Concussions affect men and women differently

According to a study, concussions affect men and women differently.

New research suggests concussion may not significantly impair symptoms or cognitive skills for one gender over another, however, women may still experience greater symptoms and poorer cognitive performance at preseason testing. The study released today will be presented at the Sports Concussion Conference in Denver, July 24 to 26, hosted by the American Academy of Neurology, the world's leading authority on diagnosing and managing sports concussion. The conference will feature the latest scientific advances in diagnosing and treating sports concussion from leading experts in the field.

The study involved 148 college athletes from 11 sports at the University of Michigan in Ann Arbor. All had taken tests of learning and processing along with other measures of the brain's abilities, such as attention and working memory speed. Of the participants, 45 percent were female, 51 percent played a contact sport and 24 percent had experienced a concussion.

They had an average of 0.3 concussions, ranging from zero to four. Men and women were equally likely to have a history of concussion, even after researchers adjusted for the percentage who played contact sports.

Women who have had a history of at least one concussion do not score lower on computerized cognitive baseline testing. However, all women, regardless of concussion history, had greater symptoms, symptom severity and poorer cognitive performance than men at baseline. Women reported on average 1.5 more symptoms and scored three points higher on symptom severity than men. On a clinical reaction time task, women were 19 milliseconds slower to react than men. On cognitive tasks assessing processing speed, attention and working memory speed women scored on average seven percent below men with the greatest difference on processing speed (8.5 percent).

"More research is needed to confirm these results and to understand why women may have lower performance at preseason baseline. The difference in performance between genders should be of great interest to athletes, coaches, athletic trainers, and doctors who utilize baseline assessments to aide recovery protocols," said study author Kathryn L. O'Connor of the University of Michigan in Ann Arbor and a member of the American Academy of Neurology.

"This finding that cognitive skills were not significantly affected by having a concussion for either gender should be reassuring to athletes who have experienced a concussion and wonder about its later effects," O'Connor said.

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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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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: Self-reported sleep issues increase Alzheimer's riskhttp://i.dailymail.co.uk/i/pix/2012/03/01/article-2108664-11FCB218000005DC-905_468x338.jpg

According to a study, older males self-reporting sleep issues increases his risk of developing Alzheimer's disease.

In a new study, researchers from Uppsala University demonstrate that elderly men with self-reported sleep disturbances run a higher risk of developing Alzheimer's disease than men without self-reported sleep disturbances. The results are published in the scientific journal Alzheimer's & Dementia.

The researchers followed more than 1,000 men, who were initially 50 year old, between the years 1970 and 2010. The results of the study show that self-reported sleep disturbances were linked to an increased risk for Alzheimer's disease during the 40-year follow-up period, particularly if they occurred late in life. The data suggest that a regular good night's sleep could support brain health in men.

'We demonstrate that men with self-reported sleep disturbances run a 1.5-fold higher risk to develop Alzheimer's disease than those without reports of sleep disturbances during a 40-year follow-up period. The later the self-reported sleep disturbance was found the higher the risk was for developing Alzheimer's disease. These findings suggest that strategies aimed at improving sleep quality in late life may help reduce the risk to develop Alzheimer's disease', says Christian Benedict, sleep researcher at Uppsala University, who led the study.

"Importantly, there are several lifestyle factors, such as exercise, that can influence your brain's health. Thus, it must be borne in mind that a multifaceted lifestyle approach comprising good sleep habits is essential for maintaining brain health as you age," says Christian Benedict.

In an earlier article published in the journal Sleep, Christian Benedict and colleagues showed that a single night of total sleep deprivation increased blood concentrations of brain molecules in young men that typically rise in blood upon acute brain damage.

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Why are brain tumors more common in men?

Research aims to explain why men get brain tumors that are more frequent and often more harmful than women.

New research at Washington University School of Medicine in St. Louis helps explain why brain tumors occur more often in males and frequently are more harmful than similar tumors in females. For example, glioblastomas, the most common malignant brain tumors, are diagnosed twice as often in males, who suffer greater cognitive impairments than females and do not survive as long.

The researchers found that retinoblastoma protein (RB), a protein known to reduce cancer risk, is significantly less active in male brain cells than in female brain cells.

The study appears Aug. 1 in The Journal of Clinical Investigation.

"This is the first time anyone ever has identified a sex-linked difference that affects tumor risk and is intrinsic to cells, and that's very exciting," said senior author Joshua Rubin, MD, PhD. "These results suggest we need to go back and look at multiple pathways linked to cancer, checking for sex differences. Sex-based distinctions at the level of the cell may not only influence cancer risk but also the effectiveness of treatments."

