CasesBlog - Medical and Health Blog: Sleep

Showing posts with label Sleep. Show all posts

Tracking Sleep With Wearables Literally Changed My Life - The Medical Futurist

From Bertalan Mesko: "I use wearable gadgets to measure the quality of my sleep and as some of the subscribers asked me how I do that in details step by step, I thought I would share the whole process and my methods in one video. I hope you will find it useful."

How to Pick the Right Bedtime - select a wake up time, count back 7 hours and add 10 minutes to fall asleep

Given the importance of a good night's sleep, how do you pick the best possible bedtime? WSJ's Heidi Mitchell and Stanford University's Dr. Rafael Pelayo discuss with Tanya Rivero.

Related:

What Makes A Great Bedtime? | Craig Canapari, MD http://bit.ly/1vstZzJ
Shift workers and people who get jet lag may gain weight because they dusturb their "inside garden" (gut microbes) buff.ly/1vzaXci

Excessive sleepiness in teenagers - What are the causes and what to do?

Adolescents and young adults (13–22 years of age) are often excessively sleepy.

This excessive sleepiness can have a profound negative effect on:

- school performance
- cognitive function
- mood
- increased incidence of automobile crashes

Excessive sleepiness - What are the causes?

The main reason adolescents don’t get enough sleep is that they simply don’t make enough time for it, because of early school hours, homework, part-time jobs, and other demands. The typical high school student falls asleep at 11 or later. One reason is that many teenagers cherish the late night as one of the few times they have all to themselves.

The “BEARS” screening is divided into 5 major sleep domains and provides a comprehensive screen for the major sleep disorders affecting children in the 2- to 18-year age range. Each sleep domain has a set of age-appropriate “trigger questions” for use in the clinical interview.

“BEARS”: A Sample Sleep History

B = Bedtime problems (Do you have any problems falling asleep at bedtime?)
E = Excessive daytime sleepiness (Do you feel sleepy a lot during the day? In school? While driving?)
A = Awakenings during the night (Do you wake up a lot at night?)
R = Regularity and duration of sleep (What time do you usually go to bed on school nights? Weekends? How much sleep do you usually get?)
S = Sleep-disordered breathing (Parent: Does your teenager snore loudly or nightly? Patient: Has anyone ever told you that you snore loudly at night?)

An algorithm can be used for diagnosing and treating sleep disorders. One sample assessment tool is shown below. Treatment should be directed at any potentially reversible process.

Excessive sleepiness - what to do?

- Adjust the lighting. As bedtime approaches, dim the lights. In the morning, expose your teen to bright light.

- Agree on a schedule, and stick to it. Tough as it may be, encourage your teen to go to bed and get up at the same time every day — even on weekends.

- Stop long naps. If your teen is drowsy during the day, a 30-minute nap after school might be refreshing. Be cautious, though. Too much daytime shut-eye might only make it harder to fall asleep at night.

- Set limits on electronic devices. Take the TV out of your teen's room, or keep it off at night. The same goes for your teen's cellphone, computer and other electronic devices.

- Relax. Encourage your teen to wind down at night with a warm shower, a book or other relaxing activities. Discourage stimulating activities — including vigorous exercise, loud music, video games, television, computer use and text messaging — an hour or two before bedtime.

- Limit the caffeine.

References:

Excessive Sleepiness in Adolescents and Young Adults. PEDIATRICS Vol. 115 No. 6 June 1, 2005 pp. 1774 -1786, (doi: 10.1542/peds.2005-0772), http://bit.ly/IcRr00

The Sleepy Teenager< - Harvard Health Publications http://hvrd.me/IcSJYO

Teen sleep: Why is your teen so tired? - MayoClinic.com http://mayocl.in/IcSZXV

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

"Six hours sleep for a man, seven for a woman and eight for a fool". Was Napoleon right?

