illness.

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Link Found Between Daytime Sleepiness and Vitamin D

A study shows a link between daytime sleepiness and vitamin D intake. Additionally, race plays a factor.

A new study suggests that there is a significant correlation between excessive daytime sleepiness and vitamin D, and race plays an important factor.

Results show that in patients with normal vitamin D levels, progressively higher levels of daytime sleepiness were correlated inversely with progressively lower levels of vitamin D. Among patients with vitamin D deficiency, sleepiness and vitamin D levels were associated only among black patients. Surprisingly, this correlation was observed in a direct relationship, with higher vitamin D levels associated with a higher level of sleepiness among black patients.

"While we found a significant correlation between vitamin D and sleepiness, the relationship appears to be more complex than we had originally thought," said David McCarty, MD, the study's principal investigator. "It's important to now do a follow-up study and look deeper into this correlation."

The study, appearing online in the Dec. 15 issue of the Journal of Clinical Sleep Medicine, involved a consecutive series of 81 sleep clinic patients who complained of sleep problems and nonspecific pain. All patients eventually were diagnosed with a sleep disorder, which in the majority of cases was obstructive sleep apnea. Vitamin D level was measured by blood sampling, and sleepiness was determined using the Epworth Sleepiness Scale.

According to the authors, this is the first study to demonstrate a significant relationship between sleepiness and vitamin D. They noted that it is logical for race to affect this relationship because increased skin pigmentation is an established risk factor for low vitamin D.

The study was not designed to examine causality. However, the authors' previous and current research suggests that suboptimal levels of vitamin D may cause or contribute to excessive daytime sleepiness, either directly or by means of chronic pain.

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Study Claims Excessive Daytime Sleepiness Linked With Attention Problems In Kids

If your child is having trouble focusing while doing schoolwork, you might need to take a look at his or her sleep habits, a new study suggests.

New research published in the journalSLEEP shows that excessive daytime sleepiness (or EDS) is linked with an increased risk of trouble paying attention at school, being hyperactive, difficulty learning and conduct problems.

"When children are referred for neurobehavioral problems, they should be assessed for potential risk factors for EDS," study researcher Susan Calhoun, Ph.D., of Penn State University, said in a statement. "Recognizing and treating EDS can offer new strategies to address some of the most common neurobehavioral challenges in young school-age children."

The study included 508 children who were part of the Penn State Child Cohort. The researchers conducted sleep testing on them and had the parents report whether their children had any excessive daytime sleepiness. Then, they divided the children up into two groups: One that had the excessive daytime sleepiness, and one that didn't.

The researchers found that excessive daytime sleepiness was linked with "neurobehavioral (learning, attention/hyperactivity, conduct) problems and poorer performance in processing speed and working memory," researchers wrote in the study.

Rather, researchers found that factors like depression or anxiety, inattention, obesity, asthma and trouble falling asleep were linked with excessive daytime sleepiness in the kids (even those who "got enough sleep" during the sleep testing, and didn't have sleep apnea).

Excessive daytime sleepiness can be caused by a number of factors, including not getting enough sleep at night, sleep apnea, medications, and other mental conditions or sleep disorders, according to a 2009 article in the journal American Family Physician.

Recently, a New York Times article also examined the link between sleep and attention problems at school. That article looked specifically at how some cases of attention deficit hyperactivity disorder (ADHD) might actually be a sign of sleep apnea, which leads to sleep deprivation and, then, problems with focusing and attention.

The New York Times reported on a recent Pediatrics journal article, showing that kids with sleep problems -- such as sleep apnea or snoring -- have a 40 to 100 percent increased risk of ADHD-like behavioral problems.

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