Rubin noted that RB is the target of drugs now being evaluated in clinical trials. Trial organizers hope the drugs trigger the protein's anti-tumor effects and help cancer patients survive longer.

"In clinical trials, we typically examine data from male and female patients together, and that could be masking positive or negative responses that are limited to one sex," said Rubin, who is an associate professor of pediatrics, neurology and anatomy and neurobiology. "At the very least, we should think about analyzing data for males and females separately in clinical trials."

Scientists have identified many sex-linked diseases that either occur at different rates in males and females or cause different symptoms based on sex. These distinctions often are linked to sex hormones, which create and maintain many but not all of the biological differences between the sexes.

However, Rubin and his colleagues knew that sex hormones could not account for the differences in brain tumor risk.

"Male brain tumor risk remains higher throughout life despite major age-linked shifts in sex hormone production in males and females," he said. "If the sex hormones were causing this effect, we'd see major changes in the relative rates of brain tumors in males and females at puberty. But they don't happen then or later in life when menopause changes female sex hormone production."

Rubin used a cell model of glioblastoma to prove it is easier to make male brain cells become tumors. After a series of genetic alterations and exposure to a growth factor, male brain cells became cancerous faster and more often than female brain cells.

In experiments designed to identify the reasons for the differences in the male and female cells, the team evaluated three genes to see if they were naturally less active in male brain cells. The genes they studied -- neurofibromin, p53 and RB -- normally suppress cell division and cell survival. They are mutated and disabled in many cancers.

The scientists found RB was more likely to be inactivated in male brain cells than in female brain cells. When they disabled the RB protein in female brain cells, the cells were equally susceptible to becoming cancers.

"There are other types of tumors that occur at different rates based on sex, such as some liver cancers, which occur more often in males," Rubin said. "Knowing more about why cancer rates differ between males and females will help us understand basic mechanisms in cancer, seek more effective therapies and perform more informative clinical trials."

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Study: Nearly half of homeless men have had traumatic brain injury

A study examined homeless men and found that nearly half of them have had a traumatic brain injury during their lifetime.

Almost half of all homeless men who took part in a study by St. Michael's Hospital had suffered at least one traumatic brain injury in their life and 87 per cent of those injuries occurred before the men lost their homes.

While assaults were a major cause of those traumatic brain injuries, or TBIs, (60 per cent) many were caused by potentially non-violent mechanisms such as sports and recreation (44 per cent) and motor vehicle collisions and falls (42 per cent).

The study, led by Dr. Jane Topolovec-Vranic, a clinical researcher in the hospital's Neuroscience Research Program, was published today in the journal CMAJ Open.

Dr. Topolovec-Vranic said it's important for health care providers and others who work with homeless people to be aware of any history of TBI because of the links between such injuries and mental health issues, substance abuse, seizures and general poorer physical health.

The fact that so many homeless men suffered a TBI before losing their home suggests such injuries could be a risk factor for becoming homeless, she said. That makes it even more important to monitor young people who suffer TBIs such as concussions for health and behavioural changes, she said.

Dr. Topolovec-Vranic looked at data on 111 homeless men aged 27 to 81 years old who were recruited from a downtown Toronto men's shelter. She found that 45 per cent of these men had experienced a traumatic brain injury, and of these, 70 per cent were injured during childhood or teenage years and 87 per cent experienced an injury before becoming homeless.

In men under age 40, falls from drug/alcohol blackouts were the most common cause of traumatic brain injury while assault was the most common in men over 40 years old.

Recognition that a TBI sustained in childhood or early teenage years could predispose someone to homelessness may challenge some assumptions that homelessness is a conscious choice made by these individuals, or just the result of their addictions or mental illness, said Dr. Topolovec-Vranic.

This study received funding from the Canadian Institutes of Health Research and the Ontario Neurotrauma Foundation.

Separately, a recent study by Dr. Stephen Hwang of the hospital's Centre for Research on Inner City Health, found the number of people who are homeless or vulnerably housed and who have also suffered a TBI may be as high as 61 per cent -- seven times higher than the general population.

Dr. Hwang's study, published in the Journal of Head Trauma Rehabilitation, is one of the largest studies to date investigating TBI in homeless populations. The findings come from the Health and Housing in Transition Study, which tracks the health and housing status of homeless and vulnerably housed people in Toronto, Vancouver and Ottawa.

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Study: Poor sleep is linked to cognitive decline in older men

A study found that poor sleep quality in old men is liked to their cognitive decline over a few years.

A new study of older men found a link between poor sleep quality and the development of cognitive decline over three to four years.

