Sleep Apnea a Common Problem for NFL Players

A new study being presented today shows that obstructive sleep apnea is common in retired NFL players.

The study involved 167 players. Results show that 60 percent of the linemen had sleep apnea. During sleep they had an average of 18.1 breathing pauses per hour.

The linemen also had an average body mass index of 34.2. A BMI of 30 or higher is considered obese.

Forty-six percent of non-linemen had sleep apnea. They had an average of 13.4 breathing pauses per hour.



The study is consistent with previous research.

A 2003 study of 302 NFL players found that they are more likely to have sleep apnea than other men their age. The risk was highest for offensive and defensive linemen.

A 2005 study found that 97 percent of NFL players are overweight, with a BMI of 25 or higher. Being overweight or obese is one risk factor for sleep apnea.

The death in 2004 of retired NFL star Reggie White focused attention on sleep apnea and the NFL. White died at the age of 43. Reports indicate that sleep apnea may have played a role in his death.

In 2007 the NFL and the NFL Players Association began working together to target heart disease and sleep apnea in retired players.

Grey's Anatomy Dissects PTSD

Post Traumatic Stress Disorder (PTSD) is common among returning military personnel, though it is not often discussed. That may change after last week’s episode of Grey’s Anatomy entitled “Elevator love Letter.”

Owen Hunt became head of trauma at Seattle Grey’s Hospital after receiving an honorable discharge from the army. Although Owen returned physically intact, his co-workers are beginning to see that he did not escape the war unscathed.

In the episode, Dr. Hunt has a nightmare that is triggered by the rotating blades of the ceiling fan in his girlfriend Cristina’s bedroom. Cristina is awakened by Owen choking her aggressively. Owen awakens, feeling confused, disturbed and ashamed.

His co-worker believes that he is suffering from PTSD. Common symptoms include memory loss, depression and anger. People suffering from PTSD continue to experience disturbing effects caused by the event, which often occur in the form of recurrent dreams or nightmares.

According to the American Academy of Sleep Medicine, nightmares tend to be the most disturbing for people with PTSD. In these dreams they may relive the event in a way that seems shockingly real.

Most people with PTSD report having disturbed sleep. It can be very hard to fall asleep or stay asleep. This is known as “adjustment insomnia.” The lack of restful sleep can make feelings of anxiety, anger and depression even worse.

A severe case of PTSD may need to be treated with intensive counseling by a trained therapist. Some forms of cognitive behavioral therapy may also improve sleep. The short-term use of medications also may give PTSD suffers temporary relief.

Understanding Child Parasomnias

Child parasomnias are sleep disorders that can put a scare into parents. Episodes can involve unusual and undesirable actions.

Nightmares may be the most familiar parasomnia. Others include sleepwalking and sleep terrors.

The good news is that these disorders tend to be common and harmless in children. In many cases the child will have no memory of the event.

But some children may have a more severe problem with a parasomnia. You should contact an AASM-accredited sleep center if a sleep problem greatly disturbs your child.

It may be hard to distinguish some parasomnias from one another. They can have similar features.

This chart will help you compare four common child parasomnias. Get tips for parents from the AASM.

Are You at Risk for Sleep Apnea?

Obstructive sleep apnea can have a severe impact on your health and well-being. Studies have linked it to problems such as heart disease, stroke, diabetes, obesity and depression.

But most people with sleep apnea are unaware that they have it. Could you be one of these people?

Find out by answering these simple questions. See if you might be at risk for sleep apnea.

Get help for sleep apnea at an AASM-accredited sleep center near you.

Insomnia and Weight Gain

A new study examined the link between insomnia and weight gain.

The study involved 14 men with primary insomnia and 24 healthy controls. It measured their levels of the “hunger hormones” leptin and ghrelin three times during one night of sleep.

Results show that men with insomnia had less total sleep time than controls. Leptin levels were similar between the two groups. Leptin helps to suppress your appetite and increase your metabolism.

