Veterans Continue to Suffer with Sleep Disorders

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New research has indicated a six-fold increase in the prevalence of a sleep disorder in U.S. veterans over an 11-year period.  Researchers noted that the highest increases in sleep disorder diagnoses were happening in patients with combat experience, posttraumatic stress disorder (PTSD), or other mental health condition.  Further, PTSD occurrences and prevalence tripled throughout the duration of the study.

A sample of more than 9.7 million U.S. military veterans was used in this study, with the age-adjusted prevalence of sleep disorders increasing to almost 6% in 2010 from 1% in 2000.  The most common diagnosed sleep disorder among the veterans was sleep apnea, including about 47% of individuals.  The second most common condition was insomnia, affecting about 26% of participants.  Those with previous or current diagnoses of chronic diseases such as cancer and cardiovascular disease were at higher risk of developing a sleep disorder when compared to those without comorbid conditions.

These results have been reviewed and published in the journal, Sleep.

The study was led by Principal Investigator and senior author, Dr. James Burch, PhD, who is an associate professor in Epidemiology and Biostatistics in the Arnold School of Public Health at the University of South Carolina.  Dr. Burch also stands as a Health Science Specialist in Columbia, South Carolina at the WJB Dorn Department of Veterans Affairs Medical Center.  He notes that PTSD-diagnosed veterans are at much higher risk of developing sleep disorders compared to others with various health conditions or other population characteristics that were examined.

This does not mean that PTSD causes sleep disorders, Burch notes, as the study was not designed to look that far into PTSD related to sleep disorders.  However, while this does not prove PTSD leads to the diagnoses, researchers did perform a follow-up study that is nearly ready for publication, which examines the issue in further detail.  This follow-up study identifies a pre-existing history of PTSD linked to increased risk of developing sleep disorder onset.

Sleep apnea is a form of sleep disordered breathing, which is characterized by symptoms of abnormal respirations during sleep, as defined by the American Academy of Sleep Medicine. Obstructive sleep apnea is what we hear most about in sleep medicine, which is a syndrome that features symptoms that obstruct the airway during sleep, including frequent starts and stops in breathing.  It is a repetitive partial or complete closure of the upper airways.

The American Academy of Sleep Medicine characterizes insomnia as regular and persistent problems falling and staying asleep throughout the night, which frequently leads to poor sleep quality, fatigue, daytime impairment, and irritability.

This above study was focused solely on U.S. veterans who sought treatment at the Veterans Health Administration between the years 2000 and 2010, with a sample total of 9,786,778, most of which consisted of men (93%), and over 751,000 had at least one sleep disorder diagnosed.

Researchers note that the trajectory of diagnoses observed here shows that the trend is likely to continue, and the results emphasize the importance of further research and the need for management of sleep disorders among veterans.

 Reference:  http://www.eurekalert.org/pub_releases/2016-07/aaos-pod071516.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.

 

Earlier Bedtimes in Children may Reduce Obesity Risk

obesity and sleep

New research has determined that preschool aged children who regularly go to bed by 8 p.m. are less likely to become obese in teenage years than children with later bedtimes.  According to the study out of the Ohio State University College of Public Health, children who went to bed after 9 p.m. were at twice the risk of obesity later in life.

 

Dr. Sarah Anderson, lead author of the study and Associate Professor of Epidemiology reminds parents that this reinforces the importance of establishing a healthy bedtime routine.  Further, it helps pediatricians provide evidence-based advice to parents in the clinical setting.

 

This can significantly lower children’s risk of developing diabetes, with a variety of positive benefits on social, emotional, cognitive, and behavioral development, Dr. Anderson states.

 

Childhood obesity is a big problem in the United States.  According to the latest figures from the Centers for Disease Control and Prevention (CDC), about 17% (over 12 million) children and teens are affected.  Obesity is a dangerous problem that can set children up for health and social struggles, including problems like heart disease, diabetes, and depression.

 

Published in The Journal of Pediatrics, this research focused on data from 977 children in the Study of Early Child Care and Youth Development.  The research closely followed babies born in 10 U.S. cities in 1991.

 

The preschool children were divided into three categories:  Those who went to bed at 8 p.m. or earlier, those between 8 p.m. and 9 p.m., and those who were put to bed after 9 p.m.  The average age was 4-1/2 years when mothers began reporting their weekday bedtime activities.

