The Common but Fixable Problem of Sleep Disorders in Athletes

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Sleep disorders are more of a problem in professional athletes than many people believe; however, individual counseling, treatment planning, and examination has been shown to help improve their sleep quality.  A new Finnish study published in the Journal of Sports Sciences reported, for the first time, that systematic measures can improve the sleep patterns of athletes and, therefore, improve their performance.

The University of Eastern Finland and Oivuani Sleep Clinic carried out this study.  The researchers analyzed survey results and sleep patterns of 107 athletes. All participating athletes were given general guidance and education on improving their sleep.  Additionally, the participants who truly suffered from a sleep disorder were referred to a specialist for systematic examination and an individualized treatment plan.

It was found in this study that one in four professional athletes had significant problems with sleep, including such symptoms as difficulty falling asleep, sleep disordered breathing, and snoring.  Additionally, most of the participating athletes got too little sleep and one in six were using sleep medications to help them fall and stay asleep throughout the night.  These medications are being used on a regular basis, both on and off season.

Every athlete surveyed stated that a good night’s sleep was just as important to his or her health as eating right and exercising.  One in four of the participants reported that the sleep guidance and education they received improved their performance in their sport.  This study demonstrated that general sleep education, examination of sleep disorders when necessary, and an individualized treatment plan improves their sleep.

Docent Henri Tuomilehto, study leader and sleep specialist says that you must sleep in order to succeed.  In order for athletes, or anyone for that matter, to reach the top of their performance, they need to be talented, train hard, and recover properly, which includes regularly getting a good night’s sleep.  Sleep is restorative.  It is regarded as a cornerstone for professional athletes’ ability to recovery and improve their performance and skill.

Very little research has been done on the sleep patterns of athletes, however.  Previous studies have only reported sleep disorders, but no correlations to athletes.

Tuomilehto and colleagues over the last four years have been in charge of sleep patterns for over 500 professional athletes in Finland.  Most recently, they have been working with HJK (their leading football team), as well as Jokerit (their hockey team).  Additionally, they have been working with athletes going for the Rio 2016 Olympics, as well as those cross-country skiers going for Lahti 2017 World Championships.

We already know that sleep disorders are widespread around the globe, in both the general public and athletes.  These disorders are so common they are now considered a chronic disease, so any study to identify and treat the issues will prove beneficial.

Tuomilehto reminds us that solid evidence of the health and cognitive problems associated with sleep disorders calls for action.  He is one of the few people in Finland who are focusing on sleep disorders in Finland, with the potential for findings that could influence the rest of the world.

Tuomilehto led an earlier study that was the first in the world to identify the benefits of healthy lifestyle habits and the treatment of sleep apnea.  Those findings led to an update in the treatment recommendations for this condition around the globe.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/uoef-sdc051916.php

 

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.

Higher Risk of Complications in Heart Failure Patients with Central Sleep Apnea

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Patients with central sleep apnea (CSA) and chronic heart failure (CHF) have a higher risk of being hospitalized and higher mortality rates than people with both obstructive sleep apnea (OSA) and CSA.  This is true whether or not they get adaptive servo-ventilation (ASV) therapy.  These results were determined in a French prospective observational study from the FACE Multicentre National Cohort Study and were presented at the 2016 ATS International Conference.

Lead author of the study, Renaud Tamisier, MD, PhD, who is from Grenoble Alpes University in France states that these results show what happens in real life with these individuals.  It focuses on how heart failure patients can have different traits in terms of cardiovascular and pulmonary diseases.  These results will be necessary in figuring out who will benefit from central sleep apnea treatments.

CSA touches the lives of about 10-20% of the sleep apnea population, but it is much less common than OSA, which some patients with CSA may have as well.  About 30% of CHF patients suffer from CSA, which results in their having breathing instability during sleep and going between hyperventilation and hypoventilation.  Hyperventilation is caused by an over sensitivity to carbon dioxide, while hypoventilation leads to apnea (stops in breathing).  This is very different from OSA, where the cause is due to throat and airway blockage.

ASV is a therapy that is like advanced positive airway pressure, and this technology has shown far more effective in the treatment of CSA than CPAP, especially in those with CHF because it improves heart function.  Since CHF is a condition where the heart does not pump blood properly, this has shown to be a beneficial treatment.

