How We Think About Sleep Affects Chronic Pain Symptoms

brain and sleep
Share This:

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.

Rate this content:
[Total: 0    Average: 0/5]
Share This:

7 Reasons Why You Can’t Stay Asleep

Can't Sleep - Insomnia
Share This:

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.

Rate this content:
[Total: 0    Average: 0/5]
Share This:

Sleep Disturbances in Adolescents Who Abuse Drugs and Alcohol

drugs alcohol and sleep
Share This:

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.

Rate this content:
[Total: 0    Average: 0/5]
Share This:

Why Do I Need a CPAP Machine?

Why Do I Need A CPAP -
Share This:

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.

Rate this content:
[Total: 1    Average: 5/5]
Share This:

Short Sleepers and Daytime Dysfunction

short sleep
Share This:

A new study out of the University of Utah published in Brain and Behavior has noted that there are neural connection patterns in the brains of short sleepers that suggest some of them may actually be getting enough sleep, but may also be more tired than they realize.

Habitual short sleepers are those who can sleep far less than the recommended amount without experiencing any daytime symptoms.

Dr. Jeff Anderson, co-author of the study, noted that the evidence helps them understand why some people do not seem to need much sleep.  He suggested that it is possible some brains can actually do the “restorations” done in sleep throughout the day while awake.

Sleep is one of the most essential functions of our body, though researchers are still unable to say exactly why that is, which makes it such an active field of research.

For the most part, scientists believe that sleep helps clear the brain of clutter thoughts that have accumulated throughout the day, and it allows for essential pieces of information to be stored in short or long-term memory centers.

Most people who get less than 7-9 hours of sleep have daytime symptoms like irritability, fatigue, and inability to concentrate.  There are a host of physical and mental health problems associated with chronic short sleep durations, including heart disease, mood disturbance, obesity, decline in cognition, and increased mortality risk.  This is not to mention the increased risk of accidents due to tiredness.

Interestingly, some can sleep six or less hours a night and report no ill effects.  In a study done in 2009, University of Utah neurologist, Chris Jones, along with his colleagues, found genetic mutations associated with short sleep duration.  The genetic factors found in this study suggest that those who can function properly on six hours or less of sleep may feel fine, but actually have “tiredness” in the mind and organs.

To answer the questions about how short sleepers can function without side effects, researchers looked at brain wire mapping.  Their goal was to figure out the connections of neurons underneath the sheath of brain cells.  The idea was to figure out how the connections are related to functionality with and without sleep.

The Human Connectome Project is a multi-university consortium that is analyzing these brain connections in 1200 people.  They are using MRI scans.  So far, data for 900 patients have been released, which allowed the University of Utah researchers to analyze the brain connectivity.

The data was split into two groups: Those who reported normal sleep duration and those who reported six hours or less a night over the last month.  The short sleepers were divided again into two groups:  Those who had daytime symptoms and those who did not.

Both short sleeper groups had connectivity patterns on MRI that were more associated to sleep than wakefulness.  People were instructed to stay awake while in the MRI; however, Dr. Anderson noted that short sleepers often drifted off while lying there in the scanner.  That includes even the people who reported no daytime dysfunction.

One hypothesis about short sleepers who deny daytime dysfunction is that their awake brain systems are in overdrive.  This suggests that while lying still and bored in an MRI scanner, they had nothing else to do than fall asleep.  There are several public safety implications in this hypothesis, because there are other “boring” activities like driving and operating a machine by rote memory that could lead to injury or accident.

Short sleepers who denied dysfunction showed increased connectivity between the cortexes that process sensory information and the hippocampus, which is responsible for memory.  Those short sleepers who fell asleep in the MRI scanner may have been performing memory consolidation, which is not something non-short sleepers can do.  This is indicative of short sleepers being able to do memory consolidation that is usually done during sleep while they are awake, reducing their need for sleep.  They could also be falling asleep during the day without even realizing it.

As with all new findings, further research is necessary to test the hypothesis.  The next part of the research that the University of Utah team will focus on is whether short sleepers without daytime dysfunction are actually doing well clinically.

In the next study, researchers will find people who sleep six hours or less naturally, regardless of the day or whether they are on vacation.  They will perform brain imaging and examine cognitive performance like driving simulator testing, which will give them objective information about how they are truly performing.

Insufficient sleep may also be affecting their ability to perceive any daytime dysfunction.  The research team is particularly interested in understanding the perceived symptoms or lack thereof in short sleepers.

