The link between insomnia and chronic pain

This study looks into a potential link between insomnia and chronic pain.

People who have problems sleeping may also be more sensitive to pain, thus potentially worsening the effects of chronic pain conditions, new research from Norway shows.

In the study, researchers measured pain sensitivity in more than 10,000 adults who were participants in the Tromsø Study, an ongoing public health study in Norway that began in 1974.

The results of the study showed that people who had insomnia were more sensitive to pain than people who didn't have sleep problems. In particular, people who were experiencing chronic pain and who also had insomnia showed a greater increased sensitivity to pain. Pain sensitivity was also linked to the amount of time it took to get to sleep.

The findings show that "the need to improve sleep among chronic pain patients, and vice versa, is evident," the study authors, led by Børge Sivertsen of the Norwegian Institute of Public Health in Bergen, Norway, wrote in their article.

In the study, the researchers first asked questions of the participants about their experience with insomnia, how long it took them to fall asleep and other sleep issues. For example, participants rated their experiences with insomnia during the previous year on a four-point scale, ranging from "never" to "more than once a week." Out of all of the participants, 10.5 percent had what the researchers considered an insomnia disorder.

The participants then completed the cold-pressor test — a standard method used to mimic chronic pain in which people are asked to place their hands in cold water for a set period of time. People who remove their hands early show a decreased tolerance to pain. In this study, the participants were asked to keep their hands in water at 3 degrees Celsius (37 degrees Fahrenheit) for 106 seconds.

The results showed that 42 percent of patients who had insomnia took their hands out of the water before the 106 seconds were up, whereas only 31 percent of all of the participants did so. This increased sensitivity to pain was greater in those with more severe or more frequent insomnia. For example, people who had insomnia once a week were 52 percent more likely to take their hands out of the water early, compared to those without insomnia. Moreover, patients who had insomnia monthly were 24 percent more likely to take their hands out of the water early.

The total amount of time that people spent sleeping showed no effect on their pain tolerance, according to the study.

The link between sleep problems and chronic pain appeared especially pronounced, according to the study. The patients with both severe insomnia and chronic pain were more than twice as likely to take their hands out of the water earlyas participants who had neither condition. This effect was "synergistic," meaning the two conditions combined had a greater effect than one would expect from just summing their individual effects, the study authors reported.

That synergy between chronic pain and sleep disorders suggests health care providers should consider jointly treating the two conditions in some patients, the authors stated. Both cognitive-behavioral therapy and medications are used to treat the two conditions separately, the authors noted, so further studies should look at using these methods to treat the conditions together.

Future research should look into not only clinical implications, but also the role of neurotransmitters in the co-occurrence of sleep disorders and pain, the authors said.

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Military members and sleep problems

This article discusses the importance of sleep for members of the military, especially post-deployment.

Improving the quality and quantity of U.S. military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new RAND Corporation study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

The report can be found online at:http://www.rand.org/pubs/research_reports/RR739.html

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Is melatonin safe for children?

This article discusses the research that has been done on melatonin and children.

Melatonin hormone should be made easily available according to some sleep experts despite the conflict of interest among researchers as to whether it is safe for inducing sleep in children or not, reports The Sydney Morning Herald.

Melatonin is a natural hormone secreted by the pineal gland of the body. The small pea-sized gland which is located just above the middle of the brain is inactive during the day and gets turned on by the suprachiasmatic nucleus (SCN) located in the hypothalamus when it gets dark. It then secretes the melatonin in the blood which is responsible for inducing sleep naturally.

Sleep plays a vital part during the early development of brain in the newborns. The Circadian rhythm or the sleep-wake cycle in the body is regulated by the light and dark and it takes time to develop, resulting in the irregular sleep schedules of newborns. The rhythms begin to develop at about six weeks, and by three to six months most infants have a regular sleep-wake cycle.

However, 30 percent of children aged under three suffer from sleep problems, with the most common causes which are either behavioral or medical, according to a Monash University study.

Pediatric sleep specialist Dr Chris Seton, Woolcock Institute of Medical Research says, melatonin is a better alternative to the antidepressants and blood pressure medication that is commonly used by the parents which cause severe side effects.

But the medical experts do not seem to be readily accepting the claim as some of the research reveals that melatonin could adversely affect development during adolescence. They also have raised concern over the increasing trend of use of the hormone for treating sleep related issues in children.

