Category Archives: Sleep

Sleep Restriction Results In Weight Gain Despite Decreases In Appetite And Consumption

According to a research abstract presented on June 8 at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies, in the presence of free access to food, sleep restricted subjects reported decrease in appetite, food cravings and food consumption; however, they gained weight over the course of the study. Thus, the finding suggests that energy intake exceeded energy expenditure during the sleep restriction

Results indicate that people whose sleep was restricted experienced an average weight gain of 1.31 kilograms over the 11 days of the study. Of the subjects with restricted sleep who reported a change in their appetite and food consumption, more than 70 percent said that it decreased by day 5 of the study. A group of well rested control subjects did not experience the weight gain.

According to lead investigator Siobhan Banks, PhD, a research fellow at the University of South Australia and former assistant research professor at the University of Pennsylvania School of Medicine, it was surprising that participants did not crave foods rich in carbohydrates after sleep restriction, as previous research suggested they might. Results indicate that even though physiologically the desire to eat was not increased by sleep loss in participants, other factors such as the sedentary environment of the laboratory and the ability to snack for longer due to reduction in time spent asleep might have influenced the weight gain.

“During real-world periods of sleep restriction (say during shift work), people should plan their calorie intake over the time they will be awake, eating small, healthy meals,” said Banks. “Additionally, healthy low fat/sugar snacks should be available so the temptation to eat comfort foods is reduced. Finally, keeping up regular exercise is just as important as what food you eat, so even though people may feel tried, exercising will help regulate energy intake balance.”

The study involved 92 healthy individuals (52 male) between the ages of 22 and 45 years who participated in laboratory controlled sleep restriction. Subjects underwent two nights of baseline sleep (10 hours in bed per night), five nights of sleep restriction and varying recovery for four nights. Nine well rested participants served as controls. Food consumption was ad libitum (subjects had three regular meals per day and access to healthy snacks, and during nights of sleep restriction subjects were given a small sandwich at one a.m.).

Abstract Title: Sustained Sleep Restriction in Healthy Adults with Ad libitum Access to Food Results in Weight Gain without Increased Appetite or Food Cravings
Presentation Date: Monday, June 8
Category: Sleep Deprivation
Abstract ID: 0385

Source:
Kelly Wagner
American Academy of Sleep Medicine

Waist size and body mass index are risk factors for sleep disordered breathing in children

Westchester, Ill. — A study in the June 1 issue of the journal SLEEP found that waist circumference and body mass index (BMI) are consistent, independent risk factors for all severity levels of sleep disordered breathing (SDB) in children, suggesting that as with adult SDB, metabolic factors are important risk factors for childhood SDB.

Results indicate that BMI and waist circumference, but not neck circumference, were significant and strong predictors of SDB at all severity levels – primary snoring, mild SDB and moderate SDB. Nasal anatomic factors such as chronic sinusitis, rhinitis and nasal drain were significant predictors of mild SDB; minority status was associated with primary snoring and mild SDB. Tonsil size, assessed by visual inspection, was not a significant risk factor for any level of SDB. Overall, 1.2 percent of children had moderate SDB (an apnea/hypopnea index of five or more breathing pauses per hour of sleep), 25 percent had mild SDB (AHI of at least one but less than five) and 15.5 percent had primary snoring.

According to principal investigator Edward O. Bixler, PhD, of Penn State University College of Medicine in Hershey, Penn., it is often assumed that the primary mechanism of SDB in children is the presence of large tonsils or adenoids. The study suggests, however, that the causes of SDB in children are more complex, that there may be a systemic influence of obesity, and that adenotonsillectomy may not always be the most effective, first-line treatment.

“Risk factors for SDB in children are complex and include metabolic, inflammatory and anatomic factors,” said Bixler. “Because SDB in children is not just the outcome of anatomical abnormalities, treatment strategies should consider alternative options, such as weight loss and correction of nasal problems.”

The American Academy of Sleep Medicine reports that snoring is one warning sign for obstructive sleep apnea, a common form of SDB that occurs when soft tissue in the back of the throat collapses and blocks the airway during sleep. Snoring that is related to sleep apnea tends to be loud and may include obvious pauses in breathing and gasps for breath. Parents often notice that the child seems to be working hard to breathe during sleep.

The study gathered data from 700 children between the ages of 5 and 12 years who were randomly selected from 18 public elementary schools in Dauphin County, Penn. Fifty-two percent were female, and 23.8 percent of the children were either Black or Hispanic.

Each child was evaluated by a physical exam and monitored for nine hours during one night of polysomnography in a sleep laboratory.