There are 301 stable CHF patients who are part of the FACE study, each with a preserved and low ejection fraction.  Of these patients, 80% have functional class II to III heart failure per the New York Heart Association – a system of classification with CHF severity categories rated on a scale of one to four.  This part of the study requires researchers to look at mortality and morbidity, sleep and respiratory data, as well as changes in cardiac function.  They also looked at whether there was preserved or reduced LVEF (left ventricular ejection fraction), co-existing CSA-OSA or predominant CSA, and whether or not they were compliant with ASV therapy.

Co-existing CSA-OSA and predominant CSA made up 30% and 70% of participants, respectively.  Of those, 75% had severe sleep apnea.  Only 74% of patients consented to receive ASV therapy.

Even though CSA-OSA and predominant CSA participants had comparable severity in their heart disease, those with predominant CSA and more severe NYHA classification were at higher risk of mortality and had more unplanned hospitalizations.  This was true whether or not ASV therapy was used.

Dr. Tamisier and colleagues already knew that patients with CHF and CSA had a poor prognosis; however, the significance of the relationship is still a question.  It is uncertain whether it is related to their CHF status or if CSA has a pathogenesis that worsens CHF.  Researchers are hopeful that the answers to these questions lie in further evaluation of the data.

Additionally, Dr. Tamisier noted that patients with CHF who have the most severe NYHA classification did not have a different prognosis whether or not they used ASV therapy.  Another study, the SERVE-HF trial, noted different findings, where patients that had the most severe case of CHF did not benefit from ASV treatment.  There remains the question of whether alternative treatments are of value.

The FACE study has given data on patients with CHF that are eligible to receive ASV.  These patients will be followed for two years.  There are a total of 22 research centers participating in this study, with the completion of data collection expected to be toward the end of 2019.

The trial noted above (SERVE-HF) was a randomized trial that took data on the effectiveness of ASV treatment in those with low ejection fraction heart failure along with Cheyne-Stokes or predominant CSA.  Cheyne-Stokes is very often associated with CSA.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/ats-hfp050916.php

 

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.

Sleep Apnea Left Untreated Can Make Melanoma More Aggressive

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A new multicenter prospective study on the relationship between cancer and sleep-disordered breathing has shown that severe obstructive sleep apnea (OSA), if left untreated, may be linked to more aggressive malignant cutaneous melanoma.  Sleep-disordered breathing is in reference to frequent starts and stops in breathing throughout the night.  This study was presented at the 2016 ATS International Conference and included researchers from 24 different teaching hospitals that were part of the Spanish Sleep and Breathing Network.

Lead author of the study, Miguel Angel Martinez-Garcia, MD, PhD, stated that this study is the first that is specifically designed to analyze the relationship between a certain type of cancer and sleep apnea.  He notes that even though additional research is necessary, this particular study shows that individuals who were part of the study had a poorer prognosis for their melanoma, highlighting the importance of identifying, diagnosing, and treating sleep apnea as soon as possible.  Dr. Martinez-Garcia is part of the Hospital Universitario y Politecnico La Fe in Valencia, Spain.

There were 412 patients involved in this study, with an average age of 55.8 years.  Each had a confirmed diagnosis of cutaneous malignant melanoma.  There were equal numbers of men and women in the study group.  Dr. Martinez-Garcia and the other researchers gathered various data points that indicated the prognosis for each patient.  This included the Clark and Breslow indices, which determines the melanoma stage.

All participants had a sleep study performed, and those who were treated in the past with CPAP were excluded.  CPAP is the primary treatment option for people with sleep apnea.

Scientists discovered that those with the most aggressive cancer were more likely to have a higher rate and severity of OSA.  This finding and relationship between the cancer and OSA was true regardless of gender, age, BMI, sun exposure, skin type, or other melanoma risk factors.

It has already been established that there is a relationship between heart disease and sleep apnea, as well as motor vehicle accidents, Dr. Martinez-Garcia stated.  This study, however, showed that there was also a relationship between cancer and sleep apnea.  While this is a very important finding for people who currently suffer from sleep apnea, Martinez-Garcia states, it is vital that they do not infer this to mean they will develop cancer as a result of sleep apnea.

Melanoma was the focus of this study for a variety of reasons.  Specifically, cutaneous melanoma is easily measured and observed.  Well-validated measures are used to determine its aggressiveness, including the Clark and Breslow indices.  Researchers who were part of the study group published, in addition to the findings of this study, a melanoma growth rate index.  Finally, previous animal studies gave a foundation for the relationship link between sleep apnea and melanoma.