The analysis of the connectome data showed the team in Utah that self-reporting sleep duration played a role in the variation between resting connectivity profiles.  Further functional MRI studies should take that and the actual sleep duration into account while interpreting results.

The researchers are hopeful that this ongoing research will answer the key questions about why each person needs a different amount of sleep.


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.

Rate this content:
[Total: 1    Average: 5/5]
Share This:

Gender and Sleep

Gender and Sleep
Share This:

The Biological Sleep Clock Differs in Men and Women

A new study published in the journal, Proceedings of the National Academy of Sciences (PNAS), September issue, has found that women are more likely to suffer from sleep disturbances than men are.

Many women have noticed that their sleep patterns are more commonly disrupted than men’s.  For example, women are more likely to have an insomnia diagnosis than men are.  Is it possible that there is a link between your sex or gender and the biological clock that regulates sleep?

According to this new study published by Dr. Diane B. Boivin and colleagues at McGill University’s Department of Psychiatry, as well as the Douglas Mental Health University Institute, the answer is yes.  There is a connection to gender and how the biological sleep clock functions.

In this research, Dr. Boivin first controlled for hormonal contraceptive use and menstrual cycles in women.  After adjusting for these aspects, researchers found that the body’s internal clock definitely affects alertness and sleep differently in men than women.

Dr. Boivin, who works out of Douglas Institute and acts as the director of the Centre for Study and Treatment of Circadian Rhythms, noted that even on a similar sleep schedule, women were more likely to fall asleep and wake up earlier than their male counterparts.  The reasoning, researchers state, is that women’s biological clocks seem to be on a more “Eastern time zone” schedule.

Furthermore, Dr. Boivin adds to her report from the study that the differences in sex seen in this research allows for better understanding of why women suffer from sleep disturbances more than men.

The Study

This experiment consisted of 15 men and 11 women, whose variations in alertness and sleep (regulated by body clock) were measured.  The women participants were on normal cycles and were evaluated during two different phases of their menstrual cycle.  This was done and treated as a critical point in the study because Dr. Boivin had previously done research that showed sleep phase was affected by menstrual cycle, body temperature, and biological rhythms.

Of note, none of the participants experienced sleep problems during the course of the study; however, the results help give perspective into why women are more affected by sleep disturbance than men, why they wake up earlier in the morning, and why they feel more tired after what seemed to be a full night’s sleep.  Furthermore, it is notable that men are more alert at night than women.

This study is suggestive that women may be unsuitable for nightshift work, biologically speaking.  Additional research is needed to confirm the theory and explore this matter further in order to develop proper treatment and interventions that are tailored to gender.

Millions of people in America suffer from sleep disturbances, especially insomnia.  A major consequence of this is that about 15% of adults with sleep disturbances also suffer from functional problems, which could negatively impact productivity and put employers and employees at risk of accident.


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.

Rate this content:
[Total: 1    Average: 5/5]
Share This:

Sleep and Antidepressants

sleeping pills
Share This:

Major depressive disorder is most often treated with antidepressants, but the transition to using them is not always a smooth one.

The average time it takes a patient to respond to medication therapy is six weeks.  Remission rates are only about 1/3, so most depressive patients would benefit from an overall better response to the drugs.

Researchers may have found a way to help.  A study out of the University of Michigan, with experts in both psychiatry and sleep medicine, found that a sleep schedule could ultimately influence those remission rates using antidepressants, as well as response time.

Less is Not More

In the past, inpatient studies have found that sleep deprivation (four to five hours) for a single night resulted in better mood the following day for about 60% of people.  Unfortunately, however, this amount of sleep deprivation is not practical or safe for people in their own homes.

 This new study from U-M was published in the Journal of Clinical Psychiatry.  It looked at 68 adults who were split into two groups: one group would spend six hours in bed every night for two weeks and the other group would spend eight hours in bed for the same amount of time.  All patients were on an antidepressant regimen (fluoxetine).

This is the first study to look at how mood is affected in outpatients on time-in-bed restrictions.  Both mood and sleep were measured every day for two weeks, and then mood was followed continuously for six weeks following that, where the patients went back to their normal sleep schedules on fluoxetine.

Dr. J. Todd Arnedt, lead investigator in the study and professor of Neurology and Psychiatry at U-M, reminds us that it is important to find safe and practical strategies to enhance depression treatments.  That is why the researchers decided to look at how modest sleep deprivation can be implemented at home alongside medication therapy.

