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.

Read more here

Narcolepsy may be responsible for your daytime sleepiness

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

With busy schedules, it’s inevitable to feel sleepy once in a while. But habitually falling asleep during the day while watching TV, reading a book, or in the middle of having a conversation could be a sign of a serious sleep disorder known as narcolepsy.

An underdiagnosed medical condition

Narcolepsy is a sleep disorder that involves the brain’s inability to regulate sleep-wake cycles normally. It affects an estimated one in 2,000 people in the United States, with symptoms typically appearing in early adulthood. Yet it is estimated that 50 percent or more patients with narcolepsy have not been diagnosed. According to a recent survey conducted by Harris Interactive on behalf of Jazz Pharmaceuticals, awareness of narcolepsy is low. One thousand members of the general public and 400 practicing physicians were surveyed about their knowledge of narcolepsy and its symptoms. Only 7 percent of members of the general public who had heard of the condition reported being “very” or “extremely” knowledgeable about it relative to other chronic diseases. That number only increased to 24 percent among primary care physicians. The majority of people surveyed could not identify all five major symptoms of narcolepsy. In fact, studies have shown it may take 10 years or more for people with narcolepsy to receive a correct diagnosis.

“The symptoms of narcolepsy are not well-recognized, which can lead to misdiagnosis,” says Dr. Aatif M. Husain, professor of neurology at Duke University Medical Center.  “By becoming aware of the symptoms of narcolepsy, individuals can have more informed conversations with their doctors, which may help lead to quicker diagnosis.”

The symptoms of narcolepsy: more than daytime sleepiness

A recent study, in which researchers evaluated health care data of more than 9,000 narcolepsy patients compared to 46,000 controls, shows that people with narcolepsy are more likely to suffer from depression, anxiety and other conditions including sleep apnea, stroke and heart failure compared to the general population. There are five major symptoms of narcolepsy. Talk to a doctor if one or more sound familiar.

* Excessive daytime sleepiness (EDS) – EDS, the primary symptom of narcolepsy, is characterized by the inability to stay awake and alert during the day resulting in unplanned lapses into sleep or drowsiness; EDS is present in all people with narcolepsy.

* Cataplexy (muscle weakness with emotions) – A sudden, brief loss of muscle strength triggered by strong emotions like happiness, laughter, surprise, or anger.

* Sleep disruption – Frequent periods of waking up during sleep.

* Sleep paralysis – A brief inability to move or speak while falling asleep or waking up.

* Hypnogogic hallucinations – Vivid, dream-like events that occur when falling asleep or waking up.

These symptoms vary from person to person and not all five symptoms must be present for a narcolepsy diagnosis. It is also important that family and friends understand these symptoms, as they may observe them and encourage their loved ones to seek medical advice sooner.

Read more here

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.

Read more here

Narcolepsy and genes

A study reports that almost all cases of narcolepsy are linked by specific genetic variants.

Imagine standing in line at the supermarket when a sudden, irresistible bout of sleep — a “sleep attack” — that lasts anywhere from a few seconds to several minutes, overtakes you. Next, imagine this happening as you ride the train home from work. Painfully, such uncomfortable scenarios may be common to people who suffer from narcolepsy. Now European researchers have discovered that a specific allele or variant of a particular gene, which is within the human leukocyte antigen (HLA) system and related to immune function, is connected to this unusual brain disorder. "This almost 100 percent association with HLA is somehow unique to narcolepsy and suggests a causal implication," lead author Mehdi Tafti, professor at the University of Lausanne, stated in a press release. The ground-breaking research appears in thecurrent issue of Sleep.

Narcolepsy defined

A rare but often disabling brain disorder, narcolepsy with cataplexy is estimated to affect about one in every 3,000 Americans while additional cases of the disorder without the cataplexy component may also exist. People with narcolepsy experience repeated daily episodes of an irrepressible need to sleep or lapses into sleep, which may occur suddenly. Cataplexy is another common symptom of the disorder and involves sudden muscle weakness — usually in the legs but also in the face and neck — that is caused by strong emotions such as laughter. Narcolepsy affects both males and female equally and appears throughout the world, though unevenly. It is most common in Japan, for instance, while being very rare in Israel. The condition is life-long and symptoms, including “sleep attacks” and cataplexy, generally start in childhood or adolescence, though in some cases they begin later in life. 

