Sleeping Pills Increase Risk of Hip Fracture in Older Adults

fractures and sleep

New research out of Cardiff University and King’s College London has found that older adults who were recently prescribed popular the sleep drugs, benzodiazepine or another ‘Z-drug’ are at least two and a half times more likely to suffer a hip fracture within the first two weeks of treatment than people who do not use any sleep pills.

Professor at Cardiff University School of Medicine and Institute of Psychiatry, Dr. Ben Carter, noted that these types of medications, especially ‘Z-drugs,’ are quickly growing in popularity, with doctors using them as their first line of treatment for sleep problems.  However, Dr. Carter notes that there is no evidence to show that they are safer to use than the older drug, benzodiazepine, with respect to risk of hip fracture.

Researchers note that this study indicates that both medications greatly increase the risk of hip fracture when prescribed as a new medication in older patients.

This research included a group of people over the age of 65 who were prescribed a hypnotic medication; findings showed that new users were two and a half times more likely to have a fracture when compared to other people of the same age who were not taking any hypnotics.  There was a 20% higher risk of hip fracture in long-term (more than 30 days) hypnotic medication users, but about 53% increased risk of fraction in medium-term (between 15 to 30 days) users.

Additionally, Dr. Carter notes that careful consideration of this increased fracture risk should be given during the medical decision-making process.  It is important for providers to focus on other clinically effective measures to reduce the risk during the first days of treatment.  These measures include things like removing hazards from the home, visual correction, medication reconciliation, and strength training.

The findings in this research validate those of prior studies that link hypnotic medication use in older adults with increased risk of dependence, cognitive decline, accidents, and fractures.  Furthermore, these particular drugs cause debilitating side effects like delayed reaction times, impaired balance, and drowsiness, creating more risk to older patients.

The article, Benzodiazepines, Z-drugs and the risk of hip fracture: A Systematic Review and Meta-Analysis,’ was published this month in the journal, PLOS ONE.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/cu-nps042617.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development.

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Attention and Creativity Suffer in Young Adults Who Alternate Between Sleep Deprivation and Sleep Marathons

sleep and creativity

New research from Baylor University shows that young adults who frequently alternate between skimping on sleep and sleep marathons have worse creativity and attention, especially if they are working on big projects.

Study co-author, Michael Scullin, from Baylor Sleep Neuroscience and Cognition Laboratory, who is also an assistant professor of psychology and neuroscience, notes that those who had more variability in their sleep each night were more likely to show  decline in their cognitive abilities throughout the week.

Especially in the heat of major school projects, students will intentionally lose sleep to get the work done, but then they follow that up with a marathon, doing this repeatedly throughout the school year.  The many deadlines and tasks associated with big projects outnumber those that come with exams, and these tasks and deadlines contribute to the variability in sleep.

These findings were published in the Journal of Interior Design, and it was specifically for those students in the interior design program; however, findings also had implications for those in the graphic design, architecture, art, and other programs that use studio-based instruction.

Assistant professor of interior design at Baylor’s, Elise King, noted that some students believe that sleep deprivation is a sort of badge of honor.  Working late is not seem as procrastination.  Instead, it is seen to be a tradition, or a culture, that is a normal part of a curriculum based in a studio.  This, they believe, helps students prepare for their career.

King notes that most people do not understand the difference between being a decorator and being an interior designer, so those in the interior design field tend to work harder to show their differences.  Recently, however, Ms. King noted professors and administrators have seen consequences to that type of thinking, including depression, mental health issues, and anxiety.  Furthermore, they recognize the dangers to driving while sleep deprived.

There is a common myth among designers, which is that the best designs are only going to come in the middle of the night.  That is a myth, however, and the truth is quite the opposite, in that regular and consistent habitual behaviors are just as important as the length of sleep you receive each night.

Executive attention functions, such as intense focus, planning, decision-making, and self-correction are negatively affected by irregular sleep patterns.  The study found that erratic sleep patterns also contribute to a decline in creativity.