Dr. Arnedt and colleagues thought they would find what other studies on sleep and depression have found – that restricted time in bed would lead to better medication response.  In fact, however, they discovered the opposite.

Those who spent eight hours in bed each night had a greater improvement in mood and medication response.  These patients were nearly twice as likely to experience remission from symptoms after eight weeks of antidepressant treatment – that is 63% compared to 33% in the six-hour group.  Furthermore, those in the eight-hour group responded faster to treatment.

For the first time, this study shows us that sufficient sleep may augment and accelerate depressive treatment response with antidepressants; however, as with all new findings, more research is necessary to confirm.

The Difference Between REM and Slow Wave Sleep

The people in the six-hour group were split up further into two groups: one set of patients was told to wake up two hours earlier, while the other was told to stay up two hours later.  The idea was to determine whether REM (dream state) or slow-wave sleep influenced the remission and response rates.  There are contradictory findings in previous studies about whether treatment response is affected by sleep stages.

After the first two weeks on this schedule, patients received a sleep study, which showed that those who stayed up later had more slow-wave sleep, while those who woke earlier had reduced REM sleep.  There was no difference in response, however.

 There was no link to a specific role in REM or slow-wave sleep as it relates to treatment response.

Monitoring Compliance

Patients were instructed to wear technology that allowed researchers to see whether the patients followed time-in-bed restrictions.

 The device used was an ActiGraph, which is similar to a Fitbit, but more sensitive to sleep, using sensors to determine if the person was in bed at their assigned hours.

For the most part, those in the eight-hour group complied with their instructions; however, those in the six-hour group had a hard time following restrictions.  Those in the early-rise group spent more time in bed than instructed.

These findings indicate that patients on a six-hour restriction would probably not follow the recommendations to spend only six hours in bed during the first two weeks of initial therapy, even if the whole six-hour condition showed better treatment response time.  Therefore, it is notable that this strategy would not be useful in outpatient settings.

In the Future

The next step in determining if sleep affects depression treatment response time is to determine whether extending and optimizing sleep time at the initiation of antidepressant therapy would improve and accelerate response time.  Optimizing sleep would require looking at sleep schedule, along with how much that person sleeps, how they sleep, their preferred sleep and wake times, as well as their sleep quality.

The researchers are looking at using more sophisticated measurement techniques as well.  This includes high density EEG and brain imaging, which will assess the direct impact of REM and other sleep stage manipulation concerning treatment response.

For now, Dr. Arnedt makes the recommendation to pay more attention to how much patients are sleeping when they start their antidepressant.  If starting a new therapy, patients should be cautioned against time-in-bed restrictions because there is a probability that it could affect how quickly they respond to the drug.

The ultimate goal is to identify good combinations of sleep and medication treatments that would be most effective for depression, which would be safe and practical in both outpatient and inpatient settings



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.


Rate this content:
[Total: 2    Average: 4.5/5]
Share This:

Increased Driving Risk in Patients with Obstructive Sleep Apnea

driving and daytime sleepiness
Share This:

A simulation study presented on 09/07/2016 at the European Respiratory Society (ERS) International Congress reported that patients with obstructive sleep apnea syndrome (OSAS) may pose potential driving risks.  The study was done out of St. James’ University Hospital in Leeds, UK and led by Drs. Akshay Dwarakanath and Mark Elliott.

There is a higher risk of accidents in patients with OSAS, as well as a significant difference in advice given by physicians about the issue.  To find the underlying cause of the issue, however, this study used standard deviation of lane position (SDLP) in a driving simulator to create a model for future studies, as well as try to identify the actual risk.

Data were collected from patients in the study.  This included two scores: Their Epworth Sleepiness Score (ESS) and their oxygen desaturation index (ODI).  The ESS looks at subjective sleepiness, while ODI measures the severity of their obstructive sleep apnea.  One hundred and twenty nine untreated OSAS patients participated in this part of the study.  Their mean age was 53 years, average ESS was 14, average ODI was 41, average BMI was 36, and they had an average of 31 years holding a driver’s license.  There were 79 people in the control study, who answered a questionnaire before going through the simulator.  Those in the control group performed the simulation once, while those with OSAS performed it twice.  Preset criteria helped determine simulator outcome using three potential results:

  1. Pass
  2. Intermediate
  3. Fail

When compared to the control group, the OSAS patients had more episodes of nodding off and admitted to sleepiness during driving.  They were also less likely to get a passing score and more likely to fail than those in the control group.  About 53% of people in the control group passed, 47% intermediate, and none of them failed.  Only 31% of the patients in the OSAS group passed, with 49% scoring at intermediate and 20% failing.  In those who failed, lane deviation was significantly worse.