Narcolepsy is considered to be both underrecognized and underdiagnosed, in part due to the difficulty of finding an appropriate diagnostic test. It is known, for example, that most patients with narcolepsy do not produce hypocretin in a deep part of the brain called the hypothalamus; prior studies have also identified five common genetic variants linked to narcolepsy with cataplexy. “Because of the discovery of the HLA association, narcolepsy is believed to be an autoimmune disease,” wrote the authors in their study. “The discovery of hypocretin (orexin) deficiency in narcolepsy with cataplexy raised the possibility that hypothalamic hypocretin-producing neurons might be the target of an autoimmune attack, motivating the search for potential genetic mechanisms.”

Seeking, then, a more precise explanation of the condition, a team of European researchers investigated HLA-DQB1, the previously identified five variants linked to the condition as well as 10 other potential variants in a sample of 1,261 European patients who have narcolepsy with cataplexy symptoms. These same patients also made their complete diagnostic work-up and their DNA freely available to the study effort. After matching these patients with 1,422 controls, the researchers began high-resolution genotyping to identify genetic variants including those in the HLA system.

Remarkably, they discovered a more definite relationship between the disorder and the genetic variants than they expected. Their results showed that participants with the HLA allele DQB1*06:02 were 251 times more likely to have narcolepsy with cataplexy than participants without the allele. In fact, the scientists discovered that DQB1*06:02 had a negative predictive value of 99.32 percent. This means that nearly 100 percent of patients who suffer narcolepsy with cataplexy are DQB1*06:02 positive. “An overwhelming portion of genetic risk for narcolepsy with cataplexy is found at DQB1locus,” wrote the authors in their study. “Since DQB1*06:02 positive subjects are at 251-fold increase in risk for narcolepsy … DQB1 genotyping may be relevant to public health policy.” More proof, then, that as human genome studies unfold, the more personal — and more effective — medicine should soon become.

Read more here

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.

Read more here

What may be keeping you up at night?

This article discusses the common issues that keep people from getting a good night's sleep, such as insomnia, sleep apnea, narcolepsy, restless leg syndrome, and periodic limb disorder.

The illusive good night’s sleep. According to the National Center for Sleep Disorders Research at the National Institutes of Health, it’s a national problem. Between stress, problems with your sleeping environment and any number of disorders, 30 to 40 percent of the U.S. adult population reports experiencing symptoms of insomnia each year.

We talked to Marcy Guido-Posey, registered polysomnographic technologist and registered sleep technologist who is a coordinator at Holy Spirit Sleep Centers, and Beverly Azemar, certified nurse practitioner at Penn State Hershey Sleep Research and Treatment Center in Hummelstown, to get the skinny on what’s keeping you from a blissful eight hours.

Insomnia

“Insomnia is defined as the inability to fall asleep, stay asleep or both,” Guido-Posey said. It can lead to impaired daytime functioning.

“When people have trouble sleeping it’s insomnia, which is a symptom and not a disease,” Azemar said. Insomnia symptoms fall into three categories:

• Transient: lasting less than one week

• Short-term: lasting one to three weeks

• Chronic: lasting one month or longer

Sleep apnea

“Sleep apnea is a decrease or total cessation of airflow during sleep,” Guido-Posey said. “Often you will hear loud, rhythmic snoring, followed by a period of silence that ends with a loud snort or gasp as breathing resumes, then stops again. This pattern repeats itself over and over.”

According to the American Sleep Apnea Association, sleep apnea occurs most frequently in men, particularly African Americans and Hispanics. It affects more than 18 million Americans. The three types of sleep apnea are:

• Obstructive sleep apnea: caused by a blockage in the airways

• Central sleep apnea: “That is when the airway is not blocked, but the brain fails to signal the respiratory muscles to breathe,” Azemar said.

• Mixed: a combination of obstructive and central sleep apnea

Narcolepsy

Narcolepsy is the chronic neurological disorder often depicted in movies by characters falling asleep suddenly during daily activities, which isn’t far from the truth. Excessive daytime sleepiness is the main symptom of narcolepsy and happens because the brain isn’t able to regulate the body’s sleep-wake cycle.

