Untreated Sleep Apnea: The Quiet Danger on the Road

By Dr. David O. Volpi

It is common knowledge that untreated sleep apnea can have dire health effects, but researchers in England found out that loss of sleep also increases a person’s risk of nodding asleep at the wheel, and getting in a car accident. That endangers not only the person suffering from the sleep disorder, but any person driving around them at any given time.

The study, which was organized by the European Respiratory Society and the European Sleep Research Society, and presented April 12, 2013 at the Sleep and Breathing Conference in Berlin, determined that people with untreated sleep apnea are more likely to fail a driving simulator test, and report nodding asleep while driving.

Let’s review: What is sleep apnea?

Sleep apnea is a breathing disorder that causes a person’s breathing during sleep to be paused and/or shallow. The pauses generally last 10 to 20 seconds, and in severe cases, can occur hundreds of times a night. With obstructive sleep apnea (OSA), the airway is blocked and/or collapses while sleeping. Air squeezing by the blockage can cause loud snoring and interrupted sleep.

As a result of the paused breathing and/or snoring, many sleep apnea sufferers are woken up throughout the night and spend more time in light sleep, rather than deep, restful REM (rapid eye movement) sleep. This chronic sleep deprivation results in daytime sleepiness, and can negatively affect job performance, mood, reflexes, concentration, and it can lead to hypertension, heart disease, and memory problems.

Testing and results of the study

To determine the effect of untreated sleep apnea on driving, the researchers conducted two separate studies. The first was a driving simulation test where 133 patients with untreated sleep apnea and 89 without sleep apnea were asked to “drive” 90 km—about 55 miles.

Various criteria was recorded, including the participants’ ability to complete the driving distance, their time spent in the middle lane, and any participation in an unprovoked crash or a “veer event” crash.

The results of the driving simulation test showed that:

• Patients with untreated sleep apnea were more likely to fail the driving simulation test—24 percent of the sleep apnea patients failed the test, compared to 12 percent of those without sleep apnea.
• In addition, many patients with untreated sleep apnea were unable to complete the test at all, had more unprovoked crashes, and were unable to follow the clear driving instructions given at the beginning of the simulation test.

In the second study, 118 people with untreated sleep apnea and 69 without sleep apnea completed a questionnaire about their driving behavior, and also took the 90 driving test on the simulator.
The results showed that:

• 35 percent of those with untreated sleep apnea admitted to nodding asleep while at the wheel, and 38 percent of this same group failed the driving simulation test.
• By comparison, only 11 percent of people without sleep apnea said they have nodded off while driving, and none of this group failed the simulator test.

Key differences in the reasons for failure

While some people in the control group (those without sleep apnea) also failed the driving simulator test, the researchers noted key differences in why they failed the test:

• 13 people with untreated sleep apnea did not finish the test because they fell asleep or veered completely off the road.
• 5 people with untreated sleep apnea failed because they spent more than 5 percent of the study outside the lane they had been instructed to stay in.

But in the control group, no one failed the simulation for either of these reasons. Again, no one in the “without sleep apnea” group failed the driving simulation due to falling asleep, veering completely off the road, or driving outside the lane.

Dan Smyth of Sleep Apnea Europe noted, "The dangers of untreated sleep apnea and driving are highlighted in both studies. These studies give weight to the need for provision of sufficient resources for early diagnosis and treatment.

While further investigation is needed to examine the reasons for failure of the simulator tests, I acknowledge the researchers for bringing light to this very dangerous side effect of untreated sleep apnea. of sleep apnea, where effective treatment ensures a return to acceptable risk levels for road users."

Are you at risk for sleep apnea?

So how do you know you may have obstructive sleep apnea? Some common symptoms include snoring, paused breathing during sleep and excessive sleepiness during the day. Increased blood pressure is another sign you may have sleep apnea.

While sleep apnea is more common in men, OSA increases in women after age 50. Being overweight may also increase a woman’s risk of having sleep apnea. Menopausal women are three and a half times more likely to get OSA, possible due to reduced amounts of progesterone.

If you experiencing one or more of the above sleep apnea symptoms on a regular basis, see a qualified sleep doctor to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

Sleep Improves Children’s Ability to Absorb Information and Learn

By Matthew D. Mingrone, M.D. of eOs Sleep

It has been common scientific knowledge for some time that when people sleep, our brains consolidate the information we subconsciously absorb during the day, and process it into explicit, conscious knowledge.

Both children and adults do this, but an interesting new study out of Germany shows that during sleep, children's brains convert subconsciously absorbed information—known as implicit learning—into active, useful knowledge even more effectively than adult brains do.
Implicit learning is typically considered subconscious learning; the acquisition of knowledge independent of conscious attempts to learn. For example, a child can say a sentence without understanding the rules of English grammar.

Explicit learning, on the other hand, is deliberate, conscious learning; the active and aware acquisition of skills and/or knowledge. Typically, explicit learning is accompanied by “meta-awareness,” a person can explain how they acquired the skill and/or knowledge.
When we sleep, implicit knowledge becomes explicit memory, making it easier for us to recall and use the information we have previously absorbed.

In a new study conducted by Dr. Ines Wilhelm of the University of Tübingen's Institute for Medical Psychology and Behavioral Neurobiology in Germany, and colleagues, the researchers studied 35 children between the ages of 8 and 11 years old, as well as 37 adults between 18 and 35.

For the test, the subjects were asked to press a sequence of buttons after they lit up. Half of the subjects did the test before sleep, the other half after sleep. They were then asked to recall the sequence of buttons/lights 10 to 12 hours later. Following a night of sleep or a day awake, the subjects’ memories were tested.