But ghrelin levels were about 30 percent lower in men with insomnia. Ghrelin stimulates appetite.

So it would seem that insomnia lowers your risk of weight gain. Less ghrelin means you would be less hungry.

But this may not be the case. Lead author Sarosh Motivala of UCLA thinks that a change may occur during the day to increase appetite. Other studies show that sleep loss decreases leptin and increases ghrelin.

What is clear is that insomnia disrupts how the body regulates appetite.

"The current study shows that insomnia patients have a dysregulation in energy balance that could explain why these patients gain weight over time," Motivala said in a UCLA statement. “"This is an exciting finding because it highlights how diverse behaviors like sleep and eating are connected.”

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.

The men in this study had “primary insomnia.” This kind of insomnia is unrelated to another health problem. It is estimated that about 25 percent of people with insomnia have primary insomnia.

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.

Learn more about the link between sleep and weight.

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.

Unable to Sleep, Unable to Work: Insomnia & Disability

How you sleep - or don't sleep - can affect how you work. Studies show that insomnia can have a negative impact on the workplace.

It can result in decreased productivity. It also can increase absences from work.

Now a new study from Norway suggests that insomnia can even increase the risk of long-term work disability.

The study involved 6,599 working adults. They were between 40 and 45 years of age.

Results show that insomnia was a strong predictor of permanent work disability. After controlling for other factors, people with insomnia were almost two times more likely to receive disability pension.

The same research team found similar results in a 2008 study. It appeared in the journal Sleep. That study involved 37,302 adults. They were between the ages of 20 and 66. Again, insomnia was associated with increased odds of receiving disability pension.

In Norway you can quality for disability if your earning ability is impaired by at least 50 percent. The U.S. Social Security Administration has a stricter definition of disability.

Social Security only pays for total disability. Five questions determine if you qualify. Learn more about disability benefits from the SSA.

About 10 percent of adults have chronic insomnia that lasts for more than a month. You can get help for chronic insomnia at an AASM-accredited sleep center near you.

Learn more about job stress and insomnia.

Women, Shift Work and Breast Cancer

BBC News reports that some women in Denmark who developed breast cancer after years of working night shifts are receiving compensation from the government.

Is there a clear link between shift work and breast cancer?

A 2008 review found only limited evidence. Yet there was enough data to convince the International Agency for Research on Cancer.

The IARC convened a working group in 2007. It was composed of 24 scientists from 10 countries. The experts reviewed all of the research.

They concluded that working night shifts is “probably carcinogenic to humans.” This means that shift work may be a factor “that can increase the risk of human cancer.”

The report was the basis for the Danish government’s compensation program. So far almost 40 women have received payment through the program.

How might night shifts promote breast cancer?

The exact mechanism is unclear. But it may be related to how shift work disrupts the “circadian rhythms” that are controlled by the body clock in your brain. This internal timing system regulates the daily cycle of various body functions.

It controls your body temperature and hormone levels. It also regulates your alertness.

One way the body promotes sleepiness is by producing more melatonin at night. This acts as a “sleep signal” for your body.

But light exposure during night shifts suppresses melatonin production and disrupts your sleep/wake cycle. These disruptions may promote the growth of cancerous tumors.

Get sleep tips for shift workers from the AASM.

Who Sleeps Better – Women or Men?

A new study takes an objective look at the sleep of 1,324 men and women. Who were the better sleepers?

In this case it was the women. During one night in a sleep lab they had a higher percentage of sleep time than the men. They also had a higher percentage of deep, slow wave sleep.

Another part of the study involved 66 young, healthy volunteers. An “external stressor” disturbed their sleep during the night to see how they responded.

Again the women slept better than the men. Their sleep was less disturbed.

“Young women are superior to men in terms of sleep mechanisms,” Dr. Alexandros Vgontzas told the Sleep Education Blog. He and his team conducted the research at the Penn State College of Medicine.