It is estimated that up to 200,000 Americans suffer from narcolepsy. It affects men and women equally. While there is no cure, treatment can involve stimulants, antidepressants and other types of prescription medication. Symptoms include:

• Cataplexy: a sudden loss of muscle control

• Sleep paralysis: the brief inability to talk or move while falling asleep or when waking up

• Hypnagogic hallucinations: scary dreams when falling asleep

• Automatic behavior: performing routine tasks without awareness, or even memory, of performing them

Restless Legs Syndrome

Willis-Ekbom disease, or restless legs syndrome, is a neurological disorder. Its hallmark is a tingling sensation in the legs or arms that results in an irresistible urge to move. The sensation varies from person to person with patients describing a creeping, crawling, or electric feeling, according to the National Sleep Foundation.

RLS is estimated to affect 7 to 10 percent of Americans. Treatments include dopaminergic agents or anticonvulsants combined with behavioral techniques.

Periodic Limb Movement Disorder

PLMD is basically RLS while you’re asleep, explained Guido-Posey. The disorder is characterized by repetitive movements such as twitching or jerking every 20 to 40 seconds. Like sleep apnea, it is often recognized first by bed partners.

PLMD isn’t considered to be a serious medical condition, but it can be a contributing factor in insomnia. The NSF recommends seeking treatment for PLMD when it’s accompanied by RLS and/or daytime sleepiness.

Symptom management with medication

Insomnia sufferers do have over-the-counter and prescription medication options to consider that may help them get a better night’s sleep. OTC drugs such as Benadryl and Tylenol PM can help with occasional sleeplessness, but the Mayo Clinic warns that they aren’t intended for long-term use.

Another issue with OTC sleep aids is the day-after hangover. “Many over-the-counter aids are antihistamines and they can also cause residual daytime drowsiness the next day,” Azemar said. She also warns that while they are fairly safe to use because they are over-the-counter, they can be abused.

Doctors can prescribe medication for their sleep-lacking patients. Common prescription brands of sleeping pills include the sedatives Ambien and Lunesta. These drugs work by relaxing patients and helping them fall asleep and stay asleep.

“When patients are prescribed a sleep aid, they are usually used for 1-2 weeks, but then again some patients need them longer. They just need to be followed and monitored to make sure they are effective and they’re getting the appropriate results,” Azemar said. Some prescription sleep aids help you fall asleep while others can be taken in the middle of the night to help you get back to sleep.

Patients are cautioned that use of prescription sleep aids can come with risks. Side effects can include dizziness, prolonged daytime sleepiness and weight gain. Use can also lead to an increased risk in nighttime falls in older adults.

Sleep hygiene

One of the most important factors in a good night’s sleep is your hygiene. Sleep hygiene is the collection of practices necessary to developing a healthy sleep schedule.

Factors in sleep hygiene include:

• Creating a sleep-promoting environment

• Maintaining a regular sleep schedule

• Sticking to healthy eating habits

• Lowering your stress level

If you are maintaining healthy sleep hygiene and still experiencing insomnia or symptoms of a sleep disorder, talk to your doctor about scheduling a sleep study and treatment options.

Read more here

Study: Cause of Narcolepsy may have been discovered

Scientists believe that brain cells that produce histamine may be the key behind determining the cause of narcolepsy.

Scientists have found that an excess number of brain cells that produce the chemical histamine may play a key role in human narcolepsy - a disorder of the central nervous system characterised by uncontrollable periods of deep sleep.

Researchers at the University of California, Los Angeles Center for Sleep Research, in 2000, published findings showing that people suffering from narcolepsy had 90 per cent fewer neurons containing the neuropeptide hypocretin in their brains than healthy people.

Subsequent work by this group and others demonstrated that hypocretin is an arousing chemical that keeps us awake and elevates both mood and alertness; the death of hypocretin cells, the researchers said, helps explain the sleepiness of narcolepsy. But it has remained unclear what kills these cells.

Now, the same UCLA team has found that an excess of another brain cell type containing histamine may be the cause of the loss of hypocretin cells in human narcoleptics.

UCLA professor of psychiatry Jerome Siegel and colleagues reported in the journal Annals of Neurology that people with the disorder have nearly 65 per cent more brain cells containing the chemical histamine.

Their research suggests that this excess of histamine cells causes the loss of hypocretin cells in human narcoleptics.

Narcolepsy is a chronic neurological disorder caused by the brain`s inability to control sleep?wake cycles. It causes sudden bouts of sleep and is often accompanied by cataplexy, an abrupt loss of voluntary muscle tone that can cause a person to collapse.