Dr. Martinez-Garcia noted that these findings implicate many factors for both physicians and patients.  A medical professional should be sought if snoring and frequent nighttime awakenings with daytime sleepiness are a problem, especially if there are other risk factors for cancer, or if cancer is already present.  Dermatologists, cancer surgeons, and oncologists especially need to be asking patients if OSA symptoms are a problem, and then work fast to refer them for a sleep study.

The researchers plan further research into this relationship and topic.  The next study will be to watch these patients over time and look for important variables like relapse, treatment resistance, development of other cancers or a second melanoma, metastasis (spread, especially to sentinel lymph nodes), and mortality.  Further, Dr. Martinez-Garcia is planning to do a multinational/multicenter study of people with other types of cancer in order to examine how long-term use of CPAP therapy may be affecting them.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/ats-usa050916.php

 

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.

REM Sleep Plays a Prominent Role in Memory Formation

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Over the last several decades, scientists have debated about whether rapid eye movement (REM) sleep is directly linked to the formation of memories.  REM sleep is the phase of the cycle when dreams appear.  It is also the restorative phase of sleep.

Researchers from the Douglas Mental Health University Institute and University of Bern published a new study in Science to address the evidence that REM sleep does in fact play a role in memory formation.  Well, in mice, at least; however, this is still a good foundation for human study.

Sylvian Williams, one of the researchers and a psychiatry professor at McGill (Douglas Mental Health University Institute) states that scientists already know that new information is stored in emotional or spatial memories before it is integrated or consolidated.  Williams explains that it has been unclear how the brain performs this process until now.  They are now able to prove that REM sleep is critical for forming spatial memory in mice.  This is the first time these two processes have been linked.

This team of researchers is also part of the CIUSS de l’Ouest-de-l’Île-de-Montréal research network.

 The Dream Quest

There have been hundreds of studies in the past that have unsuccessfully tried to isolate neural activity during rapid eye movement sleep using traditional methods of experimentation.  In this new study, however, the scientists used what is known as optogenetics.  This is a new technology developed recently that enables scientists to target populations of neurons and use light to control its activity.

Williams states that the researchers chose to target the neurons that regulate hippocampus activity.  This is an area of the brain that is critical for the formation of memories during waking hours.  It is commonly referred to as the “GPS system” of the brain.

Of course, again, it is mice that were used in this study, so it will require further human study.  In order to test the long-term memory of mice, however, the researchers trained them to find new objects in a controlled environment where there were two similarly shaped and sized objects.  The mice were spontaneous in that they explored novel objects more than familiar ones, which demonstrates their use of recall and learning.

In REM sleep, the mice were exposed to light pulses to “turn off” those neurons associated with memory in order to find out if it affected their memory consolidation.  On the following day, those same mice were not able to complete the spatial memory task that they were able to do easily on the previous day.  Compared to the control group, these mice’s memory seemed to be impaired, or even erased.

The study’s lead author, Richard Boyce, who is a doctoral student and, ironically, stayed up all night to watch the experiment, stated that quieting those same neurons at different durations in other stages of sleep did not affect the memory.  This, to the researchers, indicates the activity of memory consolidation is specific to REM sleep.

Brain Disease Implications

It is widely known that REM sleep is critical to quality sleep in all mammals, even humans, which is why this study is so important.  Poor quality sleep is frequently linked to the higher risk and onset of brain disorders like Parkinson’s and Alzheimer’s disease, two of the most debilitating conditions of our time. 

 Particularly, REM sleep is significantly problematic in those with Alzheimer’s disease and dementia.  The results from this study tell us that REM sleep disturbance may be a contributing factor to memory impairment that is often observed in patients with Alzheimer’s disease.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/mu-rem051316.php

 

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.

New OSA Treatment for Pediatric Patients with Down Syndrome

OSA Treatment Down Syndrome

Massachusetts General Hospital for Children and Massachusetts Eye and Ear have begun a new FDA-approved clinical trial recently.  Researchers will test and review the use of a hypoglossal nerve stimulator in a group of adolescents with Down syndrome and obstructive sleep apnea (OSA).  A hypoglossal nerve stimulator is currently a technology available to adults who suffer from severe OSA.  The technology stimulates the upper airway to help facilitate breathing during sleep.