 

The children were followed to an average age of 15, with bedtimes reviewed very closely to determine which teens were more prone to obesity.  There was a striking difference.  Only 1 out of 10 children in the earlier bedtime (8 p.m. or earlier) were obese in their teen years.  Comparatively 16% of the children with bedtimes between 8 and 9 p.m. and 23% of children with bedtimes after 9 p.m. were reported to be obese as a teenager.  About half the kids who were part of the study fell into the middle category of bedtimes.  One quarter had earlier and one quarter had the later bedtime.

 

Videoed interactions between mothers and children were also reviewed, because emotional climate at home can have an influence on bedtime routines.  This measurement was referred to as “maternal sensitivity,” which looks at the mother’s respect for the child’s autonomy, hostility levels, and maternal support.

 

The maternal-child relationship did not strongly impact the findings.  There was still a strong association between obesity and bedtimes.  However, it is notable that the children who went to bed later and whose mother had the lowest sensitivity ratings were at highest risk for obesity.

 

Further, it was noted that children who went to bed later were of non-white ethnicity, lived in low-income households, and their mothers received less education.

 

Research in the past has positively linked a relationship between obesity and short sleep durations.  One study associated later bedtimes with a five-year risk of obesity.  This new study is the first to use information collected 10 years after preschool.

 

This team has performed a number of sleep-related studies, with prior research illustrating the importance of routines for young children, which was used to help build this current study.  Dr. Anderson and her colleagues focused on bedtimes for this study because they have more influence on sleep duration than wake times, over which parents have very little control.

 

It is no guarantee that putting a child to bed earlier will mean they will fall into deep sleep right away; however, a consistent bedtime routine makes it more likely that the children will get plenty of sleep to perform to their highest potential during the day.

 

Pediatricians are now in a position to talk to parents about earlier bedtimes for their young children in order to help prevent obesity risk.  This evidence-based research will also help pediatricians assist parents in overcoming obstacles they may be facing with their children, which may be related to their sleep duration and quality.

 

Earlier bedtimes may be more challenging for some families than others, especially when parents work later.  There are competing demands and compromises that are constantly made in the home setting, which need to be considered when the pediatricians go to discuss the earlier bedtimes.  Most children, however, are biologically programed to be ready for sleep before 9 p.m., so it may not be as difficult as some parents may feel in the beginning.

 

The researchers noted in their published findings that while this study helps identify a link to bedtimes and obesity, it does not answer the questions about how bedtime can influence other factors of weight gain like nutrition, physical activity, and social environment, all of which remain active areas of research.

 

Reference: http://www.eurekalert.org/pub_releases/2016-07/osu-epb071116.php

 

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.

 

Mirroring Neurotechnology to Help Athletes with Concussion

exercise and sleep

After using HIRREM® neurotechnology, Brain State Technologies has reported that young athletes who suffered from symptoms of concussion are showing a number of long-term improvements.  After three months of therapy, the small group of athletes reported continued symptom reduction, with all of them returning to full activities and exercise.  These findings were presented in Chicago at the American Academy of Neurology Sports Concussion Conference this month.

 

Symptoms of sports- or recreation-related concussions include sleep disturbance, nausea, cognitive impairments, headaches, depression, and other health concerns.  Most athletes who get a concussion will recover within a few days; however, about 10% will go on to develop long-term symptoms, which can last for weeks, months, or even years.  In this study using neurotechnology, 19 people participated in the study, and each had symptoms for an average of five and a half months before using HIRREM®.

 

High-resolution, relational, resonance-based, electroencephalic mirroring (HIRREM®) is a noninvasive procedure using computer technology developed by the CEO of Brain State Technologies, Lee Gerdes, whose background also includes software engineering in Silicon Valley.  Using algorithms built into the software, brain wave frequencies are translated into audible tones, which are then returned to the person in real-time.  The intention is to support self-optimization of electrical activity patterns within the brain.

 

Most of the athletes who were part of the study went right back to participating in their chosen sport.  There were changes noted in the variability of their heart rate, which suggests that their heart could make more rapid adjustments and adapt better to pumping functions.  A portion of the participants underwent reaction testing both before and after HIRREM®, which showed even greater improvements, with better reaction times.

 

Co-investigator in the study and Director of Research at Brain State Technologies, Dr. Sung Lee, reminded the group at the presentation that concussion presents unique challenges not only to the brain, but to the rest of the body as well, because the brain is the central command station.  It was exciting to the researchers that the athletes were not only self-reporting improvements, but that there were objective measures to show better reaction times and heart rate variability, leading them to be able to participate in sports again.