For the study, researchers examined five narcoleptic brains and seven control brains from human cadavers. Prior to death, all the narcoleptics had been diagnosed by a sleep disorder center as having narcolepsy with cataplexy.

These brains were also compared with the brains of three narcoleptic mouse models and to the brains of narcoleptic dogs.

The researchers found that the humans with narcolepsy had an average of 64 per cent more histamine neurons. The team did not see an increased number of these cells in any of the animal models of narcolepsy.

"Humans and animals with narcolepsy share the same symptoms, but we did not see the histamine cell changes we saw in humans in the animal models we examined," said Siegel, senior author of the research.

"We know that narcolepsy in the animal models is caused by engineered genetic changes that block hypocretin function. However, in humans, we did not know why the hypocretin cells die. "Our current findings indicate that the increase of histamine cells that we see in human narcolepsy may cause the loss of hypocretin cells," he said. 

Read more here

Increased Risk of Narcolepsy in Children Who Received Vaccination for Swine Flu

A study from England shows there is an increased risk of children developing narcolepsy if they received the H1N1 swine flu vaccine.

A study finds an increased risk of narcolepsy in children and adolescents who received the A/H1N1 2009 influenza vaccine (Pandemrix) during the pandemic in England.

The results are consistent with previous studies from Finland and Sweden and indicate that the association is not confined to Scandinavian populations. However, the authors stress that the risk may still be overestimated, and they call for longer term monitoring of the cohort of children and adolescents exposed to Pandemrix to evaluate the exact level of risk.

In 2009, pandemic influenza A (H1N1) virus spread rapidly, resulting in millions of cases and over 18,000 deaths in over 200 countries. In England the vaccine Pandemrix was introduced in October 2009. By March 2010, around one in four (24%) of healthy children aged under 5 and just over a third (37%) aged 2-15 in a risk group had been vaccinated.

In August 2010 concerns were raised in Finland and Sweden about a possible association between narcolepsy and Pandemrix. And in 2012 a study from Finland reported a 13-fold increased risk in children and young people aged 4-19.

But a lack of reported cases in other countries led to speculation that any possible association might be restricted to these Scandinavian populations.

Narcolepsy is a chronic disorder of excessive daytime sleepiness, often accompanied by sudden muscle weakness triggered by strong emotion (known as cataplexy). To evaluate the risk after vaccination in England, a team of researchers reviewed case notes for 245 children and young people aged 4-18 from sleep centres and child neurology centres across England.

Of these, 75 had narcolepsy (56 with cataplexy) with onset after 1 January 2008. Eleven had been vaccinated before onset of symptoms; seven within six months.

After adjusting for clinical conditions, vaccination at any time was associated with a 14-fold increased risk of narcolepsy, whereas vaccination within six months before onset was associated with a 16-fold increased risk.

In absolute numbers, this means that one in 52,000 to 57,500 doses are associated with narcolepsy, say the authors.

They write: "The increased risk of narcolepsy after vaccination with ASO3 adjuvanted pandemic A/H1N1 2009 vaccine indicates a causal association, consistent with findings from Finland. Because of variable delay in diagnosis, however, the risk might be overestimated by more rapid referral of vaccinated children."

While further use of this vaccine for prevention of seasonal flu seems unlikely, they say their findings "have implications for the future licensure and use of AS03 adjuvanted pandemic vaccines containing different subtypes such H5 or H9."

And they conclude: "Further studies to assess the risk, if any, associated with the other A/H1N1 2009 vaccines used in the pandemic, including those with and without adjuvants, are also needed to inform the use of such vaccines in the event of a future pandemic."

Read more here

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.

Read more here

Strange Sleeping Habits of Celebrities

This article discusses strange yet interesting sleep habits of celebrities.

Our favorite celebrities are human and require shut-eye just like the rest of us. Everyone has to lay down for a little shut eye (whether it’s in a giant egg or on latex mattress!). Many celebrities even battle familiar sleep disorders, while others are just a little kooky. Have you ever wondered what eccentric habits or issues famous people harbor regarding sleep? Keep reading to find out.

Celebrities with Eccentric Habits

Star status and plenty of money allow celebrities to adopt unique, lavish habits. Sometimes they are purely for comfort, other times for vanity and performance enhancement. While we all have our quirks, not many people could afford high altitude chambers or 15 hours of sleep!