Results show that higher levels of fragmented sleep and lower sleep efficiency were associated with a 40 to 50 percent increase in the odds of clinically significant decline in executive function, which was similar in magnitude to the effect of a five-year increase in age. In contrast, sleep duration was not related to subsequent cognitive decline.

"It was the quality of sleep that predicted future cognitive decline in this study, not the quantity," said lead author Terri Blackwell, MA, senior statistician at the California Pacific Medical Center Research Institute (CPMCRI) in San Francisco, Calif. "With the rate of cognitive impairment increasing and the high prevalence of sleep problems in the elderly, it is important to determine prospective associations with sleep and cognitive decline."

The study involved 2,822 community-dwelling older men at six clinical centers in the U.S. Participants had a mean age of 76 years. The study is published in the April 1 issue of the journal Sleep.

"This study provides an important reminder that healthy sleep involves both the quantity and quality of sleep," said American Academy of Sleep Medicine President Dr. M. Safwan Badr. "As one of the pillars of a healthy lifestyle, sleep is essential for optimal cognitive functioning."

The population-based, longitudinal study was conducted by a research team led by Dr. Katie Stone, senior scientist at CPMCRI in San Francisco, Calif. Institutions represented by study collaborators include the University of California, San Francisco; University of California, San Diego; Harvard Medical School; University of Minnesota; and several Veterans Affairs medical centers.

An average of five nights of objective sleep data were collected from each participant using a wrist actigraph. Cognitive function assessment included evaluation of attention and executive function using the Trails B test. According to the authors, executive function is the ability for planning or decision making, error correction or trouble shooting, and abstract thinking. Results were adjusted for potential confounding factors such as depressive symptoms, comorbidities and medication use.

The underlying mechanisms relating disturbed sleep to cognitive decline remain unknown, the authors noted. They added that additional research is needed to determine if these associations hold after a longer follow-up period.

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Girls naturally more protected from autism development

This article explains why boys are four times more likely to develop autism and explains why girls may be naturally more protected from developing autism.

It takes more mutations to trigger autism in women than in men, which may explain why men are four times more likely to have the disorder, according to a study published 26 February in the American Journal of Human Genetics.

The study found that women with autism or developmental delay tend to have more large disruptions in their genomes than do men with the disorder. Inherited mutations are also more likely to be passed down from unaffected mothers than from fathers.

Together, the results suggest that women are resistant to mutations that contribute to autism.

"This strongly argues that females are protected from autism and developmental delay and require more mutational load, or more mutational hits that are severe, in order to push them over the threshold," says lead researcher Evan Eichler, professor of genome sciences at the University of Washington in Seattle. "Males on the other hand are kind of the canary in the mineshaft, so to speak, and they are much less robust."

The findings bolster those from previous studies, but don't explain what confers protection against autism in women. The fact that autism is difficult to diagnose in girls may mean that studies enroll only those girls who are severely affected and who may therefore have the most mutations, researchers note.

"The authors are geneticists, and the genetics is terrific," says David Skuse, professor of behavioral and brain sciences at University College London, who was not involved in the study. "But the questions about ascertainment are not addressed adequately."

Genetic burden:

The new study draws from the Simons Simplex Collection (SSC), a database of families that have one child with autism and unaffected parents and siblings. (This project is funded by the Simons Foundation, SFARI.org's parent organization.) In a 2011 study, researchers found that girls with autism in the SSC tend to have more large duplications or deletions of regions of the genome, called copy number variants (CNVs), than do boys with the disorder, although this disparity does not reach statistical significance2.

For the new study, Eichler and his colleagues cataloged the number of CNVs in 109 girls and 653 boys with autism from the SSC. They found that females are twice as likely as males to carry CNVs that are at least 400 kilobases long. (The larger the CNV, the more likely it is to disrupt important genes.)

When the researchers analyzed only CNVs that encompass risk genes for neurodevelopmental disorders, they found that females with autism are three times as likely as males with the disorder to carry CNVs that encompass these genes.

Females with autism also carry slightly more rare mutations that change a single DNA nucleotide than the men do. These are the "nastiest of nasty mutations," says Eichler, because they interfere with the protein's function.

The researchers saw a similar but smaller effect for CNVs in a larger group of 9,206 males and 6,379 females referred for genetic testing: 75 percent of this group turned out to have developmental delay, intellectual disability or autism.

Women in this group are 1.28 times more likely than men to carry large CNVs that include risk factors for these disorders.

Many autism-linked mutations arise spontaneously, or de novo, and about 80 percent of these come from the father.

Eichler and his colleagues found that women are far more likely than men to transmit the inherited mutations that confer autism risk.

