Significant connection found between sleep apnea and diabetes

Written by David Volpi, M.D., P.C., F.A.C.S.

It’s no secret that sleep apnea can lead to a long list of medical conditions, and worsen existing ones. Medical experts are now adding diabetes to the list. According to a new study published in February on the American Diabetes Association’s Diabetes Care website, sleep apnea can worsen Type 2 diabetes in some patients.

Sleep apnea is a potentially life threatening sleep disorder that’s caused when the muscles of the throat collapse during sleep. Obstructive sleep apnea (OSA) is the most common type of sleep apnea and also the most serious because it causes the soft tissue in the palate, throat, or tongue to “obstruct” the flow of air as a person struggles to breathe while they are asleep.

It’swell known that sleep apnea can greatly increase the risk of Type 2 diabetes. But according to Dr. Babak Mokhlesi, author of the new study and the director of the Sleep Disorders Center at the University of Chicago, sleep apnea can worsen blood sugar control in people with Type 2 diabetes because it disrupts the deepest stage of sleep, known as rapid eye movement, or REM.

For the study, Dr. Mokhlesi and his team studied patients with sleep apnea. The participants experienced apneic episodes during REM sleep. While obstructed breathing usually occurs throughout the night in sleep apnea patients, Mokhlesi and his team found that apneic episodes during the REM phase of sleep had the most detrimental effects on long-term blood sugar control.

In a New York Times article, Mokhlesi commented, “Most REM sleep occurs in the early morning hours before waking. But research shows that many patients remove their CPAP mask in the middle of the night because it can feel uncomfortable. As a result, their apnea is more likely to go untreated during REM sleep, a time that may be particularly important for anyone with diabetes.”

I applaud the efforts of Dr. Mokhlesi, and echo his comment regarding the importance of properly using a CPAP mask for the treatment of sleep apnea. If you’re having trouble with your mask, or just not using it, see a qualified sleep disorder doctor and get sized for a new, quieter, and more comfortable one. There are different CPAP masks and units on the market, so don’t settle for living uncomfortably, or going without proper treatment.

Read the full study titled, “Association of Obstructive Sleep Apnea in Rapid Eye Movement Sleep With Reduced Glycemic Control in Type 2 Diabetes: Therapeutic Implications.”

Sleep Better — Get Smart about Your Smartphone

By Dr. David O. Volpi, M.D.

Smartphones, iPads, and other personal electronic devices are great ways to communicate and entertain ourselves, but they may also be negatively impacting the quality and quantity of our sleep.

As personal electronic devices have become more ubiquitous, the bright-light emitting screens that allow the use of mobile devices in dimly lit rooms have become a more common reason for sleep disruption, whether users realize it or not.

Why is that? Melatonin is a hormone produced by the pineal gland at night and when it is dark. It is a “timer” that tells the body that it is nighttime, and time to go to sleep. Exposure to light at night, such as that in the brightly-lit screens of many personal mobile devices, can interfere with melatonin, the hormone that helps control our sleep and wake cycles.

But rest easier: New research from the Mayo Clinic in Scottsdale, AZ explains a way to reduce the impact of electronic devises on sleep cycles.

Lois Krahn, M.D., a psychiatrist and sleep expert at the Mayo Clinic and co-author of the study said, “In the old days, people would go to bed and read a book. More commonly, people go to bed and they have their tablet on which they read a book or newspaper or look at material. The problem is it's a lit device, and how problematic is the light source from the mobile device?"

That question prompted Dr. Krahn to wonder, is the light from screens always a negative factor for sleep?" To find out, Krahn and his colleagues experimented with two tablets and a smartphone in a dark room, using a meter on its most sensitive setting to measure the light the devices emitted at various settings when held various distances from a person's face.

They discovered that when the brightness settings were lowered and the devices were held just over a foot from a user's face, it reduced the risk that the light would be bright enough to suppress melatonin secretion and disrupt sleep.

Explains Krahn, “We found that only at the highest setting was the light over a conservative threshold that might affect melatonin levels. If it's at the mid setting or at a low setting, it's bright enough to use."