New ideas in chronobiology - Dr. Dieter Kunz of the Charité Hospital in Berlin talks about some of the latest ideas in chronobiology, and to what extent they do - and don't - affect our daily lives:

From the TV program Tomorrow Today | DW.DE http://bit.ly/USMQlx

Chronic insomnia - Lancet 2012 review

Insomnia is a common condition that can present independently or comorbidly with another medical or psychiatric disorder.

Treatment of chronic insomnia

Benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence.

Benzodiazepine-receptor agonists (BzRAs) are effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce. Also, most hypnotic drugs are associated with potential adverse effects.

Cognitive-behavioural therapy (CBT) is an effective alternative for chronic insomnia.

CBT is more time consuming than drug management but it produces sleep improvements that are sustained over time.

However, CBT is not readily available in most clinical settings. Access and delivery can be made easier through:

- telephone consultations
- group therapy
- self-help approaches

How to succeed? Get more sleep

Sleepwalking: Lee's story

From NHS Choices YouTube channel: Lee started sleepwalking at the age of four. In this video he describes his sleepwalking episodes, including doing artwork despite having no interest in art, plus the physical side effects when he wakes up.

Also watch Sleepwalking in children.

40% of police officers have a sleep disorder according to a JAMA study

More than a third of police officers have a sleep disorder, and those who do are more likely to experience heart disease, problems with job performance and rage toward suspects and citizens, says the NYTimes, citing a study in the JAMA. That figure is at least double the estimated 15-20% rate of sleep disorders seen in the general population.

Having a sleep disorder raised the odds of heart disease by 45%, and the odds of depression by 120%. It also raised the odds of being injured on the job by 22% and falling asleep while driving by 51%.

The JAMA report video.

The officers who had sleep disorders reported more instances of “uncontrolled anger” toward suspects and citizens and serious administrative errors. Sleep deprivation may affect the amygdala, a part of the brain where emotion is governed.

Of the 5,000 study participants, 40% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously:

- 34% screened positive for obstructive sleep apnea
- 6.5% for moderate to severe insomnia
- 5.4% for shift work disorder

Not surprisingly, the police officer who had smaller body mass indexes were far less likely to have sleep apnea. System-wide practices can have a significant impact. For example, state police officers in Massachusetts are given one hour of paid exercise time four days a week to help them stay fit. They were less liekly to have sleep apnea.

References:

Sleep Problems in Police Officers Take Heavy Toll. NYTimes.
Sleep Disorders, Health, and Safety in Police Officers. JAMA.

Comments from Twitter:

WendySueSwanson MD (@SeattleMamaDoc): Geesh.

@CrumbedOxygen: wonder if EMS similar.

Dr John Weiner @AllergyNet: Can CPAP Cure Cops?

Martin Wilson @ChInspMWilson: what is CPAP then ...??

@DrVes CPAP (continuous positive airway pressure) is a treatment option for sleep apnea. Here is more info from the Mayo Clinic: http://www.mayoclinic.com/health/cpap/MM00716

Reading on iPad before bed disrupts sleep - Kindle is OK, with the exception of Kindle Fire

As well know, the iPad contains a touchscreen liquid crystal display that, like computer screens and television sets, emits light. Exposure to such abnormal light sources inhibits the body's secretion of melatonin.

All light-emitting devices, including cellphones, "tell the brain to stay alert." Because users hold those devices so close to their face, staring directly into the light, the effect is amplified compared with, for example, a TV across the room or a bedside lamp.

References:

Reading on iPad before bed can affect sleep habits. LA Times.

Comments from Twitter:

@UChicagoMed: Is that mostly from the light? The Kindle app and Instapaper both have dark modes that aren't as bright.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? http://j.mp/Hq15aD - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work http://j.mp/Hq15aD - I use iPad daily to discuss these diagrams: http://j.mp/Hq1k5v

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

A doctor who loves night shifts

Emergency medicine physician, world-class educator and blogger extraordinaire Dr. Mike Cadogan was recently interviewed by Elsevier Australia:

Interviewer:

What are the best and worst parts of night shifts? Do you have any tips for surviving nights?