The authors note that the worsened lane deviation is indicative of poor driving performance, which is much worse in patients with OSAS who failed the simulator test, especially when they are compared to those in the control group.  This comparison is useful when giving advice to OSAS patients about their increased risk of accidents.  Finding a normal range through real time events, simulator performance, and the outcome allows researchers to stay ahead in the development of tests that would evaluate accident risk in patients with OSAS.

Furthermore, the researchers note that OSAS patients are on average 2-6 times more likely to have a traffic accident compared to those without the condition.  Nodding at the wheel and sleepiness are far more likely to be reported in patients with OSAS than the patients in the control group, or without the condition.  Unfortunately, however, there are currently no tools to help validate this aspect.

Approximately 2-4% of the population has obstructive sleep apnea, so the authors state that objective tests are necessary to help ensure the safety of all drivers and road users.  While the Driver and Vehicle Licensing Agency does offer some advice for patients and providers, the information given is arbitrary and loosely based on past evidence and studies, which has the potential of preventing people from driving who are in fact able to drive.

There are major implications to the economy and society in general with regard to the advice given by DVLA.  For instance, OSAS is most common in overweight individuals, and many drivers in developed countries are overweight.  If they are prevented from driving due to obesity, there could be issues with employment.  Additionally, there is the possibility that the problem could be driven underground.  An objective test will go a long way to helping identify actual accident risk so that clinicians can better advise their patients with obstructive sleep apnea.



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.

Rate this content:
[Total: 2    Average: 3.5/5]
Share This:

Trouble Sleeping? Listen to What Your Body is Telling You

Difficulty sleeping
Share This:

When you feel stressed, you probably notice one or more of these sensations- tight muscles, a pounding head, racing heart, upset stomach, uncomfortably sweaty palms. When you are calm, perhaps you notice that your muscles are loose, your head is clear, and your stomach is content. Even when you are sleepy, you may feel your eyes are heavy, your brain is fuzzy, or your muscles are sluggish. These are all important body clues that allow you to figure out your current emotion. In fact, you are able to feel these body clues with the help of a little-known, but extremely important sensory system called interoception.

What is Interoception?

Your Interoception system is in-charge of collecting information about what is going on inside of your body—from areas such as your heart, stomach, intestines, muscles, skin, brain and even eyes. This information is sent to the brain where it is used to figure out how you are feeling at any given point in time. For example, information collected from the stomach might let you know that you feel hungry, full, gassy, or nauseous. Interoception is constantly working behind the scenes to let you know how you are feeling: are you hungry, thirsty, in pain, hot, cold, need the bathroom, sexually aroused, calm, angry, stressed out, or even sleepy?


The Importance of Listening to Your Body

“Research has found that people with good awareness of their internal body signals are more conscious of their emotions and are able to control and adjust their emotions with greater levels of success”, says Kelly Mahler MS, OTR/L, occupational therapist and author of the book Interoception: The Eighth Sensory System. In other words, if you are clearly aware of your internal body signals, you will likely have better control over your body and essentially mind. “The degree of Interoceptive awareness, or the ability to notice and make sense of internal signals, can vary between individuals”, says Mahler.  Some people have good interoceptive awareness and are able to use internal information to urge them into healthy actions. For example, these people can clearly feel full and stop eating. They feel small levels of stress building and use a strategy to quickly decompress before the stress gets intense. On the opposite end, some people have poor interoceptive awareness and therefore may not detect certain internal body signals at all, or at least not until the signals are very, very intense. This can make quickly recognizing and managing emotions very difficult. James, a 30-year old software engineer, shares, “Quite often I don’t notice that I am getting stressed until I am at the boiling point. By then it is too late. I am far into the stress storm and it is difficult to come back out.”


What’s Sleep Got to Do With It?

Many times high levels of stress and anxiety can underlie sleep difficulties. Therefore, gaining better control over stress by increasing awareness of your internal body signals can lead to better sleep. “People with good interoceptive awareness are usually more in tune with what makes their body and mind feel calm. They tend to have a wider variety of self-calming strategies and are more successful at using these strategies”. In other words, people that are more aware of their internal signals are better able to calm their body and mind when it counts. And if you’ve ever laid awake at night tossing and turning and stressing over various aspects of life, you know that better control over your body and mind can really count in that moment.