The new Mayo Clinic research, which was presented in June at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC, in Baltimore, Md., also suggests things you can do to help prevent screen light from interfering with melatonin and affecting sleep.

These tips include dimming the smartphone or tablet brightness settings and holding the device at least 14 inches from your face while using it.

Other general tips include moving the TV and computer out of the bedroom, or at the very least, do not watch TV or work on the computer to bedtime.

With so many electronic distractions in our lives, it's important to re-claim the bedroom for its intended purpose: rest, relaxation, and sleep.

Veterans with Sleep Apnea: A Growing Human Issue

Whether or not you personally know someone who has served in Iraq, Afghanistan or someplace else on foreign soil, our returning veterans deserve our help and attention. While many have the scars of physical injury, many more veterans bear silent scars. A little known fact but of increasing concern in the medical community is that a growing number of veterans are suffering from obstructive sleep apnea (OSA), and its symptoms can be devastating for our returning war heroes as they readjust to civilian life

Consider these statistics: According to the U.S. Department of Veterans Affairs (VA), one out of every five war veterans has been diagnosed with OSA — compared with only five out of 100 civilians in the general population. And between 2008 and 2010, the number of veterans who received medical benefits related to sleep apnea grew by 61 percent, from 39,145 cases in 2008 to 63,118 cases in 2010.

These numbers beg the question: Why do war veterans suffer from sleep apnea more than non-war veterans and civilians? Some VA doctors believe that it is due to the high number of repeat deployments to Iraq and Afghanistan — soldiers are being exposed to higher levels of dust, smoke, stress and violence.

But what is at the core of this connection between war, OSA and other related conditions, such as daytime sleepiness, memory loss, a decrease in work productivity, obesity, heart disease, diabetes, and hypertension. Researchers at the Wayne State University (WSU) School of Medicine are beginning to find out.

Since the mid-2000s, WSU researchers have been studying 145 American immigrants who left Iraq before the 1991 Gulf War, and 205 who fled Iraq after the Gulf War began. All lived in the Detroit area at the time, and were asked about socio-demographics, pre-migration trauma, how they rated their current health, physician-diagnosed and physician-treated OSA, and any somatic and psychosomatic disorders.

The study’s lead investigator, Bengt Arnetz, M.D., Ph.D., M.P.H., School of Medicine professor of occupational and environmental health, and deputy director of the Institute of Environmental Health Sciences at Wayne State said, “It may be the stress of war that leads to fractured sleep, and that no one had explored this possible link before, although basic research suggests it as plausible.”

The results of the study are published in the October 2012 issue of Psychosomatic Medicine in the article, "Obstructive Sleep Apnea, Post-traumatic Stress Disorder, and Health in Immigrants.” The research showed that those who left Iraq after the war began and suffered from mental disorders such as post-traumatic stress disorder (PTSD) and depression, and self-rated their physical health as worse than their actual health, were 43 times more likely than pre-Gulf War immigrants to report OSA and later develop major chronic health issues, such as cardiovascular disease.

On the results, Arnetz said, “It's a known fact that the more exposure to violence you have, the more likely you are to report post-traumatic stress disorder (PTSD) and depression, and the worse your self-rated health is, the more likely your actual health will suffer in five to 10 years.” And I reiterate, those who were exposed to the violence of the war in Iraq were almost twice as likely to experience PTSD and depression, but also Obstructive Sleep Apnea and other chronic health conditions. I applaud Arnetz and his colleagues’ efforts, and encourage them to continue their studies so that we in the medical community can better understand, diagnose and treat war- and stress-related health conditions.

What about treatment? Diagnosing OSA in veterans can be trickier than non-veterans because of the possibility of other military-related medical conditions, such as PTSD. In addition, some military veterans suffering from OSA may underestimate the health benefits of restorative sleep, rather than be properly diagnosed and treated since its common during deployment to have fractured sleep patterns.

The good news is that there is more awareness of OSA than ever before, especially within the military. Back in February 2012, Ventus Medical, the company that makes Provent Therapy, announced that the U.S. Department of Veterans Affairs approved a multi-year, Federal Supply Schedule contract that would enable more veterans to get Provent Therapy treatment — a small, non-invasive nasal device for the treatment of obstructive sleep apnea (OSA).