The recommended amount of sleep for young adults is seven to nine hours each night; however, the 28 interior design students that were part of the Baylor study experienced fragmented sleep and shorter durations.  Just one person slept seven hours a night, and 79% got fewer than seven hours at least three nights a week.

Dr. Scullin noted that most of the students thought they were getting at least four more hours of sleep each night than what they were actually getting.

School projects for interior design are generally lengthy, with deadlines and due dates lurking several weeks or months in the future.  Most students have several projects they are trying to juggle, all of which have different tasks and deadlines.  The stress of trying to manage all these projects likely contributes to the cycle of several days’ sleep deprivation followed by several catch-up days.

Actigraphy was used to measure sleep patterns in these students, all of whom wore wristbands to sense and track their movements.  Participants were asked to keep a daily diary of the quality and quantity of their sleep as well.

Like a Fitbit device, the wristbands detect movements and arousals, but they are far more reliable and sensitive.

Students were asked to complete two testing sessions to look at their executive attention and creativity.  Each session was done in a laboratory for about one hour.  They were done on the first and last days of the study, both at the same time of day.

Creativity is described as someone’s ability to link things that, at first sight, seem to be unrelated.  Another of the tests looks at that ability.  For example, students were asked to choose a fourth word to connect three loosely related words, such as shoulder, sweat, and sore.

Generally, most students thought of words that were related to exercise; however, there was really no single type of exercise that really worked to connect the three words.  The ‘correct’ answer to link those three words was not exercise related at all, but instead it was a creative word, ‘cold.’

Working memory, or executive attention, allows people to store short-term memories while doing other tasks unrelated to that memory.  In this research, students were asked to complete tasks that had a black and white grid with squares.  Students had to make a quick decision on whether the grid was symmetrical.  These types of decisions on symmetry are easy to make; however, after several rounds, a different-colored grid was shown to the participants.  It was highlighted in red, and students repeated the cycle several times before having to recall the locations of the squares in the correct order.  Cycling between these two tasks proved to be a challenge for the students, especially with regards to keeping the square locations in mind.

Researchers note that additional investigations into how students respond to this cultural sleep behavior will be needed to determine true effects.  This research should have a bigger range of students in various studio-based programs across multiple universities.

Programs for interior design are changing fast, because people are now open to discussions about curriculum.  They are now willing to reduce the pressure put on students and focus on encouraging them to live a healthier life instead.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/bu-ass042117.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development.

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Body Temperature, Sleep, and the Circadian Rhythm

sleeping woman

An early study published this week in Neurology, a journal of the American Academy of Neurology, showed that brain injury patients have fluctuating body temperatures that are directly related to their level of consciousness.

Dr. Christine Blume, PhD, from the University of Salzburg in Austria led the study.  She noted that the findings suggest the circadian rhythm in brain injury patients who were in a coma may have better test scores in recovery if their body temperatures are similar to a healthy person’s.  This was noticeable especially regarding arousal, a necessary component of regaining consciousness.

Circadian rhythm, or the biological clock, is a cluster of carrying rhythms in the body’s functions; they are the cycles our body goes through daily, telling us when to eat, sleep, and wake up.  This clock regulates many functions in the body, including internal body temperature, which is generally set by the environment, such as darkness or daylight.

Healthy people have body temperature variations that closely correlate with their sleep-wake cycle, with their patterns being controlled by the biological clock.  Many studies have indicated that sleep disruption and a chaotic sleep-wake cycle may negatively affect the immune system and short-term memory.  In normal cycles, the core temperature in the body fluctuates at regular intervals and can drop 1-2 degrees in the early hours of the morning.

In this recent research, the team analyzed 18 brain injury patients. Some patients had unresponsive wakefulness syndrome and others were in a minimally conscious state.  A vegetative state, or unresponsive wakefulness syndrome, is characterized by the patient waking up from a coma by opening his or her eyes and then going back to sleep, but remaining unresponsive.  The other group of patients, those in a minimally conscious state, were also in a coma and woke up, but they showed signs of awareness.