Of the 27 large CNVs the researchers identified in the SSC group, 70 percent, or 19, were inherited from the mother. Mothers had similarly passed down about 57 percent of the 3,561 CNVs detected in the neurodevelopmental group.

Eichler intends to extend this work in a bigger study to assess whether certain mutations are more likely than others to be inherited.

"I think it's really critical to identify these inherited components," he says. "We know they're there, but we need to really focus on identifying the specific genes so we can advise [parents] a little more about recurrence."

However, it's unclear whether this gender bias is the result of genetics or reflects differences in diagnosis or the way females manifest symptoms of the disorder. Girls with autism tend to actively compensate for their symptoms in ways that boys don't, which may account for the discrepancy, says Skuse.

As a result, the females enrolled in studies may tend to be severely affected and carry multiple mutations. "There is some suggestion that higher-functioning females are out there in the general population, but they're not being referred," he says.

The study also does not address why women with autism transmit more mutations, or how they are protected from autism.

"We need to ask what it is about brain development that makes it such that females are protected -- because ultimately that is what we want know," says Aravinda Chakravarti, director of the Center for Complex Disease Genomics at the Johns Hopkins University School of Medicine in Baltimore. "We need to re-create that developmental environment."

The most obvious explanation for autism's gender bias is that because men have only one X chromosome, they are hypersensitive to mutations in this chromosome. In line with this theory, several autism-linked genes are located on the X chromosome. However, most of the mutations that show a gender bias in the new study are not on the X chromosome, suggesting that other factors must be involved.

This article has been modified from the original. An earlier version incorrectly stated that 80 percent of the genetic risk factors for autism arise spontaneously. The exact contribution of spontaneous genetic variants to autism is not known.

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Chronic fatigue syndrome in men and women

Chronic fatigue syndrome, once considered a men's disease, now is known to be present in both men and women.

Previously long-term fatigue was considered a male disorder caused by societal pressures. Today women comprise the majority of these patients, and they feel that their condition is their own fault. Not only has the fatigued patient changed gender. Previously doctors believed that long-term fatigue was a neurological, physical disorder, while today it is categorized primarily as psychological in nature. And while in the past, society was thought to be the cause of the disorder, today the individual is supposedly to blame.

Throughout history some people have suffered from a lack of energy and long-term, physical fatigue. Today these symptoms are classified as myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

It is commonly thought that chronic fatigue has mainly psychological causes and that it affects perfectionistic women who cannot live up to their own unreasonably high standards.

This has not always been the case. Just over 100 years ago it was primarily upper class men in intellectual professions who were affected. "Neurasthenia," as the condition was called at the time, was a physical diagnosis with high status.

No longer legitimate

"The medical understanding of long-term fatigue has changed. Previously the condition was viewed as a typically male disorder; now it is perceived as a typically female disorder. The diagnosis of neurasthenia, which has a male connotation, was changed to the ME diagnosis, which has a female connotation," explains Olaug S. Lian, a sociologist and professor at UiT The Arctic University of Norway.

Together with Hilde Bondevik of the University of Oslo, Lian has studied how the view of women and perceptions of the body, gender and femininity in two different historical periods have been manifested in the medical understanding of long-term chronic fatigue.

"Long-term fatigue was viewed as a legitimate disorder, a result of the heroic efforts of the upper class male. Today, it is a stigmatizing disorder, understood as an expression of women's lack of ability to cope with their lives, a kind of breach of character," says Lian.

Not only has the fatigued patient changed gender. Previously doctors believed that long-term fatigue was a neurological, physical disorder, while today it is categorized primarily as psychological in nature. And while in the past, society was thought to be the cause of the disorder, today the individual is supposedly to blame.

What happened to cause this change?

Upper class diagnosis

At the end of the 1800s neurasthenia was the most widespread diagnosis for long-term fatigue. Neurologists believed the condition was caused by a physical, neurological disease that affected the entire body, causing intense, long-term fatigue.

Although women were also diagnosed with the disorder, the typical patient was a man, and not just any kind of man. He was "civilized, refined, and educated, rather than of the barbarous and low-born and untrained," according to neurologist George Beard.

Society was to blame

Doctors at the time believed that the cause of the disorder could be found in a rapidly changing society -- urbanization, industrialization and women's entry into working life.

Quite simply, modern civilization ran roughshod over the nervous system of upper class men, who were overstimulated by too much pressure and activity and too little sleep and rest.

"It was regarded as both legitimate and understandable that even the 'great men' could fall apart as a result of long-term, difficult intellectual work. It was viewed as positive that the body sent signals when the burden was too great. The body was viewed as an electrical fuse box and the thinking was that it was better for one fuse to burn out rather than for the house to catch on fire," says Lian.