This is good timing, considering that a substantial percentage of veterans don't accept or adhere to continuous positive airway pressure (CPAP) therapy, even though it is a safe and effective treatment. According to Richard B. Berry, M.D., Professor of Medicine at University of Florida, "There is a great need for access to new, clinically-proven therapies—particularly easy-to-use treatments — for the increasing number of veterans with obstructive sleep apnea."

As more and more Iraq and Afghanistan veterans are realizing their post-war health problems, and because many Vietnam veterans are getting older, the number of veterans applying for OSA-related disability benefits will only continue to rise in the coming years. While OSA is a chronic condition creating a significant burden on the Veterans Healthcare System — the VA spends upwards of $500 million a year to treat veterans with sleep apnea — I believe that it is our duty as a nation to provide proper OSA treatment to our veterans to prevent additional chronic health issues. To read more about the study, go to the Wayne State University website.

Adolescents, Poor Sleep and the Toll on Their Health

Most people consider sleep disorders such as sleep apnea, snoring and poor quality sleep an adult health issue, but research is mounting that young people may suffer from sleep disorders as much as adults do.

Earlier this year, Penn State researchers published the results of a study which showed that children who have learning, attention and/or behavior problems may be suffering from a condition known as excessive daytime sleepiness (EDS)—even if tests indicate that they are getting enough sleep at night.

And The New York Times article from April 16, 2012 entitled “Attention Problems May Be Sleep Related”  also examined the relationship between children’s sleep quality and the ability to pay attention at school.

The article was on another recent study called “Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years,” published in the Official Journal of the American Academy of Pediatrics.

One researcher in the article noted that cases of attention deficit hyperactivity disorder (A.D.H.D.) in children may have been misdiagnosed—that the cause of behavior such as moodiness and hyperactivity might have been due to obstructive sleep apnea (OSA) or other sleep disorder, which caused sleep deprivation in the child. Worse, the drugs prescribed for the misdiagnosed A.D.H.D. might actually be making the child’s symptoms worse.

Now, new research from The Hospital for Sick Children (SickKids) in Toronto found a link between poor sleep quality in adolescents and a host of negative health issues, including higher cholesterol levels, higher body mass index BMI, larger waist size, higher blood pressure, increased risk of hypertension and cardiovascular disease later in life.

The hospital is one of Canada’s most research-intensive hospitals, and is recognized as one of the world’s foremost pediatric health-care institutions. For the study, lead researcher Dr. Indra Narang, Director of Sleep Medicine and Staff Respirologist at SickKids, and her colleagues studied 4,104 adolescents in the Healthy Heart Schools' Program that screens and identifies teens at risk of coronary vascular disease.

The young participants slept an average of 7.9 hours during the week, and 9.4 hours on weekends. Their sleep patterns, length and quality of sleep were recorded, and data was collected on their BMIs, cholesterol levels and blood pressures. They also found out if any participants had a family history of premature cardiovascular disease.

The results of the study were published in the October 1 edition of the CMAJ — Canadian Medical Association Journal. Almost 20 percent of the adolescents reported poor sleep quality during the week, and 10 percent reported poor sleep quality on weekends. Of the participants, almost 6 percent reported using medications to help them sleep.

From the data collected, the researchers found a link between poor sleep quality—also known as sleep disturbance—and cardiovascular risk in adolescents, based on high cholesterol levels, increased BMI and hypertension. In addition, researchers found a higher sleep disturbance score in adolescents with higher cholesterol level, higher BMI, larger waist size, higher blood pressure and increased risk of hypertension.

Higher sleep disturbance scores were also found in the adolescents who consumed more fried foods, soft drinks, sweets and caffeinated drinks, exercised less and spent more time in front of computer screens. Shorter sleep duration was also associated with higher BMI and waist size. While more research is needed, the findings of the study add to compelling evidence that poor sleep quality in young people is a problem that should be addressed.
Parents, caretakers, teachers and doctors should take a young person’s “sleepy” complaints seriously, and look for clues in their behavior that may indicate sleep deprivation, including excessive daytime sleepiness and symptoms such as inattentive behavior, trouble learning and paying attention, and weight gain/obesity.