Try Mindfulness Meditation for improved sleep

If you are searching for a way to enhance interoceptive awareness and improve your sleeping habits, mindfulness meditation can be a great place to start. Meditation helps you to focus on the feelings, thoughts, and emotions occurring in your body and mind at the present moment. This can be done through various mindfulness exercises, and it doesn’t require a lot of time. For starters, you can try focusing your attention to your breath for 2-3 minutes and take notice to the sensations involved. Is your breathing fast, slow, shallow, deep? Can you feel the air moving through your nose, down your throat and filling your chest? If your attention wanders, gently bring it back to your breath.


Interestingly, there is a brain-based explanation for why mindfulness can improve interoceptive awareness. Brain studies reveal that the insula, or the interoceptive center in the brain, is strongly activated during meditation. Those who participate in regular meditation have been found to have superior insula functioning, both structurally (thicker insula) and in terms of activity levels. On the opposite end, reduced insula function has been found in individuals with poor interoceptive awareness and is linked with certain conditions such as depression, anxiety,  ADHD and even autism. “Given that these conditions are all commonly associated with both reduced emotional control and sleep difficulties, it becomes important to consider poor interoceptive awareness as an important factor for treatment,” says Mahler.


Practice Makes Perfect

It is never too late to begin practicing mindfulness meditation and reap the benefits. Regular meditation practice can allow a person to essentially see themselves and their emotions with greater clarity. By making it a habit to become more aware of your interoceptive signals, you can gain better insight into your body and ultimately improve your control over stress. This in turn can lead to a calmer mind and a better night’s sleep. And the value of a better night sleep…priceless.


Authors: Cheryl Tierney, MD, MPH, Kelly Mahler, OTR/L, Brittany Friedson

Cheryl Tierney, MD, MPH is a Board-Certified behavior and developmental pediatrician who has been in practice since 2002. She is a native of Brooklyn, New York and completed medical school at Tufts University in Boston. Her pediatric residency was at Carolinas Medical Center in Charlotte, North Carolina. She completed Fellowships in Health Services Research, where she received her MPH at Harvard School of Public Health as well as Behavior and Developmental Pediatrics in 2002.  She is an active member of The Society for Developmental and Behavioral Pediatrics (SDBP) as well as the Academic Pediatric Association (APA). She enjoys participating in outdoor activities with her family.

Associate Professor of Pediatrics
Section Chief, Developmental Pediatrics, Penn State Hershey Children’s Hospital

Rate this content:
[Total: 1    Average: 5/5]
Share This:

Suicidal Thoughts and Behaviors Affected by Sleep

sleep deprived
Share This:

New research out of the University of Manchester and published in the journal, BMJ Open, has identified the link between suicidal ideation (thoughts and behaviors) and sleep problems.

The study was conducted by scientists out of the School of Health Sciences at the University of Manchester, alongside some researchers from the University of Oxford.  There were 18 participants interviewed about how sleep has played a role in their mood problems and suicidal tendencies.

Overall, there were three pathways to inter-related suicidal thoughts identified as developing from sleep deprivation or other sleep disorder.  The first pathway was identified as being awake late at night, which heightened the risk of having suicidal thoughts and attempts.  This is thought to be due in part to lack of sleep, as well as the lack of available resources to help at night.

The second pathway was noted to be a prolonged failure to achieve quality sleep through the night, which made life much more difficult for interviewees.  This added to depressive symptoms, increased negative thinking processes, made focus and paying attention during the day difficult, and led to malaise or inactivity.

Lastly, the third pathway was the respondents reported that sleep served as the alternative to suicide because it allowed them to escape from their daily problems that were causing so much strife and discomfort while awake.  Unfortunately, however, this desire to use sleep as an escape or avoidance tactic led to more sleeping during the day, which further exacerbated sleeping problems at night.  This then reinforced the first two pathways noted above.

Lead author of the study, Donna Littlewood, noted that this research implies that there is a desperate need for service providers like healthcare specialists and social service agents that can help during the nighttime hours.

This new research underscores the importance of maintaining healthy sleep patterns, especially in relation to coping with mental health disorders, suicidal tendencies, and behavioral difficulties.

Furthermore, services at night should be a primary consideration within suicide action plans or prevention strategies used in the medical community.  This is because these findings show that those who are awake late at night are at higher risk of suicide.




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.

Rate this content:
[Total: 1    Average: 4/5]
Share This: