Are Smart Drugs Driving Silicon Valley?

Off-label use of “cognitive enhancement” drugs such as those used to treat narcolepsy is a real concern in Silicon Valley, reports CNN Money.

Asprey’s morning dose is a mix of what’s referred to as smart drugs, a broad term for compounds that may increase cognitive function. He also describes many of them as nootropics, which generally refer to natural supplements or nutrients. The terms are often used interchangeably.

The wide umbrella includes everything from fish oil to prescription-only medications like Modafinil, a narcolepsy drug that healthy people sometimes use for the off-label purpose of working all night long.


ADHD or Sleep Disorder? New Study Suggests Similar Symptoms

A WFLA news report indicates that the American Academy of Pediatrics is alerting parents of the differences between ADHD and sleep disorders.

“If a child has a sleep disorder it’s going to be quite difficult to focus in a classroom. A child can’t concentrate. So they’re fidgeting in the classroom because they’re trying to stay awake. A teacher sees that, and they’re used to seeing ADD and ADHD, the first thing she’s going to presume is ah-ha here’s the next one,” said Dr. Akinyemi Ajayi, the medical director of the Children’s Sleep Laboratory, statewide.


Luna–A Connected Smart Mattress Cover For A Good Night’s Sleep

According to Forbes, Luna is a mattress cover that is a sensing device designed to gather data to get an accurate picture of a person’s sleep.

This is where Luna plays – Luna is a smart, connected mattress cover. It takes the traditional mattress cover – connects it to the cloud, integrates it with a bunch of other products and services and learns from the way it gets used. So let’s take a look at what Luna does.

The cover is not only a sensing device, but also a bed warmer – via a mobile application, users can control the warmth of their bed including dual-zone temperature control for those who have differing preferences form their partners.


Smartphone App Detects Sleep Apnea

Mobile technology could fill a gap in medical diagnosis, reports The Institute, which specifically reports on SleepAp.

Smartphone apps are already available to measure sleep activity such as tossing and turning, waking during the night, heavy breathing, and snoring, which could all be signs of a sleep disorder. Joachim Behar thought he might use these apps to detect sleep apnea, but after spending two months reviewing some 40 of these apps, he and his team at Oxford found them all lacking. They concluded that most were scientifically unsound and did not have any clinical evidence that they are accurate. Taking matters into his own hands, Behar designed SleepAp to help detect sleep apnea with the help of colleagues in Oxford’s department of engineering science.


Jeff Bridges Lulls Listeners to Bed With New Album ‘Sleeping Tapes’

According to Rolling Stone, actor Jeff Bridges has released a 15-song album called Sleeping Tapes designed to help you doze.

Rarely has “Your music put me to sleep” been viewed as a compliment, but that’s the goal of actor Jeff Bridges’ latest collection of songs. The actor’s new album Sleeping Tapes makes no qualms that its goal is to lull the listener to bed and features the actor’s spoken word pieces and guided meditation atop ambient soundscapes and sound collages, the Wall Street Journal reports. Bridges worked with True Detective composer Keefus Ciancia and sound engineer Doug Sax on the album.


Insomniacs May Face Increased Hypertension Risk

Insomniacs who take longer than 14 minutes to fall asleep face a greater risk of hypertension, according to new research in the American Heart Association journal Hypertension.

The study, conducted at West China Hospital, is the first to test whether insomnia with physiological hyperarousal, defined as a longer time to fall asleep, is linked to hypertension.

“We observed a strong correlation between the degree of physiological hyperarousal and hypertension,” says Xiangdong Tang MD, PhD, co-author of the study and professor of sleep medicine at West China Hospital, Sichuan University in Chengdu, China.

“In other words, those insomniacs who were hyperalert during the day and unable to relax and fall asleep during the Multiple Latency Sleep Test (MSLT) had the higher risk of hypertension,” says study co-author Alexandros Vgontzas, MD, professor of sleep research and treatment in the Department of Psychiatry at Pennsylvania State University College of Medicine in Hershey, Penn.

Insomnia is the most prevalent sleep disorder in the general population. One-fourth to one-third of the general population complains of difficuly falling asleep and about 10% have chronic complaints and seek medical help for insomnia.

Researchers studied 219 chronic insomniacs and 96 normal sleepers (average age 40 and more than 60% women). They defined chronic insomnia as difficulty sleeping for more than six months.

The participants spent one night monitored in a sleep lab and took the MLST the next day. Monitoring included four 20-minute nap opportunities at two-hour intervals: 9 AM, 11 AM, 1 PM and 3 PM. Half the participants took 14 minutes or less to fall asleep and half took more than 14 minutes to fall asleep. Those that took more than 14 minutes to fall asleep were considered “hyperaroused.”

Hypertension was based on blood pressure measures or a physician’s diagnosis. Researchers controlled for confounding factors such as obesity, sleep apnea, diabetes, smoking, alcohol, and caffeine use.

Chronic insomnia combined with an MSLT score greater than 14 minutes increased the odds of hypertension by 300%. MSLT scores greater than 17 minutes increased the odds by 400%.

“Long latency times to fall asleep during the day may be a reliable index of the physiological hyperarousal and biological severity of the disorder,” Vgontzas says.

Traditionally, insomnia has been perceived as a nighttime sleep disorder; however, several studies suggest it’s a state of 24-hour hyperarousal.

A more biologically severe type of insomnia is associated with 24-hour hyperarousal and significant cardiometabolic consequences like hypertension. The less severe form has primarily psychological roots.

Feeling hyperalert or sleepy doesn’t allow people to function at their best, feel well during the day or sleep well at night, Vgontzas says.

“Although insomniacs complain of fatigue and tiredness during the day, their problem is that they cannot relax and that they are hyper,” he says. “Measures that apply in sleep-deprived normal sleepers—napping, caffeine use, or other stimulants to combat fatigue—do not apply in insomniacs. In fact, excessive caffeine worsens the hyperarousal.”