Scientists monitored these patients for one week, recording body temperatures with sensors placed on top of the skin.  The temperature data allowed researchers to determine the length of each person’s circadian rhythm.  The temperature cycles ranged anywhere between 23.5 to 26.3 hours.

Scientists used the Coma Recovery Scale-Revised to evaluate each person’s level of consciousness.  This scale measures the ability to open his or her eyes with and without stimulation, as well as how he or she responded to sound.  Findings showed that people who had a body temperature pattern that was closely aligned with a 24-hour rhythm had better scores.

Dr. Blume noted that this research, for the first time, makes an association between body temperature in relationship to the circadian rhythm and the arousal in patients who have suffered a brain injury.  This is important because arousal is a necessary component of consciousness.  Variations in the biological clock should be watched closely by doctors who are diagnosing and treating brain injury patients.

It is important to consider the time of day the patients are tested.  Treating providers can consider creating a sleep lab that is similar to the light/dark environment that is necessary to achieve a normal sleep-wake cycle.  This type of testing and treatment may bring brain injury patients closer to waking up.

Eight patients received bright light stimulation for a week.  Researchers found that two patients had positive responses, and Dr. Blume believes that larger studies will give us a better idea of its efficacy.

MRI data was not available for review of the brain damage at the time of the study, which limited the findings.  It would have been helpful to look at the hypothalamus, which is the part of the brain that stores the body’s biological clock.

For future research, Dr. Blume suggests looking at the relationship between other rhythms, like rest-activity cycles, and the body temperature fluctuations.

 

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Sleep Deprivation Can Lead to Loss of Bone Formation

A widespread problem people have is insufficient sleep. A new study has been done on men to see if there is a link to a chronic disease risk factor of bone loss and insufficient sleep. Insufficient sleep may be an unrecognized risk factor for bone loss. On Saturday, the results of this study will be presented at the Endocrine Society’s 99th annual meeting in Orlando, FL.

The study consisted of 10 healthy men. After three weeks of insufficient sleep consecutively, the study found reduced levels of a marker of bone formation in their blood. This is compared to people who have suffered from jet lag or shift work. The biological marker of bone resorption, or breakdown wasn’t changed on these men.

Research was done by Christine Swanson, M.D. while she was a fellow at Oregon Health & Science University in Portland, Oregon, with Drs. Eric S. Orwoll and Steven A. Shea.  Research showed osteoporosis and bone fractures could come from the altered bone balance from insufficient sleep.

There are 54 million Americans with low bone mass or osteoporosis, but there is no clear cause for osteoporosis in 50 percent of Americans. It would help explain why there is no clear cause if it related to chronic sleep disturbance.

Circadian disruption has your internal body clock offset by the environment, and either your 24 hours is shorter or it is longer. This depends on whether you have a later chronotype, where you go to bed later, or early chronotype, where it’s early to bed and early to rise.  The Centers for Disease Control and Prevention reported that insufficient sleep affects more than 25% of the U.S. population occasionally, and another 10% frequently. The study with these men also analyzed if there were health consequences of sleep restriction combined with circadian disruption.

sleep and skeletal
sleep and skeletal

This study was comparable to flying four time zones west every day for three weeks.  For three weeks, in a lab the subjects went to sleep each day for four hours later than the prior day making it a 28-hour day.  In a 24-hour period, the men were only allowed to sleep 5.6 hours. This part of the study was done to emulate people that work night shifts, otherwise known as shift work. At the beginning of the study, bloodwork was taken on each of the men and then again after the 3 weeks. The bloodwork measured bone biomarkers after sleep deprivation. During this 3-week study the men ate the same number of calories and nutrients. Out of the 10 men, 6 were between the ages of 20 to 27 and 4 were between 55 and 65.

There was limited funding, so the study couldn’t exam the serum from women; however, there are plans in the future to investigate sex differences to see if there is a sleep-bone relationship.