Different genders, different causes

The comments about the diagnosis also revealed past understandings of biological gender differences. Women could get neurasthenia from sexual frustration, while men could get it from excessive sexual activity, including masturbation.

Moreover, there was a connection between gender and class.

"To simplify a bit, we can say that it was mainly middle class men and working class women whose diagnosis of neurasthenia was explained by overwork. For working class men it was due to sexual escapades, and for middle class women the cause given was heredity or 'women's issues'," explains Lian.

The fall of neurasthenia

Neurasthenia lost its popularity as a diagnosis in the early 1900s. One reason for this was that psychiatry became a medical field in its own right.

"Psychiatry took neurasthenia with it and changed its definition from a physical to a psychological condition. Since women were regarded as psychologically weaker and therefore more disposed to mental illness, the disorder became a female problem," says Lian.

Fight over definitions

Today ME is the most common name for the disorder, defined as long-term, intense fatigue that cannot be directly linked to a well-defined illness and that does not disappear with rest. The condition is chronic, it cannot be cured with medical treatment and there is disagreement as to the cause.

"The lack of scientifically generated findings, medical explanations and effective treatment make ME a diagnosis with low status and low legitimacy within the medical community," says Lian.

Currently the main theory is that ME results from an inability to handle stress and that perfectionistic people -- the "good girls" -- are especially at risk. The debate about how ME should be understood and explained is highly polarized, between those who believe that it is an illness caused by infections or vaccination and those who believe that ME has mainly psychological causes.

"I would like to see some humility about what we actually know about the disorder and not present value judgments as facts. Doctors must also be honest and acknowledge that we have very little hard-and-fast knowledge about this condition," states Lian.

Blame and shame

The two historical periods have almost identical depictions of the phenomenon of long-term fatigue, although the names are different. But there is one important difference: the disorder is no longer regarded as a legitimate, anticipated outcome of overwork.

"Today the medical community is searching for explanations of ME at the individual level. The ME patient is depicted as a woman with five-star goals and four-star abilities -- with character traits that make it hard for them to cope with their own lives," says Lian.

"When the entire problem is seen as the patient's fault, the person experiences blame and shame because it is the patient, not society, who is the cause of the illness. It is therefore the individual who is responsible for coping with the illness, such as by changing her own thought patterns," says Lian.

Wrong kind of tired

She points out that the ability to cope with one's own life is an important value in Western culture. Mental disorders, however, are associated with weakness. The current understanding of long-term fatigue is also linked to how we think about tiredness, according to Lian.

"There are strong norms for when you are allowed to be tired and worn out and how you are supposed to show tiredness in daily life. If you have been awake all night with a sick infant, you have a good reason to be tired at work. Other reasons are less legitimate. Workplace reports of absence never state that someone is at the psychologist, while it is completely acceptable to say that someone is at the dentist."

"Being tired for the wrong reasons is seen as a sign of weakness, which must be overcome and hidden. It is in this context that we must understand the medical theories on a lack of coping ability and the objections of ME patients to these theories," says Lian.

She believes such norms often make ME patients feel that the psychological explanation is a burden, although doctors do not necessarily mean for it to have this affect.

"What is it about the ME debate that makes the opposing sides so obstinate?"

"The doctors and patients talk past each other. The doctors think that an ME diagnosis is value neutral, but the patient hears 'it's my fault that I am sick and it's my responsible to get better'. But although most people feel that mental disorders have lower value than somatic disorders, it is not a given that the doctors do," says Lian.

Gendered explanation disappeared?

Although about three of four people who are diagnosed with ME today are women, the explicit, biology-based gendered explanations have disappeared from the debate, according to Lian.

"This may simply be because today we put greater focus on gender equality -- which makes it less legitimate to claim that women are naturally inferior to men," says Lian.

However, she believes that the ME diagnosis embodies a view of women that has long historical roots.

"The profile of the upper class woman from the 1800s who cannot cope with pressure and stress both inside and outside the home is still with us today," says Lian.

Cultural bias

"How can your analysis contribute to the current debate about ME?"

"We show how the medical understanding of fatigue and lack of energy is impacted by the norms and values of society at large, for example, that medical knowledge reflects the view of women in our culture. Norms and values combine with biomedical knowledge in a way that makes it difficult to see what is what," says Lian.

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Why Women Need More Sleep Than Men

This article discusses the differences that occur between men and women who get inadequate sleep.

Ever noticed how after a late night out with your man, you have a harder time the next day than he does? It's not all in your head. Thanks to different hormonal makeups, we suffer more emotionally and physically when we're short on zzzs.