 

Estimates show that about 190,000 people in the United States develop persistent sports- or recreation-related concussion symptoms every year.  The guidelines in the sports medicine industry state that athletes’ return to competitive play cannot be based on the use of drugs that will mask underlying symptoms that would otherwise prevent the individual from participating.  Not only would that put them at risk of developing further symptoms and ending their career, but the symptoms may actually be severe enough to prevent them from participating in non-athletic activities.

 

There has been a recent increase in concerns about the potential long-term effects of concussion symptoms in athletes, which is partially due to the recognition of CTE, or chronic traumatic encephalopathy, which has been reported in National Football League (NFL) players that were exposed to repeated head injuries and hard impact.

 

HIRREM® has created a “closed loop” of information exchange in clinical studies, which has been linked to improved sleep quality, reduced posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) symptoms, and better symmetry in electrical brain activity, along with other objective health benefits.

 

Reference: http://www.eurekalert.org/pub_releases/2016-07/bstl-awc071316.php

 

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.

Psychological Disorders Related to Sexual Behavior in Sleep

bed in bedroom 001 (3)

New research out of Edinburgh has found that sexual behavior in sleep (SBS) may be linked to underlying psychological and psychiatric conditions that are rooted all the way back to childhood.

The findings were presented in Edinburgh this month at the Federation of European Neuroscience Societies (FENS) Forum.  Researchers presented the likely case that SBS actually originates from childhood sleep disturbances and may be linked to more serious underlying mental health disorders.

While some people may find SBS comical in nature, others find it disconcerting and too intimate to discuss.  In any case, most sufferers and their partners find it embarrassing and exceedingly difficult to live with.  The case for SBS has been used as part of a defense in some sexual assault cases as well.

Sexual behavior in sleep, or sexsomnia as it is sometimes called, is considered a parasomnia, which describes abnormal behaviors in the autonomic nervous system during sleep.  This includes things like sleep talking, night terrors, and sleep walking.

SBS is a parasomnia characterized by the act of engaging in sexual activity during sleep, but not remembering the act upon waking.  These types behaviors can be inappropriate and out of character for that individual such as fondling, vocalizations, intercourse, and masturbation.  These actions by the sufferer are uncontrollable and can sometimes be violent.

In the past, studies and research have been focused primarily on individual case studies, forensic psychology, and expert opinions.  The research team at the University of Edinburgh have tried to take a broader view.  They examined three women and 20 men who were referred to one of the most widely known and prestigious sleep centers in the United Kingdom.

Led by Drs. Renata Riha and Ian Morrison out of the University of Edinburgh, the research panel consisted of scientists in the fields of psychiatry, psychology, sleep medicine, neurology, and law from various universities throughout Scotland. The study is part of a larger program that is investigating psychological and psychiatric causes of sleep behaviors that have been otherwise unexplained.

One of the authors of the study, Ms. Emmalee Maschauer, told delegates at the forum that this study stands out because some of the features of SBS that have not been identified previously have been targeted in this analysis.  These components include childhood onset, possible links to underlying psychiatric disorders like anxiety and post-traumatic stress disorder (PTSD), and the variable ability to recall the behaviors.  Researchers believe these are some of the more important components of the condition, especially in forensic cases, because it may influence not only treatment options for sufferers, but even the outcome of some criminal trials.

Reference:  https://www.bna.org.uk/news/view.php?permalink=AXC0YOCU5V

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.

4 Ways to Teach Your Mind to Sleep

sleep better

There can be a large mental component that prevents people from sleeping well. This may manifest as a racing mind that prevents you from falling asleep at night. It might mean you wake up multiple times per night with no real cause.

There are ways you can teach your mind to sleep deeper and to fall asleep faster. Some of these techniques are solid and have been proven with countless scientific studies, while others are on the cutting edge and more research needs to be done to reach a definitive conclusion. This article should give you a good basis on how to begin teaching your mind to sleep better.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral techniques have their roots in stoic philosophy. You can think of CBT as using your mind to critically think about how you are thinking, and then to actively begin thinking differently. Your brain is built to recognize and create patterns which is why CBT can be so powerful. Sleep itself is just another pattern that can be affected by the mind.

In this randomized, placebo-controlled clinical trial, at a single academic medical center, CBT was tested along with traditional pharmacological approaches for insomnia. 78 older adults participated to see how best to treat their insomnia, both short and long term.

