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.”

Another Reason: Oxygen Depletion from OSA Linked to Higher Rate of Cancer

Every month, I take time to write these blogs to help educate people about the negative health effects associated with obstructive sleep apnea (OSA), and the importance of getting it properly diagnosed and treated. I hope my point is getting across out there.

If you or someone you love regularly experiences OSA symptoms, such as snoring and disordered (interrupted) breathing, here’s another reason to get it checked out: Two new studies claim that OSA sufferers are more likely to die from cancer.

Their findings are significant because it marks the first time that cancer growth has been associated with sleep apnea in people. In a previous study about a year ago, Spanish researchers had already linked the intermittent lack of oxygen caused by OSA—known as hypoxia—with increased tumor growth in mice. That study also found that the mice had more dead cells, which indicates a more aggressive type of cancer.

In one of the new studies, researchers at the University of Wisconsin School of Medicine and Public Health studied data on about 1,500 state workers who have been taking part in overnight sleep studies every four years since 1989.

The researchers found that people with severe sleep apnea who had the most intermittent disordered breathing problems were almost five times more likely to die from cancer than those without OSA. They also found that people considered to have moderate cases of OSA died of cancer at double the rate than those without OSA at all.

This is consistent with the hypoxemia theory—that an increase of interrupted/disordered breathing is actually contributing to cancer cell growth … because the body is being depleted of oxygen.

What the researchers also discovered—and what I found particularly notable—was that when OSA patients who were being treated with continuous positive airway pressure (CPAP) therapy were removed from the Wisconsin study, the OSA/cancer association increased.  In other words, OSA patients who undergo CPAP treatment—who lower their interrupted/disordered breathing episodes—may likely reduce their risk of dying from cancer due to OSA-related oxygen depletion.

In the second related study, researchers at the Spanish Sleep Network used the hypoxemia index, which measures the amount of time the level of oxygen in a person’s blood drops below 90 percent at night.

The researchers followed more than 5,000 OSA patients for seven years. None of them had any cancer diagnosis when the study began, but they found that those with the most severe forms of sleep apnea had a 65 percent greater risk of developing cancer of any kind. In other words, the greater the extent of oxygen depletion during sleep, the more likely a person was to be diagnosed with cancer during the study.

It should be noted that, in both the Wisconsin and Spanish studies, the researchers only looked at cancer diagnoses and deaths in general, not the specific type of cancer.

The takeaway for all of is that this is one more study … one more reason … for you or someone you love with OSA-related paused/intermittent breathing issues to take sleep apnea seriously and get diagnosed asap.

New Study: Health Effects of Sleep Apnea Evident After One Month

It’s an interesting time in the world of sleep apnea research, a disorder in which a person has periods of slow or paused breathing during sleep. It seems that every month there is a new study showing yet another link between sleep apnea and sleep-disordered breathing (snoring, paused breathing, etc.), and its negative effects on health.

Recent studies have linked obstructive sleep apnea (OSA) to depression, silent strokes and small brain lesions, abnormalities in the blood vessels, high blood pressure, heart disease and strokes, even sudden hearing loss. And women take note: Sleep apnea has been linked to dementia in older women, and another study found that women with untreated severe OSA are three and a half times more likely to die from cardiovascular disease than women without OSA!

Clearly, the link between OSA and an increased risk of stroke has been medically established. But what effect does OSA have on the brain vessels and cerebral circulation? Researchers at the   Baylor College of Medicine in Houston, Texas developed a way to find out.

In late April, a study entitled, “Cerebrovascular Consequences of Obstructive Sleep Apnea” was presented and discussed at the Experimental Biology 2012 meeting at the San Diego Convention Center. The researchers described how they developed a new way to induce the effects of obstructive sleep apnea in mice—specifically, the closure of the airway that results in paused breathing and the physiological side effects of OSA. The new testing model enabled the researchers to mimic the symptoms and effects of OSA in humans, and thus study the results in a controlled environment.