I agree with Dr. Brian McCrindle, senior author and cardiologist at SickKids, who recommends that parents do what they can now to help improve the sleep habits of children early in life, such as monitor their caffeine intake and bedtimes, and make sure their bedrooms do not have too much media, especially late at night. Doing so can help ensure that a child’s neurobehavioral challenges are properly diagnosed and treated, leading to better behavior, greater ability to learn and a happier child.

Read the full report, “Poor sleep in adolescents may increase risk of heart disease.”

Light from Tablet Computers May Delay Sleep, Especially in Teens

I admit I love my gadgets – especially my laptop and e-reader, I’m also, as a doctor, aware of the effects that the artificial light from these devices can have on our sleep, especially following prolonged and late-night use.

The artificial, short-wave light from TV and computer screens can suppress melatonin production and throw off circadian rhythm, preventing deep, restorative sleep. Prolonged sleep disruption may also lead to increased risk for diabetes and obesity.  A new study  released in late August reinforces my opinion with some data.

Researchers at the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute in Troy, NY tested the effects of self-luminous tablets on melatonin suppression. Melatonin is a hormone produced by the pineal gland at night and is involved in regulating our sleeping and waking cycles.

The study was funded by Sharp Laboratories of America and led by Mariana Figueiro, associate professor at Rensselaer and director of the LRC’s Light and Health Program. Co-authors of the study are LRC director and professor Mark S. Rea, LRC research specialist Brittany Wood, and LRC research nurse Barbara Plitnick.

For the study, 13 participants used self-luminous tablets to read, play games and watch movies. The participants were divided into three groups. The first group viewed their tablets through a pair of clear goggles fitted with blue light. This was the “true positive” group because blue lights are known to be a strong stimulus for suppressing melatonin.

The second “control” group viewed their tablets through orange-tinted glasses, which filtered out the short-wavelength radiation that can suppress melatonin. The third group did not wear any glasses or goggles. Each tablet was set to full brightness.

The results of the study were clear: After only two hours of exposure to electronic devices with self-luminous “backlit” displays, the participants’ melatonin levels were suppressed by about 22 percent. According to lead researcher Mariana Figueiro, stimulation of the circadian system to this level may delay sleep in those using the devices prior to bedtime, especially in teens.

The researchers also determined that the type of task being performed on the tablets also determines how much light is delivered to the cornea, and therefore the impact the self-luminous light has on nighttime melatonin levels. In other words, the researchers pointed out that it is important to measure how much light a person receives from the self-luminous device.

So, what can be done with this new information? How can we use it to improve our sleep and general health? One, we can all become more aware of how much time we—and our children—spend staring at our tablets, computer and TV screens late at night. As adults, it is up to us to monitor ourselves and our children, and have the discipline to turn these machines off at least an hour before bedtime.

LRC research specialist Brittany Wood said, “Technology developments have led to bigger and brighter televisions, computer screens, and cell phones. To produce white light, these electronic devices must emit light at short wavelengths, which makes them potential sources for suppressing or delaying the onset of melatonin in the evening, reducing sleep duration and disrupting sleep. This is particularly worrisome in populations such as young adults and adolescents, who already tend to be night owls.”

Although pre-teens and teens love their late-night electronics, as parents, it is our responsibility to monitor our children’s computer use, or at the very least in older teens, educate them and make them aware of the potential; side effects of prolonged use.

Researcher Figueiro also feels that tablet display manufacturers can use this information to determine how their products affect circadian system regulation, and as a result, design more “circadian-friendly” electronic devices that could either increase or decrease circadian stimulation depending on the time of day. For example, screens that reduce circadian stimulation in the evening for a better night’s sleep, and increasing in the morning to encourage alertness.

Figueiro had another interesting idea about tablet light therapy: In the future, manufacturers might be able to use related data to design tablets that minimize symptoms of seasonal affective disorder, and sleep disorders in seniors. People might even be able to receive light treatments while playing games or watching movies, making light therapy much more enjoyable than just sitting in front of a light box.