But it is important to note that the women in this study had no sleep complaints. Many women have ongoing sleep problems that can prevent them from sleeping well.

Examples include restless legs syndrome and leg cramps. And women are more likely than men to have insomnia.

“Women indeed have more insomnia complaints than men,” said Vgontzas. “This is primarily because they suffer from depression more frequently.”

Vgontzas added that female hormones can play a protective role in helping young women sleep well. But women can lose this advantage when hormonal changes occur as they age.

In the study menopause was associated with a decrease in deep sleep. It also took more time for menopausal women to fall asleep.

Learn more from the AASM about sleep and women.

Sleep & Jet Lag on Day 2 of “March Madness”

How did yesterday’s jet lag-challenged teams fare on the first day of the NCAA basketball tournament?

BYU came out flat, fell behind and never caught up to Texas A&M. Cal State Northridge was the opposite. They started strong but faded late in a loss to Memphis.

As for UCLA, they’re probably relieved to have escaped with a one-point win. After crossing three time zones to play a late game, they’ll surely get some rest today on their day off.

Which teams are most likely to come out sluggish on day two of the tournament?

Utah St. gets to stay “home” in the Mountain time zone to play Marquette in Boise, Idaho. But it will be an early morning for the Aggies.

The 12:30 p.m. EDT tip-off means that the game will start at 10:30 a.m. locally. It will feel like 11:30 a.m. for sixth-seeded Marquette, which will travel from Milwaukee in the Central time zone.

Stephen F. Austin plays in the earliest game against third-seeded Syracuse. The 12:15 p.m. EDT start in Miami, Fla., will feel like 11:15 in the morning for the Lumberjacks from the state of Texas.

Oklahoma St. faces a similar challenge. The 12:25 EDT tip-off in Dayton, Ohio, will feel like 11:25 a.m. for the eighth-seeded Cowboys. Knoxville, Tenn., is in the part of the state that is in the Eastern time zone. So there will be no time change for the Volunteers.

Travelling east may be a challenge for Arizona St. Arizona does not recognize daylight saving time. So the state is currently three hours behind Eastern Daylight Time.

Temple will try to upset the sixth-seeded Sun Devils at 2:45 EDT in Miami. It will feel like an 11:45 a.m. start for Arizona St.

Cornell will take a long flight from Ithaca, N.Y., to Boise to play third-seeded Missouri. The 3 p.m. EDT start time won’t be a problem. But the long flight could take a toll on the players.

Fifth-seeded Florida St. also had to make the long trip to Boise to play Wisconsin. In addition to the flight, the Seminoles will have to deal with an unusual 9:55 p.m. EDT tip-off.

In the end, sleep can be a challenge for players on every team. The excitement and pressure of the tournament can lead to sleepless nights. The Herald Journal described how the Utah St. players struggled to sleep during their conference tournament.

And players aren’t the only ones fighting sleep loss. Fans on the East Coast have to stay up late to watch all of the 10 p.m. games.

So try to get some sleep even as you enjoy the madness.

Sleep, Jet Lag and “March Madness”

The NCAA basketball tournament tips off today at 12:20 p.m. EDT. Did you finish your bracket yet?

President Obama completed his bracket early. Surprisingly, he was extremely “conservative” with his picks.

His Elite Eight includes all four of the number-one seeds and three of the number-two seeds. His only sleeper? Third-seeded Syracuse over second-seeded Oklahoma.

If you’re still finalizing your bracket, one thing to keep in mind is jet lag. Some teams have to travel a long way to play their first game.

One example is UCLA. The Bruins have to cross three time zones to play upset-minded Virginia Commonwealth in Philadelphia, Pa., tonight.

The good news for UCLA is that the game won’t start until almost 10 p.m. EDT. They’ll be playing when their body clocks are set at a West-Coast time of 7 p.m. So it will feel like a normal tip-off time for the Bruins.

It’s the earlier, 12:30 p.m. EDT start times that can be more difficult for some players. Cal State Northridge and BYU both must cross two time zones to play opening-round games today. It will feel like a 10:30 a.m. start for the players on both teams.

