Cooling Cap Could Provide Insomnia Relief

There is no easy cure for insomnia. Sleeping pills appear to be a quick fix, but the potential for psychological attachment and rebound insomnia make medication for insomnia a solution for short-term problems only. Alternatively, you can seek cognitive behavioral therapy to help eliminate the harmful thoughts and bad habits that promote extended periods of insomnia. This solution is very effective but also time-consuming and requires effort and dedication.

New research presented at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS), suggests another treatment choice for insomnia may be on the horizon. The potential treatment would use a cooling cap that would lower your brain temperature to help you fall asleep.

Normally, a reduction in brain metabolism occurs as you fall asleep. However, during insomnia, the brain metabolism increases, keeping you awake. The cap helps reduce metabolic activity by cooling the front half of the brain.

The study involved 24 people. Half of the participants had insomnia. Each was subjected to several overnight sleep studies while wearing the cooling cap. The settings for the cooling cap differed each night, ranging from maximum amounts of water cooling to not wearing the cap at all.

Results show patients who wore the cooling cap set to its maximum level slept nearly as well as the subjects who didn’t have insomnia. These findings suggest the device could be a new promising therapy for insomnia sometime in the future. The treatment is still a long ways off; more studies will need to be conducted before the device can hit the marketplace.

Napping Neurons Impair Performance in the Sleep-Deprived

A new study explains why sleep deprivation makes us irritable and impairs our ability to think clearly and make decisions. A team of sleep researchers in Wisconsin and Italy have discovered that parts of your brain may be nodding off while you remain awake. The study was conducted on lab rats, but the findings likely apply to humans. An EEG was used to measure the brain waves of rats as they were kept awake four hours past their usual bedtimes.

Readings show that local populations of neurons in the brain’s cortex went silent in a seemingly random pattern as the rats remained awake. The brain patterns in these select neurons resembled slow wave or non-REM sleep. The rats’ overall EEG readings as well as their behavioral appeared no different than well-rested rats.

Researchers did notice that the rats performed progressively worse at a task that involved locating a sugar pellet. If neurons in the motor cortex switched off as the rats reached for the pellet, they were about 37 percent more likely to fail the task.

The authors of the study caution that the rats were in a state that was different than microsleeps, or very brief episodes of sleep in a sleep-deprived but otherwise awake person.

Mysteries of Sleep: Brain Activity and Sleep's Restorative Effects

Lab rats may provide us with new clues on the mechanisms that make sleep restorative. A study published Wednesday in the Journal of Neuroscience, the authors say, is the first to precisely measure brain energy to learn more about the biological functions of sleep.

Researchers observed a dramatic energy surge in certain parts of rats’ brains when the animals first fell asleep. While the rats were in deep sleep levels of adenosine triphosphate (ATP), a molecule sometimes referred to as the energy currency of life, increased in four key brain regions. Overall brain activity decreased. When researchers kept the rats awake there was no measurable energy surge.

The parts of the brain where this was observed are associated with wakefulness. One of the areas this was observed was the frontal cortex, a part of the brain associated with high-level thinking.

The authors of the study believe the flare-ups power the restorative processes only happens when during sleep. Daily waking functions may consume most of the brain’s energy, preventing restorative effects.

CPAP shown to reverse brain tissue damage from sleep apnea

New research (#0329) indicates CPAP therapy can reverse the damage to adult brain tissue caused by obstructive sleep apnea. Grey matter volume in hippocampal and frontal structures significantly increased only three months after the start of CPAP.

With treatment, the cognitive impairment caused by obstructive sleep apnea is also reversible.

The authors noticed no further improvement in gray matter volume after one year of CPAP treatment.

17 patients with severe sleep apnea and a control group of 15 healthy subjects were given brain scans at the beginning of the study, and at the three month and one year following the onset of CPAP treatment. The brain scans were taken using 3 Tesla magnetic resonance imaging (MRI) and a processing technique called “voxel-based morphometry” (VBM). VBM is often used to examine patterns of brain change in healthy aging or neurodegenerative disease and the related behavioral and cognitive effects.

The pauses in breathing caused by obstructive sleep apnea can produce abrupt reductions in blood oxygen saturation and reduce blood flow to the brain, damaging its gray matter. Gray matter refers to the color of the tissue on the cerebral cortex, where the brain does most of its information processing. Its appearance is due to a lack of myelin insulation.

The study was the subject of an oral presentation Monday afternoon at SLEEP 2010 in San Antonio.

Blogging about obesity, apnea and your brain

America’s public health epidemic is getting more play in the New York Times. This time a blogger is making the case that obesity is bad for your brain.