An article explaining the results of the study, entitled, “The sleeping child outplays the adult's capacity to convert implicit into explicit knowledge,” is published in the February 24, 2013 online edition of Nature Neuroscience.

The authors observed that after a night’s sleep, both age groups—8 to 11 and 18 to 35—remembered a larger sequence of buttons/lights than those who did not sleep. It also showed the children were better at it than the adults—almost all of the children could remember the sequence they had pressed perfectly, while adults experienced smaller gains.

Lead author Dr. Ines Wilhelm wrote, “In children, much more efficient explicit knowledge is generated during sleep from a previously learned implicit task. And the children’s extraordinary ability is linked with the large amount of deep sleep they get at night. The formation of explicit knowledge appears to be a very specific ability of childhood sleep, since children typically benefit as much or less than adults from sleep when it comes to other types of memory tasks.”

Children absorb massive amounts of information every day. They also generally sleep longer and deeper, and experience three times more slow-wave sleep and higher electrical activity in the brain during sleep than adults. This may help them “convert” the information they take in every day into knowledge they can recall and use. This is yet another important reason why parents should ensure their children are getting enough uninterrupted sleep every night.

A Good Night’s Sleep Can Be a Matter of Life and Death

Over the past three years, I have been writing the Wake Up! You’re Snoring blog with two main objectives: first, to educate you, the public, about sleep disorders, and second, to provide compelling reasons—preferably scientific evidence—why a person who may have a sleep disorder should get diagnosed and, if necessary, properly treated.

There is no shortage of scientific studies being released on a regular basis showing links between obstructive sleep apnea (OSA), insomnia, and other sleep disorders, and myriad negative health conditions, from daytime sleepiness to increased depression.

I wasn’t surprised to see a new study showing a link between insomnia, the loss of hope, and an increased risk of suicide. In a study led by Dr. W. Vaughn McCall, chair of the Medical College of Georgia at Georgia Regents University, researchers studied the mental state of 50 depressed patients between the ages of 20 and 80. More than half of the patients had attempted suicide, and most were taking an antidepressant.

It is established that insomnia and nightmares often go hand-in-hand, and are both known risk factors for suicide. The new study reaffirms that link, but researchers also wanted to find out what effect feelings of hopelessness about sleep had on suicide risk.

In the study, the researchers specifically focused on the relationship between insomnia and suicide risk by asking questions about dysfunctional beliefs about sleep, such as, “Do you think you will ever sleep again?” The scientists used psychometric testing to objectively measure the mental states and personalities of the 50 depressed patients.

Dr. McCall published the results of the study in the Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine. In the report, Dr. McCall stated, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” Dr. McCall also said, “The likelihood of being suicidal at least doubles when insomnia is a symptom.”

McCall and his colleagues have, in effect, discovered a new predictor for suicidal thinking. But why the link between lack of sleep and suicidal thoughts? Dr. McCall explained that, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” He continued, “If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, ‘My marriage is a mess, I hate my job, I can’t communicate with my kids, I can’t even sleep.’ There is a sense of failure and hopelessness that now runs from top to bottom, and (insomnia) is one more thing. It was this dysfunctional thinking — all these negative thoughts about sleep — that was the mediating factor that explained why insomnia was linked to suicide,” said McCall.

The significance of this study, like many others, is that it not only educates people about the risks associated with insomnia and other sleep disorders, but it challenges the medical community to look at things a little differently when diagnosing and treating.

In this case, examine lack of sleep and insomnia when treating depression and suicidal thinking.  The finding also is a reminder to physicians that depressed patients who report increased sleep problems should be asked if they are having suicidal thoughts, McCall said.

If you’re having trouble sleeping, here are some tips to increase your chances of getting a good night’s sleep.

• Use the bedroom for sleep. With so many electronic distractions in our lives, it’s important to re-claim your bedroom for its intended purpose: rest and sleep. Move the TV and computer out of the bedroom, or at the very least, do not watch TV, work on the computer or check your blackberry close to bedtime.
• Stick to a bedtime routine. Try to go to sleep before 10:00 pm at night, 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.
• Do activities that will get you ready for bed. Before bed, do activities that will promote sleepiness, such as a taking a warm bath, or reading a book or magazine.
• 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.

Remember, people need an average of 7-8 hours of restful sleep to fully take advantage of its restorative power and avoid daytime symptoms of fatigue. If a regular, peaceful routine incorporating the tips above doesn’t help you start sleeping peacefully throughout the night, contact your doctor. You may have a more serious cause of sleeplessness such as snoring, sleep apnea or chronic insomnia. Getting treated could prevent heart disease, hypertension and stroke.

Snoring a Top Predictor of Heart Attacks and Strokes

By Dr. David O. Volpi

I read a study recently that I immediately knew I had to make you aware of.

Researchers at Henry Ford Hospital in Detroit found that snoring is a bigger risk factor for heart disease, including stroke and heart attacks, than being overweight, having high cholesterol, and even smoking! Yes, you read that right—snoring is an even bigger risk factor for heart disease.

The study, which was submitted to The Laryngoscope journal, is the first of its kind to show a link between snoring and heart disease, similar to other risk factors, such as sleep apnea, obesity, smoking and high cholesterol are also linked to heart disease.

Snorers showed arterial damage

For the study, Dr. Robert Deeb, MD, and senior study author Karen Yaremchuk, MD, reviewed the data of 913 patients, all between the ages of 18 and 40, who had been evaluated by the Henry Ford sleep center between December 2006 and January 2012.

The researchers noticed that the carotid arteries—the arteries that supply oxygen-rich blood to the brain—had thickened among the snorers, indicating that arterial damage had occurred due to snoring.