Cal State Northridge plays Memphis in Kansas City, Mo. BYU plays Texas A&M in Philadelphia.

But can sleep really have an effect on a basketball game?

Just ask Cheri Mah of the Stanford Sleep Disorders Clinic and Research Laboratory. She has studied how sleep affects players on many of the Stanford sports teams.

One study involved six players on the men’s basketball team. Performance measures such as sprint times and free-throw shooting improved after extra sleep. So did ratings of mood and alertness.

“Sleep is a significant factor in achieving peak athletic performance,” said Mah. “Athletes across all sports can greatly benefit from extra sleep and gain the additional competitive edge to perform at their highest level.”

So sleep may be one factor that adds to the madness of this year’s tournament.

White House Photo, 3/17/09, Pete Souza

Are “Smart Drugs” a Smart Choice for a Brain Boost?

Early results from a new study in JAMA show that it may not be smart to take modafinil as a “brain booster.” The drug may have a greater risk of addiction than it was first thought to have.

The small pilot study involved 10 healthy men. Taking modafinil increased the dopamine in their brains. Dopamine is a neurotransmitter that plays a major role in addiction.

The brand name for modafinil is Provigil. It was approved by the FDA in 1998. It is a safe and effective treatment for three sleep disorders. It improves alertness in people who have excessive daytime sleepiness from narcolepsy or shift work disorder.

Modafinil also is approved for people with sleep apnea. Some people remain sleepy during the day even while treating their sleep apnea with CPAP therapy. These people may benefit from taking modafinil along with using CPAP.

But USA Today reports that there is concern that many other healthy people are taking modafinil as a “smart drug.” Students hope it will improve their performance on an exam. Professionals may take it hoping to stay sharp on a long business trip.

Doctors can prescribe the drug for “off-label” use. Or people may buy it over the Internet.

An article in The Times of London shows that this trend is not isolated to the U.S. The New York Times also has reported on the debate in academic circles over the ethics of taking smart drugs.

In 2008 a scientific review analyzed all of the modafinil research. It reports that modafinil can improve mood, fatigue, sleepiness and cognition in sleep-deprived people. The benefit is similar to that of caffeine. But the effect may last longer.

One of the most recent studies was published in the February issue of the journal Sleep. After 44 hours awake each participant was given modafinil, caffeine or dextroamphetamine.

Each stimulant provided a cognitive boost. But the advantages differed according to the type of task being tested.

But does modafinil give healthy people who are not sleep deprived a cognitive edge? The 2008 review states that this evidence is “controversial.”

In November another journal article indicated that there is little evidence to support the use of drugs to improve learning and memory. It reports that, “So far, all clinical trials of neuroenhancing drugs have either failed or demonstrated only very limited efficacy.”

Dr. Nora Volkow agrees. She is the director of the National Institute on Drug Abuse and the lead author of the JAMA study.

"It would be wonderful if one could take a drug and be smarter, faster or have more energy," Volkow told the AP. "But that is like fairy tales. We currently have nothing that has those benefits without side effects."

Possible side effects of modafinil include headache, nausea, anxiety and sleep problems. It also can cause a skin rash or other allergic reaction.

Of course one of the best ways to give your brain a boost is to get more sleep. You don’t need to take a pill, and the only cost is your time. It may be the smartest choice of all.

Sleepy Soldiers: Proposal Recommends More Sleep for U.S. Combat Troops

Stars and Stripes reports that the U.S. Army Medical Command is proposing changes to current Army sleep guidelines.

The draft proposal recommends that U.S. soldiers in combat zones get seven to eight hours of sleep each night. Current guidelines suggest that soldiers get at least four hours of sleep each day when deployed.

The change would help prevent “performance degradation” on the battlefield. The guidelines state that sleep loss can have a critical effect on problem solving and decision making. It can result in delayed reaction times, lapses of attention and confused thinking.