Co-authors are Yun Li, MD; Julio Fernandez-Mendoza, PhD; Edward O. Bixler, PhD; Yuanfeng Sun, MD; Junying Zhou, MD; Rong Ren, MD; Tao Li, MD.


Better Sleep, Fatigue Solutions Make Several Appearances on NTSB’s 2015 “Most Wanted” List

Under the broad topic of “require medical fitness for duty,” the National Transportation Safety Board (NTSB) has identified obstructive sleep apnea diagnosis and treatment as on its “most wanted list” of safety advocacy priorities for 2015.

In its explanation, the NTSB states: “The aviation medical certification system may be the most robust, but pilots are increasingly testing positive for over-the-counter sedating medications. Moreover, although the NTSB has found that obstructive sleep apnea has been a factor in multiple accidents, all transportation modes still lack a complete screening process for this condition….In the 2013 train derailment in Bronx, New York, the engineer’s sleep apnea was undiagnosed until the week following the derailment, despite many visits for occupational and personal health care. With a change in his work patterns, the combination of the untreated sleep apnea and fatigue from his disrupted sleep schedule led to his fatigue at the time of the accident. Since 2001, the NTSB has identified obstructive sleep apnea as a factor in at least nine accidents in four transportation modes.”

To mitigate the risk related to medical fitness, the NTSB has made recommendations for a comprehensive medical certification system for safety-critical transportation personnel, including “specific historical questions and physical examination procedures to identify applicants at high risk for sleep disorders”.

Strengthening commercial trucking safety is another top priority for the NTSB in 2015, and it also involves the industry better addressing sleepiness and fatigue. The NTSB states: “Regulators have taken initial steps by maintaining science-based hours of service rules and are in the process of rulemaking mandating electronic logging devices that can help assure that drivers are adequately rested. Other important rulemaking initiatives include requirements to screen drivers for obstructive sleep apnea, other potentially impairing medical conditions, and potentially impairing drugs.”

In the topic of “implement positive train control in 2015,” the NTSB also mentions the Bronx trail derailment, this time stating “The train’s engineer had fallen asleep and failed to slow the train from over 82 miles per hour (mph) to the maximum authorized speed of 30 mph as it entered a curve.” The NTSB posits “positive train control” (PTC) as a mandated solution will prevent tragedies such as that one. “Positive Train Control (PTC) can stop many rail accidents before they happen….Each death, each injury, and each accident that PTC could have prevented, testifies to the vital importance of implementing PTC now.”


Are Oral Appliances Efficacious in Sleep Apnea Patients Who Drink Alcohol?

Sheri Katz, DDS, published a case study exploring the impact of alcohol ingestion on a patient with OSA who uses oral appliance therapy.

Ingesting alcohol prior to sleep in patients with obstructive sleep apnea (OSA) exacerbates the severity and frequency of hypoxic events and may shorten the time from sleep onset to the most severe event. In the study, “Effect of Beer Ingestion on a Patient with OSA while Using Oral Appliance Therapy,” published in the Journal of Dental Sleep Medicine, Sheri Katz, DDS, investigated whether oral appliance use will protect the patient from the effects of alcohol ingestion on respiration.

Case Report Subject

For this case report, a 63-year-old female with moderate OSA (AHI of 15.8) was fitted for an oral appliance after she said she said she could not tolerate CPAP with the recommended full-face mask. The oral evalu­ation revealed that her tongue level was high, she had a Malla­mpati III soft palate classification, and her tonsils were grade 1. No other significant abnormalities were noted.

After trying the appliance, the patient reported subjective improvement in her sleep apnea symptoms. Katz says the patient reported “feeling refreshed in the morning and was no longer snoring. With such a positive report on her subjective symptoms, she and I were both excited to validate her improvement with objective data.” Katz gave the patient an oximeter to utilize that evening while she was asleep with her oral appliance.

Case Report Results

The patient showed significant oxyhemoglobin desaturations soon after retiring for the night, according to the oximeter. The period of instability lasted for approximately 1.5 hours and was not repeated for the remainder of the night. “When I saw the report, I was disappointed and puzzled to see that the first period of the night showed a significant amount of desaturations but then the results showed improvement for the rest of the night,” Katz says. “I asked her if she felt she had an average night sleep. I showed her the results and asked if she had felt ill or had any congestion or allergic reactions at the beginning of the night.  This is when she told me she had been out with friends and drank two beers.” The case report indicates that a subsequent study was performed with no alcohol 1 month later and no such events occurred.

Clinical Ramifications and Future Study

The idea has been proposed that CPAP can offset the adverse effects of alcohol on the upper airway, but this case study suggests oral appliance therapy might not be able to offer the same protection. The paper indicates that further research is needed to confirm and possibly expand on this observation. Katz writes, “If oral appliances are shown to inadequately protect the airway when under the influence of alcohol, patients must be counseled to this effect; CPAP may be a better option for patients that choose to use alcohol regularly.”

Katz says, “This is only one case study, but I want to use it as a vehicle to raise questions about whether oral appliances can keep the airway open when patients are under the influence of alcohol. They may not be able to and we, as clinicians, need to be aware of this and counsel our patients accordingly.” Katz adds, “Because alcohol consumption is so pervasive in our society and represented in all of our practices, I think we could learn a lot from studying patients randomized to OAT and CPAP, with alcohol and without alcohol.”

Katz says she does not have any current plans to pursue any further research on this subject, but believes it would be a wonderful experience to participate in research on this issue.

Cassandra Perez is associate editor of Sleep Review. CONTACT


Online monitoring system for patients with sleep apnoea

The company Medco Health at the Business, Scientific and Technological Park, Espaitec, of the Universitat Jaume I of Castellón, has developed an assistance system based on telemedicine using...

Good bedtime habits equal better sleep for kids

Children obtain better and more age-appropriate sleep in the presence of household rules and regular sleep-wake routines, according to sleep researchers.