Until manufacturers develop more “circadian-friendly” electronic devices that increase or decrease light exposure based on time of day, Figueiro offered several recommendations to reduce the effects of self-luminous tablet light on sleep, including dimming these devices at night as much as possible in order to minimize melatonin suppression, and, as I mentioned before, limiting the amount of time spent using these devices prior to bedtime.

Here’s another idea: Why not turn off the devices before bed, and pick up a good old fashioned paper book. You’ll be out like a light before you know it.

Read the full study entitled, “Light From Self-Luminous Tablet Computers Can Affect Evening Melatonin, Delaying Sleep.”

Heavy Technology Use linked to Fatigue, Stress and Depression in Young Adults

Modern technology is affecting our sleep. The artificial light from TV and computer screens affects melatonin production and throws off circadian rhythms, preventing deep, restorative sleep.

New research out of the University of Gothenburg, Sweden reinforces this fact, specifically relating to young adults. Doctoral student Sara Thomée and her colleagues at the University of Gothenburg's Sahlgrenska Academy conducted four studies to find out the effects of heavy computer and cell phone use on the sleep quality, stress levels, and general mental health of young adults.

For the study, Thomée and her team asked 4,100 young adults between age 20 and 24 to fill out questionnaires. They also interviewed 32 of them who were considered heavy information and communication technology (ICT) users. The researchers analyzed and compiled the data, and the results revealed that intensive use of cell phones and computers can be linked to an increase in stress, sleep disorders and depressive symptoms in young adults.

Some of the more specific findings are:

• Heavy cell phone use showed an increase in sleep disorders in men, and an increase in depressive symptoms in both men and women. 

• Those constantly accessible via cell phones were the most likely to report mental health issues.  

• Men who use computers intensively are more likely to develop sleeping problems.
• Regular, late night computer use is associated with sleep disorders, stress and depressive symptoms in both men and women.
• Frequently using a computer without breaks further increases the risk of stress, sleeping problems and depressive symptoms in women.
• A combination of both heavy computer use and heavy mobile use makes the associations even stronger.

So, what’s behind this link between technology use and negative health symptoms? The researchers have not yet fully determined why heavy technology users are more likely to have sleep disorders, higher stress and mental health issues, but one theory is that people with these symptoms are more likely to reach out and contact friends and family via technology.

I tend to think that the relationship between technology and stress, sleep disorders and depression has more to do with the overuse of technology in our society, especially among young people. If you’re a parent like I am, than you know first-hand how difficult it can be to get children to turn off the computer or put down their phone and stop texting so you can, just maybe, have a real conversation.

This is a growing and serious public health hazard that should be acknowledged and addressed by both the medical community and technology industry. It’s been scientifically proven that the light from TV and computer screens affects melatonin production and melanopsin stimulation, and throws off our circadian rhythms. This interrupts or prevents deep, restorative sleep, causing an increase in stress and depressive symptoms.

In the words of head researcher Sara Thomée, "Public health advice should therefore include information on the healthy use of this technology.” I couldn’t agree more. Just like alcohol ads, so should technology companies carry warnings on their products and in their advertisements. “Text responsibly.” “Don’t surf, then sleep.” You get the idea.

What can we, as individuals, do to protect our health from the negative impact of the ubiquitous technology in our society? Quite simply, turn it off, and get some good sleep. When you are on the computer for any length of time, take more frequent breaks, and impose limits on the amount of time you spend online. Trust me, the world will wait patiently for another Facebook post or text from you.

Remember, people need an average of seven to eight hours of restful sleep to fully take advantage of its restorative power and avoid daytime symptoms of fatigue. So turn off your TV and computer at least one hour before you go to sleep. Don’t sleep with your cell phone on and next to your bed. (Few things are more frustrating than being awakened in the middle of the night by an unimportant text message.)

Re-claim your bedroom for its intended purpose: restful sleep. Move the TV and computer out of the bedroom, or at the very least, don’t watch TV or work on the computer too close to bedtime. Stick to a bedtime routine. Get at least 7-8 hours of sleep every night. Try to go to sleep and wake up around the same time every day, even on weekends. Try to keep to within 20 minutes of the same time each morning and night.

