Led By Domestic Neurology Business, Natus Sees Record Growth

“I am very pleased with our fourth quarter results as we achieved record revenues and earnings. Both our neurodiagnostic and newborn care businesses performed well in the quarter led by outstanding performance in our domestic neurology business,” says Jim Hawkins, Natus Medical president and CEO, in a release. “Our non-GAAP fourth quarter gross margin of 62.9% and our non-GAAP full year operating margin of 16.1% for 2014 were most satisfying as improving margins were a major goal for Natus in 2014. We look for continued margin improvement in 2015.”

For the fourth quarter ended December 31, 2014, Natus reported revenue of $94.0 million, an increase of 4% compared to $90.6 million reported for the fourth quarter 2013. For the full year ended December 31, 2014, the company reported revenue of $355.8 million, an increase of 3% compared to $344.1 million reported for 2013. Cash and cash equivalents increased by $8.9 million to $66.7 million during the quarter. Total debt was reduced by $8.0 million, as the company repaid in full its long term debt. Natus also repurchased $1.2 million of company stock during the fourth quarter.

“Our recent acquisitions of NicView and Global Neuro-Diagnostics (GND) along with the continued development of our Peloton hearing screening service business are expanding our served markets and driving growth as we enter 2015,” Hawkins says. “NicView expands our offering with an innovative solution for streaming video to families with NICU babies, from any device-from anywhere in the world. GND brings Natus the leadership position in neurodiagnostic video EEG testing services that can be performed at the patient’s home, hospital, or physician’s office. These new offerings are the beginning of an expanding service business and position Natus for accelerating revenue growth and record earnings in 2015.”


At-Home Sleep Apnea Test Lets You Avoid Night in Clinic

A Newsmax Health report examines the accuracy and efficiency of at-home sleep apnea tests.

 Until recently, the only way to get tested for sleep apnea was to report for an overnight study at a sleep lab and let a clinician watch you snooze.

But now there’s a way to get an accurate diagnosis from the comfort of your own bed.

Experts say new home tests are just as good as in-lab studies at detecting moderate-to-severe obstructive sleep apnea (OSA), a serious condition that affects an estimated 18 million Americans, most of whom don’t know they have it.

View the full story at


Working 4 You: Lack of Sleep Contributing to Childhood Obesity

A Journal of Pediatrics study reveals that lack of sleep is a contributing factor to obesity in children, as reported by

 Doctors say not getting enough sleep may mean suppressing your appetite and make you want to eat more. That can lead to problems like heart disease, high blood pressure and diabetes.

And doctors say sleep is an important part of a balanced healthy lifestyle, including at least one hour of exercise each day and a healthy diet.

Watch the news segment at


Sleep Improves, Structures Infant Memory

While infants sleep they are reprocessing what they have learned. Working with researchers from the University of Tübingen, scientists from the Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig have discovered that babies of the age from 9 to 16 months remember the names of objects better if they had a short nap. And only after sleeping can they transfer learned names to similar new objects. The infant brain thus forms general categories during sleep, converting experience into knowledge. The researchers also showed that the formation of categories is closely related to a typical rhythmic activity of the sleeping brain called sleep spindles: Infants with high sleep spindle activity are particularly good at generalizing their experiences and developing new knowledge while sleeping. The results are published in Nature Communications.

The flow of information from the sensory organs is largely cut off while we sleep, but many regions of the brain are especially active. Most brain researchers today believe that the sleeping brain retrieves recent experiences, thereby consolidating new knowledge and integrating it into the existing memory by strengthening, re-linking or even dismantling neuronal connections. This means that sleep is indispensable for memory.

The Max Planck researchers have found this to be the case even in infants and toddlers. In order to study the impact of sleep on infant memory, they invited parents to attend a study with their 9- to 16-month-old children. During the training session, the infants were repeatedly shown images of certain objects while hearing the fictitious names assigned to the objects. Some objects were similar to each other, varying only in their proportions, colors or in certain details. The similar objects, which belonged to the same category according to their shapes, were always given the same names. During this process, the researchers recorded the infants’ brain activity using electroencephalography (EEG).

One group of infants spent the next one to two hours sleeping in their prams while an EEG was recorded, while the others remained awake, going for a walk in their prams or playing in the examination room. In the subsequent testing session, the researchers again presented the infants with picture-word pairs-this time both in the same combinations as in the learning session and in new combinations-and again measured their brain activity while doing so.