The overall average AHI was 0.8 breathing pauses per hour of sleep, with a maximum value of 24.6. The prevalence of moderate SDB was higher in older children; two percent of children between the ages of 9 and 12 years had moderate SDB, compared with only 0.2 percent of children between 5 and 8 years of age.

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A media fact sheet about obstructive sleep apnea is available at http://aasmnet.org/Resources/FactSheets/SleepApnea.pdf , and information for the public about obstructive sleep apnea in children is available at http://www.sleepeducation.com/Disorder.aspx?id=71.

SLEEP is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. SLEEP, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

For a copy of the study, “Sleep Disordered Breathing in Children in a General Population Sample: prevalence and Risk Factors,” or to arrange an interview with the study’s author, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research. As the national accrediting body for sleep disorders centers and laboratories for sleep related breathing disorders, the AASM promotes the highest standards of patient care. The organization serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine, advocating for recognition, diagnosis and treatment of sleep disorders, educating professionals dedicated to providing optimal sleep health care and fostering the development and application of scientific knowledge.

Online cognitive behavioral therapy is effective in treating chronic insomnia

Westchester, Ill. — A study in the June 1 issue of the journal SLEEP demonstrates that online cognitive behavioral therapy (CBT) for chronic insomnia significantly improves insomnia severity, daytime fatigue, and sleep quality. Online treatment also reduces erroneous beliefs about sleep and pre-sleep mental arousal.

Results indicate that 81 percent of treated participants (30 of 37) reported at least mild improvement in their sleep after completing the five-week program, including 35 percent (13 of 37) who rated themselves as much or very much improved. Thirty percent of treatment group completers were receiving an additional hour of sleep at the end of the program. Those who received treatment also developed healthier attitudes about sleep and were less likely to report having an overactive mind at bedtime.

According to principal investigator Norah Vincent, PhD, psychologist at the University of Manitoba in Winnipeg, Canada, the researchers were surprised by the significant results in the absence of any ongoing support from a clinician. The treatment program consisted of psychoeducation about insomnia, information concerning sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy.

“Although each segment of the CBT program is important, the cognitive therapy module was the most positively rated,” said Vincent. “The cognitive therapy section was designed to help individuals to develop realistic expectations about sleep and the impact of sleep on next-day functioning while teaching a variety of strategies for coping with an overactive mind and worries.”

The study involved118 adults with chronic insomnia who were referred to a teaching hospital behavioral medicine sleep clinic or who had responded to a newspaper advertisement. Those included in the study were required to have high-speed Internet access and a home computer, as well as an insomnia complaint with daytime impairment occurring more than four nights a week for six months or longer.

Participants were randomly assigned to a treatment or wait-list group; those on the wait list were informed that they would receive access to treatment once their follow-up data was received, and they were asked to refrain from treatment-seeking during the course of the study. Individuals receiving treatment engaged in online CBT from home for five weeks with no clinician interaction. The online treatment used audiovisual clips as the main teaching component, downloadable mp3 files for relaxation training and PDF files for psychoeducation and cognitive therapy. Findings were based on self-reported data gathered from a post-treatment questionnaire packet and sleep diaries.


There was a 33-percent drop-out rate, and physician-referred participants were significantly more likely to drop out than community-recruited participants. According to the authors, the rate of attrition for North American in-person psychotherapy is 22 percent.

Vincent said that most individuals could potentially benefit from online CBT for chronic insomnia, as the program has been used successfully by people ranging in age from 18 to 80 years. The researchers speculate that the program also could help teenagers.

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A media fact sheet about insomnia is available at http://aasmnet.org/Resources/FactSheets/Insomnia.pdf, and information for the public is available at http://www.sleepeducation.com/Disorder.aspx?id=6.

SLEEP is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. SLEEP, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

For a copy of the study, “Logging on for Better Sleep: RCT of the Effectiveness of Online Treatment for Insomnia,” or to arrange an interview with the study’s author, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.

AASM is a professional membership organization dedicated to the advancement of sleep medicine and sleep-related research. As the national accrediting body for sleep disorders centers and laboratories for sleep related breathing disorders, the AASM promotes the highest standards of patient care. The organization serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine, advocating for recognition, diagnosis and treatment of sleep disorders, educating professionals dedicated to providing optimal sleep health care and fostering the development and application of scientific knowledge.

Living With Fibromyalgia and Chronic Fatigue

Lifestyle changes and the right medications can help ease fatigue and restless sleep from fibromyalgia.
By Jeanie Lerche Davis
WebMD Feature

Jackie Yencha is somebody who gets things done — as much as possible. She has been coping with fibromyalgia and chronic fatigue most of her life. But she pushed through college, got married, is raising two kids, and holds a top-level volunteer position with a fibromyalgia advocacy agency. She and her family even organize a charity golf tournament every year to honor her mother, who died of a rare cancer.