The researchers hypothesized that the thickening of the artery walls could have been due to the trauma and inflammation caused by snoring. But previous research on sleep apnea and artery disease has found the opposite: arterial damage comes first, reducing the oxygen level in the blood, leading to interruptions in breathing. The thickening of the arteries may also be contributing to the snoring in the patients.

Even more interesting: The snorers’ arterial walls had thickened, even though none of the patients had been diagnosed with obstructive sleep apnea (OSA). While OSA often develops from snoring and has been known as an indicator of cardiovascular disease, there’s been little evidence until now to prove that arterial damage can actually begin with snoring.

What these results mean

So what are the medical implications of the Henry Ford study? Let’s review coronary artery disease for a moment. Coronary artery disease (CAD), also known as atherosclerosis, occurs when waxy plaque builds up on the inner walls of the arteries.

Over time, the arterial walls thicken and stiffen, restricting blood flow to the heart and/or brain. It is commonly know that CAD is a precursor to conditions such as heart attack, stroke, and heart failure.

The results of the Henry Ford study—that the carotid arteries had thickened among the snorers, is important to pay attention to because it means that snoring, not just OSA, is a high risk factor for coronary artery disease, heart disease, and other related conditions.

Drs. Deeb and Yaremchuk’s research is groundbreaking because arterial blockage and other forms of heart disease are usually detected only after significant permanent damage has been done.

This new research should encourage snorers—and those who love them—to visit a doctor to discuss cardiovascular health and stroke prevention, and get properly diagnosed and treated.

The research is clear that doctors should add snoring to the list of coronary artery disease risk factors, along with high blood pressure, high cholesterol, diabetes, smoking and family history. Perhaps if patients and their doctors considered snoring a serious health threat and treated it accordingly, there would be a great reduction in heart disease.

Women with Sleep Apnea Show Higher Brain Damage, Anxiety than Men

An estimated 18 million Americans have obstructive sleep apnea (OSA), including one in four women over 65, according to the National Sleep Foundation.

And several recent studies have linked OSA to health disorders specifically in women. Sleep apnea has been linked to dementia in older women,  and another observational study found that women with untreated severe OSA are 3.5 times more likely to die from cardiovascular disease than women without OSA.

Here’s another reason for women to take sleep apnea seriously: A first-of-its-kind study out of the UCLA School of Nursing discovered that women with sleep apnea are more likely to suffer a higher degree of brain damage than men with sleep apnea.

What is obstructive sleep apnea? OSA is a disorder that occurs when a person's breathing is repeatedly interrupted during sleep, sometimes hundreds of times a night. During each obstruction, the oxygen level in the blood drops, which over time, causes myriad health problems. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems, among other disorders.

The new UCLA study

UCLA has been on the cutting edge of sleep apnea research. About 10 years ago, the same UCLA research team that conducted the new study was the first to show that men with OSA have damage to their brain cells.

For the latest multi-year study, entitled "Sex Differences in White Matter Alterations Accompanying Obstructive Sleep Apnea,” the researchers studied patients diagnosed with OSA at the UCLA Sleep Laboratory. They compared the nerve fibers in the patients' brains, known as “white matter,” to the nerve fibers of people without OSA or other sleep problems. The goal was to find the differences in brain damage, if any, between men and women with OSA.

Results of the study

The researchers found that women are actually more affected by sleep apnea than men. Additionally, women with OSA have more severe brain damage than men suffering from a similar condition. The women with sleep apnea also showed higher levels of depression and anxiety symptoms.

Specifically, the study found that women were impacted in the cingulum bundle and the anterior cingulate cortex areas in the front of the brain involved in decision-making and mood regulation.

Based on the results, chief investigator Paul Macey said, “Doctors should consider that OSA in women may be more problematic and therefore need earlier treatment in women than men.”

With the results of this study as a foundation, the next step is for the researchers to find out if treating sleep apnea can help the brain.

In a “chicken or egg” scenario, did the OSA cause the brain damage, or did the brain damage cause the OSA?  Or did the common conditions, such as depression, dementia or cardiovascular issues cause the brain damage, which in turn leads to sleep apnea?

The study and resulting questions are fascinating, and one thing is for sure: both men and women who are having trouble sleeping should get checked for obstructive sleep apnea and other sleep disorders.

Researchers estimate that up to 85 percent of people with severe sleep apnea have not been diagnosed yet.

Many times, sleep apnea can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition, so be specific about the symptoms you are experiencing.

Don't wait to get checked—it could save your life, or someone you love.

For more information, read the article, “Women with sleep apnea have higher degree of brain damage than men, UCLA study shows.”

Can more sleep help ease pain? Yes, says new study!

Chalk another one up for the benefits of sleep. Researchers at the Sleep Disorders and Research Center at the Henry Ford Hospital in Detroit have found that getting more sleep improves daytime alertness and reduces pain sensitivity in healthy adults.

The study was led by Timothy A. Roehrs, Ph.D. of the Sleep Disorders and Research Center at the Henry Ford Hospital and supported by the Fund for Henry Ford Health System. Roehrs and his colleagues studied 18 pain-free, but mildly sleepy volunteers.

For the study, the participants were randomly assigned to four nights of either their normal amount of sleep, or extending their sleep time to 10 hours in bed per night. Their daytime sleepiness was measured on days one and four using the Multiple Sleep Latency Test (MSLT), a tool that measures how quickly a person falls asleep. Their pain sensitivity was also measured using finger withdrawal latency pain testing to a radiant heat stimulus.

The first study to prove sleep reduces pain.