Tom Cruise
Actor Tom Cruise reportedly sleeps in a very nerdy room, alone in a dark, soundproof “snoratorium” so his snoring doesn’t bother others in his household, according to the Daily Mail.

Lady Gaga
Infamous eccentric Lady Gaga reportedly enjoyed the “egg” from her 2011 MTV appearance so much that she renovated her apartment to include in place of a bed, says Mirror. Supposedly it serves as a peaceful meditation spot.

Eminem
Rapper Eminem takes the dark room principle to a new level by covering windows in aluminum foil to block out light. According to The Sun, it helps mitigate the effects of jet-lag when he travels. However,according to an interview with Complex, his busy schedule eventually got the best of him, resulting in a sleep med dependency.

Mariah Carey
Diva Mariah Carey sleeps surrounded by up to 20 humidifiers in an effort to prevent sore throats, tells V magazine. She also once told Interview magazine that she sleeps 15 hours a night to be able to perform at her best, but no word if that still stands with twin toddlers!

Michael Phelps
Prolific Olympic swimmer Michael Phelps revealed on “60 Minutes” that he sleeps in a high-altitude sleeping chamber designed to simulate high altitudes. This apparently makes the body work harder, and keeps him in peak performance while training – it certainly didn’t hurt.

Martha Stewart
Queen of domesticity, Martha Stewart, told People magazine that she only sleeps about four hours per night because there is not enough time in the day. Driven, self-critical personalities often loathe remaining in bed for more than a few hours, but such low amounts of sleep are typically discouraged.

Celebrities with Sleep Disorders

The National Sleep Foundation estimates that over 70 million Americans suffer from a sleep disorder, so it is no surprise that some celebrities do as well. While they may live the good life, they aren’t immune from stress, insomnia, and genetics.

Sleep Disorder Basics

If you have sleep apnea, insomnia, narcolepsy, you’re not alone – some of the most successful people do, too, that is probably why comfortable latex mattress beds were invented in the first place.Obstructive sleep apnea is characterized by extreme snoring that results from partial or complete blockage of one’s airways while sleeping, potentially leading to disrupted sleep, heart problems and more. Insomnia refers to chronic patterns of difficulty falling asleep, remaining asleep, or waking early with being able to return to sleep. Narcolepsy is defined as the uncontrollable urge to fall asleep during the day resulting from the body’s inability to regulate sleep/wake cycles.

Jennifer Aniston
A-List actress Jennifer Aniston has said she experienced somnambulance (sleepwalking) when under stress. Once, she sleepwalked out of her home, only awaking when the alarm went off.

George Clooney
Actor George Clooney told The Hollywood Reporter that he must have the television on to fall asleep, and that he wakes at least 5 times per night which point to insomnia. Supposedly, he does some if his best screenplay writing during this time though. Now who would have thought that dreams can help you get creative?

Shaquille O’neal
Basketball legend Shaq was diagnosed with sleep apnea during a sleep study by Harvard Medical School. He treats it with a CPAP device, which is a nasal mask worn during sleep.

Jimmy Kimmel
Comedian and late-night host Jimmy Kimmel has narcolepsy, diagnosed in adulthood. According to aninterview with Esquire, it strikes him in the afternoons and he has fallen asleep during meetings and even while driving.

Rosie O’Donnell
Comedian and talk show host Rosie O’Donnell announced on The View that she has sleep apnea. Before receiving treatment, she would stop breathing over 200 times a night, and sometimes for up to 40 seconds!

Now that you know the sleep habits of celebrities, you can be assured you aren’t the only one who snores, keeps odd hours, or sleeps in egg beds. Sleep remains a mystery and oft cited annoyance but every human must catch Zzz’s, no matter how we choose to do it.

Read more here

Animals can also have sleep disorders

Interesting information about animals and the sleep issues they can face.

Sometimes people ask if animals dream or have sleep disorders like them. The answer is yes! Just watch a sleeping dog for a few minutes and you will see their eyes moving from side to side, just as human's do during REM sleep.