They found that CBT alone could reduce the time spent awake by as much as 55%. When combined with some pharmaceuticals the effectiveness was boosted to 63%.

Here is the kicker: Those that underwent cognitive behavioral training continued to sleep better into the future. The group that only took sleep inducing drugs lost the sleep benefits as soon as they stopped taking the medication.

“Subjects treated with behavior therapy sustained their clinical gains at follow-up, whereas those treated with drug therapy alone did not.” – Charles M. Morin, PhD; et al.

Autogenic Training

Dr. Shultz was a german psychiatrist that developed autogenic training (AT) in the 1930’s. It is a mind-body technique that allows you to relax much more deeply than you typically are able to throughout the day.

Autogenic training has many things in common with self-hypnosis. It can produce physical phenomenon, it can become self-guided, and can put the mind in a meditative state.

In this cohort analysis study made by the Royal London Hospital for Integrated Medicine and University College London Hospitals, autogenic training was shown to positively impact insomnia.

There were 153 participants, of whom 73% were identified as having a sleep-related problem. The study showed improvements in sleep onset latency (how fast you fall asleep), falling asleep more quickly after waking up, feeling more refreshed, and feeling more energized after waking up. There were positive emotional benefits too, as well being, anxiety, and depression scores all significantly improved after a course in autogenic training.

This quote from the article sums it up nicely:

“This study suggests that [autogenic training] may improve sleep patterns for patients with various health conditions and reduce anxiety and depression, both of which may result from and cause insomnia. Improvements in sleep patterns occurred despite, or possibly due to, not focusing on sleep during training. [Autogenic training] may provide an approach to insomnia that could be incorporated into primary care.” – Bowden A, Royal London Hospital for Integrated Medicine

Hypnosis and Hypnotherapy

Although the root word of hypnosis is “hypnos” the greek word for sleep, modern hypnotherapy does not involve a person becoming unconscious. Hypnosis works by bringing about a self-directed altered state, often called a hypnotic trance, which leaves a person more susceptible to beneficial instructions.

Rather than being magic, hypnosis could more properly be described as an enhanced state of learning. You can learn new habits and new beliefs much faster in a hypnotic state. The current field of hypnosis is intertwined with the latest in practical neuroscience and it is evolving as we learn more about how the brain works.

Hypnotic relaxation techniques have been shown to improve sleep. In this multifaceted program for treatment of insomnia in adolescents, hypnosis was used in conjunction with progressive muscle relaxation and CBT to improve sleep in the study participants. More than that, progressive muscle relaxation is also a very common procedure used to induce hypnotic trance.

This describes the process of the study:

“Each treatment session starts with a short warm-up game and ends with the rehearsal of an imaginative or hypnotherapeutic procedure (trance). Participants are asked to practice these trances between the sessions.”

“The adolescents showed a significantly shorter sleep onset latency after the treatment. Furthermore, total sleep time as well as sleep efficiency were significantly higher after the treatment although going to bed earlier is unpopular with adolescents…. The adolescents not only gained more knowledge about sleep and sleep hygiene but also more skills to resolve their sleep problems by applying behavioral as well as hypnotherapeutic strategies.” – Angelika A Schlarb, Department of Psychology, University of Tuebingen.

Another study that researched the efficacy of hypnosis in the treatment of insomnia had this to say:

“Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions.” – Ng BY, Department of Psychiatry, Singapore General Hospital

Although it was quick to add why there is not much data on this powerful technique:

“It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.”

Hypnosis has been shown time and again to be effective for things like reducing anxiety, pain, and even the side effects of chemotherapy. It’s no wonder that it is starting to show how powerful a tool it can be for sleep.

Mindfulness Meditation

Meditation is another useful tool that can help improve the quality of your sleep. As a psychological technique, mindfulness meditation allows a person to reflect on their true thoughts and to begin to slow their racing mind.

Mindfulness Based Stress Reduction (MBSR) techniques have become in vogue recently as more studies have come out demonstrating how effective they can be for increasing emotional well being. Recent research has shown that a regular practice of meditation can actually change the structure of the brain itself, increasing areas associated with emotional control, and shrinking areas linked to stress and worry.

This quote from a meta analysis of 38 articles studying mindfulness helps to identify MBSR as a useful tool for insomnia:
“There is some evidence to suggest that increased practice of mindfulness techniques is associated with improved sleep and that MBSR participants experience a decrease in sleep-interfering cognitive processes (eg, worry). More research is needed using standardized sleep scales and methods, with particular attention to the importance of MBSR home practice.” – Winbush NY

Conclusion

People sometimes think that if you can’t sleep easily, the best thing to do is to reach for the medication. While medication can be helpful, it’s more apparent that psychological approaches are an effective front line tactic to help a person sleep.