AADSM Launches Online CE Opportunities in Dental Sleep Medicine

With more patients being diagnosed with sleep apnea and oral appliance therapy emerging as a key treatment, a background in the management of sleep-disordered breathing allows medical professionals to provide much needed care to patients and grow their practices. The American Academy of Dental Sleep Medicine (AADSM) just launched online training modules that offer a convenient and simple way to continue education in dental sleep medicine–and take advantage of the growing opportunities in the field.

With these continuing educational programs, it’s now easier than ever to gain more knowledge and stay at the forefront of new research and emerging trends in dental sleep medicine. Each online learning module can easily be streamed on any computer or mobile device. The cost is $35 for members and $50 for non-members, and registrants can access the course at their convenience via the AADSM website for one year.

Now available, the first course, “Introduction to Sleep and Sleep Disordered Breathing,” provides an overview of the current understanding of the nature and physiology of sleep as well as the causes, risk factors, consequences, and efficacy of the treatment of obstructive sleep apnea with CPAP.

Future courses will cover the following topics:

  • Airway Anatomy, Physiology, and Pathology
  • Oral Appliance Selection
  • Occlusal Registration
  • Side Effects and Management
  • Oral Appliance Therapy Alternatives: What Happens if it Doesn’t Work?
  • TMD, Bruxism, and Sleep Disordered Breathing
  • Insurance and Medical Coding

To purchase or learn more, visit the learning modules section of the AADSM website.


A Good Night’s Rest: The Best Sleep Apps

A Live Science news report examines the best smartphone apps available on the market to monitor and improve sleep.

Sleepbot has three major features: a motion-tracker, a sound-recorder and a smart alarm. You can choose to activate one, all or any combination of these features simply by tapping a checkmark next to each — making this app one of the easiest to navigate of all the apps we reviewed. To track your nighttime motion, plug in the phone (all of these sleep apps are battery hogs), start the app and place the phone face-down on your bed near your body. The sound-recording feature will automatically detect sleep-talking, snoring and bumps in the night and record clips so you can get a better idea of nighttime disturbances in the morning.


Over-the-counter sleep aids linked to dementia

Higher dosage or long-term use of common drugs with anticholinergic effects is linked to significantly increased risk of dementia - including Alzheimer’s - says large study.

Increased risk of high blood pressure in people with insomnia

A large sleep-monitoring study has found a link between hypertension and insomnia, suggesting a connection between a 24-hour state of hyperarousal and raised blood pressure.

Why all-nighters don’t work: How sleep and memory go hand-in-hand

Brandeis researchers observe an unknown connection between sleep and memoryWant to ace that test tomorrow? Here's a tip: Put down the coffee and hit the sack.

Morphine after tonsillectomy ‘potentially life-threatening’ for children

Study halted after researchers find that the use of morphine to relief pain in children after tonsillectomy surgery led to dangerous respiratory problems.

Good Bedtime Habits Equal Better Sleep for Kids

Children obtain better and more age-appropriate sleep in the presence of household rules and regular sleep-wake routines, according to sleep researchers.

The researchers found that well-established rules for getting good sleep, such as limited caffeine and a regular bedtime, led to sufficient sleep quantity and adequate sleep quality. In contrast, when parents and children had electronic devices on in the bedroom after bedtime, sleep deficiency was more likely.

Reducing the encroachment of technology and media into sleep time and supporting well-known sleep hygiene principles should be a focus of public health intervention goals for sleep health, the researchers say.

Orfeu Buxton, now an associate professor of biobehavioral health at Penn State, led a team conducting the 2014 National Sleep Foundation Sleep in America Poll, “Sleep in the Modern Family,” whose overall objective was to obtain a current picture of sleep in families with at least one school-aged child. The results are published today in Sleep Health.

The researchers evaluated US households with children aged 6 to 17 years old through Internet-based interviews. A total of 1,103 parents or guardians of an average age of 42 completed surveys; 54% were female.

“We were interested in parental perception of the importance of sleep duration and sleep quality, habits, and routines of the families and children, and obstacles preventing adequate sleep,” Buxton says in a release.

According to researchers, although the majority of parents endorsed the importance of sleep, 90% of children did not sleep the full amount of time recommended for their age group.

Some of the primary consequences of poor sleep among children and adolescents are behavioral problems, impaired learning and school performance, sports injuries, problems with mood and emotional regulation, and a worsening of health-related issues including obesity.

Evidence also indicates that in adolescence, lack of sleep may be related to high-risk behaviors such as substance abuse, suicidal behaviors, and drowsy driving.

Significant predictors of age-adjusted sufficient sleep duration—estimated conservatively as at least 9 hours for ages 6 through 11 years and at least 8 hours for ages 12 to 17 years—included parent education, regular enforcement of rules about caffeine, and whether children left technology on in their bedroom overnight.

“We have previously demonstrated the negative effect that use of light-emitting technology before bedtime can have on sleep, and now in this study we see how parental rules and routines regarding technology can influence the quantity and quality of their children’s sleep,” says Anne-Marie Chang, assistant professor of biobehavioral health at Penn State and co-author of the study. Chang and colleagues recently showed that reading on an iPad before bedtime, compared to reading a print book, can impair sleep, delay circadian timing, and degrade alertness the following morning.

“An important consequence of our modern-day, 24/7 society is that it is difficult for families—children and caregivers both—to get adequate sleep,” Buxton says. “Sleep in the family context frames sleep as involving interactions between all members of a household and interactions with the environment of the home as well as exogenous factors like work or school affecting any member.”

Several potential reasons for poor sleep include the use of technology in the bedroom, complicated and busy daily schedules with competing work, school, social, and recreational activities, as well as neighborhood noise from vehicular traffic, commercial or industrial activity, and neighbors.

Within the family dynamic, a consistent bedtime routine improves sleep, whereas television use in the bedroom generally is associated with curtailed sleep.

“Good quality and sufficient sleep are vital for children,” Buxton says. “Just like a healthy diet and exercise, sleep is critical for children to stay healthy, grow, learn, do well in school, and function at their best.”


