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How We Think About Sleep Affects Chronic Pain Symptoms

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New research out of the University of Warwick Department of Psychology Sleep and Pain Lab has found that negative thoughts about pain and insomnia affect conditions like fibromyalgia, arthritis, and back pain.  Cognitive behavior therapy, or CBT, can be used to manage and treat this issue.

One of the primary authors of the study, Esther Afalalu, and her colleagues developed a scale that measures how chronic long-term pain patients think and feel about pain and sleep, as well as the measurement of their quality of sleep.  This study is the first of its kind to look at both sleep and pain in order to explore how the cycle of pain continues more rapidly in sleep-deprived persons.

There were four groups a part of this study, of which all participants were suffering from some form of chronic pain condition and poor sleep.  The scale used to test these patients found that those who believed they would get poor sleep as a result of pain ended up sleeping more poorly and suffering from worsened pain.  The results indicate that the scale was vital in determining the patient’s level of pain difficulty and their level of insomnia.  Furthermore, the more quality sleep they received, the more relieved their pain was.  This change and reduction in pain was even more prevalent in those who underwent CBT for both insomnia and pain.

This study gives therapists and providers the necessary means to identify, treat, and monitor thoughts about pain and sleep that may be interfering with sleep quality.  This allows for the application of effective CBT treatments for chronic pain patients who suffer from insomnia.

Dr. Afalalu reported in the press release of this study that current treatments for chronic pain are focused mostly on managing symptoms with medications, without much emphasis on sleep patterns.  However, developing therapies and new research indicates that tackling both sleep problems and pain simultaneously is the best option for treatment in these patients.  The scale is a good clinical tool that can be used to accurately and effectively monitor treatment during therapy.

Another one of the study’s authors, Dr. Nicole Tang, PhD, reported that our thoughts can have a major impact on our behaviors, emotions, and physiology, both directly and indirectly.  How we think about the link between sleep and pain influences how we cope with the pain and manage the insomnia.  While some of these thoughts are likely healthy and well-intended, based on prior clinical practices, more rigid thoughts are misinformed and detrimental to sleep and pain management.

This new Pain-Related Beliefs and Attitudes about Sleep (PBAS) scale was created in order to help clinicians identify the beliefs that are potentially harmful to the patient, causing them increased insomnia and pain symptoms.  These research findings and information about the scale were published in the Journal of Clinical Sleep Medicine.


Author: Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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7 Reasons Why You Can’t Stay Asleep

Can't Sleep - Insomnia
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Sleep difficulties are a common problem for millions of adults. Even if you can get to sleep, you might have trouble staying asleep. Does this sound familiar? You drift off to dreamland, but find yourself wide awake at 3 a.m., or maybe you wake up every few hours throughout the night.

Adequate sleep is supposed to leave you feeling refreshed and ready to start your day. But if your sleep is interrupted, you’re likely to feel fatigued and sleepy the next day.

So what gives? There are several factors that may interfere with getting your zzz’s including the following:

Too much caffeine: You probably already know caffeine is a stimulant and can affect your ability to fall asleep. But it can also lead to poor quality sleep including waking up in the middle of the night. Caffeine has a three to five-hour half-life, which means it takes your body that many hours to get rid of half the caffeine you consumed. coffee-caffeineThe bottom line is you may feel the effects of caffeine several hours after you consume it. Keep in mind, energy drinks, cola, chocolate and certain teas also contain caffeine. Your best bet is to avoid caffeine about six hours before bed.

Stress: Stress and lack of sleep seem to go hand in hand. If you’re stressed, it can be hard to sleep well and may lead to middle of the night insomnia. When you don’t get enough sleep, that can also lead to more stress and it becomes a vicious cycle. According to the American Psychological Association, adults who get less than eight hours of sleep each night report higher levels of stress symptoms than those who sleep longer. Although it can be easier said than done, it’s important to unwind and unplug before bed.