The analysis of brain activity showed that the infants had learned the names of the individual objects during the training session, irrespective of their age. The situation with categorization, however, was different: At the end of the training session, they were unable to assign new objects to the names of similar objects which they had heard several times.

During the subsequent testing session, the brain activity of the infants who had slept after the training session was markedly different from that of the group who had stayed awake. While the group who had stayed awake had forgotten the names of the individual objects, the children in the sleep group remembered the object-word mappings. There were also radical differences in their abilities to categorize the objects. “The infants who slept after the training session assigned new objects to the names of similar-looking objects,” says Manuela Friedrich of the Max Planck Institute for Human Cognitive and Brain Sciences, in a release. “They were not able to do that before their nap, and nor were the ones who stayed awake able to do it. This means that the categories must have been formed during sleep.”

While the children’s age had no effect, a particular type of brainwave called the sleep spindle has a significant impact on learning outcomes. Sleep spindles occur when nerve bundles between the thalamus and the cerebral cortex generates rhythmic activity of 10 to 15 cycles per second. They are known to influence memory consolidation in adults. “The greater an infant’s spindle activity, the better it can assign category names to new objects after sleep,” Friedrich says.

These results show that sleep significantly affects memory organization even in the infant brain-and at a time when memory is growing on a massive scale. “The waking infant brain quickly forgets newly learned names, but during sleep, words are more durably linked to objects and imprinted,” says Angela Friederici, director at the Leipzig-based Max Planck Institute and head of the study.

Sleep and sleep spindles also enable the infant brain to pool similar meanings. Apparently, when the brain is largely cut off from outside influences, it can organize its experiences and form new generalizations. “In this way, sleep bridges the gap between specific objects and general categories, thus transferring experience into knowledge,” Friederici says.


Freedom from CPAP Book

A book written by a board-certified ENT and a dentist specializing in sleep apnea treatment is a new resource for patients who are interested in options other than CPAP to treat their sleep apnea.

Freedom from Cpap: Sleep Apnea Hurts, the Cure Doesn’t Have To by Dr David G. Dillard and Dr Mayoor Patel provides a uniquely comprehensive overview of sleep apnea from both an ENT and a dental perspective.

Dillard, a Navy veteran, is board certified by the American Board of Otolaryngology, Head and Neck Surgery. He has over a decade of experience in the treatment of ENT problems and obstructive sleep apnea. He is the patent-pending innovator of multiple devices and treatments that are the result of his many years experience in his field. Dillard held an academic appointment at Emory University School of Medicine, currently holds an academic appointment at the University of Georgia School of Medicine.

Patel has earned multiple fellowships and quadruple board certified the area of orofacial pain and dental sleep medicine. He presently is an adjunct faculty member with Georgia Regents University and The Atlanta School of Sleep Medicine. Contributions have been published textbook chapters, various professional and consumer articles. He also holds patents on oral appliance for sleep apnea and other related products.

The book is available from in both ebook and paperback versions.


Whole Health Dentistry Book

Namrita Singh, DMD, the owner of Allen Whole Health Dentistry in Allen, Texas, has written a book called Whole Health Dentistry: Why Your Mouth is the Key to Your Body’s Health.

“The problem is that most of us see the mouth and its health as a separate entity from the rest of the body. I want to emphasize that although the mouth is a vital, sensitive organ that requires its own specialization, it is still a part of the body,” she says in the book.

With a dental examination by a skilled dentist using the current available diagnostic tools and procedures, such as oral DNA and scans, patients can be screened for sleep apnea, other airway obstructions, various inflammatory diseases, cancer, TMJ, STD virus, and more, Singh says, adding that the field of dentistry has come a long way and now stands beside other medical practices in its importance to disease detection and the whole body health of the individual.

The book is available on in both Kindle and paperback versions. Chapter 3 focuses on sleep apnea.


Lack of Sleep is Second Most Common Cause of Tardiness Among Employees

According to a CareerBuilder survey, lack of sleep is the second most common cause for tardiness for employees, with 30% of employees citing it.

The most common cause cited for tardiness is traffic (50%). Rounding out the top 5 are:

  • bad weather (26%)
  • trying to get the kids to school or daycare (12%)
  • public transportation issues (6%)

When asked how often they come in late to work, more than 1 in 5 workers (23%) admitted they do it at least once a month, and 14% say it’s a weekly occurrence for them.

More than 2,100 hiring and human resource managers and more than 3,000 workers across industries participated in the nationwide survey, conducted online by Harris Poll from November 4 to December 2, 2014.