Dogs and cats have many of the same sleep disorders as humans including sleep terrors, nocturnal seizures, narcolepsy, cataplexy and limb movements.¹

Narcolepsy is known to occur more frequently in certain breeds of dogs, including Doberman pinschers, poodles, Labrador retrievers, beagles and dachshunds. Horses can also be affected. This disorder is usually inherited from the parents. Animals with narcolepsy also tend to have cataplexy when they are excited, for example when the feeding bowl arrives. It is treated much as it is in humans, with stimulants and anti-depressants.

It appears that most mammals and birds have REM sleep. It is questionable as to whether reptiles have REM sleep based on one study with turtles.² Brain structures are different than in mammals and birds, so it is difficult to say absolutely.

You may be wondering, which mammal has the most REM sleep per day. The platypus ranks number first, getting about eight hours of REM sleep.³ The ferret, armadillo and possum also have high amounts of REM sleep daily. The giraffe and horse have the least at about 0.5 hours.

I hope you've found this information fun and interesting. The next time a patient complains of sleep difficulties, tell them they are not alone. They have only to look around their home to see how sleep affects their pets.

Sharon M. O'Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.

References

1. Schenck, Carlos. Sleep: A Groundbreaking Guide to the Mysteries, the Problems, and the Solutions. New York: Penguin Group. 2007. pp. 258-263.
2. Zepelin, Harold. Siegel, Jerome. Tobler, Irene. Chapter 8. "Mammalian Sleep". Principles and Practice of Sleep Medicine Fourth Edition Philadelphia: Elsevier Saunders, 2005. pp. 91-100.
3. Siegel, Jerome. Chapter 10. "REM Sleep". Principles and Practice of Sleep Medicine Fourth EditionPhiladelphia: Elsevier Saunders, 2005. pp. 120-135.

Read more here

What is narcolepsy?

Narcolepsy is a very serious disease. Information on narcolepsy and ways to treat it.

Narcolepsy: Definition and Treatment

Narcolepsy is a chronic, rare sleep disorder. It is a disease of the central nervous system. When one suffers from narcolepsy they experience bouts of sleepiness throughout the day. Although it is rare the disease is the second most common sleep disorder affecting about every 1 in 2,000 Americans. It usually starts in the adolescent or teenage years and all races and sexes are equally likely to suffer from the disease.

Narcolepsy is caused by a lack of hypocretin chemicals in the brain. The chemical is release by cells and those who suffer from narcolepsy have a minimal amount of cells that carry the chemical. The chemicals are produced by the hypothalamus and have to do with the secretin hormone.

Most who suffer from narcolepsy are unaware and it goes untreated. It is estimated that several thousand people suffer from the disease but are unaware of it. The disease is very severe and can disable one’s daily life.

Narcolepsy is companioned by several serious symptoms such as sleep paralysis, which leaves a person unable to move, hallucinations, and cataplexy which is a sudden onset of muscle weakness. Cataplexy can cause a person to fall down or not be able to hold up their head and it is believed that it is triggered by emotions.

Narcolepsy is treated by using a combination of several medications. Stimulants are used to help control the fatigue while some of the other symptoms are treated with medications similar to anti-depressants. Since there can be some adverse reactions to these medications most patients are only given the stimulants. If the fatigue can be controlled it helps in controlling the other symptoms.

There are also non-medicated treatments that are used less frequently. Educating a person with narcolepsy and it being completely understood by the patient and their family has shown to help reduce the symptoms. Another treatment is to set up scheduled sleep and nap times and try to keep awake as much as possible in between times. This can cause your body to get used to sleeping when it’s supposed to and being awake at other times.

For each person a different form of treatment is going to be more effective. Treatments are designed on a very personal basis. Sometimes a combination of medication and behavioral treatments are used.

Currently there are no cures for narcolepsy. However, scientists are currently working on finding a way to replace the missing molecules that carry the hypocretin. If these molecules could be replaced narcolepsy could be cured. The procedure, unfortunately, is going to be very difficult. The molecules cannot be inserted or ingested because they would be broken down by the body before reaching the brain. Artificial drugs will have to be invented that will allow the molecules/chemicals to get to the brain to do their job. Scientists do not believe that replacing this molecule would necessarily lead to a cure of the disease. It is commonly believed that there is a possibility that the body destroys the molecule and that is why it is not present in those who suffer from narcolepsy.

Narcolepsy is constantly being studied and more discoveries are being made. It is hoped that within 10 years there will be some more effective and longer lasting treatments for the disease.

Read more here