The results of the study were published in the Dec. 1 issue of the journal Sleep. It is the first research of its kind to prove that extended sleep in mildly sleep-deprived adults can significantly reduce their sensitivity to pain.

The results showed that the extended sleep group—those who slept more than normal—slept 1.8 hours more per night than the normal sleep group. It also showed that they experienced less daytime sleepiness. This increase in sleep time during the four nights correlated to increased daytime alertness, as well as less sensitivity to pain.

Regarding the pain test, the extended sleep group showed a greater tolerance for pain/reduced pain sensitivity. The length of time before participants removed their finger from a radiant heat source increased by 25 percent. The researchers noted that this increase in “finger withdrawal latency” is greater than the effect found in a previous study where participants used 60 milligrams of codeine.

In their report, the researchers stated that the results, combined with data from previous research, suggest that increased pain sensitivity in sleepy individuals is the result of their underlying sleepiness.

Timothy Roehrs, PhD, the study’s principal investigator and lead author said, “The results suggest the importance of adequate sleep in various chronic pain conditions or in preparation for elective surgical procedures. We were surprised by the magnitude of the reduction in pain sensitivity, when compared to the reduction produced by taking codeine.”
Read the press release for the study, “Extended sleep reduces pain sensitivity.”

Lack of sleep and an increase in strokes.

Roehrs’ study adds to growing evidence that more regular, restorative sleep can help reduce the risk of health problems, and the opposite is true, as well.

Last June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.
It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchers followed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart, no pun intended. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary. There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of regular, restorative sleep

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

Is the quality of your sleep making you gain weight?

How many of us would like to lose a few pounds, but look for external ways—outside of our bodies—to lose weight?  Perhaps we should be looking more inward, not only at our personal diet and exercise levels, but the length and level, or phase, of our sleep.

Recently, I read an article in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology. In it, researchers from St. Luke's-Roosevelt Hospital and Columbia University in New York shed some light on the link between our length and phase of sleep, and hunger and weight gain.

The researchers investigated the effects of “sleep architecture” on hunger to determine whether specific stages of sleep—not just the duration of sleep—affect the appetite and food cravings in healthy adults.

What they found is compelling, and cause for further attention: the length of time of sleep, as well as the percentage of overall sleep in different sleep stages, are associated with decreased metabolic rate, increased hunger, and increased intake of calories, specifically from fat and carbohydrates.

For the study, head researcher Ari Shechter and his colleagues studied a random sample of 27 healthy adults between the ages of 30 and 45. The participants underwent two six-day periods of laboratory observation, during which they were slept different lengths of time.

During a "habitual sleep" phase, they were allowed to sleep for nine hours; in the "short sleep" phase, they were allowed just four hours of sleep. Each of the two sleep phase studies were separated by four weeks to make sure the participants fully recuperated, and the women were observed at the same phase of their menstrual cycle. The amount of time spent in each sleep phase—stage 1, stage 2, slow wave sleep (SWS), and REM sleep—was recorded.

For the first four days in both sleep phases, the participants ate meals to meet their energy requirements for weight maintenance. On day four, they rated their hunger and level of desire for different foods. On day five, their resting metabolic rate (RMR) was measured, and for the final two days of the sleep phase studies, the participants were allowed to select their own foods.

The researchers then compared the participants' sleep architectures in both the short sleep and habitual sleep conditions. They also analyzed the relationships between sleep architecture, resting metabolic rate, food intake and food desire ratings.

Shechter and his colleagues found that sleep duration is important, but sleep composition—the time and percentage of overall sleep spent in each stage—also plays an important role in the link between sleep and obesity.

Head researcher Shechter explained, “Any number of various factors like obstructive sleep apnea, certain drugs/medications, chronic exposure to short sleep duration, shift work, jet lag, and changes in the scheduling of the sleep episode, can affect sleep stage quantity and distribution. Our data may provide an explanation for the greater obesity prevalence observed within some of these conditions."

Read the full article, “Changes in Sleep Architecture Increase Hunger, Eating.”
The results of this study remind me of another study I blogged about not long ago on “social jetlag,” another reason for all of us to get more sleep.

Social jetlag is a modern syndrome caused by the discrepancy between our internal body clock and our social clock. And according to Professor Till Roenneberg, Ph.D. at the University of Munich’s Institute of Medical Psychology in Germany, that gap between how much sleep we need and how much we’re actually getting is contributing to our global weight gain and the growing worldwide obesity epidemic.

Each of us has a physiological clock, and that internal clock — also known as our circadian rhythm — is regulated by daylight and darkness to prompt us to go to sleep or wake up. We also have a social clock of things that make up our daily lives, such as our work schedules and social calendars.

The problem is, in our modern society of too-late work hours and too much time in front of computer screens, we are listening to our social clocks more than our physiological clocks, causing a greater sleep gap known as social jetlag. As a person’s circadian rhythm gets more out of whack, their physiological clock gets set later and later, keeping them awake into the night, and feeling chronically tired during the day.

In their study, Professor Roenneberg and his fellow researchers in Munich discovered that people with different weekday and weekend sleep schedules—i.e., those with more social jetlag — were three times more likely to be overweight. That is a significant increase worth repeating: Three times more likely to be overweight!

Furthermore, the body mass index (BMI) of the overweight participants tended to increase as the gap between their weekday and weekend sleep clocks widened.
I applaud the efforts of Roenneberg and his team for their work in particular, because they are bringing a public awareness of a growing syndrome that is affecting many people worldwide — not just shift workers or those with irregular work schedules.

So, why does social jetlag cause weight gain? One of the theories is that late hours encourage irregular meal times and late-night eating, when the body has more difficulty digesting and metabolizing food. That translates into body fat. Another is that chronically tired people are less likely to exercise and more likely to smoke and drink, further contributing to weight gain.