"Poor sleep certainly had a more profound effect on women than on men," says Edward Suarez, Ph.D., an associate professor at Duke University School of Medicine and lead researcher of a studythat looked at the relationship between poor sleep and poor health. He found that for women, reduced sleep was associated with a significant increase in risk of heart disease and diabetes, as well as more stress, depression, anxiety, and anger. However, these associations were weaker or nonexistent for men.

What gives? Testosterone. Levels of this hormone rise after poor sleep in men, and "because it decreases insulin and increases muscle mass, testosterone has an anti-inflammatory effect, which kept men's stress hormones lower," he explains.

Unfortunately for us, women's hormones, especially progesterone, do not have that same stress-dampening effect. Estrogen is known to have an anti-inflammatory effect, so the decline in the hormone as we get older could contribute both to worse sleep and to feeling even crappier after a night spent tossing and turning.

And while you may have seen recent headlines proclaiming that women need more sleep than men, the truth is a lot more complicated, says Aric Prather, Ph.D., an assistant psychiatry professor at the University of California, San Francisco and author of a larger 2013 study that confirmed Suarez's findings. "I don’t think there is any good evidence yet that women needmore sleep than men," Prather says. "The present data is more in support of the fact that women may be more susceptible to the negative effects of poor sleep quality."

In both studies, physiological stress was measured by looking at blood levels of C-reactive protein (CRP), which rises in response to inflammation and is considered a better marker of stress than looking at cortisol levels alone. The volunteers were also asked to rate their sleep quality. 

In addition to overall snooze time, Suarez's study looked at four different aspects of "disturbed" sleep: how long it took subjects to fall asleep, how many times they woke in the night, how long it took them to fall asleep again, and if they awoke too early in the morning. Surprisingly, it wasn't just the total number of hours in the sack that made the difference. According to Suarez, the No. 1 factor correlated with an increase in CRP for women was taking more than 30 minutes to fall asleep when they first hit the sheets. This is a double-whammy for women, he says, who not only are we 20 percent more likely to suffer from insomnia than men but also suffer more ill effects from it.

Large epidemiological studies have found that women tend to rate their quality of sleep as worse than men even when their sleep is shown through objective measures to be better. "This raises the question of whether women may be more sensitive to sleep problems, which may have biological consequences, including elevations in inflammation," Suarez says.

Kelly Glazer Baron, Ph.D., clinical psychologist and director of the Behavioral Sleep Program at Northwestern University Feinberg School of Medicine, adds that bad sleep can become a vicious cycle: Shoddy shut-eye boosts stress, which in turn causes insomnia for many people, leading to even more stress on top of what you experience every day.

But there are things women can do to mitigate these effects. "We can improve how we prevent disease over lifetime simply by making small improvements in our sleep," Suarez says. This is why it's important to promptly treat sleep problems, especially insomnia. Baron says that if your insomnia reaches the point where it is making it hard to function during the day, talk to your doctor about lifestyle modifications and other options. 

She also recommends establishing a regular fitness routine. "It’s been known for a long time that exercisers sleep better," she says, citing her recent studies showing that 16 weeks of aerobic exercise at moderate intensity four days a week helped women get at least seven hours of sleep a night and also improved their perception of the quality of their rest.

Finally, don't forget the recommendations from the National Sleep Foundation, Prather says (which you likely can recite in your sleep—or as you stare at the ceiling): Go to bed at the same time every day of the week, avoid heavy meals before bed, establish a relaxing bedtime routine, don't nap, and exercise daily.

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How sleep can help protect your brain

A study shows that sleep deprivation can result in a loss of brain tissue due to certain molecules found in the brain after losing sleep.

A new study from Uppsala University, Sweden, shows that one night of sleep deprivation increases morning blood concentrations of NSE and S-100B in healthy young men. These molecules are typically found in the brain. Thus, their rise in blood after sleep loss may indicate that a lack of snoozing might be conducive to a loss of brain tissue. The findings are published in the journalSleep.

Fifteen normal-weight men participated in the study. In one condition they were sleep-deprived for one night, while in the other condition they slept for approximately 8 hours.

"We observed that a night of total sleep loss was followed by increased blood concentrations of NSE and S-100B. These brain molecules typically rise in blood under conditions of brain damage. Thus, our results indicate that a lack of sleep may promote neurodegenerative processes," says sleep researcher Christian Benedict at the Department of Neuroscience, Uppsala University, who lead the study.

"In conclusion, the findings of our trial indicate that a good night's sleep may be critical for maintaining brain health," says Christian Benedict.

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Insomnia increases risk of death

A study finds a link between insomnia and increased mortality risk.

