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Posts tagged ‘cure for snoring’

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

Sleep Better -- Get Smart about Your SmartphoneSmartphones, iPads, and other personal electronic devices are great ways to communicate and entertain ourselves, but they may also be negatively impacting the quality and quantity of our sleep.

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

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

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

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

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

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

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

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

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

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

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

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.

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.”

Pain and SleepChalk 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.”

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.


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