There are reports which say that children with epilepsy and cerebral palsy were prescribed with melatonin way back since 1991. But it is now believed children with behavioural issues, such as ADHD, are more likely to be given melatonin now.

A senior research fellow at The University of Adelaide, David Kennaway says that the studies done on adults and animals have linked melatonin to a negative impact on reproductive, immune, cardiovascular and metabolic systems. In a research article published in the Journal of Paediatrics and Child Health, he says “It is not registered for use in children anywhere in the world and it has not undergone the formal safety testing expected for a new drug, especially long-term in children.”

But Dr Chris Seton, feels otherwise and says,”There is no evidence that it’s anything but a very safe drug. In the contexts of drugs given to kids, it’s at the top in terms of safety”.

The Sleep Health Foundation has cautiously approved the use of melatonin in children, stating it “appears to be safe and works well in the short term”.

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Study: Drinking problems later for teens who skip sleep now

A study shows that teens who skip sleep now have more drinking problems later in life.

Sleep-deprived teenagers find it difficult to focus in class, and they're more likely get sick. They are also more likely to develop problems with alcohol later on, according to a study published Friday in the journal Alcoholism: Clinical & Experimental Research.

The study included teens who suffered from conditions like insomnia as well as those who simply weren't getting enough sleep. Teenagers ages 14 through 16 who had trouble falling or staying asleep were 47 percent more likely to binge drink than their well-rested peers.

Sleep problems were linked to even more issues with alcohol later on.

Teens who had trouble sleeping when the researchers first checked in with them were 14 percent more likely to drive drunk and 11 percent more likely to have interpersonal issues related to alcohol a year later. And five years after that — when everyone was college-aged or older — those who had sleep issues in high school were 10 percent more likely to drive drunk.

About 45 percent of adolescents don't get the recommended eight to 10 hours a night, polls show.

The findings are based on data collected from 6,500 adolescents who were part of the larger National Longitudinal Study of Adolescent Health, which began tracking a group of adolescents in the mid-90s.

Researchers have known for a while that lack of sleep and alcohol use are related, says Maria Wong, a psychologist at Idaho State University who led the study. "This study shows that sleep issues can actually precede and even predict alcohol use later on."

And the influence of sleep on drinking behaviors can be dramatic, Wong tells Shots. In the study, each extra hour of sleep the teens got corresponded with a 10 percent decrease in binge drinking.

"We're not saying that sleep is the only risk factor for alcohol use," Wong says. In fact, another study published in the same journal issue found that a combination of genetics and peer influence affect teens' decisions to drink.

But a child's genetic makeup isn't something anyone can change, Wong says, "and beyond a certain extent, we cannot control whom kids spend time with outside the home."

Sleep, however, may be something that teenagers and their parents can control. "If we can make sure they have enough sleep, we can help them make good choices," Wong says.

Of course, that's much easier said than done. Teens don't usually take well to having bedtimes imposed on them. And even if they did, forcing kids to get in bed early won't necessarily help, says Dr. Maida Chen, the director of the Pediatric Sleep Disorders Center at Seattle Children's Hospital. "Because of their biology, simply saying to teens, 'Go to sleep earlier' is not a plausible solution," says Chen, who wasn't involved in the recent research.

The body's natural circadian rhythms tend to shift during adolescence, Chen explains, so teens may find it difficult fall asleep until 11 p.m. or midnight.

That's why many parents and pediatricians have been pushing to delay school start times for middle and high school students. "Teens have to get up at 5 or 6 in the morning in order to get to school by 7 or 8," Chen says, which means that most of them aren't getting nearly enough rest.

Last year the American Academy of Pediatrics issued a policy statement calling on middle and high school to start at 8:30 a.m. or later.

"This new research shows what we have long suspected — there seems to be a link between lack of sleep and risky behaviors in teenagers," Chen says.

The people involved in the recent study were teenagers in the 1990s, Chen points out. "I wouldn't be surprised if the situation was in some ways worse these days," she says, "because nowadays, everyone has some electronic distraction that they carry into bed with them."

Many of the patients Chen sees at Seattle's Children come in because their grades have started to fall or because they're having behavior issues at school, she says.

"This is not just about teens not sleeping enough and then feeling a bit grumpy the next day," Chen says. "Sleep really affects their ability to function and make good decisions."