All the men in the study after three weeks had reduced levels of a bone formation marker compared to the beginning of the study. This reduction is called PINP. Additionally, the younger men had a greater decline. There was a 27% decline in the younger men versus 18% in the older. The study revealed old bone could break down without new bone being formed, while the levels of the bone resorption marker CTX did not change at all.

While bone growth and accrual are crucial for long-term skeleton health, this data is suggesting that sleep disruption earlier in life is detrimental to bone metabolism. There will need to be another study to see if there will be differences in the data with women.

Reference: https://www.eurekalert.org/pub_releases/2017-04/tes-psd033117.php

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Depression Linked to Diabetics Who Prefer Later Sleep-Wake Times

diabetes and sleep

New research finds that type 2 diabetics who prefer evening activities and consider themselves night owls are more likely to have symptoms of depression than early birds.  This is true regardless of sleep quality.  These findings will be presented at the 99th annual meeting of the Endocrine Society in Orlando, Florida this Saturday.

Lead author of the study and associate professor at Mahidol University Faculty of Medicine in Thailand, Dr. Sirimon Reutrakul, notes that this research is important because of the high prevalence of depression in type 2 diabetics.  Furthremore, Dr. Reutrakul reminds readers that prior studies have linked untreated depression to poor patient outcomes and compliance with treatment plans, putting them at greater risk of complications.

Past studies on the general public have shown that people with a later chronotype (those who prefer going to bed later and waking up later) were more likely to have symptoms of depression than those with an early chronotype.  Dr. Reutrakul and her team decided to look just at type 2 diabetics since they have such a high risk of depression.  The goal was to determine whether a later chronotype was directly associated with depression in patients with this chronic condition.

The researchers anticipated that chronotypes would differ depending on geographic location, with those near the equator preferring earlier activities; therefore, they studied two separate groups of diabetic patients in different geographical regions: Thailand and Chicago.

There were 194 patients in the Chicago group, with 70% of them being women.  There was a similar group in Thailand, which had 282 patients, 67% of which were women.  All respondents were asked to complete questionnaires about depression, preferred times of activity and sleep, and sleep quality.  Those in the Chicago group completed the surveys between February and April.  Those in Thailand, however, answered questionnaires throughout the entire year to determine if there were any seasonal variations.

In both groups, however, more depression symptoms were reported by those who preferred later activities and sleep than by those who were early to bed and early to rise.  This finding was true even after researchers adjusted for age, sex, sleep quality, and other factors that could contribute to depression.

Dr. Reutrakul notes that findings indicate there is a link between cognitive or psychological functioning and the circadian rhythm of those with type 2 diabetes.  She did note, however, that there is no evidence of cause and effect, so the association is only modest.

She stated that additional research is necessary to explore different combinations of interventions that may help modify or synchronize the biological clock, such as melatonin and light therapy.  Understanding the relationship between the biological clock and depression symptoms presents an opportunity for discovering different treatment strategies that would improve the mental and physical health of diabetes patients.

 Reference:  https://www.eurekalert.org/pub_releases/2017-04/tes-lst033117.php

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Better Sleep from an Ancient Herb?

Herbal Remedies for Sleep

With millions of people reporting sleep problems, the Sleep Institute of Japan performed research on alternative herbal remedies that have been known to help with sleep.  They found that there is a specific component in Ashwagandha herb leaves that induces sleep.

What is Ashwagandha?

Ashwagandha (Withania somnifera) is a heavily researched ancient Indian herb that is central to the field of Ayurvedic medicine.  Ayurveda is a Traditional Indian system of medicine, which has been used for thousands of years.  Its primary focus is on balancing the body’s systems using herbs, diet, and yogic techniques.

As indicated by the Latin name, somnifera, the herb is specifically designed to induce sleep and has been used for centuries to treat insomnia and other sleep disorders.  Several medical studies validate the sleep-inducing effects of Ashwagandha, but the active component that is responsible for this action is widely unknown.

The research team out of the University of Tsukuba’s International Institute for Integrative Sleep Medicine was led by Drs. Mahesh K. Kaushik and Yoshihiro Urade.  The team investigated the properties of the different components in Ashwagandha by recording brain activity and waves during sleep, using electroencephalogram (EEG) and electromyography (EMG) to measure the brain’s activity.