The article cites two recent studies conducted at the Walter Reed Army Institute of Research. The first study was published in the journal Sleep in 2007. It shows that 53 hours of sleep deprivation can impair the ability to make some moral judgments.

The second study is in the current issue of Sleep. It shows that “banking sleep” before a period of sleep deprivation can reduce the effects of sleep loss on performance and alertness.

The study restricted the sleep of two groups to three hours in bed for seven nights. Prior to the sleep restriction, one group extended their nightly sleep to 10 hours in bed for one week. The other group maintained a typical nightly sleep time of about seven hours in bed during the week before sleep restriction.

The “extended sleep” group performed better during sleep restriction. They were better able to remain awake during the day. Their performance also rebounded faster after the period of restricted sleep.

Image courtesy of the U.S. Army.

Are You Dream Deprived?

Sleep deprivation can have a severe impact on your health and well-being. Sleeping less than seven hours per night increases your risk of obesity, diabetes, high blood pressure, heart disease and depression.

The Times in London reports that sleep loss also may cause you to suffer from “dream deprivation.” The article suggests that healthy dreaming is vital to your overall mental wellness.

Is the article right - do dreams really matter? It depends on who you ask.

Some believe dreams have symbolic meaning or predict future events. Others see dreams as random, meaningless information.

New theories suggest that dreaming helps your brain process both old memories and new information. The brain may use dreams to help you adapt to events in your life.

What do you think? Are you suffering from dream deprivation? How important are dreams to you? Do you even remember your dreams when you wake up in the morning?

Is Your Cell Phone Keeping You Awake at Night?

You may think that you can’t live without your cell phone. But maybe you’d sleep better without it.

A study from Sweden in 2008 involved 21 healthy subjects between the ages of 14 and 20. They were divided into two groups.

A control group used their cell phones for no more than five calls or text messages per day. The other group used their phones for more than 15 calls or text messages per day. One of these participants had more than 200 text messages per day. Only one of the 21 subjects turned the phone off at night.

Results show that people with excessive cell phone use had a number of sleep problems. They had irregular sleeping hours and took longer to fall asleep.

Their sleep was more agitated, and they woke up more often. It took them longer to reach the stage of deep sleep. They also had more trouble waking up in the morning and were more tired before mid-day.

In 2007 a study in the journal Sleep found that teens who use cell phones after “lights out” are more likely to be tired one year later. The odds of being “very tired” were 3.3 times higher for those who used the cell phone at any time of night.

But it’s not just the time spent on the phone that can hinder your sleep. The cell phone itself – or your exposure to its radio frequency field - may affect your sleep.

One study in 2007 involved 36 women and 35 men. They were exposed to three hours of an 884 MHz wireless signal.

After exposure it took participants longer to reach the stage of deep sleep. They also spent less time in deep sleep.

But another study in 2007 failed to find similar results. Ten subjects were exposed to a defined radiofrequency electromagnetic field. They did not find a significant effect on sleep.

Another study in 2006 exposed 55 volunteers to cell phone emissions for 30 minutes. There was no impact on melatonin production. But there may be an effect on the timing of melatonin production. The body produces more melatonin at night as a "sleep signal."

So it remains unclear how and how much cell phones may affect your sleep. But it may be best to turn your phone off and keep it out of the bedroom at night. Sleep without it, even if you can’t live without it.

Will Smarter Phones Make Us Better Sleepers?

With iTunes and an iPhone, you can do much more than download Soulja Boy’s latest hit song. Some application developers are even hoping the iPhone will help you sleep better.

Developer Mark Cooke and composer Norihiko Hibino worked together to create “Prescription for Sleep.” They describe it as “a music visualizer that is intended to act as a sleep aid.” It combines “soothing imagery and therapeutic music” to help you fall asleep.



The Milwaukee Journal-Sentinel reports that two college students won a $10,000 prize for developing “Proactive Sleep.” It analyzes your sleep cycle to determine the best time to wake you up in the morning.