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Young kids' sleep and obesity

Young kids not getting enough sleep could lead to obesity later in life.

Lack of sleep and sleep-related breathing problems appear to boost children's risk of obesity, a new study finds.

What isn't clear from the study, however, is whether the sleep issues actually cause obesity, or if something else might explain the association between sleep problems and obesity.

Researchers analyzed data from about 1,900 youngsters in England. The researchers had about 15 years of follow-up on the children. Those who got the least amount of sleep at ages 5 and 6 had between a 60 percent and 100 percent increased risk of being obese at age 15. (For children aged 5 or 6, fewer than 10.5 hours of sleep a night is considered too little, according to the researchers.)

Children who got too little sleep at other ages were not at increased risk for obesity, according to the study.

The researchers also found that one-quarter of the children were at increased risk of obesity due to sleep-related breathing problems such as snoring and sleep apnea. Those with the most severe sleep-related breathing problems were twice as likely to become obese by ages 7, 10 and 15.

The risk was slightly lower in children whose sleep-related breathing problems peaked at ages 5 or 6, but was still 60 percent to 80 percent higher than among those without sleep-related breathing problems.

The researchers didn't look at whether children with both these risk factors had a higher risk of obesity than those with just one of the risk factors.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," study author Karen Bonuck, a professor of family and social medicine, and obstetrics, gynecology and women's health at Albert Einstein College of Medicine in New York City, said in a college news release.

"We know that the road to obesity often begins early in life. Our research strengthens the case that insufficient sleep and SDB (sleep-disordered breathing) -- especially when present early in childhood -- increase the risk for becoming obese later in childhood," she added.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is enlarged tonsils or adenoids. If these are a problem, they can be removed through surgery. Another possible cause is misalignment of the jaws and teeth. This problem can be treated with a night guard or orthodontics.

Learning good sleep habits can help children get adequate sleep, Bonuck said.

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Sleep issues in children with mental health diagnoses

Sleep issues are common among children with mental health diagnoses, and may go undiagnosed due to the co-existing conditions.

Sleep difficulties, particularly problems falling asleep, are common among toddlers and preschoolers with mental health issues, according to a new study.

"Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity and attention," said the study's leader, John Boekamp, clinical director of the pediatric partial hospital program at Bradley Hospital in Providence, R.I.

However, he said, sleep disorders may be unrecognized and underdiagnosed in young children, particularly when behavioral or emotional problems are present.

The study, published online in Child Psychiatry & Human Development, involved 183 children aged 6 years or younger receiving outpatient treatment for psychiatric problems. The researchers examined the prevalence of sleep disorders among these children and the nature of the sleep problems.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings. Collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp in a hospital news release.

Recognized sleep disorders, particularly sleep onset insomnia, were more common than expected, the researchers found. Overall, 41 percent of children in the study met the criteria to diagnose a sleep disorder.

Sleep problems were most common in kids with disruptive behavior, and attention, anxiety and mood problems, the researchers found.

Early sleep problems could not only be the result of behavioral and emotional problems, but could also contribute to them, the researchers noted.

"Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms, and psychiatric symptoms affecting their sleep-wake organization," said Boekamp. "It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children."

Sleep problems can complicate treatment for challenging behaviors, such as aggression and attention and mood problems. Daytime sleepiness and fatigue can make these problems even worse, the study's authors noted.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp.

"Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment," he explained.

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Study: Sleep issues common for children with psychiatric disorders

A study found that sleep issues are more common for children with a psychiatric disorder.

John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital recently led a study that found sleep difficulties - particularly problems with falling asleep - were very common among toddlers and preschool-aged children who were receiving clinical treatment for a wide range of psychiatric disorders. The study, titled "Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders," is now published online in the journal Child Psychiatry & Human Development.

"The most common sleep difficulties reported nationally for toddlers and preschoolers are problems of going to bed, falling asleep and frequent night awakenings – collectively, these problems are referred to as behavioral insomnias of childhood," said Boekamp. "Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschooladjustment, and problems of irritability, hyperactivity and attention."

Boekamp's team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children's difficulties with behavioral and emotional self-regulation. "Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization," said Boekamp.

The partial program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children aged from newborn to six who have serious emotional, behavioral or relationship disturbances. This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program. Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings. Overall, 41 percent of children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety and mood problems.

"It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children," said Boekamp. "Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present."

Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention and mood. Sleepiness and fatigue may exacerbate these problem behaviors.

"This study is a great reminder that it's critical for mental health providers working with young children and their families to ask about children's sleep," said Boekamp. "Simple questions about children's sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment."

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Study: Children with ADHD benefit from treating sleep problems

A study shows that children with ADHD benefit from treating underlying sleep problems.

Addressing sleep problems often improves psychiatric symptoms in children and teens, including those with attention-deficit/hyperactivity disorder and chronic pain.

Sleep-focused treatment improves mood and quality of life in children with attention-deficit/hyperactivity disorder (ADHD), asthma, chronic pain, and cancer, according to speakers at symposium on sleep in children with chronic health conditions at the annual meeting of the American Academy of Sleep Medicine and Sleep Research Society in Minneapolis in June.

Children with ADHD are two to three times more likely to have trouble sleeping than children without the disorder, said Penny Corkum, Ph.D., a professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia. Their sleep problems may undermine daytime performance, said Corkum, who directs research and training at Colchester Regional Hospital’s ADHD Clinic.

In research reported at the meeting, she and colleagues assessed sleep in 30 children newly diagnosed with ADHD and 30 age- and sex-matched typically developing controls. The children’s mean age was about 8.5. At baseline, children with ADHD took 47 minutes to fall asleep in the sleep laboratory, while controls took 24 minutes. Children with ADHD slept about 30 minutes less than controls.

In a four-week medication trial, the researchers gave the 30 children with ADHD either a standard single daily morning dose of methylphenidate or a placebo, in random order for two weeks. While children took longer to fall asleep and slept less when taking the stimulant than when taking the placebo, parents and teachers said their behavior improved.

Children being evaluated for problems with attention, Corkum said, should also be screened for sleep disorders. Consequences of sleep disorders such as obstructive sleep apnea, insomnia, and periodic limb movement disorder/restless leg syndrome may mimic symptoms of ADHD.

Children with and without ADHD, she added, benefit from having a consistent bedtime, learning to fall asleep on their own, sleeping in a dark room, and avoiding television, computers, telephones, and other electronic devices near bedtime.

Children and adolescents with persistent pain commonly report difficulty falling or staying asleep or complain of poor quality sleep, said symposium speaker Tonya Palermo, Ph.D., a professor of anesthesiology and pain medicine at the University of Washington, Seattle.

About 5 percent to 8 percent of children and adolescents in community samples experience moderate to severe disability from persistent pain, most often in the head, abdomen, or limbs, she noted. Common causes include headache disorders, juvenile arthritis, and sickle-cell disease.

Some have depression. Their pain medications may be sedating. These youngsters often say, “I’m always tired,” Palermo noted. Many take frequent and often long naps that may interfere with school or social activities. Concerned parents may allow children to stay in bed late in the morning.

Engaging children and adolescents in self-assessment, Palermo said, may foster improved sleep habits. She asks them to abstain from watching television in their bedroom for a week, for example, to see how that affects their sleep. She also encourages them to use an alarm clock and get up on their own and to maintain a consistent weekday/weekend schedule.

Palermo and colleagues also found that poor sleep diminishes the effectiveness of cognitive-behavioral therapy for chronic pain. She said sleep-specific intervention may need to be delivered before pain-focused behavioral therapy starts.

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Sleepless nights after divorce are linked to raised blood pressure

A study looked into people who have long-term sleeplessness following a divorce and found they are more at risk for high blood pressure.

People who suffer long-term sleep problems after a divorce are at risk for a rise in blood pressure, a new study suggests.

Previous research has linked divorce to major health problems and even early death, but few studies have examined the reasons for this link. Sleep trouble may be one of the causes, according to the University of Arizona investigators.

Their study included 138 people who had been separated or divorced for about 16 weeks. They reported on the quality of their sleep during three lab visits over seven-and-a-half months. Their blood pressure also was checked during those visits.

The researchers did not see a link between sleep problems and blood pressure in the participants' early lab visits. However, there was a delayed effect, they said.

"We saw changes in resting blood pressure were associated with sleep problems three months earlier. Earlier sleep problems predicted increases in resting blood pressure over time," study co-author David Sbarra, an associate professor of psychology, said in a university news release.

The longer participants' sleep problems lasted, the more likely they were to have a rise in blood pressure.