How does Ashwagandha help sleep?

The water component of the leaf contained triethylene glycol (TEG), which changed rapid eye movement sleep, as well as increased the restorative sleep stages, or non-rapid eye movement sleep.  The alcohol extract from the leaves contained withanolides, which did not improve or change sleep in any way.  TEG sleep showed the same patterns as a normal night’s sleep.  The TEG products available for commercial use were shown to increase non-REM sleep and add more restorative time to those stages.  This led researchers to conclude that TEG is the Ashwagandha leaf’s active component responsible for helping with sleep.

sleep research

Other sleep disorders might benefit from this herb

Sleep disorders like restless leg syndrome and insomnia are prevalent in most cultures, especially in the middle-aged population.  An estimated 10-15% of the world’s population suffer from insomnia, with 30-60% of those people being elderly.  Insomnia is directly linked to health problems like heart disease, obesity, diabetes, depression, mania, and anxiety.

Conventional medicine dictates pharmaceuticals will treat insomnia and other sleep disorders; however, those medications are accompanied by sometimes severe side effects and risk of adverse reactions.  Ashwagandha, however, is a crude powder made from a leaf. This herb can be consumed safely every day to help with sleep, and there are no known side effects associated with the herb.  Researchers believe this will revolutionize the field of sleep disorder treatment using natural plant-based therapies.

It is noted in this study, however, that this research is still in its infant stages and not yet mature enough to confidently recommend to patients and providers.  Further research will focus on the clinical application of TEG to assist with sleep disorders.  Primarily, researchers want to determine the safety of TEG and whether there are any possible toxicities to biological processes, as TEG is primarily used for industrial purposes.

Authors of this research are considering the effects of TEG on stress, since Ashwagandha has been used for treatment of anxiety and depression for thousands of years, leading them to believe that this plant may rebalance certain aspects of the nervous system.  Further studies will include identifying the area of the brain most affected by TEG and determining what exactly it is doing to induce sleep.

Reference:  https://www.eurekalert.org/pub_releases/2017-03/uot-sht033017.php

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

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Impaired Ability to Recognize Facial Expressions is Linked to Sleep Deprivation

sleepy face

A study out of the University of Arizona Psychology Department found that a rough night’s sleep may impair your ability to read the room when it comes to facial expressions.

Published in Neurobiology of Sleep and Circadian Rhythms, the research reported that participants who were sleep deprived had a harder time recognizing happy and sad facial expressions than those who were well rested.

However, it is notable that sleep-deprived participants did not show any impairment in recognizing other emotional facial expressions like anger, surprise, fear, and disgust.  That may be because those expressions and emotions are more primitive, and they are wired differently in our brains to help us survive dangers.

Research was led by the UA professor of psychology, psychiatry, and medical imaging, Dr. William D.S. Killgore.

Social emotions like sadness and happiness do not indicate threat like anger and fear do, so they are emotions that are not as necessary for immediate survival.  When we are sleep deprived, we are more likely to dedicate all resources to recognizing only things that put us in immediate danger.

Dr. Killgore notes that even when you are sleep deprived, you should still be able to identify when someone is trying to harm you.  In that kind of situation, being able to read whether someone is happy or sad is not that important, so social emotions are put on the backburner when your body is trying to fight the effects of exhaustion.

Dr. Killgore collected data from previous research that focused on how sleep deprivation affects emotional, social, and moral judgements.

Fifty-four people were analyzed in this study.  They each were shown a photograph of the same man’s face expressing different degrees of emotions like sadness, anger, fear, happiness, disgust, and surprise.  The participants then had to determine which of those emotions was being expressed on the man’s face.

The images were intentionally somewhat ambiguous, using commonly confused expressions that were morphed and modified by a computer program.  For example, one expression may have shown 30% surprise and 70% sadness.  This was done to analyze the participants’ ability to recognize more subtle expressions.  A total of 180 images of blended facial expressions were shown in each session.