Whatever the causes, it is in all our personal best interests to become more aware of our own physiological clocks and get more restful sleep. Doing so can help us all maintain a healthy body weight, avoid many health problems, feel better and live happier, more productive lives.

So, now that you have this new knowledge about sleep, weight gain, I suggest you give yourself a wonderful personal gift: get more sleep, especially during the holiday season, when many people are overeating and busier than usual. Also spend more time outdoors and exercise. More and better sleep is one of the best gifts you can give yourself for the holidays.

Read Professor Roenneberg and his team’s full report entitled, “Social Jetlag and Obesity,” published in the May 10 issue of Current Biology.

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.”

Less Than Six Hours Sleep/Night Increases Strokes

Lack of sleep and an increase in strokes. According to new research, the two conditions are very connected, even in otherwise healthy adults.

In early June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.

It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchersfollowed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary.  There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of more–and better—sleep.

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

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.”

“Social Jetlag” Contributing to Global Weight Gain

Here’s another reason to get more sleep — and another new term to describe one of our modern maladies: “social jetlag.” What exactly is social jetlag? It is a syndrome caused by the discrepancy between our internal body clock and our social clock. And according to Professor Till Roenneberg, Ph.D. at the University of Munich's Institute of Medical Psychology in Germany, that gap between how much sleep we need and how much we’re actually getting is contributing to our global weight gain and the growing worldwide obesity epidemic.

Each of us has a physiological clock, and that internal clock — also known as our circadian rhythm — is regulated by daylight and darkness to prompt us to go to sleep or wake up. We also have a social clock of things that make up our daily lives, such as our work schedules and social calendars. The problem is, in our modern society of too-late work hours and too much time in front of computer screens, we are listening to our social clocks more than our physiological clocks, causing a greater sleep gap known as social jetlag. As a person’s circadian rhythm gets more out of whack, their physiological clock gets set later and later, keeping them awake into the night, and feeling chronically tired during the day.

Professor Roenneberg and his fellow researchers in Munich discovered the negative effects of social jetlag after compiling and studying the sleep habits of more than 65,000 adults over the past 10 years. Roenneberg and his team recorded sleep times and other data of the participants, such as height and weight, and started to draw conclusions.

The results of the study — which you can read in the May 10 issue of Current Biology — showed that people with different weekday and weekend sleep schedules—i.e., those with more social jetlag — were three times more likely to be overweight. That is a significant increase worth repeating: Three times more likely to be overweight!  Furthermore, the body mass index (BMI) of the overweight participants tended to increase as the gap between their weekday and weekend sleep clocks widened.

Two-thirds of participants reported at least one hour's difference in their average weekday and weekend sleep schedules, and more than 10 percent reported three-plus hours difference between their weekday and weekend sleep schedules. Roenneberg and his colleagues also found that people who are chronically sleep-deprived are also more likely to smoke and drink more alcohol and caffeine.

The results of the study are similar to those of previous studies linking a higher body mass index and even diabetes to the irregular sleep schedules and sleep deprivation of shift workers. But I applaud the efforts of Roenneberg and his team for their work in particular, because they are bringing a public awareness of a growing syndrome that is affecting many people worldwide — not just shift workers or those with irregular work schedules.

So, why does social jetlag cause weight gain? One of the theories is that late hours encourage irregular meal times and late-night eating, when the body has more difficulty digesting and metabolizing food. That translates into body fat. Another is that chronically tired people are less likely to exercise and more likely to smoke and drink, further contributing to weight gain.

Whatever the causes, it is in all our personal best interests to become more aware of our own physiological clocks and get more restful sleep. Doing so can help us all maintain a healthy body weight, avoid many health problems, feel better and live happier, more productive lives. In the words of Professor Roenneberg, “Good sleep and enough sleep is not a waste of time but a guarantee for better work performance and more fun with friends and family during off-work times.” Knowledge of the study and an increased awareness of the effects of social jetlag can also have positive effects on the economy and education: Companies can make more informed decisions about employees’ work schedules and schools can make more educated decisions about school hours.

So, now that you have this new knowledge about social jetlag, your physiological and social clocks and how a gap between your weekday and weekend sleep schedules can contribute to your weight gain, what are you going to do about it? I present you with a personal challenge that will only help you feel better. I challenge you to get more sleep. Turn off the TV and computer and go to bed earlier. Forego that invitation for a late-night dinner. Spend more time outdoors, and if you’re stuck in an office all day, try to sit near a window. I promise you, you’ll feel less social jetlag.

To read Professor Roenneberg and his team’s full report entitled, “Social Jetlag and Obesity,” published in the May 10 issue of Current Biology.

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.”

One More Reason to Get Checked: Sleep Deprivation Can Cause Weight Gain

It’s no surprise that I use my blog as a forum to educate you on various sleep disorders, and the many reasons to get them diagnosed and treated properly. At the risk of sounding alarmist, not getting a sleep issue checked out—even one you may think is fairly benign—can have dire consequences.

Conditions such as sleep apnea that cause sleep deprivation are linked to poor concentration and memory, increased risk of diabetes, hypertension and high blood pressure, heart attacks and strokes, depression and sexual dysfunction.

As if these reasons aren’t enough to scare you into getting tested, here’s another one that just came out: Lack of sleep is now linked to overeating, and as a result, weight gain. That information was just announced at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 conference in San Diego.

To be more specific, according to the study’s abstract, sleep is an important regulator of metabolism and energy expenditure. When acute sleep deprivation occurs, the hormone leptin is reduced, while the hormone ghrelin is increased, promoting caloric intake, but not energy expenditure. The likely result is weight gain.