The first patient in the trial has had a case report done, which was reported in the May issue of the journal, Pediatrics.  This patient had the stimulator implanted on April 8, 2015, and this marks the first time in which the technology has been used in a patient under the age of 18 in the United States.  Now, the trial is going to be expanded to four more sites around the country.

Dr. Christopher J. Hartnick, lead investigator of the study and the director of Pediatric Otolaryngology at Massachusetts Eye and Ear states that there is still a long way to go to demonstrate the efficacy and safety of this technique in children; however, the case study is a significant first step.  Most compelling is that this research could potentially help a group of patients with a condition that is very difficult to treat.

Approximately 60% of young patients with Down syndrome also suffer with severe obstructive sleep apnea, so this issue presents a unique constellation of challenges for treatment.  For example, one of the key anatomical problems with OSA is that tongues will fall back into the throat during sleep and obstruct the airway, and many people with Down syndrome have larger tongues, making this an even greater problem.  Additionally, many patients are sensitive to air blowing on their faces, which would make wearing a mask, such as that used in a CPAP or BiPAP machine, very difficult and likely intolerable.

With the threat of heart conditions like hypertension and heart disease caused by untreated sleep apnea, and without favorable treatment options for those with Down syndrome, patients’ families and physicians are often left with the difficult decision of resorting to the invasive procedure of a tracheostomy should obstructive apnea prove to be severe and unsafe.

The hypoglossal nerve stimulator works by activating nerves in the upper airway and causing the tongue to move forward and out of the airway while sleeping.  The stimulator is implanted surgically by placing a cuff around branches of the nerve and then connecting it to a receiver in the chest with wires, as well as to a sensor that is located below the ribs.  The sensor works by detecting breathing interruptions and then sending signals to the cuff, which sets the entire process into motion.  The technology can be programmed by physicians and caregivers to turn on at a certain time each night, usually about a half hour after the child lays down for sleep.

The first patient was a 13-year-old young man who needed a tracheostomy tube in order to breathe because the CPAP machine was intolerable.  This child has responded positively to the therapy thus far.  A follow-up sleep study three months after the surgery showed a decrease in obstructive sleep apnea symptoms using an index score to below 10 from above 40.  He has been able to have the tube removed with excellent results.

Since this first surgery was performed, four additional patients have had the device surgically implanted.  The patients in the clinical trial are followed closely with sleep studies and through regular office visits in order to completely evaluate the safety of the technology and treatment.

Co-author of the study, Brian Skotko, M.D., M.P.P., who is co-director of the Down syndrome program at Massachusetts General, states that the stimulator is potentially a game changer for the Down syndrome community because the patients who were part of the study have already experienced life-changing results.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/meae-ctu050916.php

Credit Photo by Garyfallia Pagonis.

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.

Mobile App Helps Scientists Determine Sleep Patterns

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A new study combining mobile apps, big data, and math modeling of sleep patterns around the world has analyzed the roles of biology and society in the setting of sleep schedules.

Led by mathematicians out of the University of Michigan, this study utilized a smartphone application at no charge that would reduce jetlag in order to obtain sleep data from people in 100 different nations; thousands of people were analyzed.  Scientists looked at the impact of gender, age, and light exposure to the home country on the amount of sleep people get, along with the time they go to bed and the time they wake up.

Their findings showed that there are cultural pressures that can interfere with the natural circadian rhythm, which were most notable at bedtimes.  Researchers note that morning responsibilities such as kids, school, and work do play a role in wake time, though it is not the only component.  The trends at the population level indicate the expected outcomes of sleep patterns based on current knowledge of the circadian rhythms.

One of the researchers who was part of the study, Daniel Forger, a mathematician, stated that it is apparent in their findings that society governs bedtimes and the internal clock governs wake times, in which a later bedtime contributes heavily to sleep loss.  Further, there was a strong effect on wake time from peoples’ biological clocks, and that is not referring to their alarm clocks.  It is believed that these findings will help quantify the differences and similarities between social and solar timekeeping.

When discussing biological or internal clocks, Forger is referring to the circadian rhythm, or sleep-wake cycle.  It is in reference to the bodily fluctuations in function and behavior that are linked to the 24–hour day.  As mentioned in previous studies, these rhythms are managed by clusters of more than 20,000 neurons located behind the eyes, which are regulated by sunlight.