Mike Cadogan:

I love night shifts. The dark corridors, the cool air, the rising moon, the autonomy of decision-making, the authority, the midnight snacks and the sense of joyous achievement walking home with the sun rising and against the tide of tired, depressed faces gripping their morning coffees and bemoaning the need to be at work on such a glorious sunny day…

Think positive, be strong and enjoy autonomy. Remember that everybody else is on night shift with you, and most of them don’t want to be there either…but there is no need to be grumpy, rude, or pompous. Make friends with the night owls and collaborate, you will find your workload will dramatically decrease… Make enemies with the permanent night staff at your peril!

References

Interview with Mike Cadogan, author of the acclaimed On Call: Principles and Protocols by Student Ambassador Emma Sharp.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Sleep Habits Differ by Ethnicity but All Groups Are Sleep Deprived

All ethnic groups said they missed work or family functions because they were too sleepy, with the percentage ranging up to 24%, according to a 2010 "Sleep in America" survey by the National Sleep Foundation (NSF).

Some distinct differences are listed below:

On weekdays or workdays, African Americans reported they slept the least - 6 hours, 14 minutes, compared to 6 hours, 34 minutes for Hispanics, 6 hours, 48 minutes for Asians, and 6 hours, 52 minutes for Caucasians.

10% of African Americans and Hispanics reported having sex every night or nearly every night in the hour before bedtime, compared to 4% of Caucasians and 1% of Asians.

African Americans had different pre-bedtime activities and tended to pray in the hour before bedtime - 71% of them said they prayed but only 18% of Asians did so.

Asians were least likely to drink alcohol an hour before bed - a practice that many mistakenly think will help sleep. Only 1% of Asians had a nightcap every night or nearly every night, compared to 7% of whites, 4% of African Americans and Hispanics.

Caucasians were most likely to sleep with their pets - as well as more likely to sleep with their spouse or significant others: 16% of them say they sleep with a pet, and 72% say they sleep with their partners. In comparison, only 4% of Asians, 4% of Hispanics, and 2% of African Americans let the pet on the bed.

References:

The 2010 Sleep in America poll by the National Sleep Foundation (NSF).

Sleep Habits Vary by Ethnicity. WebMD, 2010.
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Night shift workers are fighting ancient rhythms that order them to hunt or forage

From the National Geographic Magazine:

We sleep 1.5 hour less a night than we did just 100 years ago

We sleep on average 1.5 hour less a night than we did just a century ago. Some of our epidemic of insomnia or sleeplessness is probably just our refusal to pay attention to our biology. The natural sleep rhythms of teenagers would call for a late morning wake-up—but there they are, starting high school at 8 a.m.

The night shift worker sleeping in the morning is fighting ancient rhythms in his or her body that order him or her awake to hunt or forage when the sky is flooded with light. Yet he or she has no choice.

We fight these forces at our peril. Harvard's researchers note that going without sleep for 24 hours or getting only 5 hours of sleep a night for a week is the equivalent of a blood alcohol level of 0.1 percent. Yet modern business ethic celebrates such feats. "We would never say, 'This person is a great worker! He's drunk all the time!' "

One in 20 medical residents admits to making a fatigue-related mistake that resulted in the death of a patient

A 2004 study included 2,700 first-year medical residents. These young men and women worked shifts that were as long as 30 hours twice a week. The research revealed the remarkable public health risk that this sleep debt entailed. "We know that one out of five first-year residents admits to making a fatigue-related mistake that resulted in injury to a patient. One in 20 admits to making a fatigue-related mistake that resulted in the death of a patient. One day people will look back on what will be viewed as a barbarous practice."

References:

The Secrets of Sleep. National Geographic Magazine, 2011.