She'd like to do more than that — but that's just not going to happen. Yencha is always fighting sleep problems. “I literally get sick if I don't get sleep,” she says. Even on good days, her energy level may fizzle early. “Fatigue is my biggest problem,” Yencha tells WebMD. “I've had to give up a lot of things because of the fatigue.”

Fibromyalgia and chronic fatigue syndrome are considered separate but related disorders. They share a common symptom — severe fatigue that greatly interferes with people's lives.

Insomnia — and the lack of deep, restorative sleep — is a big part of the problem, explains Mary Rose, PsyD, a clinical psychologist and behavioral sleep specialist at Baylor College of Medicine in Houston.

Sleep and Fibromyalgia Fatigue

When Rose first sees a patient with fibromyalgia syndrome and chronic fatigue, she makes sure that other causes of fatigue, like anemia (low blood count) and thyroid problems, have been addressed.

Improving a patient's sleep is an important part of easing fibromyalgia fatigue, Rose tells WebMD. “We know from research that sleep improves mood, pain, and in general how people feel during the day. Regardless of the reasons for the chronic fatigue, if we can get some control over quality of sleep, we're likely to see positive benefits to mood, fatigue, concentration.”

The chronic lack of sleep affects a patient's overall health as well as their pain, Rose adds. “They feel lousy, exhausted, and their immune system can be damaged.”

Steven Berney, MD, chief of rheumatology at Temple University Health System in Philadelphia, agrees. “In fibromyalgia, all treatments are geared toward helping people sleep better,” he tells WebMD. “If we can improve their sleep, patients will get better.”

Living With Fibromyalgia and Chronic Fatigue

Sleeping pills aren't the answer, says Rose. They are intended for chronic long-term use.  

Indeed, living with fibromyalgia is more than just popping a pill, says Martin Grabois, MD, chairman of physical medicine and rehabilitation at Baylor College of Medicine in Houston. “A good deal is self-treatment. Patients have to be active, not passive.”

First step: Patients may need to be checked for symptoms of snoring and sleep-related breathing problems. Sleep apnea, respiratory problems, allergies, and big tonsils or tongue are among the possibilities, Rose tells WebMD. “A lot of those things can be corrected.”

What you can do. Lifestyle changes — cutting back on caffeine, alcohol, and smoking — may be necessary to improve sleep. Sleep habits may need to change. To make your bedroom more sleep-friendly, it's important to:

  • Limit noise, light, and other stimuli (like pets).
  • Keep the room temperature and bedding comfortable.
  • Do something relaxing before bed, like listening to music or reading.
  • Turn the alarm clock so it's not facing you.

If you're having trouble getting to sleep, get up and do something restful in another room, Rose advises. “Don't lie in bed, worrying and stressing. Get up, go to the other room. When you're calmer, relaxed, feel tired, go back to bed.”

Don't nap. Make sure your sleep time follows a regular schedule, she adds. “A lot of patients have circadian rhythm problems. Napping can throw you off. Any sleep during the daytime will be taken from your sleep at night.”

Reduce stress. Anything that reduces stress — yoga, Pilates, meditation — will help you sleep better, says Rose. It will also help normalize heart rate and blood pressure, so you feel better. Psychological therapy, relaxation exercises, visualization, meditation, and biofeedback can help ease anxiety, tension, and stress.

Start stretching. Several times a day, it's important to give tight muscles a good stretch. Before you get out of bed in the morning, start with stretching: move your head and neck, and you're your shoulders up and down. Make stretching a ritual. A warm bath can make the stretch more comfortable.

Exercise. Getting regular exercise is also important, Rose says. “Any time you have pain, insomnia, and fatigue, I always say exercise. Exercise has a profound effect on mood, weight, and fatigue. Water exercise is easier on joints, so it's a lot more tolerable for fibromyalgia patients.”

Although physical therapy and exercise may be difficult, the short-term pain is a trade-off, she explains. “Even though you feel a lot of pain and discomfort, pushing yourself is important. Exercise helps reduce stress, and that helps sleep and reduces fatigue.”

Pace yourself. Moderation is important if you have fibromyalgia, says Grabois. “When people feel good, then they tend to do too much — then pay the price later. Others give up on exercise altogether, because they don't sleep well, feel fatigued, and exercise makes the fatigue worse.”

Start with very low intensity exercise and build up very slowly, he advises. “I'm not saying run around the block three times. I'm saying walk around the block one time — and do it on a regular basis, seven days a week.”

With daily activities, it's good to set up a scheduled routine. Be careful about overdoing it, so you don't deplete your extra energy. Learning moderation is a skill that can help you get things done despite discomfort and fatigue.