It’s often time not one thing that helps a person rebuild their sleep pattern. It can be a combination of meditation, relaxation techniques, hypnosis, sleep hygiene, and CBT that finally allows a person to sleep better. If you have trouble sleeping you should find what works best for you by trying many different approaches.

ABOUT THE AUTHOR:

Benjamin Schoeffler, Ch,t. is a board certified medical hypnotist with the IMDHA. He has a private practice in Boise, ID at Thrive Hypnotherapy and an online sleep hypnosis program.

 

Night Terrors? Sleep Walking? Don’t Lose Sleep When Your Child Has These Common Sleep Complaints!

sleep night terror nightmare

What are parasomnias?

Parasomnias are common sleep disruptions that can occur when a child is falling asleep or waking up.   Parasomnias occur at the transition of deep sleep and consciousness where a child’s brain can be caught in between the two states, and explains why a child can appear awake but actually be sleeping.  This article will discuss examples of parasomnias including sleep talking (somniloquy), sleep walking (somnambulism), night terrors (pavor nocturnus), and confusional arousals.

Common features to all Parasomnias

Parasomnias are common in childhood and share many features.  They are generally harmless and most children outgrow them. A child may appear awake, but their brain is asleep and unaware of the event.  Unlike nightmares, a child will awaken unaffected and have no recollection of it the next day.  Other than sleep talking, most other parasomnias happen around the same time, usually within 4 hours of falling asleep. While parents may worry their child might have multiple events throughout the night, this isn’t the norm.

Categories of Parasomnias

To ease our understanding of how to approach these different conditions, we classify them into two distinct categories. The first category includes sleep talking (somniloquy) and confusional arousals, which are found to be innocent and generally do not require intervention. Sleep talking is a condition in which a child vocalizes during sleep.  Confusional arousals are characterized by a child waking up briefly.  He or she may have a slow reaction time, have trouble understanding questions, and act confused before returning to bed with no recollection of the event the next day.

Do you ever wonder if your child will wake up if you try moving them? Sleep talking is an easy way to determine how deeply your child is sleeping.  If your child is speaking clearly, they are in a lighter stage of sleep and more likely to wake up if disturbed.  Mumbling and incoherent speech indicate deeper sleep, during which your child is less likely to awaken.

The second category of parasomnia classification includes night terrors (pavor nocturnus) and sleepwalking (somnambulism), which are generally innocent, but in certain circumstances may require intervention. Night terrors are episodes that are named for their appearance rather than what a child is actually perceiving. If your child is having a night terror, he or she will appear panicked and exhibit behaviors such as screaming, sweating, breathing rapidly, and crying, when in fact he or she is actually asleep.  A common misunderstanding is that your child is having a nightmare, yet not experiencing anything that is actually frightening them and will have no recollection of the event once awakened in the morning.  Lastly, sleepwalking is commonly seen in school-aged children and is characterized by walking in a state of partial wakefulness.

Treatment options for Parasomnias

When observation is the only intervention:

Sleep talking and confusional arousals are harmless and require no intervention.

When observation is the preferred intervention:

When night terrors are infrequent (less than a few times a week) and brief (less than 20 minutes in duration), observation and reassurance are generally all that is needed.  Talking to or touching your child during a night terror can prolong the episode, but by letting it run its course, you can significantly shorten the event.

When sleepwalking is infrequent, we recommend gently guiding your child back to bed without waking him or her. While it is not dangerous to wake a sleepwalker, it is not necessary. If there are concerns the child may leave the house or use sharp objects, take simple safety precautions such as securing knives and installing wireless door chimes on exit doors.

When behavioral strategies are the preferred intervention:

When night terrors and sleepwalking are frequent, particularly for a sleepwalker who has already engaged in a dangerous behavior (e.g. leaving the home, engaging in aggressive acts during sleep) ,“planned night awakenings” can prevent parasomnias.  This involves waking a child briefly for 7 consecutive nights 30 minutes before the earliest possible event is likely to occur.  Other strategies include avoiding sleep deprivation, setting a regular bedtime routine, and following healthy sleep habits.