For the study, the researchers induced sleep apnea in the mice while they slept. Surprisingly, they found that—after just one month of induced repeated apneas—the mice’s “cerebral vessel dilatory function” was reduced by as much as 22 percent, and the mice’s cerebrovascular function did not function as normal, or before the apneas.

In other words, after just one month of repeated apneas, after a month of repeated apneas, the blood vessels in the mice’s brains did not work as well as they did.

What are the implications of this study? According to the researchers, one is that the new method of testing provides researchers with a more accurate and complete way to study the effects of sleep apnea on people. The other, which I find compelling, is that only one month of moderate, repeated sleep apnea caused a change in cerebrovascular function which could result in a stroke. It is important to note that the results of the study correlates with other studies that show similar cell dysfunction in arteries, which has caused an increased risk of stroke in OSA patients.

This just reinforces the speed in which sleep apnea can damage the body, and the importance of getting diagnosed and treated as quickly as possible.  The results are also a wake-up call to both sleep and medical doctors that damage to the vascular wall in brain arteries could be a factor predisposing an individual with OSA to stroke. Sleep and medical doctors should be working more in tandem to treat patients.

Again, it is in interesting time for sleep apnea research. And I hope and encourage researchers to continue studying and publishing their results so we can all better understand the symptoms and treatments of this disorder. I believe the need for treatment will only increase with time. As obesity, hypertension and other related conditions continues to plague this country, and as the general population ages, we will see an increase in OSA cases. It is no longer a male condition—women, non-obese people and even children can have OSA.

An estimated 18 million Americans have sleep apnea, including one in four women over 65, according to the National Sleep Foundation. While apnea is more common in men, it increases in women after age 50. And some researchers estimate that up to 85 percent of people with clinically significant sleep apnea have not even been diagnosed yet.

Sleep apnea and other sleep-related disorders are prevalent in our society, and people need to wake up to the symptoms and risks associated with them. (I am on a personal mission to educate people about this, and my blog is one of the ways in which I do so.)

So how do you know if you have sleep apnea? The first step is to become aware of some common symptoms, including trouble falling asleep at night, waking throughout the night, chronic snoring, morning headaches, poor memory, daytime sleepiness/falling asleep during the day, bad moods and irritability, increased depression and trouble concentrating/driving/making decisions.

If you have any of the symptoms mentioned above, and suspect that you may have sleep apnea, please get checked out by a doctor who specializes in sleep disorders. Be specific about the symptoms you are experiencing. Many times, sleep apnea can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition. Also, some doctors are too quick to prescribe a medication, rather than do a full sleep disorder work up. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait—it could save your life, not to mention help your bedmate keep his or her sanity.

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.

Sleepy on the Job? Tips for a Better Night’s Sleep

There’s no denying that sleep deprivation, and the health issues that result, are becoming more prevalent in our go-go, techno society. But a recent sleep study by the National Sleep Foundation (NSF) grabbed my attention as particular cause for concern.

Every year, the NSF releases a Sleep in America® poll.  For its 2012 survey, the NSF examined the specific sleep habits and work performances of transportation workers—pilots, train operators, truck, bus, taxi and limousine drivers. The transportation workers were asked about the duration and quality of their sleep, specifically on work nights, and how it affects their work performance.

Some of the results of the survey are:

• About one-fourth of the train operators and pilots polled said that sleepiness has affected their job performance at least once a week.
• One in five pilots polled—about 20 percent—said they have made a “serious error” as a result of on-the-job sleepiness.
•  One in five pilots and one in six train operators admit to a “near miss” due to on-the-job sleepiness.
• Pilots and train operators are more likely than non-transportation workers to have been involved in a sleep-related car accident while commuting.
• Among all workers surveyed, train operators and pilots report the most work day sleep dissatisfaction.
• Almost two-thirds of train operators and one-half of pilots say they rarely or never get a good night’s sleep on work nights.
• About one-third of bus, taxi, and limo drivers said they rarely or never get a good night’s sleep on work nights.