It has long been understood that circadian rhythms are the primary drivers of sleep schedules, even since the invention of 9-5 workdays and artificial light.  This new research will help identify the role of society in these schedules.

Mr. Forger and his colleague, Olivia Walch, got together several years ago and released a smartphone application, Entrain, which assists traveling individuals in adjusting to new time zones and avoiding jet lag.  This app makes custom schedule recommendations based on light and darkness time.  In order to use the application, the user would need to enter their usual hours of sleep and light exposure, after which they are given an option to submit anonymously to the University of Michigan for study.

Naturally, the quality of recommendations depended greatly on the truth and accuracy of the individual’s information.  Researchers believe that the people who were more motivated to get over jetlag quickly were more careful in their reporting of sleep habits and history.

Thousands of people submitted their information to U-M, which was further analyzed for patterns.  Recognized correlations were put to the test in a circadian rhythm simulator, which is a  mathematical model based on the knowledge of how light affects the brain’s SCN (suprachiasmatic nucleus).  This is where the 20,000+ neurons reside.  This model allowed researchers to dial the sun at will in order to find the correlations in extreme conditions.

Ms. Walch does note, however, that sleep patterns and bedtimes don’t respond the same way in the real world as they do in the model, as the model is missing the society component.

National averages of sleep time ranged between 7 hours and 24 minutes in Singapore to a maximum of 8 hours and 12 minutes in the Netherlands.  This is not a large window of time; however, researchers make note that every 30 minutes of sleep makes a difference in cognitive functioning and long-term overall health.

There is an important lever for sleep-deprived people in these findings, the researchers state.  The CDC has noted that one in three American adults are not getting the recommended 7 hours of sleep every night.  Additionally, they note that sleep deprivation puts one at risk of developing health problems like high blood pressure, obesity, heart disease, stroke, stress, and diabetes.

In addition to the above, researchers at U-M also found that:

  • Men in middle age got the least amount of sleep, usually fewer than 7 to 8 hours
  • Women tend to schedule their sleep more than men, on average about a half hour more. Generally, they go to bed earlier and wake up later, and it is more often seen in women between the ages of 30 and 60.
  • Individuals who spend time outside in sunlight everyday go to bed earlier than those who stay indoors most of the day.
  • Those over 55 were more prone to schedule their sleep than those under 30. This could be due to a narrowed window that older people can fall asleep and stay asleep.

Sleep is vital to health and well-being, more so than most people realize, the researchers state.  Even six hours a night puts one at risk of developing a serious sleep debt.

It does not take long to develop a sleep debt and begin to see functional decline.  Being overly tired gives a feeling of drowsiness and inability to concentrate, which can be terrifying for some people, especially if they think they’re performing tasks to their best ability.  Performance levels drop, but perception of performance goes unaltered.

This work demonstrates that smartphone technology can be a reliable source for gathering a great deal of information to study at a very low cost.

Reference:  http://www.eurekalert.org/pub_releases/2016-05/uom-suh042916.php

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.

Why am I always tired?

feel tired and feel sleepy

“Why am I always tired?” is one of the most frequently asked questions on the internet. There are several potential causes for ‘being tired’. Here, we will discuss the causes of being tired. First, it is important to determine what is meant by ‘being tired’.

Let’s first discuss the word ‘Tired’.

The word “tired” can mean different things to different people. Clinicians usually try to differentiate if the person has fatigue or excessive daytime sleepiness.

Fatigue generally refers to the sensation of not having enough energy to complete certain tasks. The differential diagnosis (potential causes) of fatigue is very long. The list includes medications, anemia, depression, medical disorders, and many other causes.

Excessive Daytime Sleepiness, or EDS, has a much shorter list. However, the list is still long. Generally, the list includes causes that interfere with quality or quantity of sleep.

Causes of Excessive Daytime Sleepiness 

Many of the causes of Excessive Daytime Sleepiness include sleep disorders, such as sleep apnea, insomnia, circadian rhythm disorders, narcolepsy, and other sleep disorders.

Let’s return to determining the difference between fatigue and sleepiness. With fatigue, a person will usually complain that he or she does not have enough energy to get going, or to do certain things. But, when they close their eyes sitting or laying down, they do not fall asleep. This is an important point in differentiating the two symptoms.