The author references studies comparing brain scans of average and severely overweight people. Obese people, on average, tended to have smaller, more atrophied brains - a feature of dementia.

The blogger offers a list of suggested causes, included genetics and fat cell secretions that damages brain cells. Here at the Sleep Education blog we want to focus on an aspect the blogger only briefly mentioned: obesity, obstructive sleep apnea and brain function.

The disorder, most commonly affecting obese middle age men, has been linked to progressive brain damage. Men with untreated OSA have less brain gray matter, which may lead to cognition problems.

Stroke risk is also elevated. In a study published earlier this month, researchers found men with mild to severe forms of obstructive sleep apnea were nearly three times more at risk of having a stroke than their peers. For women, the risk for stroke only really increased during severe cases of sleep apnea.

Treatment options are available. The AASM recommends dietary weight loss combined with either CPAP or an oral appliance.

Find out if you have symptoms of sleep apnea and if you’re at risk.
Then go to sleepeducation.com to learn how CPAP therapy can save your life.

Get treatment at an AASM-accredited sleep center near you.

Solving SIDS: The Serotonin Connection

A new study found low levels of serotonin in the brain tissue of infants who died from SIDS. The study suggests that a brain defect may cause some babies to be more vulnerable to sudden death while they sleep.

The results were published today in JAMA.



The autopsy analysis involved 35 infants who died from SIDS. They were compared with five infants who died from known causes.

Researchers examined small samples of tissue from the medulla. This is a region at the base of the brain. It regulates basic functions such as body temperature, breathing, blood pressure and heart rate.

Results show that serotonin levels were 26 percent lower in SIDS cases than in controls. Serotonin is a brain chemical that helps regulate mood. It also plays a role in regulating vital functions like breathing and blood pressure.

Measurements of “tryptophan hydroxylase” also were 22 percent lower in SIDS infants. This is an enzyme that is needed to make serotonin.

The authors suspect that this defect may hinder an infant’s capacity to respond to breathing challenges. As a result the child may inhale carbon dioxide that was exhaled while sleeping face down.

"Our research suggests that sleep unmasks the brain defect," senior author Dr. Hannah C. Kinney said in an NIH news release. "When the infant is breathing in the face-down position, he or she may not get enough oxygen. An infant with a normal brainstem would turn his or her head and wake up in response. But a baby with an intrinsic abnormality is unable to respond to the stressor."

Kinney hopes that a test will be developed to detect the abnormality. Steps could be taken to protect the infants who are most vulnerable.

She also said parents should continue to follow the Back to Sleep tips for safe infant sleep.

"Until 12 months of age, babies should sleep on their backs in a crib with a firm mattress, and without toys, soft pillows, excessive blanketing or excessive clothing," she told AFP.

An earlier study led by Kinney involved 31 infants who died of SIDS. The brainstems from SIDS infants contained more neurons that make and use serotonin. This suggested that the brain was compensating for low levels of serotonin.

Read more about sleep and infants and SIDS.

Study Finds Less Brain Gray Matter in Men with Sleep Apnea

A new study reports that men with severe obstructive sleep apnea have less brain gray matter. This may help explain the cognitive problems that often occur in people with OSA.

The results were published in the Feb. 1 issue of the journal Sleep.

The South Korean study involved 36 men with severe OSA. They had an average of 52.5 partial and complete breathing pauses per hour of sleep. Their average age was 44.7 years. They were compared with 31 healthy, male, age-matched controls.

Brain scans were conducted using magnetic resonance imaging (MRI). A processing technique called “optimized voxel-based morphometry” found structural differences in gray matter by examining the entire brain.

Results show significant differences between men with severe OSA and healthy controls. Gray matter concentrations were decreased in multiple brain areas of men with OSA.

“Poor sleep quality and progressive brain damage induced by OSA could be responsible for poor memory, emotional problems, decreased cognitive functioning and increased cardiovascular disturbances,” study co-author Dr. Seung Bong Hong told the AASM.

The NINDS reports that “gray matter” refers to the cerebral cortex. This is where the brain does most of its information processing. The cortex is a layer of tissue with a gray-colored appearance.

The men in this study were newly diagnosed and untreated. Dr. Hong said that they could benefit greatly from treatment with CPAP therapy.

“The use of continuous positive airway pressure – CPAP - therapy could stop further progression of brain damage in patients with severe OSA,” said Hong.