The baseline response to the photographs when well-rested were compared to their responses after one night of sleep deprivation.

The more obvious facial expressions, like a frown or grin, could be identified without any problem, regardless of how much sleep that person got the night before; however, tired participants had a tough time recognizing subtle expressions of sadness and happiness, even though their ability to identify other emotions was not impaired.

After a good night’s sleep, the participants had no problems recognizing those sad and happy expressions, immediately returning to baseline level after recovery sleep.

The difference between the two was not as significant as some might hope; however, it is enough evidence to suggest that long-term sleep deprivation could have a significant effect on social interactions.

Dr. Killgore notes that in this society, most people are not able to get the recommended seven to eight hours of sleep each night, with the average being less than six hours of sleep.  This could impair the ability to read common emotions and, therefore, interfere with daily interactions.  For instance, you may respond inappropriately to a person who is sad because you thought they were angry.  Social emotions are uniquely human, so not being able to identify those in other people could lead to some serious complications in everyday life.  You would be unable to read what your spouse or partner needs from you as well.

This research was built onto the existing work focused on how sleep deprivation affects the brain’s prefrontal cortex, which is responsible for making decisions, judgements, and using emotions.

An earlier study from Harvard found that sleep deprivation causes a disconnect between the prefrontal cortex and the amygdala, which is the part of the brain that helps you respond to emotions.

Essentially, these two parts of the brain control emotions and help us recognize those expressions on others, and sleep deprivation causes them to lose their communication.  The point of this study was to test that theory from the Harvard study, and Dr. Killgore is confident that it does.

Reference:  https://www.eurekalert.org/pub_releases/2017-03/uoa-sdi032317.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development.

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Sound Waves Help Older Adults Achieve Deep Sleep

sound waves deep sleep

Deep sleep is important for memory consolidation, yet, as human beings enter into middle age, the quantity of deep (or slow wave) sleep they achieve is known to decrease significantly. Researchers believe that this reduction in slow wave sleep is one of the causes of memory loss when we age, and neuroscientists are constantly researching new methods to enable people to achieve better quality sleep in their older years.

 A recent study, published by scientists at Northwestern University (March, 2017) has shown that a promising new way to achieve deep sleep in older adults, is gentle sound stimulation (such as the sound of waves or water flowing), synchronized to the rhythm of brain waves. The study showed that elderly adults who relied on this technology, not only achieved more deep sleep but were also able to recall more words. Previous research had shown that acoustic stimulation methods worked well with young adults in terms of increasing the quantity of deep sleep but the new study is the first of its kind to be carried out on older adults.

In the study, 13 participants between the ages of 60 and 84 received acoustic stimulation on one night, and placebo stimulation on another night. On both occasions, participants took a memory test before sleeping, and again in the morning. Those who received the placebo stimulation showed better results in the morning than they had at night time, but those who received ‘pink-noise stimulation’ using a specific algorithm, saw three times as much improvement in their test results. Memory improved in accordance with the degree of slow wave sleep stimulation provided, indicating that deep sleep is indeed important for memory retention, even for older people.

The secret of pink noise stimulation lies in the algorithm developed by one of the study authors, Giovanni Santostasi, a specialist in Neuroscience, Biotechnology and Biostatistics. This algorithm is both automated and adaptive, capable of monitoring slow wave activity in the EEG, and phase-locking the timing of the pink noise stimulation to one particular phase of the slow wave. The algorithm adapts to each individual, given that each person achieves deep sleep at a different time.

Achieving deep sleep is as vital as keeping our circadian rhythms in sync. Failing to respect the natural sleep-wake cycle can lead to everything from problems with learning to sleep disturbance and mood changes, while deep sleep is crucial for hormone regulation and physical renewal. The lead authors of the study noted that although larger studies would be necessary to confirm the efficiency of pink noise stimulation in older adults, the technology could eventually be offered to people for home use. They are currently conducting research into whether or not acoustic stimulation can improve cognitive functioning in adults with mild cognitive impairment. Previous studies carried out in these individuals showed that there is a possible relationship between quality of sleep and memory impairment.