With EDS, obviously when the person does sit or lay down for a rest opportunity, the person does fall asleep.

What can I do to be more alert and less sleepy?

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There are many things that you can do to be less sleepy. Once you know what the cause is, then you know where one of the fixes might be. A good start with improving daytime alertness is following good sleep hygiene. This includes getting adequate total sleep time. It also includes avoiding alcohol and caffeine before bedtime, not watching TV or reading in bed, and have a comfortable, quite, and dark bedroom.

Yes, people can have, and often do have, both complaints. It is also common for someone to have more than one problem. To start, it helps to know the difference between Excessive Daytime Sleepiness and fatigue. Instead of asking, “Why am I always tired?”, the question should be “Why I am always so sleepy?” or “Why I am I always so fatigued?”.  Once this has been determined, the next step is to figure out why.

In the following pages, we will explore some of the many sleep disorders that contribute to being sleepy. Part 2 – Sleep Disorders

ADHD Children Sleep Less and More Poorly

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Parents of ADHD children have claimed for years that their children have more trouble falling and staying asleep and have poorer quality sleep than other children.  A study out of Aarhus University has found that there is some truth behind this claim.

Recent studies have reported that approximately 70% of parents with ADHD children state that their child has a hard time falling and staying asleep and that their pre-bedtime routines take a long time.  Unfortunately, however, many science-based studies using electrodes to measure sleep quality have not been able to link ADHD and sleep quality.  This new Danish study gives some merit to these parental concerns and shows that children with ADHD do, in fact, sleep worse than other children their age.

Behind the study is lead researcher, Anne Virring Sorensen, a medical doctor at the Child and Adolescent Psychiatric Hospital in Risskov.  She reported that their study validates their experience, which is that their child with ADHD takes longer to get to bed and fall asleep.  With the measurements used in this study, researchers have seen also that these children have disruptive sleep, especially deep sleep.  Only looking at the length of sleep will tell you that children with ADHD sleep an average of 45 minutes less than other children; however, it is the quality of sleep that is most concerning, researchers state.

It is reported that two out of three children diagnosed with ADHD have at least one additional psychiatric condition, which in all likelihood increases the risks of poor sleep quality.  However, even when scientists look only at those with an ADHD diagnoses, they find that there is still a big difference in the patterns compared to children in the control group without a diagnosis.

In this Danish study, researchers also reviewed the daytime sleep patterns, and the findings were surprising.

They found that children with ADHD were able to fall asleep more quickly during the day than at night.  This is so surprising because one of the primary characteristics of ADHD is hyperactivity; however, researchers note that this hyperactivity may be compensatory for the inability to sleep during the day.

Researchers being unable to find a correlation between poor sleep quality and ADHD in the past may be due to the different methods of measurement.  In this study, electrodes were attached to the children for polysomnography readings during an afternoon at the hospital.  However, they still slept in familiar home surroundings.  Previously, children were admitted to sleep centers in a hospital overnight in order to get a sleep study performed.

Anne Virring Sorensen makes it clear in her findings that the children in this study received no medication to help them fall asleep.  This is a major concern because many ADHD children are given medication at night to help them sleep.

 This study will be important for both the short and long term, researchers believe.  So far, clinicians and parents are pleased that their concerns about their ADHD child getting poorer sleep have been confirmed.  Of course, the next step in this process is to identify the correlation that will help develop more efficient treatment regimens in the future.  This is an important foundation for further study, Sorensen states.

Findings of this study were published in the Journal of Sleep Research. 

 Study Facts

  • The study included a total of 76 children with ADHD, with an average age of 9.6 years.
  • Twenty-five healthy children made up the control group.
  • There were two types of studies:
    • Use of multiple sleep latency tests, which looked at the speed in which children were able to fall asleep
    • Outpatient examinations with electrodes, also called polysomnography
  • So far, this is the largest study that includes both of the above types of studies, as well as both children with and without ADHD

Reference:  http://www.eurekalert.org/pub_releases/2016-05/au-cwa050416.php

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.

The Mapping of Our Internal Clock

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The SCN (suprachiasmatic nucleus) makes the body run properly and on time.  It acts as the control center for our genetic clock and the circadian rhythm, which regulates multiple functions including insulin sensitivity, hunger, sleep, body temperature, hormonal levels, cell cycles, etc.  The suprachiasmatic nucleus has been extensively studied, but its neural network has remained a mystery to scientists.