The results of the poll are some cause for alarm, and reinforce the growing problem of sleep disorders and the potential risks they pose, such as commuter car accidents and errors by public transportation drivers responsible for many people.

Persistent sleep problems left untreated can also lead to myriad health problems, 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.

Common Symptoms of Sleep Disorders

Many people experience some occasional difficulty sleeping and/or daytime fatigue. But how does a person know if he or she has a temporary sleep problem that can be remedied 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?

The first step is to be aware of some common symptoms of sleep disorders. Keep in mind that symptoms vary between disorders, such as snoring, sleep apnea, insomnia, restless leg syndrome, nasal obstruction, narcolepsy, so it pays to do some research based on what you are personally experiencing.

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

The Link Between Lifestyle and Sleep Problems

If you or someone you know is experiencing some of the above common symptoms of sleep disorders, the next step is to examine if lifestyle habits are contributing to the difficulty sleeping, fatigue and irritability during the day and other symptoms.
Some behavioral/lifestyle questions to ask include:

• Am I watching TV or using the computer late at night and too close to bedtime?
• Am I consuming too much caffeine during the day?
• Am I taking a medication that may be affecting my sleep quality and duration?
• Is there something particularly stressful going on in my life that is causing me worry and anxiety?
• Am I exercising enough to help alleviate some of that stress and tension?

See a Specialist—And Be Specific

Many sleep problems can be remedied by making some common sense behavioral changes. However, if you or someone you know is experiencing one or more of the above symptoms on a regular basis, see a qualified ear, nose and throat doctor or otolaryngologist to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

When you see a specialist, be specific about the symptoms you are experiencing. Many times, sleep apnea and other sleep disorders can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition. Some doctors, for example, still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up.

It may help to keep a sleep log (or, more accurately, lack of sleep log) next to your bed to write down what you are experiencing, when you wake and some symptoms you experience. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait — it could save your life.

To read the full report, see “Sleepy Pilots, Train Operators and Drivers”  on the National Sleep Foundation website.

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.

Women and Sleep Apnea: At Greater Risk Than We Thought

A few months ago, my blog entitled, “Who’s Suffering More from Lack of Sleep — Men or Women?”  discussed “the sleep battle of the sexes,” specifically, who suffers more from sleep disorders — men or women? In that blog, I made the point that, while men are generally more likely to suffer from obstructive sleep apnea (OSA) than women, men are also more likely to get tested and treated for the disorder.

That’s not good, because we are learning that many more women than previously thought suffer from OSA, and leaving it unchecked can have dire consequences on a woman’s cardiovascular health.

I read a recent women and sleep apnea study out of Spain that said that women with untreated severe OSA are three and a half times more likely to die from cardiovascular disease than women without OSA. Three and a half times!

Thankfully, the study also showed that women who treat their severe sleep apnea at night with a technique called continuous positive airway pressure (CPAP) significantly reduce their risk of heart attack-related deaths to about the same risk level as women without OSA.

The study was conducted by Dr. Francisco Campos-Rodriguez, director of the sleep-disordered breathing unit at Valme University Hospital in Seville, Spain. To read a summary of the study, go to the Annals of Internal Medicine.

The research is a wake-up call to both patients and doctors because it is the first published results that link OSA to cardiovascular death in women, and that CPAP treatment can reduce OSA-related mortality risk.

It also shines a light on the need for more research regarding sleep apnea and women, as well as the need for women to take their symptoms seriously, and not just consider OSA “a man’s disease.”

What Women Should Know About 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. According to the National Sleep Foundation, one in four women over age 65 have sleep apnea.

Being overweight also increases 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 have any of the symptoms mentioned above, and suspect that you may have sleep apnea, please get checked out by a doctor who specializes in sleep disorders. Be specific about the symptoms you are experiencing. Many times, sleep apnea can be misdiagnosed in women as chronic fatigue, insomnia, depression, or some other non-specific condition.

Also, some doctors still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait — it could save your life.