A quick lesson in endocrinology:

Leptin and ghrelin are appetite hormones. Leptin helps regulate hunger, appetite, and metabolism. When you have low levels of leptin in the body—perhaps due to sleep deprivation—the hormone will tell receptors in the hypothalamus of the brain, “Hey, I’m hungry, feed me.” Normal healthy levels of leptin, on the other hand, will let the brain know that you’ve had enough and are no longer hungry. 

Ghrelin is known as the hunger hormone because its job is to tell the hypothalamus when you are hungry and need to eat. That is why ghrelin levels are elevated in the body when you are hungry, and decrease after you have eaten. Ghrelin also promotes fat storage, and has been linked to the accumulation of abdominal fat.

It stands to reason, then, that if sleep deprivation reduces leptin—causing you to feel hungry—and increases ghrelin—also causing you to feel hungry and eat, then sleep deprivation is likely to lead to overeating and weight gain.

So, how did the researchers come to this conclusion?

Virend Somers, M.D., Ph.D., professor of medicine and cardiovascular disease at the Mayo Clinic, Rochester, Minnesota and his colleagues conducted an eight night sleep test on 17 people—11 men and six women—between the ages of 18 and 40.

Eight of the subjects in the “random group” were made to sleep less than they normally do, while the other nine in the “control group” slept their normal amount of time.

All subjects were able to eat as much as they wanted throughout the testing periods, and their daily caloric intake was measured. In addition, their daily sleep times and energy expenditures were measured, and their blood was collected at the end of the test period.

The results of the test are interesting: The sleep deprived group—who slept one hour and 20 minutes less than the control group per night—ate around 549 more calories per day than the normal sleep group. However, the sleep deprived group who ate more did not expend much more energy than the normal sleep group.

The conclusion again is: Less sleep, plus more calories and no increased activity equals more weight gain. It’s a vicious cycle. So let’s turn this equation around. When you sleep well and get enough rest, you help your body to function properly, including your appetite, metabolism and the hunger hormones mentioned above.

And so I continue my tireless crusade against sleep disorders. If you’re having trouble sleeping, from sleep apnea, snoring or some other disorder, get it checked out and treated by a qualified sleep doctor. Doing so could save you a lot, including a few notches around your belt.

To read the abstract of the study, see Insufficient Sleep Increases Caloric Intake but not Energy Expenditure.

How Do You Know if You Have a Sleep Disorder

Many people experience some occasional difficulty sleeping and/or daytime fatigue. But how do you know if your sleep problem is temporary and can be fixed with some simple behavioral changes, or if it is a legitimate disorder such as snoring, sleep apnea, sinusitis or nasal obstruction that should be diagnosed and treated properly?

That is one of the most common questions we get here at Eos Sleep.

The first thing you can do is take an honest look at your lifestyle habits. Are you watching TV or on the computer too close to bedtime? Consuming too much caffeine during the day? Taking a medication with sleep-related side effects? Is there something particularly stressful going on in your life that needs to be addressed?  Are you exercising enough to help relieve tension and anxiety? The good news is that many sleep “issues” can be remedied by making some common sense behavioral changes.

However—and I would be remiss if I didn’t mention it at this point—persistent sleep problems left untreated can lead to myriad health problem, including memory and concentration problems, increased risk of high blood pressure, hypertension, stroke and heart attacks, depression, diabetes and sexual dysfunction. Severe cases of sleep apnea can even be fatal.

Besides these sobering health risks, an untreated sleep disorder can also be the root cause of poor performance at work or school, car accidents and other activities that require focus and concentration.

New research is exposing the societal risk that can result from untreated sleep apnea and other sleep disorders. The National Sleep Foundation’s 2012 “Sleep in America” poll, which focused in on the sleep habits and performance of transportation workers, states that about one in 10 Americans are likely to fall asleep at an inappropriate time and place, such as during a meeting or while driving.

Other results of the study: About one-fourth of polled train operators (26%) and pilots (23%) admit that sleepiness has affected their job performance at least once a week, compared to about one in six non-transportation workers (17%).

Even more concerning: One in five pilots (20%) admit that they have made a serious error and one in six train operators (18%) and truck drivers (14%) say that they have had a “near miss” due to sleepiness.

The numbers are in: Sleep problems are prevalent in our society, and people need to wake up (no pun intended) to the symptoms and risks associated with them. Some common symptoms of sleep disorders include:

•    Trouble falling asleep at night
•    Waking throughout the night
•    Chronic snoring
•    Morning headaches
•    Poor memory
•    Daytime sleepiness/falling asleep during the day/low energy
•    Bad moods/irritability
•    Increased depression
•    Trouble concentrating/driving/making decisions

Keep in mind that symptoms vary between disorders, whether it’s snoring, sleep apnea, insomnia, restless leg syndrome, nasal obstruction, narcolepsy or some other sleep disorder,  so it pays to do some research based on what you are personally experiencing. If you experiencing one or more of the above symptoms on a regular basis—meaning, more than once in a blue moon—it is imperative that you see a qualified sleep doctor, and get diagnosed and treated properly. The good news is there are multiple options and minimally invasive techniques available today to treat your sleep disorder.

New Study Uncovers the Beliefs Behind Behavior of Poor Sleepers

Difficulty Sleeping

I do my best to stay up (no pun intended) on the latest research and findings regarding sleep-related disorders and their treatments. New results out of Ryerson University in Toronto don’t surprise me — that taking sleeping pills or drinking alcohol is not a long-term solution for dealing with insomnia.