When to consult your physician:

In severe cases where behavioral interventions fail, short term treatment with medications may be available to help. If your child’s condition does not seem to respond to typical suggestions, or you are worried there might be another cause for your child’s sleep problems, consult your pediatrician.  In some cases, parasomnias have been linked to sleep apnea and your child’s doctor is the best source of information to determine if your child is at risk for this condition.


Authors: Cheryl Tierney, MD, MPH, Taylor Aves, Eugenia Gisin, Alexandra Lazzara, Megan Veglia

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.

President, ABA in PA INITIATIVE
Associate Professor of Pediatrics
Section Chief, Developmental Pediatrics, Penn State Hershey Children’s Hospital

Acupressure Helps with Fatigue and Sleep Quality of Cancer Survivors

acupressure and sleep

Women who have been treated for breast cancer often complain of lack of sleep and persistent fatigue, but a new study has found that acupressure helps to reduce that constant feeling of tiredness.

Breast cancer treatment comes with the unfortunate long-term symptom of fatigue, with approximately 1/3 of women experiencing moderate to severe symptoms for up to 10 years following their treatment.

Published in JAMA Oncology, this recent study reported that acupressure reduced excessive tiredness by 27% and 34% over a period of six weeks.  One of the healing methods used (relaxing acupressure), was used on 1/3 of the women studied, and 2/3 of them were able to reduce their fatigue and achieve more normal levels of tiredness.

The author of this study and associate professor of Family Medicine at the University of Michigan, Dr. Suzanna Zick, M.D., MPH, notes that fatigue is not often a focus of attention in chronic disease patients, especially those with cancer, even though it has a significant impact on quality of life.  The benefits of this study, Dr. Zick notes, is that acupressure is very easy to learn and can be done in the comfort of the patient’s home by themselves.

Acupressure comes from traditional Chinese medicine techniques, and it involves putting pressure on specific points on the body using the fingers, thumbs, or a special device.  Two types of acupressure were used in this study: stimulating acupressure, which increases energy, and relaxing acupressure, which is often used to treat insomnia.  The points that are stimulated on the body differentiate them.

The Michigan Tumor Registry was used to identify and consent 424 breast cancer survivors.  These participants were randomly placed into one of three groups: stimulating acupressure, relaxing acupressure, and usual care, which included the typical sleep-management techniques used with insomnia patients.  The women who were part of the acupressure groups were taught the location of their specific points, as well as how to stimulate those pressure points, so that they could easily do it at home for six weeks.

When the six weeks was up, both acupressure treatments showed sustained improvements in fatigue levels, but the relaxing acupressure participants reported improved sleep quality, decreased disruption in sleep, and overall higher quality of life.

There have been prior studies that showed evidence that acupuncture may help with fatigue symptoms; however, acupuncture is usually not covered by insurance and needs to be done by a professional once or twice a week for six weeks.

On the other hand, the types of acupressure done in this study are easy to do at home, without the need of office visits or out-of-pocket costs.

The participants in this study were given 15 minutes of education on the points to use and how to stimulate them, and all were able to accurately locate and apply the appropriate amount of pressure by the end of the training.  Of note, some women reported mild bruising at pressure sites.  Approximately 12% of participants self-discontinued due to the process being too time-consuming.

This intervention could be considered one of the easiest low-cost treatment options for patients with fatigue and insomnia, Dr. Zick reports.

In addition to publishing their findings, the researchers are working on creating a mobile application that will teach acupressure.  They will put further time into investigating why acupressure helps with fatigue and sleep, and they will determine whether it would be effective for those who are undergoing active cancer treatments and treatments for other types of cancers.

Reference:  http://www.eurekalert.org/pub_releases/2016-07/uomh-arf070616.php

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.

Low Quality Sleep Can Lead to Inflammation

human cells

The journal, Biological Psychiatry, has published a new meta-analysis study that shows inflammatory markers present in those with long sleep duration and sleep disturbance complaints.

Dr. John Krystal, Editor of the journal, emphasized the importance of the analysis, which highlighted the fact that both too little and too much sleep has been linked to inflammation, which is one of the many processes that often contributes to depressive symptoms and other health concerns.

The Centers for Disease Control and Prevention (CDC) has long since warned the public that sleep deprivation is a big problem that is sweeping the nation.  The most common sleep disorders, like insomnia, have been found in previous studies to be linked to increased mortality rates and risk of developing an inflammatory disease.