Sleep environment: Your sleep environment can contribute to poor sleep. For example, loud noises can jolt you from a sound sleep or light peeking through the shades can wake you. Fortunately, there are ways to make your bedroom more sleep-friendly. Invest in a quality mattress and comfy bedding and consider keeping your bedroom cool, which most people find helps sleep. Make sure your curtains are heavy enough to block out sunlight and use a white noise machine or earplugs to block sounds from outside.

An aching back: Back pain can disrupt sleep and leave you struggling to find a comfortable position. If you have chronic back pain, it’s important to treat the underlying cause. Also, your sleep position can make a big difference in your comfort level. The right position for you may depend on whether your upper or lower back ache. To take the pressure off your back, the Mayo Clinic recommends sleeping on your side with your knees slightly pulled up towards your chest with a pillow between your knees.

Hormones: Your hormones play a role in several functions including sleep. When there is an imbalance or a fluctuation, shifting hormones can contribute to sleep disturbances. A woman’s menstrual cycle, pregnancy, perimenopause and menopause often cause hormonal changes that may affect their quality of sleep. For example, decreased estrogen can lead to hot flashes, which wake you up at 2 a.m. You can’t always control your hormones, but you can make your environment conducive for sleep, unwind before bed and stick to the same sleep schedule. If those strategies don’t help, talk with your doctor. Hormonal replacement therapy or additional treatment may be an option.

Alcohol: If you enjoy a cocktail before bedtime, you know alcohol may help you get to sleep. But the bad news is it actually can interfere with your quality of sleep. As the alcohol metabolizes and the effects wear off, it prevents deep sleep, which causes restless sleep throughout the night. Consider limiting alcohol a few hours before you hit the sack.

Eating too late: A light midnight snack may be fine, but a heavy meal too close to bedtime may leave you tossing and turning during the night. Eating large portions before you turn in for the night can lead to indigestion and acid reflux. If you want a snack before bed, keep it light and stay away from spicy and greasy foods.



American Psychological Association. Stress and Sleep.  Retrieved September 2016

Mayo Clinic. Insomnia.  Retrieved September 2016


Author: MaryAnn DePietro, CRT A medical writer and licensed respiratory therapist with over a decade of clinical experience. MaryAnn DePietro has been published in magazines, newspapers and on health websites. She earned degrees in both respiratory therapy and rehabilitation. As a therapist, she has worked with hundreds of patients with medical conditions, such as COPD, asthma, sleep apnea and cancer.

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Sleep Disturbances in Adolescents Who Abuse Drugs and Alcohol

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Adolescent sleep disturbances and habits may be a related to drug and alcohol abuse, according to a new study led by scientists out of the University of Pittsburg School of Medicine Departments of Psychiatry and Psychology.  Published in Drugs and Alcohol Dependence, researchers noted that both quality and duration of sleep during later childhood years might be an indicator of drug and alcohol use in adolescence.  The drug, specifically, is cannabis.

Lead author of the study and associate professor of psychology and psychiatry, Dr. Brant P. Hasler, PhD, noted in his press release that it could be quite challenging to treat and/or prevent drug and alcohol problems once they exist.  It is notable, however, that doing everything possible to ensure proper sleep quality and duration in late childhood will go a long way to reducing risk of substance abuse in later years.

In order to determine if there is a link between sleep and substance abuse, 186 boys from West Pennsylvania were analyzed in this study.  Their mothers filled out the Child Sleep Questionnaire, which was part of a larger study that looked at how boys from low-income households may be at higher risk of abuse.  Additionally, researchers wanted to determine if they were more vulnerable and resilient.

The survey was done when the children were 11 years old and calculated their sleep quality and duration.  At the age of 20 and 22 years, the same boys were asked about their lifetime use of alcohol and cannabis.

Results were adjusted for socioeconomic issues, neighborhood dangers, internalization and externalization of problems, race, and self-regulation.  At age 11, sleep quality and duration were linked to the early use of substances all through adolescence.

In the study, participants who slept the most and those who slept the least were compared.  Those who slept the least were more likely to report earlier use, repeated use, and frequent intoxication of both cannabis and alcohol.  For every one hour less they got at the age of 11, there was a 20% increase in the first use of cannabis and/or alcohol, Dr. Hasler noted.