Athlete’s Circadian Phenotypes Impact Athletic Competition Outcomes


This is Emily Defroand (left) and Holly Payne (right), two ‘larks’, students at the University of Birmingham, Great Britain hockey players, and participants of the study by Roland Brandstaetter and Elise Facer-Childs. Photography by Andy Smith

The outcome of that big sporting event you just can’t wait to watch may depend on how the timing of the match aligns (or doesn’t) with the internal biological clocks of the athletes on the teams, according to a study reported today in the Cell Press journal Current Biology. Athletes and coaches would do well to make note and adjust their schedules accordingly, the researchers say.

The study found that the performance of competition-level athletes varies over the course of the day by as much as 26%. People who would naturally prefer to sleep in will give their best performances hours later in the day than early birds will.

“If a 1% difference in performance can make the difference between 1st place and 4th place in a 100 meter race and actually win you the gold medal at the Olympics, then imagine what a 26% difference in your performance could give you,” says Roland Brandstaetter from the University of Birmingham in the United Kingdom, in a release. “Our research takes us away from the idea of ‘time of day of the race’ and directs us more to internal biological time.”

In other words, he says, what time is it for your body clock?

Earlier reports had suggested that athletes’ personal best performances are always in the evening. But those studies had not actually taken into account whether those athletes were “night owls” or “morning larks.” While an individual’s circadian phenotype often does shift from childhood into adolescence and adulthood, there are real physiological differences between people based on their natural sleep/wake patterns.

Brandstaetter and his co-author Elise Facer-Childs used a novel test to characterize the circadian phenotypes of more than 120 athletes. They then selected 20 athletes representing early, intermediate, and late types and tested their cardiovascular endurance in a standard fitness test at six times of day.

Those fitness tests revealed considerable variation in individual performance over the course of the day. The best predictor of how well those groups performed at a given hour was the time elapsed since their entrained awakening–that is, the time since they would have gotten up in the morning if left to their own devices, alarm clocks switched off. While an early riser may be at his or her best in the early afternoon, someone who sleeps late hits his or her peak much later at night.

The findings “leave no doubt that the correct determination of an athlete’s personal best performance requires consideration of circadian phenotype, performance evaluation at different times of day, and analysis of performance as a function of time since entrained awakening,” the researchers conclude. And the findings could come in handy for the rest of us, too.

“Obtaining a personal best performance is on everyone’s agenda, but how to do it, now that is a different question,” Facer-Childs says. One thing now seems sure: we’d be well advised to shift our attention from the clock on the wall to the one that’s ticking inside each of us.


Natus Medical Acquires Global Neuro-Diagnostics

Natus Medical Inc has entered the neurodiagnostic services market through the acquisition of Global Neuro-Diagnostics (GND). GND was profitable in 2014 with revenue of approximately $7 million.

GND’s service offers patients a more convenient way to complete routine video EEG testing which can be performed at the home, hospital, or physician’s office. The service also provides comprehensive reporting and support to the physician.

“GND brings video neurodiagnostics to our growing service portfolio,” says Jim Hawkins, president and CEO, in a release. “GND successfully pioneered this service in Texas and we look forward to now expanding it to our customers throughout the United States.”


Key element in circadian clock speed discovered

In a discovery that may lead to new treatments for sleep disorders, jet lag and other health problems tied to circadian rhythms, researchers have identified a determinant of the circadian clock's period.

Up to 2 per cent of Germany’s population is dependent on hypnotics

Every year, the statutory health insurance companies cover bills for some 230 million daily doses of benzodiazepines.

OTC Sleep Aids with Anticholinergic Effects Linked to Increased Dementia Risk

A large study links a significantly increased risk for developing dementia, including Alzheimer’s disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine (Benadryl). JAMA Internal Medicine published the report, called “Cumulative Use of Strong Anticholinergic Medications and Incident Dementia.”

The study used more rigorous methods, longer follow-up (more than seven years), and better assessment of medication use via pharmacy records (including substantial nonprescription use) to confirm this previously reported link. It shows a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist-and may not be reversible even years after people stop taking these drugs.

“Older adults should be aware that many medications-including some available without a prescription, such as over-the-counter sleep aids-have strong anticholinergic effects,” says Shelly Gray, PharmD, MS, the first author of the report, in a release. “And they should tell their health care providers about all their over-the-counter use.” The report tracks nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought (ACT), a joint Group Health-University of Washington (UW) study funded by the National Institute on Aging.