"What we found was if you're having sleep problems up to about 10 weeks after your separation, they don't appear to be associated with your future increase in blood pressure," Sbarra said. "However, after 10 or so weeks -- after some sustained period of time -- there seems to be a cumulative bad effect."

The study, published recently in the journal Health Psychology, only established an association between divorce-related sleep problems and higher blood pressure, not a direct cause-and-effect relationship.

"In the initial few months after a separation, sleep problems are probably pretty normal, and this is an adjustment process that people can typically cope with well," Sbarra said.

Sleep problems that persist for an extended period might mean something different, he added. "It may mean that people are potentially becoming depressed, that they're struggling with getting their life going again, and it is these people that are particularly susceptible to health problems," he explained.

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What causes sleep issues for Parkinson's patients?

This article discusses the link between Parkinson's disease and sleep issues, and what may cause sleep issues for people with Parkinson's disease.

Up to 70% of Parkinson’s disease (PD) patients experience sleep problems that negatively impact their quality of life. Some patients have disturbed sleep/wake patterns such as difficulty falling asleep or staying asleep, while other patients may be subject to sudden and involuntary daytime sleep “attacks.” In the extreme, PD patients may exhibit REM-sleep behavior disorder (RBD), characterized by vivid, violent dreams or dream re-enactment, even before motor symptoms appear. A review in the Journal of Parkinson’s Disease discusses the underlying causes of sleep problems in PD, as well as medications, disease pathology, and comorbidities, and describes the most appropriate diagnostic tools and treatment options.

Sleep problems in PD patients can have wide-ranging adverse effects and can worsen in later stages of the disease. Sleepiness socially isolates patients and excessive sleepiness can put patients at risk of falls or injury, and can mean patients must give up driving. Sleepiness can impair cognition and concentration, exacerbate depression, and interfere with employment. Wakefulness at night impairs daytime wakefulness and may also cause mood instabilities and can exhaust caregivers.

“Diagnosis and effective treatment and management of these problems are essential for improving the quality of life and reducing institutionalization of these patients,” says lead author Wiebke Schrempf, MD, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Department of Neurology, Division of Neurodegenerative Diseases, Dresden, Germany.

Dr. Schrempf and colleagues describe some of the complexities associated with treating sleep problems in PD patients, such as the worsening of sleep problems by dopaminergic medications used to treat motor symptoms. Lower doses of levodopa or dopamine agonists are able to improve sleep quality partly by reducing motor symptoms such as nighttime hypokinesia (decreased body movement), dyskinesia (abnormal voluntary movements), or tremor (involuntary shaking), which interfere with normal sleep. However, the same medications may also cause excessive daytime sleepiness. The report describes how changing medication, dose, duration of treatment, or timing of administration can improve outcomes.

The presence of other conditions common in PD patients such as depression, dementia, hallucinations, and psychosis may interfere with sleep. Unfortunately, some antidepressants can also impair sleep.

Sleep problems may also be harbingers of future neurodegenerative disease. Patients with RBD exhibit intermittent loss of normal muscle relaxation during REM sleep and engage in dream enactment behavior during which they may shout, laugh, or exhibit movements like kicking and boxing. “RBD seems to be a good clinical predictor of emerging neurodegenerative diseases with a high specificity and low sensitivity, whereas other early clinical features of PD, such as olfactory dysfunction and constipation, are less specific,” says Dr. Schrempf. “These early clues may help identify PD patients before motor symptoms appear, when disease-modifying therapies may be most beneficial.”

PD is the second most common neurodegenerative disorder in the United States, affecting approximately one million Americans and five million people worldwide. Its prevalence is projected to double by 2030. The most characteristic symptoms are movement-related, such as involuntary shaking and muscle stiffness. Non-motor symptoms, such as worsening depression, cognition, and anxiety, olfactory dysfunction, and sleep disturbances, can appear prior to the onset of motor symptoms.

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Hypnosis to help with sleeping problems

This article explains how hypnosis could help people with sleep problems.

Insomniacs and light sleepers alike might benefit from hypnosis to coax them into a deep sleep, suggests a new study published in the journal Sleep.

Researchers from the University of Zurich and Fribourg concluded that hypnosis can increase the quality of sleep, eliminating the need for medications the effects of which have long been questioned by the medical community.