Furthermore, the worse the quality of sleep, the more likely they would use alcohol at an earlier age, become intoxicated by the alcohol more frequently, and return to use after short periods.  Additionally, poor quality sleep was linked to earlier use of cannabis, intoxication from its use, and repeated abuse; however, there was no link to first use of cannabis when compared to sleep quality.

In considering other factors and influences, like peer pressure, researchers were able to determine that sleep disturbances and problems were linked to the use of substances at an earlier age.  Therefore, it is safe to assume that the prevention of substance abuse starts with regulating sleep patterns in later childhood years, preadolescence.  Sleep treatments could also help with the treatment of current substance use problems.


Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

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Why Do I Need a CPAP Machine?

Why Do I Need A CPAP -
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If you’ve been diagnosed with obstructive sleep apnea (OSA), there is a good chance your doctor wants you to wear a CPAP machine. Anybody that has one knows they can be a bit challenging. Some are bulky, and not exactly the most attractive piece of equipment taking up space in the bedroom. It’s easy for some people to ignore these machines and not wear them. But wearing a CPAP machine when you have sleep apnea doesn’t just give you better quality sleep; it may save your life.

When you have obstructive sleep apnea, obstructions in your airway cause periods of apnea, which means there are long pauses in breathing, sometimes for many seconds at a time throughout the night. CPAP machines are the most popular treatment for OSA. CPAP stands for continuous positive airway pressure. A patient with OSA may wear a CPAP machine with a mask that fits just over the nose, or both the nose and mouth. The mask applies continuous pressure into the airway, keeping the airway open and stopping obstruction.

Why Use CPAP?

If you have OSA and are supposed to wear a CPAP machine, skipping out on it may not seem like a big deal, but there is a good chance not wearing it will lead to more serious health conditions.


When you have periods of apnea, blood oxygen levels decrease making your heart work extra hard to pump oxygen through the body.  This causes your heart rate and blood pressure to both elevate, putting added stress on the heart.

Risks of Untreated Sleep Apnea

Studies show many people with OSA have hypertension, which is high blood pressure. This happens when the force of blood being pushed through the arteries is high. If not controlled, hypertension causes damage to the heart and vessels, and you are at risk for even more serious conditions.


If untreated, sleep apnea may lead to congestive heart failure (CHF). CHF happens when your heart does not pump out enough oxygenated blood to the body. Fluid then builds up elsewhere in the body including ankles, legs, and lungs, making it hard to breathe.

OSA may lead to heart arrhythmias including atrial fibrillation. Atrial fibrillation is a quivering, irregular, and many times rapid heartbeat. Periods of apnea with an irregular heartbeat could even lead to sudden death.

OSA can also lead to coronary artery disease (CAD). With CAD, a plaque is built up in the walls of arteries, making them narrow, causing restricted blood flow to the heart. This can lead to heart attack, and also may lead to premature death.

There is also a risk of stroke. The effects of stroke can be severe disability or death, and people with OSA may have a more difficult time recovering from any effects.

In any case, oxygen is important for the heart. Lack of oxygen, even during sleep puts too much pressure on your cardiovascular system, and eventually it can weaken.

Even if you do not currently suffer from any of these conditions, there are still good reasons to treat your sleep apnea and wear your CPAP machine. During apnea, not only are blood oxygen levels low, but carbon dioxide in the blood becomes elevated. This can cause headaches, memory loss, fatigue, and may even make you more dangerous behind the wheel.

The continuous pressure from your CPAP will keep your airway open so you can breathe. This way blood oxygen levels stay where they should, and carbon dioxide levels don’t get too high. There may be other CPAP alternatives for treating your sleep apnea, so discuss it with your doctor if you have concerns. But if your doctor recommends a CPAP machine, wear it. It can save your life.

Author: Kristina Diaz is a Registered Respiratory Therapist and a health and wellness enthusiast and writer.

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