In a new study from Harvard John A. Paulson School of Engineering and Applied Sciences, Washington University in St. Louis, and the University of California Santa Barbara, researchers have found that SCN neurons are linked to each other, which sheds immeasurable light on this area of the brain.  By understanding this brain structure and how it responds to disruption, scientists will be able to tackle more illnesses such as posttraumatic stress disorder and diabetes.  Additionally, researchers of this study report that disruption to the rhythms that come from the SCN, i.e., shiftwork and nighttime blue light exposure, negatively interferes with health.

The findings were published in the Proceedings of the National Academies of Science (PNAS).

The first author of the paper, John Abel from SEAS, stated that due to the noisiness of the cells within the SCN, it has been incredibly difficult to understand.  There are in excess of 20,000 neurons that reside within the SCN, and each of them have their own task of regulating the circadian rhythm; however, they also communicate with their fellow neurons in order to maintain relationships.  Now, scientists are able to cut through that noise of communication and determine which cells are sharing what with the others.

There are two hemispheres in the SCN, so it looks like a small brain.  It is located inside the hypothalamus.  It takes cues of light from the retina, which is what allows it to keep track of time and reset itself when needed.  When the SCN is functioning normally, all neurons in both hemispheres demonstrate a synchronized pattern in their oscillation.

Abel and the research team disrupted this synchronized pattern in order to better understand the network structure.  They did this by using a potent neurotoxin found in pufferfish, which turned the usually steady, rhythmic oscillating pulse into disconnected beats.  Then, they removed the toxin and used information theory to determine how the network re-established communication between cells.

John Abel likened this process to trying to determine if a group of people were friends without being able to look at their text messages or phone calls.  In large groups, you probably would not be able to tell who was a friend of whom, but if a group of people showed up to a party together, it is safe to assume that they communicate on a friendly basis.

At a single-cell resolution, the research team was able to identify groups of friendly neurons in the center of each hemisphere.  They shared a lot of information with each other during the resynchronization process.  Additionally, researchers found that there were dense connections between the hubs of each hemisphere.  The area called the shell outside the hub showed neurons that behaved like acquaintances rather than friends and shared very little information.

Researchers were surprised to find that the shell did not contain functionally connected collections of neurons.  Previously, it was assumed that the neurons in the shell played a bigger role in communication; however, this study shows that it is the core neurons that mediated the clustering.

It was also assumed in past research that the core SCN dominated the process because of its role in receiving light cues from the retina.  The use of the neurotoxin to disrupt circadian rhythm, however, allowed researchers to demonstrate the core to be the key player in resynchronization without light cues.

Co-author of the paper, Professor Frank Doyle, stated that in the 15 years of studying the complex control mechanisms involved in the circadian rhythms, this is the work that brings them closer to understanding the communication between neurons.  This would demonstrate the importance of seeing the link between genes, the cells, and the SCN tissue.

 Reference:  http://www.eurekalert.org/pub_releases/2016-05/au-cwa050416.php

 

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.

To Sleep Train or Not To Sleep Train, That is the (Ongoing) Question

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As a Pediatric Sleep Specialist, I am often confronted by parents with the question of whether they should sleep train their children. These parents express a strong desire and need for sleep for themselves and their children, but they are confused and overwhelmed as to how to proceed (if, at all). Sleep training, also referred to as “cry it out” (or CIO on the various message boards and chat groups), has been and continues to be one of the most controversial parenting topics. The good news is that there is so much information available to parents about sleep training, however, that is the bad news as well. With the advent of the internet, parents are bombarded with so much information about sleep training, and much of it is contradictory. After many sleepless nights, including 2am Google searches, on how to get their children to sleep, parents end up more confused and unsure about how to proceed with sleep training, and even if sleep training is right for their family. As a Clinical Psychologist, an expert in the field of Pediatric Sleep, and as a mother who successfully sleep trained her sons many years ago, I hope to shed some light on this topic and help parents in their quest for the elusive full night of sleep!