"It opens up new, promising opportunities for improving the quality of sleep without drugs," says biopsychologist Björn Rasch, who headed the study at the Psychological Institute of the University of Zurich in conjunction with the Sleep and Learning project.

The study limited its participants to women, due to their increased susceptibility to hypnosis on average. A total of 70 healthy young women were divided into groups according to their susceptibility to hypnosis and invited to the sleep laboratory for a 90-minute midday nap.

The test group listened to 13 minutes of pre-recorded hypnosis before sleeping, and the control group listened to neutral dialogue over loudspeakers.

The most hypnotizable participants experienced an 80 per cent increase in slow wave sleep.

"The results may be of major importance for patients with sleep problems and for older adults," says psychologist and study leader Maren Cordi. "In contrast to many sleep-inducing drugs, hypnosis has no adverse side effects."

The findings indicate that even healthy individuals with a delayed circadian preference could further increase their health by taking steps to get to sleep earlier.

Deep sleep is referred to in the scientific community as slow wave sleep (SWS) and is measured by the actual speed of the brainwaves.

It is understood to be the most restorative of the sleep phases, for during SWS growth hormones are secreted, promoting cell repair and stimulating the body's immune system.

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Binge drinking, marijuana use, and poor academic performance predicted by sleeping problems

A study shows that binge drinking, marijuana use, and poor academic performance are predicted by problems sleeping.

While the temptations to stay up late are many, a small new study suggests a very good reason for college students to hit the hay. Those who are poor sleepers are more likely to get worse grades and to withdraw from a course, according to a new study. In fact, the effects of poor sleep were about as strong as binge drinking and marijuana use on a student's academic performance.

The researchers analyzed data from over 43,000 students included in the spring 2009 American College Health Association's National College Health Assessment (NCHA). After controlling for potentially confounding factors that might predict how a college student fares academically, like clinical depression, feelings of isolation or chronic health problems, the researchers found that getting poor sleep was a strong predictor of problems at school.

While few students are likely to have a clinical sleep disorder, Roxanne Prichard, Ph.D., associate professor of psychology at the University of St. Thomas in St. Paul, Minnesota tells The Huffington Post, about 60 percent say they have some kind of problem sleeping. But for all the effort colleges put into anti-drinking and de-stressing campaigns, little time or money is spent to promote better sleep -- and doing so could help both students and the colleges themselves, she says.

"Sleep really isn't systematically approached in a way that could have major economic benefits to both the students and the universities in terms of increased retention," she says. Indeed, reducing the number of courses a student withdraws from by just one ups his or her probability of graduating by 14 percent, she says -- and it goes without saying that student retention is good for a university's bottom line.

Prichard hopes more schools decide to include a screening for sleep problems among students, which could ultimately limit costs of care of university health centers, she says. "I don't think sleep problems are showing up on the questionnaire intake forms for health services, and that could be explaining a lot of the other problems that you see showing up," she says. "Recurrent illness could be sleep problems."

Prichard and co-investigator Monica Hartmann, Ph.D., professor of economics at the University of St. Thomas, found that poor sleep was even more detrimental among freshmen, according to the study. "I think that's partially because freshmen have the worst sleep of any age group," she says. Not only are they hungry for independence from their parents, but they also are more likely to be "delayed phase" -- essentially, they are more biologically inclined to be night owls because of their age, she says. Focusing especially on first-year students is a smart idea for universities, she says, because freshmen-year success (or lack thereof) is a strong predictor of whether or not a student drops out his or her sophomore year.

The research, published in an online supplement of the journal SLEEP, will be presented Tuesday, June 3, at SLEEP 2014, the 28th annual meeting of the Associated Professional Sleep Societies.

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Study: Poor sleep doubles number of hospitalizations in heart failure patients

A study shows that heart failure patients have double the number of hospitalizations when they do not sleep well.

Poor sleep doubles hospitalizations in heart failure, according to new research in nearly 500 patients presented today at EuroHeartCare 2014.

EuroHeartCare is the official annual meeting of the Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Cardiology (ESC). This year's meeting is organized jointly with the Norwegian Society of Cardiovascular Nurses. It takes place 4-5 April in Stavanger, Norway.

Dr Peter Johansson, first author of the study and a heart failure nurse at the University Hospital of Linköping, Sweden, said: "Sleep is important for everyone and we all have to sleep to feel good. We know that sleep problems are common among patients with heart failure. But until now there was no data on whether poor sleep persists over time and how that relates to hospitalizations."

He added: "Our study shows that some patients with heart failure have chronic sleep problems and this more than doubles their risk of unplanned hospitalizations. We need to ask all our heart failure patients whether they sleep well and if not, find out why."

The current study included 499 patients hospitalized for heart failure who participated in the Co-ordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH) study. During the initial hospitalization, information was collected on physical functioning, mental health and sleep. Sleep problems were assessed using the question "Was your sleep restless?" from the Centre for Epidemiologic Studies Depression Scale (CES-D). After 12 months the researchers recorded the number and cause of unplanned hospitalizations during the follow up period and assessed sleep again.

The researchers found that 215 patients (43%) had sleep problems at discharge from the initial hospitalization and nearly one-third (30%) had continued sleep problems at 12 months. Patients with continued sleep problems were two times more likely to be hospitalized during the follow up period than those without any sleep problems. Risk was double for all-cause hospitalizations and for cardiovascular hospitalizations. The results were adjusted for physical and mental health factors to ensure that the association was real.

Of the 284 patients without sleep problems at initial discharge, 14% developed a sleep problem during the follow up period. There was a trend for these patients to have more cardiovascular hospitalizations than patients without sleep problems but the finding was not significant.

Dr Johansson said: "Our finding that consistently poor sleep leads to twice as many hospitalizations in patients with heart failure underlines the impact that sleep can have on health. In Sweden we don't generally ask our heart failure patients about sleep and this study shows that we should. If patients say their sleep is poor that may be a warning signal to investigate the reasons."

He added: "Patients may have poor sleep hygiene, which means they do things that prevent them from getting a good night's sleep. These include drinking coffee or too much alcohol late at night, having a bedroom that is too hot or too cold, or having upsetting conversations before going to bed."

Dr Johansson continued: "Patients need to have realistic expectations. One night of poor sleep is unlikely to be a cause for concern, and sleep patterns naturally change with age. But patients who say they consistently have poor sleep should be taken seriously. To help the patients, health professionals for example can look at their medications or send them to a sleep lab for a sleep apnea investigation."

There are a number of possible explanations for the observed association between poor sleep and increased hospitalizations in patients with heart failure. Previous studies have shown that poor sleep can increase inflammatory activity and levels of stress hormones, both of which accelerate the progression of heart failure. It is also known that poor sleep is related to psychological distress, and it could be that these patients worry more about changes to their health and are more likely to visit the hospital.

Dr Johansson said: "Poor sleep may itself lead to worsening heart failure and increased hospitalizations. Alternatively it could be a signal that patients have other problems like sleep apnoea or psychological distress that are keeping them awake. All heart failure patients should be asked about sleep so that if there is a problem we can find out what it is and provide treatment."

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Sleep Problems Run In Families - A Challenge for Parental Behavior

This article discusses she most recent Sleep in America Poll which shows that sleep issues can run in families.

Let's model best sleep hygiene by turning off our electronic toys.  JR

The National Sleep Foundation has released its annual Sleep in America Poll. This year, the poll examines sleep in the modern American family. How well—or not—are parents and children sleeping today? What are the challenges facing families in their pursuit of high-quality, plentiful sleep? What are the strategies that parents are using to help their children sleep, and how well are those strategies working? These are some of the questions that this year’s sleep survey investigates. The answers paint a picture of American families needing more sleep than they are getting, and struggling to contend with challenges to sleep that are a product of technologically-driven and highly-scheduled lives.

The survey included 1,103 adults with at least one child between the ages 6-17 living in their households. Among respondents, 54% were mothers. The families surveyed varied in size: 40% of respondents had 2 children, 24% had 1 child, and another 24% had 3 children.  Eleven percent of respondents had 4 or more children in their households. Adults reported on their own sleep and answered sleep questions about their children.

The results indicate challenges to sleep within American families that are, in fact, distinctly modern. Despite a high level of awareness of the importance of sleep to health and well being, neither children nor their parents are getting enough high quality sleep. This appears to be in part because of a heavy rotation of evening activities and commitments for both adults and children. Technology has taken up residence in most bedrooms—parents’ and children’s—to the detriment of sleep for both. The survey also found that parents’ own behaviors about sleep, as well as their willingness to set rules for their children’s sleep, can have a significant effect on sleep within the family:

• There is broad consensus among parents about the importance of sleep to their family’s mental and physical health. More than 90% of parents reported their belief that sleep is highly important to the health and well being of both adults and children in their family.