Before bed, do activities that will promote sleepiness, such as a taking a warm bath, or reading a book or magazine. It also helps to maintain a cool temperature in your bedroom. A cool but comfortable temperature is ideal for sleep. Too warm and you will be fitful, too cold however can be uncomfortable and disturb your sleep.

Exercise regularly but not after the late afternoon. Even though exercise helps regulate sleep, rigorous exercise causes endorphins in the body to circulate which can have a stimulant effect, and keep you awake longer at night.

Stay away from caffeine at night. The effects of caffeine are different from person to person, and may last hours after your last cup of coffee, so make your last cup of coffee, regular tea or soda earlier in the day. Avoid alcohol and medicines that make you drowsy. Even if you think it is helping you fall asleep initially, alcohol and medicines that makes you drowsy may affect your sleep throughout the night.

And finally, if you feel that you are suffering from persistent sleep disorder, get checked out by a qualified sleep doctor. Regular, healthy sleep is one of the best things you can do for your mental and physical health.

Read the full report, entitled, “Intensive Mobile Phone Use Affects Young People´s Sleep.”

Lack of Sleep is Stressing Us Out, New Study Says

Stress in our life is not only caused by what we do and our busy schedules—stress is also caused by what we don’t do, namely, not get enough sleep. A new study by researchers in England and the Netherlands have discovered that a severe lack of sleep creates a response in the immune system that is similar to the body’s immediate response when it experiences a stressful situation. Yes, even lack of sleep is stressing us out.

The study was a joint effort by the Department of Forensic Molecular Biology at the Erasmus MC University Medical Center in Rotterdam and the Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, and the University of Surrey Clinical Research Centre in England.

So how did the researchers determine this? They compared the white blood cell counts of 15 healthy young men under both normal and severely sleep-deprived conditions.

In the first phase of the study, the men followed a strict schedule of eight hours of sleep per night every day for one week. They were also exposed to at least 15 minutes of outdoor light within the first 90 minutes of waking, and prohibited from using caffeine, alcohol or medication during the final three days of the first week.

The researchers required this in order to stabilize the participant’s circadian clocks and minimize sleep deprivation before the second phase of the study. The researchers then categorized and measured each participant’s white blood cells.

In the second phase of the study, the men stayed awake for 29 continual hours, and their white blood cells were again recorded and compared to the white blood cell numbers collected in the first phase of the study.

According to the researchers, the effect of sleep loss on the white blood cells was immediate. The white blood cells known as granulocytes showed a loss of day-night rhythmicity—the circadian rhythm of the granulocytes slowed—and their numbers also increased, particularly at night. This reaction directly mirrors the body’s white blood cell response to stress.

Read the full study entitled, “Diurnal Rhythms in Blood Cell Populations and the Effect of Acute Sleep Deprivation in Healthy Young Men,” published in the July 2012 issue of the journal, Sleep. 

The results of the study are in line with other previous research that shows a link between lack of sleep and a negative immune system response. In March of this year, the University of Rochester Medical Center published results that showed that the immune system of older adults who do not get enough sleep responds to stress with inflammation, increasing the risk for mental and physical health problems.

These studies and others like them reinforce the fact that more quality, restful sleep not only helps us feel better – it may also help us avoid myriad poor mental and physical health conditions. So, get some sleep out there — you’ll feel less stressed out!

Is Excessive Daytime Sleepiness the Cause of Learning and Behavior Problems in Children?

For months now, I have been writing about the studies that are being published—seemingly by the month—linking obstructive sleep apnea (OSA) to more and more medical conditions, including hypertension,heart disease, mood and memory problems.

The latest research didn’t surprise me, but it did upset me more than usual — because it concerns our children, and the negative effects that poor sleep can have on their ability to pay attention, learn and control their behavior.

On May 1, the results of a study by Penn State researchers was published showing that children who have learning, attention and/or behavior problems may be suffering from a condition known as excessive daytime sleepiness (EDS)—even if tests indicate that they are getting enough sleep at night. 