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

How to succeed? Get more sleep

In this 4-minute talk, Arianna Huffington (founder of The Huffington Post) shares a small idea that can awaken much bigger ones: the power of a good night's sleep. Instead of bragging about our sleep deficits, she urges us to sleep our way to increased productivity and happiness -- and smarter decision-making.

Quotes from the talk:

"I was recently having dinner with a guy who bragged that he had only gotten four hours sleep the night before. And I felt like saying to him, "You know what? If you had gotten five, this dinner would have been a lot more interesting."

There is now a kind of sleep deprivation one-upmanship. Especially here in Washington, if you try to make a breakfast date, and you say, "How about eight o'clock?" they're likely to tell you, "Eight o'clock is too late for me, but that's okay, I can get a game of tennis in and do a few conference calls and meet you at eight." And they think that means that they are so incredibly busy and productive, but the truth is they're not."

People who get less than 6 hours sleep per night have an increased risk of dying prematurely

People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.

The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.

Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.

"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.

Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.

References:
Bad night's sleep can hamper body's insulin use. Reuters.

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

"Sleep eaters" binge on sugary, high-calorie snacks, sometimes 5 times a night

Consequences of nighttime eating can include injuries like black eyes from walking into a wall or hand cuts from a prep knife, or dental problems from gnawing on frozen food.

Upwards of 10 percent of adults suffer from some sort of parasomnia, or sleep disorder, like sleepwalking or night terrors. Some have driven cars or performed inappropriate sexual acts — all while in a sleep-induced fog. About 1 percent, mostly women, raid the refrigerator.

References:
Raiding the Refrigerator, but Still Asleep - NYTimes.com.

Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Can a Midday Nap Make You Smarter? Adults Who Nap for 90-minutes at 2 PM Learn and Perform Better at Tests

According to a new study, if you devote your lunch hour to a nap, you may perform and learn better in the afternoon.

Napping at midday, when the brain's ability to learn may have deteriorated, may clear the brain's memory "storage area" and make room for new information.

In the study, the nap group was given the chance for a 90-minute siesta at 2 p.m.; the no-nap group was asked to stay awake.

People in the group which didn't nap had a 10% reduction in their learning capacity. The people who had a nap improved their ability to learn by 10% (not much).

References:

Can a Mid-Day Nap Make You Smarter? WebMD.

Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

Better Sleep, Better Learning? Obstructive sleep apnea can reduce a child’s IQ by 10 points

From Science Life Blog at the University of Chicago:

Pediatric obstructive sleep apnea, or OSA, can have long-term, detrimental effects on a child’s cardiovascular and respiratory health. But it can also create neurocognitive effects, such as a reduced ability to learn and retain information.

OSA can reduce a child’s IQ by as many as 10 points, while treatment in children with OSA can improve grades.

References:

Better Sleep, Better Learning? « Science Life Blog « University of Chicago.
http://sciencelife.uchospitals.edu/2010/02/15/better-sleep-better-learning

Sleep duration is shorter in obese children http://goo.gl/z5JFs
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).

Chronic sleep loss decreases performance - One night of good sleep is not enough to recover from chronic sleep deficit

On average, a person needs about eight hours a night to preserve performance.

Acute sleep loss is being awake for more than 24 hours in a row and chronic sleep loss is getting only about four to seven hours of sleep per night.

While most people caught up on acute sleep loss with a single night of 10 hours sleep, those with chronic sleep loss showed deteriorating performance for each hour spent awake.

People are largely unaware that they are chronically sleep-deprived but they are more vulnerable to sudden sleepiness, inattentiveness, and potentially, accidents and errors.

Three days is not enough to recover from chronic sleep loss, but they still do not know how many days or weeks may be needed.

References:
Chronic sleep loss hampers performance. Reuters, 2010.

Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

Is sleep the biggest mistake nature has made?

From the NYTimes:

Scientists are not sure why sleep exists at all, it is hard to explain the great diversity of sleeping habits in different species. For example, why should lions get 15 hours a night and giraffes just 5?