Last year the Sleep Education Blog reported that CPAP therapy may help restore a normal pattern of brain activation. Other studies have provided more evidence that untreated sleep apnea causes brain damage.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk. Get help for sleep apnea at an AASM-accredited sleep center near you.

Read more about sleep and the brain.

Chronic Insomnia: Less Brain Gray Matter in Older Adults

A new study from The Netherlands examined regional brain volume in people with insomnia.

The study involved 24 adults with chronic primary insomnia. They were between the ages of 52 and 74 years. Seventeen of them were women. They were compared with 13 people who had no sleep problems.

Results show that people with insomnia had a smaller volume of gray matter in the left orbitofrontal cortex. This reduction in gray matter was strongly correlated with the severity of insomnia.

The NINDS reports that “gray matter” refers to the cerebral cortex. This is where the brain does most of its information processing. The cortex is a layer of tissue with a gray-colored appearance.

The study also found reduced gray matter volume in the precuneus. This cortical area may have a central role in tasks such as episodic memory retrieval.

A press release noted that the affected brain regions play a role in evaluating pleasure. They also have a role in the brain’s “resting state.”

Most people with insomnia have “secondary” insomnia. It occurs along with another medical problem, mental illness or sleep disorder. It also may result from the use of a medication or substance. In contrast primary insomnia is unrelated to another health problem.

A 2008 study in the journal Sleep linked primary insomnia to low levels of a brain chemical. Results show that GABA levels are reduced by 30 percent in adults with chronic primary insomnia.

Last year a study proposed that “cooling the brain” may be a new way to treat insomnia. Subjective benefits were reported by 75 percent of participants.

Read more about insomnia. Get help for an ongoing sleep problem at an AASM-accredited sleep center near you.

Is Ambien a Miracle Cure for Severe Brain Damage?

Most people who take zolpidem – the generic name for Ambien – have insomnia and want to fall asleep. But can the drug help some people wake from an unconscious state?

For years ReGen Therapeutics in London has been working on a “zolpidem project.” It is developing new, low-dose, non-sedating formulations of zolpidem; the goal is to use zolpidem to reverse “brain dormancy.”

Now the Moss Rehabilitation Research Institute (MRRI) in Philadelphia has announced that it will launch a federally-funded study of zolpidem. It intends to enroll about 100 people who are in a vegetative or minimally conscious state due to brain injury. The study will be led by Dr. John Whyte.

The NINDS reports that people in a vegetative state are unconscious and unaware of their surroundings; but they maintain a sleep-wake cycle and periods of alertness. A person who remains in this condition for more than a month is in a “persistent” vegetative state.

In May Whyte published a study involving 15 people; each person was vegetative or minimally conscious. They were given 10 mg of zolpidem by a feeding tube.

One vegetative participant had a significant response; he became minimally conscious. This effect was repeated in a replication assessment. But the other 14 people showed no improvement.

Some previous studies of zolpidem have yielded dramatic results.

A 2008 report from Stanford described a 35-year-old man with a brain injury; eight months after the injury he was given zolpidem twice a day. This produced an increase in his alertness, speech and movement.

A similar case occurred in Israel. It involved a 50-year-old woman with a brain injury. After taking zolpidem she regained the ability to speak and feed herself. The effect would occur within 45 minutes of taking the drug; it would last for three to four hours before she returned to her former state. The effect was repeatable on a daily basis.

A 2006 study involved three people; each had been in a permanent vegetative state for at least three years. Daily response to zolpidem was monitored for three to six years. The study found a long-term improvement in brain function.

But a 2008 report from the U.K. was less promising. It involved a 44-year-old man; four years after a traumatic brain injury he remained minimally conscious. On zolpidem he showed no improvement; by some assessments his condition worsened.

Exactly how might zolpidem improve brain function? Why do some people show no response to the drug? These questions remain to be answered.

Sleep Apnea, CPAP & Brain Activity

A study in the Sept. 1 issue of the journal Sleep examined the brain activity of people with obstructive sleep apnea.

The study from Italy involved 17 men with OSA who had never been treated. They had an average age of 44 years.

At the start of the study the men underwent a neuropsychological evaluation. They were tested in areas such as learning, recall, attention and vigilance. They also completed a verbal working-memory task during a functional MRI brain scan.

They were evaluated again after three months of treatment with nightly CPAP therapy. Their performance and brain activity were compared with 15 healthy controls.

Results show that the men with OSA had neurocognitive impairments prior to treatment. Most of these deficits improved after treatment with CPAP.

But during the working-memory task there was no significant difference in the cognitive performance of untreated men with OSA and healthy controls; their accuracy and response times were similar. Men with OSA also showed similar levels of performance before and after treatment with CPAP.