The study was conducted by Heather Hood, a PhD student in clinical psychology and lead author of the study, along with Dr. Colleen Carney, director of Ryerson's Sleep and Depression Laboratory, and graduate psychology student, Andrea Harris.

Hood is an insomnia therapy specialist and had previously researched the link between anxiety disorders and “safety behaviors” — things people do to self-treat a disorder. With the new research, Hood and her associates wanted to examine the relationship between insomnia and safety behaviors, such as taking sleep medication or drinking alcohol before bed. Specifically, they wanted to uncover the belief systems of poor sleepers: how much a person with insomnia believes that their behaviors are helping them sleep, even if those behaviors are not helping them sleep at all.

According to the National Sleep Foundation, 48 percent of Americans report occasional insomnia. And a recent Harvard Medical School study determined that insomnia costs U.S. companies about $63 billion a year due to missed days and poor work performance. Clearly, lack of sleep and insomnia are an American pandemic, and the efforts of Hood, Carney and Harris to help uncover the beliefs behind the behavior of poor sleepers was resulted in some very important information.

For the insomnia/safety behavior study, the researchers asked 397 Ryerson University undergraduate students to complete an online survey that asked about their safety behaviors. The questionnaire also asked how often they performed their nightly rituals, and how much they felt they needed to fall sleep. They were also asked how they defined insufficient sleep, and to what extent they went to in order to avoid feeling tired.

The results of the study, published in the December 2011 issue of Behavior Therapy, found that 40 percent of the students polled were poor sleepers who were likely to use safety behaviors, such as taking sleep medication or drinking alcohol, which in fact, not helping them fall sleep. They also observed that the poor sleepers felt dependent on these behaviors and believed they helped them sleep, even though the behaviors were actually compounding their sleeping problems. The students who did not experience sleep problems often didn't think of anything — they simply fell asleep.

Based on the research, Dr. Colleen Carney, director of Ryerson's Sleep and Depression Laboratory, believes that poor sleepers who engage in safety behaviors are actually disrupting their sleep in the long term. These safety behaviors are driven by unhelpful beliefs about sleep, but people suffering from insomnia or poor sleep feel they need to do these things to help them fall asleep.

Dr. Carney’s conclusion: That cognitive behavior therapy — not taking a pill or a drink of alcohol—is the best long-term treatment for insomnia and other sleep disorders.With cognitive behavior therapy, patients are taught to work with their physiology to help develop good sleeping habits and learn how to fall asleep naturally, rather than relying on chemicals. In our pharmaceutical society, that seems like a rogue idea … but I believe it’s the right one.

The Relationship between Seasonal Affective Disorder and Sleep Problems

One of the most common questions I get in the office during the winter months has to do with seasonal affective disorder: What is it? Do I have it? And what can I do about it? Seasonal affective disorder is a very real form of depression that may affect six out of every 100 people in the United States, according to the American Academy of Family Physicians.

Symptoms of SAD generally manifest in late fall, when the days become shorter and colder, and people enjoy less natural sunlight. Symptoms include, but are not limited to, feelings of sadness, hopelessness and helplessness, lack of energy, loss of sexual interest and usual pleasurable activities, irritability and restlessness, cravings for carbohydrates and overeating (which can lead to weight gain and compound negative and depressive feelings), trouble concentrating, difficulty sleeping and/or insomnia and at the extreme end—thoughts of death or suicide. Symptoms of SAD are usually most intense during the darkest months of the year, so it stands to reason that the farther a person lives from the equator, the higher the incidence of SAD occurs.

These sleep-related symptoms are of particular interest to me, and are usually the catalyst for a person with SAD to come see me for a consultation and treatment. A person with SAD who suffers from sleep problems may go to sleep early and stay in bed for nine or ten hours, but not experience refreshing sleep.  Because of a lack of restful sleep, people with SAD are often drowsy and have trouble concentrating and working during the day.

The relationship between sleep and depression is a bit of a “chicken or the egg” relationship. Which came first? SAD-related depression, or the sleeping problems? It depends. For some, symptoms of SAD occur first—for others, sleep problems appear first. Depression may cause the sleep problems, and sleep problems may cause or worsen the other SAD symptoms.

There is a common link between people with depression and insomnia. Studies have shown that people with insomnia have a ten-fold risk of developing depression compared with people who sleep well. Further, developing depression is highest among those with both sleep onset and sleep maintenance insomnia.

People with depression may also experience insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, experiencing restful sleep and daytime sleepiness. People who suffer from depression are also five times more likely to have a breathing-related sleep disorder than non-depressed people, according to a study at the Stanford University School of Medicine. The 2003 study by Stanford researcher Maurice Ohayon, MD, PhD, found that people with depression were found to be five times more likely to suffer from obstructive sleep apnea (OSA), the most common form of sleep disordered breathing. This was one of the first studies to make the connection between depression and sleep disorders.  More current research has confirmed the connection.

So, if you believe you are experiencing SAD-related depression and/or sleep disorders, please see a psychiatrist or sleep specialist about it. There are treatments such as morning light therapy that can offer some relief, so you don’t have to suffer unnecessarily through the winter blues. Call me—I’m happy to help.

Who’s Suffering More from Lack of Sleep—Men or Women?

This week, I was interviewed by WCBS-TV New York for a news segment called, “Sleep: the Battle of the Sexes.” The topic was one I am very familiar with: People suffering from lack of sleep, and how it can affect daytime mood, mental acuity, job performance and relationship intimacy.

The show drilled down a bit farther and asked: who is more likely to suffer from a sleep disorder, men or women? And of the two genders, which performs better despite a lack of sleep?