Try medications. Antidepressants and other medications can help greatly in pain control, says Rose. “If your body is worn down, and you're in pain, it's something to consider. I tell people, you can always quit taking it. We can see if it helps.”Anti-inflammatories and analgesics can also help.

The FDA has approved three drugs to treat fibromyalgia: Lyrica, Cymbalta, and Savella. Lyrica is an anti-epileptic drug. Cymbalta — an antidepressant — is in the category of drugs known as selective serotonin and norepinephrine reuptake inhibitors (SNRIs). Savella is also an SNRI.

Consider complementary therapies. Alternative therapies like massage and acupuncture have helped some people living with fibromyalgia. Be sure to talk to your doctor before trying natural or complementary therapies, Rose advises.

Volunteer work, hobbies, and a social support network also help make it easier living with fibromyalgia. So does a sense of humor.

“Anything you do to make your quality of life better — to give you more happiness — you can't lose,” Rose tells WebMD. “Do what brings you happiness, and chances are it will help you refocus, get your focus away from the pain.”

Restless Legs Syndrome: Causes and Treatments

by Patrick Boardman

Restless Legs Syndrome is a condition where limbs, usually the legs, have sensations of pain, itching, pins and needles, or other discomfort which produces an irresistible urge to move and which is temporarily relieved by flexing and moving the legs around. It usually occurs in the evening and isn’t as pronounced in the morning but is a cause of insomnia for the sufferer. RLS affects people of all ages but is more common after age forty. This article will deal with both primary RLS (meaning not caused by any other medical condition) and secondary RLS, as 60% of cases are familial (primary) and can be traced to an “autosomal” (meaning a non sex-determining) dominant chromosome. Secondary RLS usually occurs after the age of forty in people who are obese, who have had recent surgery, and those with osteoarthritis.

No prevention method has been established or studied but there are treatments available that alleviate the symptoms; one is a natural supplement branded as “All Calm”, a pure, refined, concentrated, and safe “magnesium citrate” in a special bio-available form that is prepared and consumed like tea so that it acts immediately. The manufacturer uses only USP grade ingredients and markets the preparation exclusively. It provides relief from both chronic Restless Leg Syndrome and bothersome leg cramps.

In 2005, the FDA approved the first drug for treatment of the disorder, ropinirole (Requip). In 2006, the FDA also approved pramipexole (Mirapex). In addition several drugs approved for other conditions have been found to be helpful in clinical studies. These medications fall into four major classes: dopaminergic agents, sleeping aids, anticonvulsants, and pain relievers.

Evidence suggests that your doctor should test you for iron deficiency and then supplement your diet with iron or vitamin B-12. It’s also necessary to look at other medications that may have RLS worse such as medicine for high blood pressure, heart conditions, nausea, colds, allergies, or depression. Herbal remedies, alcohol, and diet can be factors to be considered. No single pharmaceutical drug for RLS has proven to be entirely effective in eliminating the symptoms for everyone. The imbalance suggests that lifestyle, exercise, and diet are such major factors on the neurological communication with the muscles. Symptoms can be lessened with stretching, running, massage treatment, acupressure, yoga, tai chi, or simple walking. Having a good balance of nutrients with iron, potassium, and B vitamins is always a good idea. Bananas contain high levels of potassium and are effective at reducing cramps in the calves and thighs.

When sleep deprivation occurs it may be wise to eliminate caffeine as much as possible. Chocolate, coffee, tea, and soft drinks all contain high levels of caffeine and should be avoided to prevent sleep loss. Good sleep habits like regular hours rather than naps or oversleeping will help to keep the body’s energy ready to function rather than to sink into depression and fatigue.

Whether the treatment is pharmaceutical or natural it’s advisable to consult with your doctor since medicines or dietary substances can affect each other and may be dangerous. Various drugs have been used in the treatment of RLS: antidepressants such as Prozac, Elavil, and Lexapro; antihistamines found in cold, allergy, and over-the-counter sleeping pills; anti-nausea medications like Phenaergan, Reglan, and Compazine; even some psychiatric medications to treat bipolar disorders and schizophrenia. These substances can be dangerous and should be taken only on the advice of a doctor. With the success rate of the natural remedy All Calm, it is probably best to try the most natural substance available before using pills that have general toxic effects on other systems of the body. As with every remedy, be sure to follow the instructions carefully and use only after consulting a doctor if you have a medical condition.

The author is a writer experience in editing textbooks for a stress specialist. He began treating chronic leg cramps with a remedy, “All Calm” that he discovered online and proved to give effective relief. The treatment carries a money-back guarantee and is safe to use.

Article Source: Restless Legs Syndrome: Causes and Treatments