There was a large overlap in the pattern of brain activity in OSA men and healthy controls during the working-memory task. But some regions were less active in men with untreated OSA; additional brain regions also showed increased activation. Then after three months of CPAP therapy, men with OSA showed decreases in the activation of certain brain regions.

What does this mean? The authors suggest that the results support the “compensation hypothesis.”

OSA may cause brain dysfunction. To maintain performance the brain has to compensate for this loss. So it “recruits help” from other brain regions.

Treatment with CPAP therapy helps restore a normal pattern of brain activation. Then the brain no longer needs extra help to preserve cognitive performance.

A similar study of people with insomnia was presented in June at SLEEP 2009; it found that adults with primary insomnia have increased brain activation during a working-memory task.

In March the Sleep Education Blog reported that OSA may cause brain damage; brain imaging studies have found a loss of brain tissue in people with sleep apnea.

“Brain Music”: Sleeping Better by Listening to the Music of Your Mind

According to the U.S. Department of Homeland Security, your brain has its own music soundtrack. And this “brain music” just might help you sleep better.

The DHS wants to help emergency responders sleep well when they end a stressful shift. So it is studying the use of “brain music.”

How is this music recorded? The Loudoun Times-Mirror in Virginia reports that you wear a skullcap that contains EEG sensors. For about five minutes these sensors record your brain waves.

Then a computer analyzes the data. It finds the rhythm of your brain waves and transforms the unique pattern into two musical compositions. One has a fast tempo to boost alertness; the other has a slow tempo to promote relaxation.

You listen to this music at scheduled times according to your needs. It is believed that this musical feedback triggers a natural response in your brain. The fast-paced music gives you a burst of productivity and energy; the relaxing music helps you recover from a stressful situation. You can listen to a brain music sample provided by the DHS.

Does it work? It is still being tested as part of the DHS Readiness Optimization Program. But the idea has intriguing possibilities.

There is some support for using music to sleep better. A small study in 2008 showed that music therapy may reduce insomnia symptoms in older adults. Music relaxation improved their sleep and reduced their anxiety.
Another study of young adults between 19 and 28 years of age found similar results. They listened to relaxing classical music for 45 minutes at bedtime. This improved their sleep quality and reduced depressive symptoms.

There also is strong evidence that supports the use of cognitive behavioral therapy to treat insomnia. CBT is effective and has long-lasting results. Treatment methods include relaxation training and biofeedback.

“Brain music” therapy combines some elements of both music therapy and CBT. Should it be included as one of the techniques used in CBT? The evidence is not in yet.

But a sleep specialist at an AASM-accredited sleep center can determine which insomnia treatment is best for you.

Image by Michael Summers

Evidence that Obstructive Sleep Apnea Causes Brain Damage

A new article on SleepEducation.com reports on the link between obstructive sleep apnea (OSA) and brain damage.

A recent brain imaging study from France found a loss of “gray matter” in people with sleep apnea. A UCLA team reported similar results in a June 2008 study.

They found that people with sleep apnea have tissue loss in the mammillary bodies. These are brain regions that help store memory.

The same team published another brain imaging study in the journal Sleep in July 2008. It shows that people with sleep apnea have extensive alterations in “white matter.” The damage can affect mood, memory and blood pressure control.

The studies highlight the importance of treating sleep apnea. The most common treatment for sleep apnea is CPAP.

Learn more about the benefits of CPAP therapy.

Surgery Helps “Boy Who Couldn’t Sleep”

ABC News and Good Morning America report that a risky surgery has helped a 3-year-old boy who was unable to sleep.

Before the surgery Rhett Lamb was awake nearly 24 hours a day. Although his body was exhausted, his mind remained alert.

The sleepless nights caused plenty of trouble. He had mood and behavioral problems. He couldn’t even speak. Overall he was functioning at the level of an 18-month old.

His problems also took a toll on his parents. They were emotionally and physically exhausted. Caring for him around the clock caused them to suffer from sleep deprivation too.

For years his parents struggled to find the source of his problem. Finally a doctor discovered the cause: chiari malformation.

CM occurs when the space at the lower rear of the skull is too small. This puts pressure on the brain and pushes it downward. As a result brain tissue may be forced into the spinal canal.

The surgery appears to have been a success. Rhett shocked his parents when he slept through the night for the first time. They rushed to his room in the morning to make sure he was breathing.

Now that he is sleeping well, Rhett’s development has improved dramatically. For the first time in his life he is interacting and playing with other children.