The study authors also stated that more research would be required to elicit the effects of repeated nights of pink noise stimulation on the brain physiology and memory. The positive results achieved thus far, they noted, could indicate that the elderly population (particularly those with a high risk for cognitive decline, such as the elderly and those with cardiovascular disease) could benefit greatly form this relatively simple intervention. Future studies would therefore need to focus on repeated use at home, potentially over various weeks, as a means of improving memory in high-risk groups.

Some of the areas most affected by cognitive decline in the elderly include memory, processing speed and executive function. Elderly adults often complain that they cannot recall specific facts or episodes; this type of decline is related to age-related dementia. The researchers noted that cognitive decline is often attributed to failures in encoding and/or retrieval of information, yet consolidation also plays a vital role in optimal cognitive functioning.

Further Reading

Recovery.org, What Role does Your Biological Clock Play in Recovery?, accessed March, 2017.

Acoustic Enhancement of Sleep Slow Oscillations and Concomitant Memory Improvement in Older Adults, accessed March, 2017.

 How the Brain Consolidates Memory During Deep Sleep, accessed March, 2017.

Researchgate.net, Longitudinal invariance of adult psychometric ability factor structures across 7 years, accessed March, 2017.

Mayoclinic.com, Mild Cognitive Impairment, accessed March, 2017.

Guest Author: Anne James is a freelance writer. She previously held a management role in healthcare.

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Sleep Apnea in Children Could Lead to Changes in Mood and Cognition

A new study from the University of Chicago compared children between 7 and 11 years old with sleep apnea to children who slept normally.  Findings showed that there were significant decreases in gray matter in various regions in the brains of the sleep apnea children.  Gray matter is responsible for memory, emotions, perception, speech, movement, self-control, and decision-making.

Sleep apnea affects approximately 5% of children in the world, so these findings point to a connection between delayed growth of the developing brain and sleep disturbances.  The noticeable and proven gray matter reduction in children with sleep apnea – a treatable disorder – adds another reason for parents to consider getting early treatments for their child if there are symptoms of sleep apnea.

Director of pediatric clinical sleep research out of UC, Dr. Leila Kheirandish-Gozal, notes that these findings are astonishing.  There is no precise guide to link cognitive deficits with gray matter loss; however, evidence shows a widespread problem of neuronal damage and loss when compared to children of the same age without any conditions.

These findings were published in Scientific Reports on March 17.  Researchers analyzed 16 children with a diagnosis of obstructive sleep apnea (OSA).  The children stayed overnight in UC’s pediatric sleep laboratory to have their sleep patterns analyzed throughout the night.  Additionally, all children underwent brain scans, MRI, and neuro-cognitive testing.  Scientists from the University of California in Los Angeles analyzed the images.

Those analyses were compared to the MRI and neuro-cognitive tests from nine healthy children from the general population that matched the gender, age, weight, and ethnicity of the children with sleep apnea.  The results for the 16 OSA children were also compared to 191 MRI’s of children who were already part of an MRI database in the National Institutes of Health.

The gray matter in brains of the OSA children was significantly reduced in several regions.  These regions included the prefrontal cortices (responsible for planning, personality, and complex behavior), the frontal cortices (movement, memory, judgement, language, problem solving, and impulse control), the parietal cortices (integration of sensory input), the temporal lobes (selective listening and hearing), and the brainstem (control of respiratory and heart functions).

The consequences of reduced gray matter may be obvious on the scans and comparisons, but the true effects are difficult to measure.

Co-author of the study, Dr. David Gozal from UC, notes that while the MRI scans provide a good amount of information regarding the difference in volume levels within the brain of apnea patients, it is still unclear how and when the neurons are affected at a cellular level.  MRI scans are not designed to determine the size, movement, and presence of brain cells.  From the MRI, there is no way for scientists to determine when the damage and loss occurred.  However, prior studies from this same group connected the cognitive deficits with disease severity, when the deficits can be detected.