“But of course, no one should stop taking any therapy without consulting their health care provider,” says Gray, who is a professor, the vice chair of curriculum and instruction, and director of the geriatric pharmacy program at the University of Washington School of Pharmacy. “Health care providers should regularly review their older patients’ drug regimens-including over-the-counter medications-to look for chances to use fewer anticholinergic medications at lower doses.”

For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg/day of doxepin, 4 mg/day of chlorpheniramine, or 5 mg/day of oxybutynin for more than three years would be at greater risk for developing dementia. Gray says substitutes are available for the first two: a selective serotonin re-uptake inhibitor (SSRI) like citalopram (Celexa) or fluoxitene (Prozac) for depression and a second-generation antihistamine like loratadine (Claritin) for allergies. It’s harder to find alternative medications for urinary incontinence, but some behavioral changes can reduce this problem.

“If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient,” Gray says, “they should use the lowest effective dose, monitor the therapy regularly to ensure it’s working, and stop the therapy if it’s ineffective.” Anticholinergic effects happen because some medications block the neurotransmitter called acetylcholine in the brain and body, she says. That can cause many side effects, including drowsiness, constipation, retaining urine, and dry mouth and eyes.
“With detailed information on thousands of patients for many years, the ACT study is a living laboratory for exploring risk factors for conditions like dementia,” says Gray’s coauthor Eric B. Larson, MD, MPH. “This latest study is a prime example of that work and has important implications for people taking medications-and for those prescribing medications for older patients.” Larson is the ACT principal investigator, vice president for research at Group Health, and executive director of Group Health Research Institute (GHRI). He is also a clinical professor of medicine at the UW School of Medicine and of health services at the UW School of Public Health.

Some ACT participants agree to have their brains autopsied after they die. That will make it possible to follow up this research by examining whether participants who took anticholinergic medications have more Alzheimer’s-related pathology in their brains compared to nonusers.


Menopause Does Not Create Difficulty Sleeping

Women in their late 30s and 40s who have trouble sleeping are more than three times more likely to suffer sleep problems during menopause than women who have an easier time getting shut-eye, according to a new study by researchers from the Perelman School of Medicine at the University of Pennsylvania. Only 25% of women who had reported no earlier sleep problems developed moderate or severe insomnia or other sleep disturbances during a 16-year period around menopause. What’s more, the researchers say that these sleep woes did not appear to be caused by menopause itself, which may quell common fears about symptoms associated with this phase of life. The study, published in the journal Menopause, is among the first to document long-term sleep patterns in women in the years before, during, and after menopause.

“Sleep problems are a major issue for women approaching mid-life, particularly for women who have moderate or severe sleeping problems before reaching menopause as they are likely to experience increased issues throughout the transition,” says lead author, Ellen W. Freeman, PhD, research professor in the department of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania, in a release. “A small subgroup of women with only mild sleep disturbance prior to menopause also experienced worsening sleep disturbance during the transition, but our results show that for the majority of women, menopause does not further exacerbate existing sleep problems or cause new ones.”

The study assessed annually the sleep patterns of 255 women participating in the Penn Ovarian Aging Study who reached natural menopause during a 16-year period (1996-2012). At enrollment, all women were aged 35 to 48 years and premenopausal, with 28% reporting moderate-to-severe sleep disturbances, which is similar to the prevalence of insomnia symptoms among adults, and 56% reporting no sleep disturbances at all. Over the 16 year period, 82% of the sample experienced moderate-to-severe issues with sleep, while only 7% had no poor sleep.

The study also found that hot flashes are strongly associated with poor sleep as expected, but a large proportion of poor sleep in menopausal women occurred without hot flashes. The finding, Freeman says, indicates that sleep difficulties in the transition to menopause in generally healthy women should not automatically be imputed to ovarian decline.

“Our study raises the question of why a significant increase in poor sleep should surface for a group of women who experienced only mild sleep problems earlier, but not among women who had moderate or severe sleep problems,” Freeman says. “This is an area for future study and many potential factors should be considered, such as hormone fluctuations or changes, stress, anxiety, relationships, life events, and health problems.”

Freeman adds that clinicians should be alert to the strong possibility that poor sleep in women approaching menopause is not simply caused by menopause or hot flashes.

“Possible reasons for poor sleep instead may include health problems, anxiety, and stress,” she says, advising that clinicians should ask patients whether they had problems sleeping before midlife as well as obtain information on the level and duration of earlier poor sleep patterns to devise the most effective treatments.


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.


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