Not Everyone’s Internal Clock Is Set for the 9-to-5

Sleep disorders put some workers out of sync with traditional schedules and are estimated to cost employers $2,000 per employee in lost productivity every year, reports The Atlantic.

No matter how early she went to bed, Maggie couldn’t fall asleep until the early hours of the morning. Though constantly exhausted, Maggie (she asked that I not use her last name) got good grades in high school, but she’d frequently get in trouble for coming in late and napping during her morning classes.

Maggie dreamt of going to medical school. Unfortunately, she couldn’t concentrate during early morning science classes in college, and she had to switch her major from biology to literature. Her post-grad situation was no better: Waking up for her 8:30 a.m. teaching position turned her into a zombie, and she lost her job because she lacked enthusiasm. She switched career paths to take on a marketing position that was supposed to be afternoon-only, but once her boss started requiring her to come in mornings, it didn’t work out—and she’s now unemployed.


Sleeping with Pet May Aggravate Sleep Issues

Baylor College’s Dr Mary Rose says pets should sleep in beds of their own.

“Many times when you tell someone that they need to sleep without their pet, they get very protective,” said Dr. Rose, assistant professor of pulmonary, critical care and sleep medicine at Baylor. “So it’s important to determine what works best for them to optimize their lifestyle with a pet.”


Mike Napoli Enduring Long Recovery from Sleep Disorder

Boston Red Sox baseball player Mike Napoli recently underwent surgery for sleep apnea and recounted the details to Comcast SportsNet.

Napoli had been diagnosed long ago with a sleep disorder, a condition he seemingly managed for a while with the help of a CPAP (Continuous Positive Airway Pressure) mask, medication and a dental mouthpiece.

But as Napoli got older, the problem worsened. He found it virtually impossible to get quality sleep and lacked energy, to the point where he would often nap before games rather than take batting practice.


Swans’ New Sleep Pods

The Sydney Swans, an Australian football team, has added sleep pods to its change room to allow players to rest and recover, as indicated on a Swans Media news report.

“There’s been a lot of research around napping during the day and certainly one of the advantages we have is that we have players who live between Bondi and Coogee and they can duck home and catch up on some work, or a bite to eat or have a quick relax at home,” Peter Berbarkov told SwansTV.

“If players need to catch up on sessions during the day, we’re providing them with the option to have a nap during the day which the research really supports.


FAA to Issue New Sleep Apnea Guidance on March 2

On March 2, the Federal Aviation Administration (FAA) will issue new medical guidance to Aviation Medical Examiners (AMEs), the agency said on Friday. The new guidance will incorporate industry and Congressional feedback balanced with FAA and National Transportation Safety Board (NTSB) safety concerns about pilots flying with obstructive sleep apnea (OSA).

Based on feedback from industry on the FAA’s draft guidance, the new guidance does not rely on body mass index (BMI) and allows a pilot to keep flying during evaluation and treatment. The FAA plans to publish the new guidance in the FAA Guide for Aviation Medical Examiners on March 2, 2015.


FMCSA: Medical Examiners Should Rely on “Medical Training and Expertise” for OSA Diagnosis, Treatment

In a bulletin issued this month by the Federal Motor Carrier Safety Administration (FMCSA), the agency reminds its certified medical examiners to use their “medical training and expertise in determining whether a driver exhibits symptoms and/or multiple risk factors for OSA [obstructive sleep apnea].”

“The current regulations and advisory criteria do not include guidelines concerning OSA screening, diagnosis, and treatment,” the bulletin states. “Medical examiners should rely upon their medical training and expertise in determining whether a driver exhibits symptoms and/or multiple risk factors for OSA, and they should explain to the driver the basis for their decision if the examiner decides to issue a medical certificate for a period of less than two years to allow for further evaluation, or to deny a driver the medical certificate.”

The bulletin appears to give medical examiners wide latitude in screening, diagnosis, and treatment options. The bulletin states that home sleep tests that ensure chain of custody are acceptable diagnostic tools and that weight loss and oral appliances are included in the spectrum of acceptable treatments for truckers.

Specifically, the bulletin states:

  • Screening: With regard to identifying drivers with undiagnosed OSA, FMCSA’s regulations and advisory criteria do not include screening guidelines. Medical examiners should consider common OSA symptoms such as loud snoring, witnessed apneas, or sleepiness during the major wake periods, as well as risk factors, and consider multiple risk factors such as body mass index (BMI), neck size, involvement in a single-vehicle crash, etc.
  • Diagnosis: Methods of diagnosis include in-laboratory polysomnography, at-home polysomnography, or other limited channel ambulatory testing devices which ensure chain of custody.
  • Treatment: OSA is a treatable condition, and drivers with moderate-to-severe OSA can manage the condition effectively to reduce the risk of drowsy driving. Treatment options range from weight loss to dental appliances to Continuous Positive Airway Pressure (CPAP) therapy, and combinations of these treatments. The Agency’s regulations and advisory criteria do not include recommendations for treatments for OSA and FMCSA believes the issue of treatment is best left to the treating healthcare professional and the driver.”

The FMCSA also states that drivers with “moderate-to-severe OSA” are the primary safety goal, defining that as an AHI greater than or equal to 15.


Progress with New Product Launches Helps ResMed Achieve Double-Digit Growth

ResMed‘s revenue for the second quarter ended December 31, 2014, was $423.0 million, a 10% increase compared to the quarter ended December 31, 2013. Net income was $91.2 million, an increase of 5% compared to the quarter ended December 31, 2013.

“We are pleased to report strong double-digit revenue growth, demonstrating excellent progress with our new product launches,” says Mick Farrell, ResMed CEO, in a release. “We achieved robust commercial performance across all regions, including double-digit growth in the Americas.”