Insomnia, the most common sleep disorder, affects up to one-third of the population in the United States. In new findings, researchers from Brigham and Women's Hospital (BWH) have found that some insomnia symptoms are associated with an increased risk of mortality in men. These findings are published online in Circulation and will appear in an upcoming print issue.

"Insomnia is a common health issue, particularly in older adults, but the link between this common sleep disorder and its impact on the risk of death has been unclear," said Yanping Li, PhD, a research fellow in the Channing Division of Network Medicine at BWH and lead author of the paper. "Our research shows that among men who experience specific symptoms of insomnia, there is a modest increase risk in death from cardiovascular-related issues."

Specifically, researchers report that difficulty falling sleep and non-restorative sleep were both associated with a higher risk of mortality, particularly mortality related to cardiovascular disease.

Researchers followed more than 23,000 men in the Health Professionals Follow-Up Study who self-reported insomnia symptoms for a period of six years. Beginning in 2004 through 2010, researchers documented 2025 deaths using information from government and family sources. After adjusting for lifestyle factors, age and other chronic conditions, researchers found that men who reported difficulty initiating sleep and non-restorative sleep had a 55 percent and 32 percent increased risk of CVD-related mortality over the six year follow up, respectively, when compared to men who did not report these insomnia-related symptoms.

"We know that sleep is important for cardiovascular health and many studies have linked poor or insufficient sleep with increased risk factors for cardiovascular-related diseases," said Xiang Gao, MD, PhD, a researcher in the Channing Division of Network Medicine at BWH and Harvard School of Public Health and senior author of this study. "Now we know that not only can poor sleep impact disease risk, but it may also impact our longevity. While further research is necessary to confirm these findings, there is overwhelming evidence that practicing good sleep hygiene and prioritizing sufficient and restful sleep is an often overlooked but important modifiable risk factor in overall health."

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Sleep apnea risk factors

This article discusses different risk factors for obstructive sleep apnea.

Obstructive sleep apnea is a deadly sleep disorder. Those with obstructive sleep apnea may feel lethargic after a good night's sleep or you may snore loudly. But, there are certain risk factors associated with obstructive sleep apnea. We explore these risk factors.

Risk factors of obstructive sleep apnea:

1) Age: Obstructive sleep apnea is mainly associated with age. Those above 60 are prone to obstructive sleep apnea, but there are other risk factors that bring down the age group for sleep apnea.

2) Males: Having the X and Y chromosomes can make you prone to obstructive sleep apnea.Yes, males have a higher chance of developing apnea.

3) Weight: Excessive weight can result in obstructive sleep apnea. Over weight individuals tend to have thicker necks which make it difficult to breath. But obstructive sleep disorder can also affect individuals who are thin.

4) Genes: Family history of obstructive sleep disorder and narrow airway that you may have inherited are risk factors for obstructive sleep apnea.

5) Menopause: Though obstructive sleep apnea is prone to men, it can affect women after their menopause, especially is they are overweight.

6) Difficulty is breathing: Individuals who have nasal congestion and allergies associated with the respiration system are likely to develop obstructive sleep apnea. But it also depends on the breathing with correlation to the above mentioned risk factors.

7) Smoking: Smoking tends to build up water in the upper airway and also results in inflammation of the air way. These are the risk factors of developing obstructive sleep apnea.

8) Relaxed muscles: Sedatives that relaxes the muscles is a risk factor for obstructive sleep apnea.

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Study: Migraine sufferers are twice as likely to also have depression

A study claims that depression is twice as likely in people who suffer from migraines in comparison to those who do not.

People who suffer from migraines are about twice as likely to be depressed and have suicidal thoughts, according to Canadian researchers, who say women and young people with migraines are particularly vulnerable to what Winston Churchill has called “the black dog” of depression.

Researchers at the University of Toronto surveyed more than 67,000 Canadians, over 6,000 of those reporting they had been diagnosed with migraine by a health care professional.

Both women and men with migraine were more than twice as likely to suffer from depression as those without the disease (women: 12.4% vs. 5.7%; men: 8.4% vs. 3.4%).

Serious thoughts of suicide – also known as suicide ideation – were also more common for migraine sufferers (women: 17.6% versus 9.1%; men: 15.6% versus 7.9%). Migraine sufferers under the age of 30 had four times the odds of suicidal ideation than those 65 and over.

Previous studies have also shown a link between migraines, suicide and depression, but this is one of the first to dig deeper and look at other factors associated with the comorbidities.  The study is published online in the journalDepression Research and Treatment.

Among both women and men with migraine, being younger, unmarried, poor, or disabled increased the odds of depression – in some cases dramatically. Single people with migraine were found to have 50% and 70% higher odds of depression and suicidal thoughts.