Future collaborative studies with UCLA are underway, which will use state-of-the-art technology and imaging techniques to attempt to answer the questions raised in this study.  Without further research and cognitive function tests before the onset of OSA, there is no way to measure how neuron loss affects functioning.

As an example, someone who is born with an IQ of 180 may lose 8 to 10 points on that scale because of sleep apnea; however, that may never be apparent.  If the child’s IQ is average (between 90 and 100) and they sustain that drop in IQ because of sleep apnea, that could place them below the national normal average.

It may be too soon to measure to effects in children of this age group.  Studies that connected higher intelligence with increased gray matter are well-documented, but only in adolescents that are an average age of 15.4 years.

The potential to reverse the effects of gray matter reductions are essentially undiscovered; however, it is likely that decreased gray matter in so many areas of the brain interferes with brain functioning and will put the child at risk of developmental delays.  This should prompt detailed research to determine the best ways to prevent severe cognitive delays in children.

 Reference:  https://www.eurekalert.org/pub_releases/2017-03/uocm-usa031517.php

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

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Bright Light Therapy for Patients with Parkinson’s and Sleep Disorders

light bulb

Bright Light Therapy for Patients with Parkinson’s and Sleep Disorders

 Bright light therapy is a treatment that has been used in patients with disruptions in their circadian rhythms.  This is the internal biological clock that tells the brain and body when it should be awake and when it should sleep.  There are several factors that could disrupt this rhythm, including chronic disease, travel, stress, and light pollution.

Recent studies published in Psychogeriatrics and JAMA Neurology have found that bright light therapy (BLT) may be helpful in some debilitating chronic diseases like dementia, Alzheimer’s, and Parkinson’s disease, which are notorious for negatively affecting sleep patterns in sufferers.

For the most part, hypnotic drugs are used to help with sleep, but side effects can be extremely troublesome for patients who are already cognitively and neurologically compromised.  Dementia and Parkinson’s patients react badly to sleep drugs because of the daytime sleepiness, amnesia, and additional fall risks.

Therefore, bright light therapy was trialed first in Alzheimer’s and dementia patients, and then in Parkinson’s patients.

Daytime administration of BLT was helpful for dementia patients because it retrained the circadian rhythm to override the disturbances; however, as with all studies, researchers noted some limitations and issues.

They did not adjust findings to types or grades of dementia, and there is no set protocol for BLT administration yet.  In the study of dementia and Alzheimer’s patients, 17 participants were given BLT for one hour a day in the morning for a total of two weeks.  Four of the 17 patients showed marked improvement in their sleep quality, all of whom had Alzheimer’s type dementia.  These patients were still in earlier stages of the disease.  This indicates that BLT could be an effective preventive measure for Alzheimer’s patients, depending on type and grade.

Parkinson’s disease patients have limited options to treat their sleep problems as well.  As noted in the study published in JAMA Neurology from Northwestern and Rush Universities, bright light therapy showed significant improvement in daytime sleepiness for these patients, per results on the Epworth Sleepiness Scale; however, dim-red light therapy also showed some improvements in sleep quality.

A total of 31 patients participated in this Parkinson’s study, which was randomized and placebo-controlled. Patients were split into two groups: one group received bright light therapy and the other received dim-red light therapy for one hour a day over the course of two weeks.

Patients who received BLT reported improvement in sleep metrics like reduced number of nighttime awakenings and the ability to fall asleep faster.  Both forms of light therapy showed increases in physical activity.

Light therapy is a non-invasive or pharmaceutical intervention that is well-tolerated.  It may prove to be a good intervention for chronic disease patients with disrupted sleep-wake cycles.  As with all scientific findings, further research with larger and more diverse patient populations would be beneficial in determining the efficacy of bright light therapy for sleep disturbance.

 References:

https://www.ncbi.nlm.nih.gov/pubmed/28127845

https://www.ncbi.nlm.nih.gov/pubmed/28241159

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

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