Farrell continues: “During the quarter, we continued to roll out the ResMed Air Solutions Platform with the launch of our AirCurve 10 series of cloud-connected bilevel devices. We also continued the global roll-out of our new life support ventilation system, the Astral platform. We drove consumer awareness of sleep by launching the S+ by ResMed, the world’s first non-contact sleep management solution that helps you monitor and improve your sleep health; we also integrated the S+ with Apple HealthKit….We drove top-line revenue growth in the first half of this fiscal year by launching a strong, innovative portfolio of products and solutions. Longer term, we are focused on our strategy to continue to grow our core sleep apnea market, as well as to invest in high-potential growth opportunities: helping patients with COPD, neuromuscular disease, and cardio-respiratory conditions. Our results this quarter show that our solutions continue to meet the needs of our key customer groups, including patients, physicians, healthcare providers, and payers. We are executing to our mission: improving patient quality-of-life, lowering healthcare costs, and preventing chronic disease progression.”

Analysis of Second Quarter Results

In the second quarter of fiscal year 2015, revenue in the Americas was $231.0 million, a 12% increase over the prior year’s quarter. Revenue in combined Europe and Asia Pacific was $192.0 million, an 8% increase compared to the quarter ended December 31, 2013.

Gross margin in the second quarter was 62.2%, lower than the prior year, mainly due to an unfavorable product mix and declines in average selling prices, which were partially offset by manufacturing and supply chain improvements.

Selling, general, and administrative expenses were $122.5 million for the quarter, a 10% increase over the quarter ended December 31, 2013. SG&A expenses were 29.0% of revenue in the quarter, compared to 29.1% in the quarter ended December 31, 2013, primarily due to higher marketing costs associated with recent product releases and an increase in variable employee compensation costs.

Research and development expenses were $29.3 million for the quarter, or 6.9% of revenue. R&D expenses decreased by 1% compared to the quarter ended December 31, 2013.

Operating profit for the quarter was $109.1 million and cash flow from operations was $106.0 million.

Amortization of acquired intangible assets was $2.3 million ($1.7 million, net of tax) during the quarter. Stock-based compensation costs incurred during the quarter of $11.7 million ($8.1 million, net of tax) consisted of expenses associated with employee equity grants, and the company’s employee stock purchase plan.


Reducing Work-family Conflicts Helps People Sleep Better

A multi-institution team of sleep researchers recently found that workers who participated in an intervention aimed at reducing conflict between work and familial responsibilities slept an hour more each week and reported greater sleep sufficiency than those who did not participate in the intervention. The study is published in the inaugural issue of Sleep Health, the journal of the National Sleep Foundation.

“Increasing family-supportive supervision and employee control over work time benefited the sleep of hundreds of employees, and even greater effects may be possible if sleep is overtly addressed in workplace interventions,” says lead author Ryan Olson, PhD, of Oregon Health & Science University, in a release. “The Work, Family, and Health Network Study intervention was designed to reduce work-family conflict. It did not directly address sleep, yet sleep benefits were observed.”

The invention focused on the US employees of an information technology firm. Groups of randomly selected managers and employees participated in a 3-month social and organizational change process that included interactive sessions with facilitated discussions, role-playing, and games. Managers were also trained in family-supportive supervision and self-monitored how they applied the training on the job. Data were collected through qualitative interviews 12 months after the intervention was introduced and by actigraphy. Actigraphy measures of sleep quality and quantity were taken at the beginning of the intervention, to establish baseline measures for participants, and 12 months after the intervention. Each of the 474 participants’ activity recordings were evaluated by two scorers, who identified periods of sleep relative to each participant’s waking activities.

“I applaud the methodological rigor of Olson and colleagues’ approach to assessing the Work, Family, and Health Network Study’s effect on the sleep duration and quality of a real world population,” says Dr Lauren Hale, editor-in-chief of Sleep Health. “This study demonstrates that interventions unrelated to sleep can improve sleep in the population. Furthermore, these findings serve as a reminder that there are opportunities to deploy innovative interventions to improve sleep.”

The authors had hypothesized that both sleep duration and insomnia would be improved in the study’s twelfth month; secondarily, they hypothesized that any improvement in sleep quality and duration would be mediated by employees’ enhanced control over their work time and reduced work-family conflict assessed at the sixth month after baseline. Researchers created a statistical mediation model that accounted for the multiple temporal aspects of actigraphic sleep data and participant characteristics.

“Here we showed that an intervention focused on changing the workplace culture could increase the measured amount of sleep employees obtain, as well as their perception that their sleep was more sufficient,” says lead investigator Orfeu M. Buxton, PhD, Pennsylvania State University (with secondary appointments at Harvard and Brigham and Women’s Hospital). “Work can be a calling and inspirational, as well as a paycheck, but work should not be detrimental to health. It is possible to mitigate some of the deleterious effects of work by reducing work-family conflict, and improving sleep.”

The researchers plan to continue this line of study and connect future workplace interventions with personalized interventions to help individuals improve their sleep.


Brain Researchers Discover Similarities Between Dreaming, Wakefulness

Researchers from the Max Planck Institute for Human Development in Berlin and the Max Planck Institute of Psychiatry in Munich have discovered that the brain area that enables self-reflection is larger in lucid dreamers. Thus, lucid dreamers are possibly also more self-reflecting when awake.

Lucid dreamers are aware of dreaming while dreaming. Sometimes, they can even play an active role in their dreams. Most of them, however, have this experience only several times a year and just very few almost every night. Internet forums and blogs are full of instructions and tips on lucid dreaming. Possibly, lucid dreaming is closely related to the human capability of self-reflection—the so-called metacognition.

Neuroscientists from the Max Planck Institute for Human Development and the Max Planck Institute of Psychiatry have compared brain structures of frequent lucid dreamers and participants who never or only rarely have lucid dreams. Accordingly, the anterior prefrontal cortex, ie, the brain area controlling conscious cognitive processes and playing an important role in the capability of self-reflection, is larger in lucid dreamers.

The differences in volumes in the anterior prefrontal cortex between lucid dreamers and non-lucid dreamers suggest that lucid dreaming and metacognition are indeed closely connected. This theory is supported by brain images taken when test persons were solving metacognitive tests while being awake. Those images show that the brain activity in the prefrontal cortex was higher in lucid dreamers. “Our results indicate that self-reflection in everyday life is more pronounced in persons who can easily control their dreams,” says Elisa Filevich, post-doc in the Center for Lifespan Psychology at the Max Planck Institute for Human Development, in a release.

The researchers further want to know whether metacognitive skills can be trained. In a follow-up study, they intend to train volunteers in lucid dreaming to examine whether this improves the capability of self-reflection.


Chronic insomniacs may face increased risk of hypertension

Insomniacs who take longer than 14 minutes to fall asleep face a greater risk of hypertension, according to new research. This study is the first to test whether insomnia with physiological hyperarousal, defined as a longer time to fall asleep, is linked to hypertension.

Good bedtime habits equal better sleep for kids

Children obtain better and more age-appropriate sleep in the presence of household rules and regular sleep-wake routines, according to sleep researchers.

Interventions to reduce work-family conflict ‘improve sleep’

A new study has shown that reducing conflict between work and family responsibilities led to an improvement in sleep duration and quality.

Reducing work-family conflicts in the workplace helps people to sleep better

Workers who participated in an intervention aimed at reducing conflict between work and familial responsibilities slept an hour more each week and reported greater sleep sufficiency than those who did not participate in the intervention, a study shows.

Eye health could help diagnose people with chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is well known for causing exhaustion. It's also linked to a wide range of other symptoms such as pain, poor sleep and trouble concentrating.

Sleeping on stomach ‘may raise risk of sudden death in epilepsy’

Sleeping on the stomach may raise the risk of sudden unexpected death in people with epilepsy, a new study finds. Researchers say sleeping on the back instead may reduce this risk.

Dr Christopher P. Landrigan Named to Virgin Pulse Science Advisory Board

Christopher P. Landrigan, MD, MPH, is one of eight members of the newly created Virgin Pulse Science Advisory Board. Culled from a wide variety of experts and luminaries across the well-being spectrum whose research has long benefited Virgin Pulse, the advisory board ensures that Virgin Pulse is consistently monitoring and acting on the research and drivers of real, long-lasting behavior change and well-being as the company continues to enhance its platform.

Landrigan is director of the sleep and patient safety program at Brigham and Women’s Hospital and Research Director of Inpatient Pediatrics at Boston’s Children’s Hospital. A major focus of his work has been evaluating the effects of healthcare provider sleep deprivation on patient and provider safety, and the effects of interventions to reduce these risks.

Other board members include:

Shelley Carson, PhD, a Harvard-educated doctor of experimental psychopathology. Her research focuses on creativity, psychopathology, and resilience.

Nicholas A. Christakis, MD, PhD, MPH, who directs the Human Nature Lab at Yale University and is the co-director of the Yale Institute for Network Science. He is a social scientist and physician who conducts research in the areas of biosocial science, network science, and behavior genetics.

Eric A. Finkelstein, PhD, MHA, executive center director of the Lien Centre for Palliative Care and professor at the Duke‐National University of Singapore Graduate Medical School and research professor at Duke University Global Health Institute.

Ron Goetzel, PhD, senior scientist and director of the Institute for Health and Productivity Studies at the Johns Hopkins University Bloomberg School of Public Health, and vice president of Consulting and Applied Research for Truven Health Analytics.

I-Min Lee, MBBS, ScD, MPH, professor of medicine at Harvard Medical School and professor of epidemiology at the Harvard School of Public Health. Her research primarily focuses on the role of physical activity in preventing chronic diseases and enhancing longevity.

David Nash, MD, MBA, founding dean of the Jefferson School of Population Health at Thomas Jefferson University. He is internationally recognized for his work in public accountability for outcomes, physician leadership development, and quality-of-care improvement.

P. K. Newby, ScD, MPH, MS, a Harvard-trained nutrition scientist and food writer with more than 15 years of experience researching and teaching why what we eat matters, farm to fork.


Consumer Health Industry Reaches $216.4 Billion in Sales Globally in 2014

According to Euromonitor International’s latest research, the consumer health industry experienced 5.7% growth (current/fixed currency terms) with US$216.4 billion in retail sales globally in 2014. Over-the-counter (OTC) remedies such as sleep aids, eye care, dermatologicals, and digestive remedies performed very well with US$36 billion in sales globally. Sports nutrition grew strongly in the mass market with US$10 billion in sales globally, yet still represents the smallest category within the consumer health industry at 4.7% share.

“The industry keeps growing at a healthy pace as significant corporate consolidation will transform the competitive landscape and the rise of mobile health will impact consumer behavior in years to come,” says head of industry research, Monica Feldman, in a release.

Latin America posted the fastest growth at 7% from 2013 with US$20 billion in sales in 2014 as more remedies became available to consumers in the OTC setting. The Middle East and Africa followed with 6% and US$7.3 billion, respectively, where regional initiatives for local manufacturing boosted affordable options for consumers. Although Eastern Europe shows an apparent decline of -1% in sales due to problems in Russia and Ukraine, this result is relative as sales in Russia are not underperforming when viewed in local currency.

Global and regional corporate activity included significant mergers, acquisitions, and joint ventures such as Bayer’s acquisition of Merck & Co, and GSK’s partnership with Novartis, creating new competitive pressures in the industry.

From the consumer perspective, mobile health, or mHealth, is engaging consumers via mobile apps and devices with the purpose to modify behavior toward improved health outcomes. This in turn will create new possibilities for OTC switches in novel therapeutic categories.


Contact-free Monitoring Company EarlySense Secures $20 Million in Financing

Contact-free monitoring company EarlySense Ltd has completed a $20 million financing round, led by Samsung Ventures with an investment of $10 million. Existing investors whose participation was also substantial include Pitango Venture Capital, Welch Allyn, JK&B, Proseed, and Noaber.

EarlySense’s solutions monitor heart and respiratory rate, as well as movement and sleep. It also offers OEM solutions for companies looking to expand their products by providing contact-free and continuous sensing capabilities. The company’s international headquarters are in Israel. The US headquarters are in Waltham, Mass. The EarlySense System is currently installed in hospitals, rehabilitation centers, and homes in the United States, Europe, Asia, and Australia.

“We invest in companies that are paving the way for their respective industries. EarlySense has developed and brought to market a unique, breakthrough technology that will improve the lives of consumers through health parameter sensing and monitoring. This technology, based on algorithms, analytics, and smart Health/IT capabilities, has been commercialized in the professional healthcare market over the past few years. This has built powerful clinical and market validation. Our investment is evidence of our belief in the need to bring sensors to hundreds of millions of consumers and we will do all that is in our hands to contribute to EarlySense’s accelerated growth,” says Gonzalo Martinez de Azagra, head of Samsung Ventures Israel, in a release.

Avner Halperin, CEO of EarlySense, says, “We are happy to have Samsung join our vision of bringing smart sensors to health and wellness at homes, hospitals, and long term care. As a global leader in consumer products, Samsung can increase our reach to homes and will facilitate accelerated growth in that market. We are also honored by the vote of confidence from our existing investors, including Welch Allyn and the ongoing partnership we share together. We have made great progress to date and look forward to our continued growth and introduction of our innovative technology into additional market areas, in an effort to save lives and improve quality of life.”


CareCentrix, Evolent Health Sign Agreement for Sleep Management Program

CareCentrix, a company that manages patient care to the home, has signed a 3-year agreement for a sleep management program with Evolent Health, a technology-enabled operating partner to healthcare systems undergoing value-based care transformation. Sleep management is a large and growing challenge with 44 million adults suffering from some form of sleep-disordered breathing.

Evolent entered the agreement with CareCentrix on behalf of one of its large healthcare system clients to help coordinate treatment of sleep disorders for the system’s patients. The CareCentrix Sleep Management program, the only complete end-to-end sleep management solution, is designed to give patients the greatest opportunity for therapeutic success when being treated for obstructive sleep apnea and other sleep disorders.

“Our program allows us to test and manage sleep disorders in the most cost-effective and patient-friendly way–at home,” says John Driscoll, CareCentrix CEO, in a release. “Not only are we able to save critical health care dollars by ensuring the most appropriate care, we’re also very proud of the 94% satisfaction rate we have with the patients we work with through our sleep program.”

Dr Elizabeth Malko, Evolent’s executive vice president of clinical transformation and operations, says, “Our agreement with CareCentrix is directly aligned with our goal of integrating the latest care innovations into our comprehensive population health management offering. We are glad to be working with CareCentrix in our effort to transform care delivery through solutions that provide exceptional value to our system partners, their care teams, and their patients.”


Pumping Iron Legend “Big Mike” Katz to Discuss His Sleep Apnea

“Big Mike” Katz still has Arnold Schwarzenegger and Lou (“The Incredible Hulk”) Ferrigno on his speed dial. The three bodybuilders met during the making of the 1977 niche classic Pumping Iron.

About 10 years ago, Katz was diagnosed with sleep apnea and now, at age 70, depends on his CPAP machine for the deep night’s sleep his big frame needs. As a client, he now has DME company National Sleep Therapy on his speed dial as well.

Katz will be the featured guest during the next free group virtual support session, “CPAP Talk –Live!”–everything you wanted to know about sleep apnea—set for Wednesday, February 4 from 7 to 8 PM (ET). The town-hall-style forums are held at the same time on the first Wednesday of each month, sponsored by National Sleep Therapy. In recent months, enthusiastic CPAP users from 10 states have joined in the monthly sessions. (To participate: Just prior to the session, call 800-204-6655, enter access code 342-2187#.)

Katz, who played for the NY Jets with Joe Namath, was a former Mr. Olympia bodybuilding champ. Today, Big Mike hasn’t slowed down much. With his son, he operates five fitness studios in Connecticut, sticks to a tough exercise regimen, trains fitness clients, and speaks on behalf of Special Olympics and youth fitness. (He was a high school health education teacher and earned advanced degrees in the field.) Most important, he makes time to enjoy his grandchildren.

“It takes a bit to get used to wearing the CPAP mask at night, but it’s worth the effort,” he says in a release. “I don’t want to shorten my life or sleep through my grandkids’ childhood–waking up when they’re 16, wondering where the time went.”

CPAP Talk-Live! is hosted by National Sleep Therapy President Eric Cohen.

Interested individuals may also send questions in advance either via Facebook or using the form. For more information, call 888-867-8840 or e-mail


How Gut Bacteria Affect Brain Health

The hundred trillion bacteria living in an adult human—mostly in the intestines, making up the gut microbiome—have a significant impact on behavior and brain health. The many ways gut bacteria can impact normal brain activity and development, affect sleep and stress responses, play a role in a variety of diseases, and be modified through diet for therapeutic use are described in a comprehensive article in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert Inc, publishers. The paper, “The Gut Microbiome and the Brain,” is available free on the journal’s website until February 21, 2015.

In the paper, Leo Galland, Foundation for Integrated Medicine, presents an up-to-date understanding of the relationship between the proteins produced by intestinal bacteria and the human central nervous system. The author explores the various mechanisms through which the microbiome can influence the brain: by stimulating and over-stimulating the immune system, producing neurotoxic agents, releasing hormones or neurotransmitters identical to those made by the human body, or through direct neuronal stimulation that sends signals to the brain.

“The microbiome has become a hot topic in many branches of medicine, from immune and inflammatory diseases, such as Crohn’s and IBD to cardiovascular diseases,” says co-editor-in-chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences, University of Central Florida, in a release. “Scientists are not only aware of the ‘good’ and the ‘bad’ microbes in the gut but are becoming increasingly aware of how they could alter the metabolism beyond gut.”


DeVilbiss Healthcare Quest Full Face CPAP Mask

DeVilbiss Healthcare has added the new Quest Full Face CPAP Mask to its growing line of CPAP therapy interfaces.

Available in five sizes, the Quest Full Face CPAP Mask was designed with a membrane inside the cushion and a series of flanges around the cushion’s base to provide a secure seal for a wide array of facial profiles. It is constructed of a thin, soft silicone material, and its body is dishwasher safe for simple cleaning.

“The Quest Full Face Mask provides CPAP patients with an improved fit and maximum comfort for extended wear,” says Brian Palmer, product marketing director-Sleep for DeVilbiss, in a release. “Its light weight and easy adjustability make it a great, user-friendly choice for patients.”

With swivel port micro-vent holes to reduce noise and no obstructive forehead bar, the Quest mask was created to deliver practical, comfortable therapy to the CPAP patient. The mask has a contoured design and ribbed support and is equipped with four-strap headgear with
multiple quick release points.


In Drosophila, Memory-Consolidating DPM Neurons Linked to Sleep

Scientists have long known that sleep, memory, and learning are deeply connected. Most animals, from flies to humans, have trouble remembering when sleep deprived, and studies have shown that sleep is critical in converting short-term into long-term memory, a process known as memory consolidation.

But just how that process works has remained a mystery.

The question is, does the mechanism that promotes sleep also consolidate memory, or do two distinct processes work together? In other words, is memory consolidated during sleep because the brain is quiet, allowing memory neurons to go to work, or are memory neurons actually putting us to sleep?

In a recent paper in the journal eLife, Brandeis University graduate students Paula Haynes and Bethany Christmann in the Griffith Lab make a case for the latter.

Haynes and Christmann focused their research on dorsal paired medial (DPM) neurons, well-known memory consolidators in Drosophila. They observed, for the first time, that when DPM neurons are activated, the flies slept more; when deactivated, the flies kept buzzing.

These memory consolidators inhibit wakefulness as they start converting short-term to long-term memory. All this takes place in a section of the Drosophila brain called the mushroom body, similar to the hippocampus, where our memories are stored. As it turns out, the parts of the mushroom body responsible for memory and learning also help keep the Drosophila awake.

“It’s almost as if that section of the mushroom body were saying, ‘hey, stay awake and learn this,’” says Christmann in a release. “Then, after a while, the DPM neurons start signaling to suppress that section, as if to say, ‘you’re going to need sleep if you want to remember this later.’”

Understanding how sleep and memory are connected in a simple system, like Drosophila, can help scientists unravel the secrets of the human brain.

“Knowing that sleep and memory overlap in the fly brain can allow researchers to narrow their search in humans,” Christmann says. “Eventually, it could help us figure out how sleep or memory is affected when things go wrong, as in the case of insomnia or memory disorders.”


Small Changes in Lifestyle Could Be the Solution to Night Terrors – Sleep Expert

A news report from the Independent.IE examines the small changes that can ease night terrors in children.

 ”Bringing forward a bedtime by 30 minutes can make a completely difference to children and their sleep,” she said.

“Getting enough sleep is very important. Some of the biggest triggers for sleep deprivation are irregular sleep schedules, like going to bed at different times and one of the largest triggers is not getting enough sleep in the first place.

Get the full story at


Why all-nighters don’t work: How sleep, memory go hand-in-hand

Scientists have long known that sleep, memory and learning are deeply connected but how has remained a mystery. The question is, does the mechanism that promotes sleep also consolidate memory, or do two distinct processes work together? In other words, is memory consolidated during sleep because the brain is quiet or are memory neurons actually putting us to sleep? In a recent paper, researchers make a case for the latter.

Good-quality sleep when younger, not older, may benefit later-life memory

A new study finds maintaining good quality of sleep as a young or middle-aged adult, rather than in older age, may benefit learning and memory later in life.

MedEvac Foundation to Fund Sleep Study for EMS Clinicians

The MedEvac Foundation International has approved grant funding for Dr Daniel Patterson to investigate sleep-wake patterns and real-time fatigue reduction in EMS clinicians.

The medical transportation community requires that emergency care be available 24 hours a day. Shift work requires the prehospital emergency clinician to diverge from normal circadian sleep cycles and be alert when the pressure to sleep is greatest. While recent data suggest a link between sleep, fatigue, and safety in the EMS setting, the data are limited to cross-sectional designs and subject to recall and measurement bias. The proposed study will provide detailed prospective observational data to address questions regarding the relationships between shift duration, sleep/wake cycles, and behavioral alertness.

The overarching goal of the study is to address the Foundation’s research priority of “educational techniques and technologies aimed at improving patient care, critical decision making, safety, or other areas pertinent to transport medicine.” Patterson, along with several colleagues, intends to accomplish this goal by performing a multi-site study of air-medical EMS clinicians. The Foundation Board has approved Phase 1 of the study, which will involve a prospective observational study of sleep/wake cycles, shift work duration, intershift recovery, fatigue, and behavioral alertness (ie, psychomotor vigilance). The analysis of Phase 1 data will focus on differences between 12-hour versus 24-hour shifts.

This study will have a significant impact on the transportation community. First, the debate on shift duration (shorter versus longer shifts) is ongoing and unresolved. Many EMS systems use extended shift periods in light of low patient volume and resource limitations. Other systems use shifts of shorter duration. The relationships between shift duration, sleep, fatigue, and performance are complex and the data to support a prescribed shorter or longer shift schedule are limited.

“The Foundation is excited to support this study, which I believe is vital to not only better work place environments, the safety of our industry’s professionals, and of every patient-in-need, but it will help improve the level of patient care to an optimal level,” says Rick Sherlock, MedEvac Foundation International president and CEO, in a release.

Patterson and colleagues also proposed a Phase 2 for their study. Phase 2 will be considered for funding upon completion and presentation of Phase 1. Phase 2 would involve an experimental study design, and test novel fatigue risk management intervention that uses real-time assessment and intervention to improve alertness of EMS clinicians during shift work as well as their overall sleep health.


Sleep tight and stay bright? Invest now, researcher says

Sound sleep in young and middle-aged people helps memory and learning, but as they hit their seventh, eighth and ninth decades — and generally don’t sleep as much or as well — sleep is not linked so much to memory, a researcher says.


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