For the study, the researchers conducted sleep testing on 508 children, and asked their parents to report if their child seemed excessively sleeping during the day. Then, the children were divided into two groups: children with excessive daytime sleepiness, and those without EDS. The results, published in the May 2012 issue of SLEEP,  showed that the children in the parent-reported EDS group were more likely to have "neurobehavioral” problems, including behavior/conduct problems, attention/hyperactivity and poorer performance in learning speed and working memory than children without indications of EDS.

What surprised the researchers was that, even if a child was in the EDS group, few also showed signs of short (not enough) sleep when tested. As a result, the researchers did not associate short sleep with any of the learning, attention and behavior problems.

So, what is causing these children’s extensive daytime sleepiness if they are getting enough sleep (at least on paper)? Like in adults, perhaps it is not just the length of sleep time, but the quality of sleep that determines restorative rest, or not.

A New York Times article from April 16, 2012 entitled “Attention Problems May Be SleepRelated”  also examined the relationship between children’s sleep quality and the ability to pay attention at school. The article was on another recent study called “Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years,” published in the Official Journal ofthe American Academy of Pediatrics. 

What I found disturbing about this article was that it pointed out that many cases of attention deficit hyperactivity disorder (A.D.H.D.) in children may have been misdiagnosed—that the cause of behavior such as moodiness and hyperactivity might in fact be due to obstructive sleep apnea (OSA) or other sleep disorder, which is causing sleep deprivation in the child. Worse, the drugs diagnosed for the A.D.H.D. are probably making the child’s symptoms worse!

This should be a call to arms for parents, caretakers, teachers and the medical community. If you know of a child suffering from sleep deprivation and/or extensive daytime sleepiness, and the symptoms that result, such as behavioral and learning problems … speak up and suggest they get tested for a sleep disorder first.

 Impairment due to EDS in daytime cognitive and behavioral functioning can have a significant impact on children's development. This is not to say that A.D.H.D. cannot be a true cause, but misdiagnosis of anyone—especially a child prescribed drugs—should not be tolerated.

Stay aware of the child’s behavior; look for clues, such as inattentive behavior and obesity, take a child’s “sleepy” complaints seriously … and then say something. You could be the reason a child’s neurobehavioral challenges are properly diagnosed and treated, leading to better behavior, greater ability to learn and a happier child.

Read the abstract of the report, “Learning, Attention/Hyperactivity, and Conduct Problems as Sequelae of Excessive Daytime Sleepiness in a General Population Study of Young Children.”

Brain Damage from Snoring?

Brain Damage from Snoring?

Snoring from sleep apnea can have dangerous consequences. For years physicians have known that chronic snoring can cause daytime symptoms of fatigue that affect cognitive function and memory loss due to the interruption in sleep it causes. A new study out of Australia from the Institute for Breathing and Sleep at Melbourne’s Austin Health reveals not just an impact in function. Snoring while you sleep could be the cause of brain damage.

During the Australian study, brain scans of 60 people in their mid 40’s who were recently diagnosed with sleep apnea, a common sleep disorder, showed “a decreased amount of gray matter” compared to healthy sleepers. Sleep apnea is caused by the airways collapsing while asleep at night, pausing breathing and forcing sleep apnea sufferers from rousing from a deep sleep, sometimes “hundreds of times a night,” according to Dr. O’Donoghue of Austin Health. This pause results in the brain being deprived of oxygen as well as "surges in blood pressure".

Since the scans showed decreased amount of grey matter in the brain, it meant there was damage in certain areas. According to O’Donoghue, the damage was evident in two pockets of the brain, one that handles memory and the other known to allow smooth movement and changes in attention during complex tasks. Earlier studies have showed that this part of the brain is activated during a driving task, and therefore may explain why sleep apnea patients have an increased risk of car accidents.

"What specific part of sleep apnea might cause these changes we can’t say, but we can see the changes that have occurred…The take home message is if you complain of these sort of symptoms it is not a good idea to ignore it, you should seek help," Dr. O’Donoghue said.

This research was presented at the 22nd Annual Scientific Meeting of the Australasian Sleep Association and Australasian Sleep Technologists Association Conference, in Christchurch, New Zealand.