• Despite this recognition about the importance of sleep, both children and their parents are struggling to get enough sleep, and to sleep well. Fewer than 45% of children between the ages 6-17 are sleeping 9 or more hours per night. Recommendations for sufficient sleep amounts for children vary by age, but at all stages of childhood and adolescence, children need at least 9 hours of sleep per night. Younger school-age children need in excess of 10-11 hours nightly.

• As children age, their nightly sleep shortens, according to these results. Among 12-14 years olds, less than a third were reported to be sleeping 9 hours a night. Among older adolescents ages 15-17, a majority—56%–were reported to be sleeping no more than 7 hours nightly.

• Researchers compared the amount of sleep to quality of sleep, and found that children who slept less also were more likely to experience lower quality sleep. Among children who slept fewer than 7 hours a night, more than a quarter—28%–were reported to have poor quality sleep.

• Parents tended to rate their children’s sleep quality as significantly better than their own. Only 13% of adults reported their sleep as excellent, compared to 42% who rated their children’s sleep this highly.

• When asked about the challenges they face in getting enough sleep for themselves and their children, parents cited busy schedules as the most common obstacle. Evening activities were the most frequently cited challenge, both for parents and for children. For children, homework was also often reported as a nightly obligation that delayed bedtime or otherwise made sleep more difficult.

A substantial majority of adults and children are sleeping in proximity to at least one or more electronic device, according to the survey results. Televisions, computers, tablets, smartphones, gaming and music devices are commonly found in children’s bedrooms as well as in their parents’:

• 89% of adults and 75% of children have at least 1 electronic device in their bedrooms. Roughly half of children—51%–and 68% of adults have 2 or more electronic devices in their bedrooms.

• Televisions are the most common electronic devices in both parents’ and children’s bedrooms. MP3 players, tablets and smartphones are also common in both.

• The results also indicate that these devices are frequently left on during the night, rather than turned off before bedtime.

Electronic devices pose serious hazards to sleep when they take up residence in the bedroom. These devices emit light that disrupts sleep cycles and alters sleep-related hormone levels. The noise and stimulation that they provide is counterproductive to sleep, pushing back bedtimes and risking waking during the night when they are left on. It’s not surprising, then, that the survey found children with electronic devices in their bedrooms slept less and experienced lower quality sleep than those children without these gadgets in their bedrooms. Sleep quality suffered most dramatically when the devices were regularly left on during the night. And the more devices were present, the worse children slept.

Despite the sleep problems associated with electronics in the bedroom, many adults and children use these devices as a means to fall asleep, according to the survey. Sixty-six percent of adults reported a habit of relying on television or videos to help them fall asleep, and 37% used the internet. Parents reported that their children often used these same tactics to help them sleep: 47% of children were reported to watch television to fall asleep with some regularity, and 27% played games or used the internet to help bring about sleep.

One of the more striking details about how technology is intruding on sleep? The prevalence of texting and emailing after initially falling asleep, among both children and their parents. More than one quarter of adults—26%–either read or sent emails and text messages after first falling asleep for the night, as did 16% of children. More than half of the children who texted and emailed during the night had parents who did so as well.

This points out another important finding from the survey: the influence of parents’ sleep -and-technology-related habits on their children’s own sleep behaviors. The results indicate that children with electronic devices in their bedrooms are significantly more likely to have parents’ who also have these devices in their bedrooms. Children who let their devices run during the night are also more likely to have parents who do the same.

Ready for some good news about parental influence on kids’ sleep? Parents who establish sleep-related rules and enforce them consistently report their children sleep longer and better than children whose parents don’t apply regular rules to bedtime. These rules include consistent bedtimes, and also govern before-bed activities like watching television, using phones, playing video games, and drinking soda with caffeine. Children in households with sleep rules that are routinely enforced sleep an average of 1.1 additional hours per night.

There are a lot of moving pieces in this picture of the American family’s sleep life—busy schedules, crowded and active evening hours, constant temptation from technology. These threats to high-quality and plentiful sleep are not going away—in fact, they’re more likely to proliferate. It is our modern-day challenge to find ways to manage these ever-present demands with balance and moderation—and with an eye on protecting sleep.

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