“We spend a third of our life sleeping, and it seems so maladaptive - ‘the biggest mistake nature has made.' But another way of looking at it is: unnecessary wakefulness is a bigger mistake.”

My opinion: I do not think sleep can be qualified as a "mistake". In any case, if nature makes "mistakes", the evolution process gradually fixes them.

References:

Sleep May Be Nature’s Time Management Tool. NYTimes.
Sleepiness and sleep-disordered breathing may be found in 19-29% of children with positive allergy test (http://goo.gl/AfCWZ).
Image source: Sleeping kitten. Wikipedia, Tilman Piesk, public domain.

'Time-bending drug' for jet lag tasimelteon helps transient insomnia

The term “jet lag” may have been first coined in 1966. Tasimelteon is a drug used for the treatment of insomnia and other sleep disorders. It is a selective agonist for the melatonin receptors MT1 and MT2 in the suprachiasmatic nucleus of the brain, similar to older drugs such as ramelteon.

Suprachiasmatic nucleus

The suprachiasmatic nucleus is a tiny region on the brain's midline in a shallow impression of the optic chiasm responsible for controlling circadian rhythms.

The left optic nerve and the optic tracts, suprachiasmatic nucleus not labeled, but diagram illustrates region. Image source: Wikipedia, public domain.

G protein-coupled receptor (GPCR)

A melatonin receptor is a G protein-coupled receptor (GPCR) which binds melatonin. Three types of melatonin receptor have been cloned in humans: MT1 and MT2.

According to the American Chemical Society, "If you had to make a wild guess about the target of a certain drug, your best odds are with “G-protein coupled receptor.” Drugs targeting members of this integral membrane protein superfamily, which transmit chemical signals into a wide array of different cell types, represent the core of modern medicine. They account for the majority of best-selling drugs and about 40% of all prescription pharmaceuticals on the market."

Melatonin receptors agonists

Melatonin receptors ligands (agonists) include:

Melatonin
Ramelteon
Tasimelteon

A bottle of melatonin OTC supplement. Image source: Wikipedia, Ged Carroll, Creative Commons Attribution 2.0 License.

Products containing melatonin have been available as a dietary supplement in the United States since 1993.

Ramelteon, marketed as Rozerem. Image source: Wikipedia, public domain.

Rozerem is the first in a new class of sleep agents that selectively binds to the MT1 and MT2 receptors. Ramelteon caused hyperprolactinaemia 2-3x more often than placebo in clinical trials.

Ramelteon does not bind to GABA receptors, thus it has not been shown to produce dependence, withdrawal and rebound insomnia that is typical with GABA modulators.

Tasimelteon Studies

Circadian rhythm sleep disorders are common causes of insomnia for millions of individuals.

Two recent studies evaluated the efficacy of the melatonin agonist tasimelteon for treatment of transient insomnia associated with shifted sleep and wake time.

Tasimelteon reduced sleep latency and increased sleep efficiency compared with placebo. The frequency of adverse events was similar between tasimelteon and placebo.

The BBC labeled tasimelteon a 'time-bending drug' for jet lag because it can "reset" the body's natural sleep rhythms. Findings would be welcomed by millions of people - "shift-workers, airline crew, tourists, football teams, etc.

Tips for avoiding jet lag

Sleep well before you travel
Shift your watch to your destination time zone as soon as you board the plane
Avoid alcohol
Spend plenty of time outdoors in the daylight

References:

Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. The Lancet, Volume 373, Issue 9662, Pages 482 - 491, 7 February 2009.
Tasimelteon, from Wikipedia, the free encyclopedia.
Melatonin receptor, from Wikipedia, the free encyclopedia.
It's a GPCR world. Filmore, David (2004). Modern Drug Discovery (American Chemical Society) 2004 (November): 24–28.
'Time-bending drug' for jet lag. BBC, 2008.