What we know is that men and women have different circadian rhythms. According to an article by the Proceedings of the National Academy of Sciences of the United States of America,  “The circadian rhythms of melatonin and body temperature are set to an earlier hour in women than in men, even when the women and men maintain nearly identical and consistent bedtimes and wake times. Moreover, women tend to wake up earlier than men and exhibit a greater preference for morning activities than men.”

In other words, women tend to go to sleep and wake up earlier than men. We also know thanks to a Penn State study that women need 6.8 hours of sleep per night, while men require just 6.2 hours. While scientific studies are interesting, there is a discrepancy between these numbers and what I am seeing in my office at the Manhattan Snoring and Sleep Center.

Based on the facts, one would think women are getting to sleep earlier and sleeping longer than their male counterparts. But are women getting the sleep they need? In my anecdotal opinion, they are not, and they are suffering quietly for it. In our society, men are stressed out, but women are really stressed out. The physical demands of balancing career and family, along with the mental strain of worrying about finances and future is taking its toll on the women in our society. 

Don’t get me wrong, men worry and suffer from sleep disorders too. But they seem more willing to speak up and seek treatment. Women, on the other hand, being the selfless caregivers they are, stay focused on others and what needs to be done and power through their day. Which explains another Penn State study that found sleep deprived women made fewer mistakes compared to men in a series of computer tasks. It seems that, although women need more sleep, they do better without it because, for better or worse, they’re just more used to it.

Whether a man or woman is suffering from a lack of sleep, the fact is that a sleep disorder can lead to negative health issues, including an increased chance of hypertension, heart disease, osteoporosis and inflammatory disease.

In addition to personal health issues, a sleep disorder can wreak havoc on a relationship. The partner of a patient once shared with me how his snoring and sleep apnea had impacted their relationship. It led to weeks without quality REM sleep, and she said it left her feeling groggy with low energy, cranky, unable to concentrate for long and she was more prone to getting sick. His constant snoring caused her to start sleeping on the couch, which led to resentment, lack of intimacy and loss of connection.

I have made it clear in previous blogs that I am not a marriage counselor or relationship expert. But I can tell you unequivocally that, if you or your partner snores or suffers from a lack of sleep on a consistent basis, it will negatively affect your relationship.

In the end, circadian rhythms and who performs better and the sex of the person with the sleep disorder doesn’t matter. What matters is getting it treated and keeping the relationship healthy.

This also bears repeating: Turn off the TV when you go to sleep. Falling asleep with the TV or computer on interrupts deep REM sleep because the light from the screens interfere with the production of melatonin, a hormone that tells our bodies when it’s time to go to sleep. Do yourself a favor and turn off the TV, computer and lights at night. Your brain and body will thank you for it the next day.

To watch “Sleep: The Battle of the Sexes” on CBS2 New York, click here.

Stop Snoring — It Can Be the Secret to Happy Marriage

I am by no means a marriage therapist. However, I hear couples complain all the time in my practice. They come in for a snoring test appointment, and within seconds the husband makes a comment such as “my wife made me come.” Snoring is more common in men than women, but the reverse is also common.

The snoring spouse who feels “dragged” to the doctor’s office is resentful that his or her snoring problem can’t be left alone. The spouse that does the dragging-in is frustrated and tired. Ordinarily affectionate couples can have a strain in their relationship caused by snoring. Sometimes if it wasn’t for their spouse, a snorer wouldn’t even know they had a problem. As one of my patients recently told me, “I was very surprised when my lovely wife first clued me in that I was snoring at night. It was disturbing her sleep, but I didn’t realize that snoring was the cause of my own fatigue.”

The reason for resentment is understandable. Snoring can cause daytime symptoms that can cause serious problems in one’s waking life, and unfortunately, it is not just the snorer that suffers – the snorer’s spouse can suffer just as much. According to the National Sleep Foundation,  39% of American adults get less than seven hours of sleep each weeknight, and more than one in three (37%) are so sleepy during the day that it interferes with daily activities. The sleep loss associated with snoring—whether it’s the snorer or the bed partner who is awakened by the snoring, interrupts important recuperative sleep which can impair a person’s ability to perform cognitive tasks involving memory, learning, reasoning, and mathematical processes. It can impair motor skills and can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

Symptoms can be even more severe for the snorer if they have sleep apnea, a condition which causes them to stop breathing often many times a night, and wake gasping for air. Sleep apnea is linked to lung and heart disease, diabetes, obesity and stroke.

The disruption of sleep from snoring is causing couples to have a hard time sleeping together. Fifty-three percent of adults say they have relationship problems because of their or their partner's sleep disorder, the National Sleep Foundation found in a recent study. To avoid the symptoms of daytime sleepiness, many couples choose not to sleep together in the same bed.

In the book, "Two in a Bed: The Social System of Couple Bed Sharing," author Paul C. Rosenblatt interviewed 42 couples, and examined how sharing a bed affects the couple’s relationship. Many couples described the intimacy and comfort level of sleeping in the same bed is extremely important to their relationship. As he describes in the book, in their time together before drifting off to sleep, “couples catch up on what's going on with one another, plan, make decisions, deal with disagreements and solve problems.”

With their hectic schedules, many couples often only have this time to catch up. It is no wonder why it’s crucial to their relationship. Unfortunately snoring can force one spouse into another room for the sake of sleep, and this crucial together time is hard to replace in their busy lives otherwise.

If your marriage is suffering because you or your spouse snores, the key to reconciling is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical, in-office and minimally invasive treatments available to snorers today. Although I would never make the claim that I’ve saved marriages, I’ve heard back many times from patients who tell me that it wasn’t until after their snoring was cured did they realize how much happier they are snuggling next to their spouse again.