When sleep deprived parents call me to inquire about my services, one of the first things they tell me is how they “want” their kids to sleep and how much they themselves “want” to sleep as well. These statements are almost always tinged with parental guilt. In order to not only educate, but also to alleviate that self imposed guilt, I reassure these parents that their desire for sleep is not just a “want” but also a very important “need”. We are all human beings with the basic biological needs to breathe, eat, and SLEEP! Of course we all “want” to be well rested, but we also all physically “need” to sleep in order to function on a daily basis. Some parents have the misunderstanding that it is our job to be up all night with our children and we should resign ourselves to the fact that we will never sleep again. Of course, when our children are newborns this is to be true. However, as our children pass the infancy stage and beyond, it is imperative that everyone in the family get a good night’s slee.

There are two common misconceptions about sleep training that I believe are important to clarify. The first misconception is that “my child is just not a good sleeper”. It is true that some children are naturally better sleepers than others. However, all healthy children can develop good sleep habits. In order for this to happen, however, it is up to the parents to be consistent and to follow age appropriate sleep schedules and sleep routines for their children. The most common reasons for unsuccessful sleep training are inconsistency and developmentally inappropriate sleep schedules. It is not beneficial to label children “poor sleepers” and to just give up the hope of a well rested family. The short term sleep training journey to raising a great sleeper will result in a lifetime of longer lasting positive effects on the whole family.

The second misconception is that sleep training is all about the “cry-it-out”. It is not the crying (the quality nor the quantity) that teaches children to fall asleep and stay asleep. It is actually the learned behavior of self soothing (which is not innate in most children and must be cultivated by their parents) that allows a child to fall asleep unassisted and fall back to sleep unassisted. The crying (also known as protesting) is just the byproduct of learning the critical self soothing skill, which healthy children can learn to master rather quickly. Furthermore, there are several other central components to a sleep training program, such as consistent and age appropriate sleep schedules including naps, consistent bedtime and nap time routines, and safe and healthy sleep environments, that without, parents will not have the sleep training success they so desperately need, and deserve.

Another common issue that arises for parents during their decision to move forward with sleep training is the emotional component to the sleep training journey. Many parents question their emotional capacity to handle any protesting from their child, as well as question their sleep training decision by perusing the websites that try to convince parents that they are doing harm to their child if they choose to sleep train. Overall, the existing and quite limited negative research studies have actually looked at the overall daily crying response in children in neglectful environments and did not look at children’s cry response solely in sleep training settings in loving homes. Children that are allowed to learn how to become independent sleepers and experience the byproduct of a finite amount of protest crying cannot be compared to the infinite crying of children who are neglected throughout the day and night. Furthermore, the parents that I have worked with the past 11 years are, in fact, the exact opposite of neglectful parents. They understand the necessity of sleep for their children and themselves, and they desire a happy and healthy family. I have yet to have worked with a family who has regretted their choice to sleep train. In fact, most tell me they wish they didn’t wait so long! If parents want to focus on research, I strongly advise them to focus, instead, on the solid and non controversial research about the detrimental effects of sleep deprivation on both children and adults’ health, mood, temperment, behavior, cognitive development, and performance in the home, school and work settings. Healthy sleep has only been shown to have positive effects on the physical, cognitive, behavioral and psychological growth and development of all humans. I highly doubt I will ever come across a study that shows the positive effects of sleep deprivation!

Most parents, at one time or another, will question their parenting choices. For the parents who are undecided about embarking on the sleep training journey, I hope I have helped you make an informed decision about if and how to proceed in getting your family well rested. We all have the same end goal – a happy and healthy family. No matter what roads our parenting journey take us down, I hope we all reach our end goal!

Author: Whitney Roban, Ph.D.

PEDIATRIC SLEEP SPECIALIST

Dr. Whitney Roban considers sleep a necessity, not a luxury.  She lives and works by one philosophy: parenting is one of the hardest jobs, made even more difficult when a family doesn’t sleep. Her mission is to give the gift of sleep to families through her information dissemination and emotional support based sleep training system, as well as her parent and corporate wellness education workshops.

With a Ph.D. in Clinical and School psychology from Hofstra University, Whitney began her career creating psychoeducational books and games for Childswork/Childsplay. Whitney formed SLEEP-EEZ KIDZ and SLEEP WELL/WORK WELL and has helped hundreds of children and their parents sleep soundly every night.

For more information about Dr. Whitney Roban, SLEEP-EEZ KIDZ and SLEEP WELL/WORK WELL, please visit www.sleepeezkidz.com.  You can also visit facebook.com/sleepeezkidz and twitter.com/sleepeezkidz.