Some chemicals or substances in the body will point to an inflammatory process, including interleukin-6 (IL-6) and C-reactive protein (CRP).  In addition to identifying inflammation, these substances can predict health problems like hypertension, type 2 diabetes, and other cardiovascular concerns.  While there have been dozens of studies to investigate the mechanisms that link immunity and sleep health, they are incredibly varied, making it difficult to understand the true effects.

What was needed was a systematic review of existing studies to find the commonalities between inflammatory markers and sleep.  This recent article by Richard Olmstead, Judith Carroll, and Michael Irwin from the Cousins Center for Psychoneuroimmunology at UCLA Semel Institute for Neuroscience, did just that.  The scientists analyzed 72 published articles, which included more than 50,000 individuals from clinical and population-based studies.  IL-6, CRP, and tumor necrosis factor alpha were used as the primary inflammatory indicators.

Those individuals who were defined as having a normal sleep duration got between seven and eight hours of sleep each night.  It was noted in this meta-analysis that CRP and IL-6 levels were increased in those who had longer than eight hours of sleep each night and sleep disturbance, which is defined as poor quality sleep or complaints of insomnia.  Additionally, CRP levels were increased in those who reported less than seven hours of sleep each night.  There were no links to an increase in tumor necrosis factor alpha.

Mr. Irwin, one of the authors of the report, says that insomnia or other sleep disturbances need to be viewed as a risk factor for inflammation, similar to the negative effects of a sedentary lifestyle or a high-fat diet.  Treatments should target sleep behaviors and hygiene as a primary strategy for reversing the inflammatory responses and reducing the risk of disease.

With physical activity and diet, Irwin says, sleep health may become the third regular component of a healthy lifestyle.

Reference:  http://www.eurekalert.org/pub_releases/2016-07/e-psh070616.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.

What is Catathrenia?

parasomnias

Catathrenia is a parasomnia – abnormal behavior of the nervous system during sleep – and characterized by groaning on exhalation during sleep.  The person will usually take a very deep inhalation, hold their breath for a moment, and then release with a long, sustained, usually high-pitched groan.

It is believed that catathrenia occurs most often during the rapid eye movement (REM) stage of sleep; however, there are studies that have found it to be present during all stages of sleep.  It is not the same as sleep apnea or regular snoring, as the person often wakes up feeling fully rested, even though their bed partner will probably not say the same.

Catathrenia is a condition that is more bothersome to a spouse or bed partner than it is to the individual; however, there are some cases where the person will awaken with expiration due to oxygen desaturation; therefore, many studies have suggested this condition may be a feature of sleep-disordered breathing.

What the Research Shows

With its inclusion as a parasomnia into the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2) about a decade ago, catathrenia has made its way into the sleep medicine nomenclature, but with much debate about its causes, treatments, and background.

One study, done in 2008, which was published in the journal, SLEEP, was performed to try to determine if catathrenia was a symptom of sleep-disordered breathing or a condition all on its own.  Researchers also wanted to determine if previous literature was correct in reporting that CPAP (continuous positive airway pressure) was a viable treatment option for someone with catathrenia.

CPAP is the primary form of treatment for someone with sleep apnea or sleep-disordered breathing.

In this particular study, which was performed at the Stanford Sleep Disorders Clinic, seven women between the ages of 20 and 34 years with an average BMI of less than 25 were studied over a period of five years.  Each of the women (or their partners) had reported ongoing, long-term sleep groaning.

All participants in the study underwent clinical evaluation, sleep questionnaires, physical examination, an overnight sleep study, a log provided by their sleep partner for 10 days noting when and how long the groaning occurred, and craniofacial evaluation (looking for septal deviation, structure deformity, turbinate enlargement, etc., which can all affect breathing).

CPAP was administered to all seven women, but if they could not tolerate the CPAP machine, which is noisy and can be uncomfortable, then they were offered the option of undergoing a special soft tissue/upper airway surgery.

Groaning was present in all stages of sleep, which was relieved in all participants who used CPAP.

Five of the women elected to undergo surgery, only three of which followed up after the procedure and were given additional oral appliance treatment.  All three women experienced ultimate resolution of catathrenia more than three years later.

Causes and Background of Catathrenia

It is still unclear what causes the nighttime groaning or who is more likely to suffer the condition.  Some studies found that there was a similarity in cases concerning the size of their jaw (all patients have a small jaw).  Furthermore, about 14% of patients reported a positive family history of catathrenia.

In this study at Stanford, it was noted that 43% of participants had a past history of some sort of parasomnia (such as sleep talking) in childhood, 86% had orthodontic procedures, and 71% had tooth extractions in adolescence.