“The vulnerability of young people with migraine to depression and suicidal ideation is particularly worrying. For both genders, migraineurs under the age of 30 had at least six times the odds of current depression and four times the odds of lifetime suicidal ideation when compared to those aged 65 and above,” wrote lead author Esme Fuller-Thomson, a professor in the Department of Family & Community Medicine, University of Toronto.

“Older migraineurs, by contrast, have had a longer time to adjust to their condition, for example, by learning effective coping mechanisms or achieving adequate treatment, which may reduce the perceived burden of their illness.”

The first onset of migraine is typically experienced in late adolescence and early adulthood. The researchers believe diagnosis of migraine at a young age may interfere with normal developmental processes, such as obtaining an education, building a career, and starting a family.

“We are not sure why younger migraineurs have such a high likelihood of depression and suicidal ideation. It may be that younger people with migraines have not yet managed to find adequate treatment or develop coping mechanisms to minimize pain and the impact of this chronic illness on the rest of their lives,” said study co-author and former graduate student Meghan Schrumm.

The researchers say health care providers treating patients with migraine should be alert to signs of depression, particularly if the patient is younger and single.

“Informing a wider range of health professionals and migraine sufferers themselves about the patterns of depression and suicidal ideation surrounding age, marital status, and activity limitations may help to increase awareness of the comorbidities of migraine and empower migraineurs to come forward with their mental health concerns,” said Fuller-Thomson.

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What increases risk for sleep apnea?

This article discusses 8 things and behaviors that can increase a person's risk for sleep apnea.

It used to be that if someone told you you snored, you shrugged it off as more of an annoyance to them than anything telling about your own health and wellbeing.

Today, we have a greater understanding of at least one potential risk of being a frequent snorer: You could have sleep apnea, a potentially harmful sleep disorder during which people stop breathing, sometimes hundreds of times a night.

Obstructive sleep apnea (OSA) is the most common type of sleep apnea, and occurs when the muscles in the back of the throat collapse, causing the opening through which air passes to disappear. (Watch this video for an in-depth explanation of what happens during OSA.)

But certain people are more likely to experience this interruption of breathing than others. We asked Dr. Matthew Mingrone, lead physician for EOS Sleep Centers in California specializing in sleep apnea and snoring issues, to help explain why.

Obesity
Likely the most indicative risk factor is carrying too much extra weight. Obese adults are seven times more likely to develop OSA than their normal-weight peers, according to WebMD. OSA is essentially a blockage of the upper airway, says Mingrone. Part of the tissue running from the nose to the voicebox collapses, cutting off the passage of oxygen. Excess weight adds to the pressure on tube, he says, making the diameter of the opening even smaller than it already is.

Neck Circumference

Obese people aren't the only demographic with larger-than-average necks. Consider the muscular build of professional athletes, for example, who aren't obese but thanks to muscle development are larger than us mere mortals.

Men with a neck circumference greater than 17 inches and women over 15 inches have a higher risk of OSA, WebMD reported.

Age
People of any age can develop sleep apnea, but the condition is more common the older you get, according to the National Heart Lung and Blood Institute. "As we get older, we lose tone and elasticity as part of the normal aging process," says Mingrone. With that natural softening of the tissue in the throat, there's higher likelihood of collapse, he says.

Family History
It's not that you have a genetic predisposition to developing sleep apnea, says Mingrone, like a specific type of cancer that may run in families. Instead, it's likely that you've inherited certain aspects of your physical makeup that increase sleep apnea risk, he says. If Mom's being treated for sleep apnea and you've inherited her narrow jaw, you may have a similar doctor's visit in your future.

Alcohol Use

Because it's a muscle relaxant, alcohol too close to bedtime can lead to episodes of apnea, says Mingrone, even in someone who doesn't have OSA. And in those with the disorder, alcohol can lengthen the duration of apnea episodes, according to the National Institute on Alcohol Abuse and Alcoholism.

Race
Studies show that both sleep apnea risk and sleep apnea severity vary by race. It may be due to anatomical differences in the airways of different ethnic groups, according to Mingrone.

Smoking

Current smokers are 2.5 times more likely to have OSA than smokers and nonsmokers combined, according to a 2001 study. "Smoking most airway tissue swell because it's an irritant," says Mingrone. Swelling in the nose and the throat further reduces the space for air to flow through.

Gender
Middle-aged men are twice as likely to have OSA than women of the same age, according to the American Lung Association. Mingrone says in his practice, about 15 to 20 percent of patients are female. The variance may be due again to anatomical differences, especially since men are simply bigger than women more often than not.

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