 Tips for Living with Catathrenia

Since catathrenia is not a particularly dangerous condition and is not associated with the development of more concerning health problems, there has been very little research in the way of determining origin and treatment options.  It is notable that the studies mentioned in this article are very small scale, with a group of people who were otherwise healthy.  Further research will be needed to determine best courses of treatment.

 

On the other hand, Dr. Roxanne Valentino of St. Thomas Center for Sleep recommends some ways to help bed partners deal with catathrenia.  These include:

  • Don’t panic: Catathrenia is harmless.
  • Listen: Catathrenia could potentially mask other problems, such as apnea.  Groaning happens on exhalation, there are very few nighttime awakenings, and the person will usually feel well rested upon awakening.  Listen for other abnormal sounds, like wheezing, gasping on inhalation, or excessive snoring.
  • White Noise: A fan or humidifier would be good options to block out some of the groaning noise.
  • Earplugs: These are helpful if the groaning is mild.
  • Seek Medical Attention: If all else fails, talk to a doctor or sleep specialist about obtaining a study or possibly undergoing CPAP treatment.

Sources:

  1. Catathrenia. (2011, June). Retrieved July 05, 2016, from https://en.wikipedia.org/wiki/Catathrenia
  2. Guilleminault, C., Hagen, C. C., & Khaja, A. M. (2008). Catathrenia: Parasomnia or Uncommon Feature of Sleep Disordered Breathing? Retrieved July 05, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2225555/
  3. Romano, N. (2012, January 26). 5 Tips For Battling Catathrenia. Retrieved July 05, 2016, from http://www.huffingtonpost.com/2011/06/03/catathrenia-tips_n_870979.html

More or Less than Average Sleep Puts Men at Higher Risk of Diabetes

diabetes and sleep apnea

The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism published a new study that reports men who sleep too few or too many hours may be at higher risk of developing diabetes.

Diabetes is an epidemic in our American culture, with over 29 million people suffering with the diagnosis, according to the Endocrine Facts and Figures Report by the Endocrine Society.  Lead senior author of the study, Femke Rutters, PhD, of the VU Medical Center in Amsterdam reported that over the last five decades, the average sleep duration for individuals has gone down by 1.5 to 2 hours.  During the same time period, the prevalence of diabetes has doubled.

Dr. Rutters noted that in this study of nearly 800 otherwise healthy people, there were gender-specific relationships between glucose metabolism and sleep duration.  Men who were sleeping too little or too much experienced less insulin response in the body, which reduced their glucose uptake and significantly increased their risk of getting diabetes some time down the road.  Women showed no such association.

This was a cross-sectional study that analyzed the risk of diabetes and sleep duration in 788 individuals.  A subset of people in the EGIR-RISC (European Relationship between Insulin Sensitivity and Cardiovascular Disease) study was also analyzed in this research.  This study included healthy adults between the ages of 30 and 60 years.  Participants were brought in from 19 studies in 14 countries throughout Europe.

Sleep and physical activity were measured using a single-axis accelerometer, which is a device that tracks movement.  Diabetes risk was assessed using a device called a hyperinsulinemic-euglycemic clamp, which measures the efficacy of the body’s use of insulin, the hormone that processes blood sugars.

Throughout the study, it was noted that men who were getting more or less sleep than average were more likely to have insulin resistance, or an inability of the body to process sugars.  The average amount of sleep for men is seven hours.  The men on either side of the spectrum – too little or too much sleep – showed higher sugar levels than the men who were getting the average seven hours of sleep each night.

Of interesting note was that women who slept more or less than the average were more responsive to insulin than the women who slept the average number of hours each night.  Furthermore, they had increased function of the beta cells, which are located in the pancreas and produce insulin.  Researchers believe this means that lack of sleep does not put women at risk of diabetes.

These findings show, for the first time, that there is an opposite effect of sleep loss on diabetes risk between women and men.  Researchers believe this might be the result of having a healthy population in the study, rather than analyzing those known to be at risk for diabetes.  Furthermore, the researchers note that insulin sensitivity and sleep were measured with more sensitive devices than in previous studies.

However, this study shows that even healthy individuals are at risk of diabetes if they are sleeping too much or too little.  This is why improving sleep habits is imperative to overall good health.

 Reference:  http://www.eurekalert.org/pub_releases/2016-06/tes-bla062416.php

 

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.