After waking you up it uses a game to test your alertness and reaction time. Poor performance indicates that you woke up from a stage of deep sleep. Performing well is a sign that you woke up from a stage of light sleep.

The program uses this information to “learn” more about your sleep cycle. This helps it predict when to wake you up on the days that follow.

The Washington Post reports that a “White Noise” application offers 40 sounds to soothe you to sleep. You can choose the sound of ocean waves, chirping crickets or even a humming air conditioner.

But is all of this necessary? Do we need more gadgets and programs to help us sleep? Or do we just need to get back to the basic habits of sleeping well?

What do you think - is new technology hindering our sleep? Or does it offer new ways to help us sleep better?

Come back tomorrow to learn about studies that examine whether or not cell phones have a negative impact on our sleep.

The Young & the Restless: Children, TV & Bedtime

The AP reports that there is some controversy over a bedtime TV program for children. “The Good Night Show” is a three-hour block of programs for children between the ages of 2 and 5. It airs from 6 p.m. to 9 p.m. on the PBS Kids Sprout network.

A network executive says the show is a helpful tool in the “real world” where most homes have a TV on at night. It’s a better viewing option for children than other programs that are on at the same time.

But critics say that parents should be interacting with their children instead of plopping them in front of the TV at night. They also say that TV viewing can make it harder for children to fall asleep. It stimulates them when they should be winding down.

Research shows that there is good reason to be concerned. Studies indicate that watching TV can have a negative effect on children’s sleep.

A study in 1999 involved 495 children in kindergarten through the fourth grade. Increased TV viewing at bedtime was linked to bedtime resistance, delayed sleep onset, sleep anxiety and short sleep duration.

Research also shows that sleep problems frequently occur when children have a TV in their bedroom.

A 2007 study involved children who were 5.5 years of age. Having a TV in the bedroom was associated with sleep problems. Forty-one percent of the children had a TV in their bedroom.

You might think that this problem is unique to children in the U.S. But it is common in other countries as well.

One study involved children between 6 and 12 years of age in Japan. Watching TV, playing video games and surfing the Internet had a negative impact on sleep. Children were more active before bedtime if they had a TV or video game system in their bedroom.

About 18 percent of children in a Chinese study had a TV or computer in the bedroom. These children had later bedtimes and wake times, and shorter sleep durations. They also were more likely to display bedtime resistance and sleep anxiety.

In a study from Belgium, teens with a TV set in their bedroom went to bed later and spent less time in bed. Teens who watched more TV also woke up later and were more tired.

It’s clear that parents should keep the TV out of their child’s bedroom. While you’re at it, take the computer out of the bedroom too.

You also can help your child wind down for bedtime by turning off the TV and the computer earlier in the evening.

Parenting Challenges: Children & Bedtimes

At 7:30 p.m. you begin your nightly bedtime ritual for your 8-year-old. A relaxing, warm bath. Brush the teeth. You talk about what happened during the day. Read a favorite bedtime story. Sing a lullaby. It ends with a kiss goodnight.

At 8:30 p.m. your child quickly drifts off to sleep for a solid 10 hours. Then he or she wakes at 6:30 a.m., bright, perky, happy, and ready for the day ahead.

Sounds great. Almost perfect. Ideal. Nostalgic and Cleaveresque. But is it really possible?

Even the Obama girls are supposed to be in bed by 8 p.m. in the White House. That news caused a bit of a guilt trip for Dr. Perri Klass.

In a New York Times article she admits how far she missed the mark with her kids.

“I’m not sure any of my three children ever had a regular bedtime before 9:30 or 10.”

And she notes that this was in the 1980s. At that time there were fewer technological distractions competing for our attention at night.

No Internet and e-mail. No cell phones. No double-disc, extended edition, bonus-feature DVDs. No TiVo.

OK, so maybe there was Super Mario Brothers. But overall, wasn’t it easier for both parents and kids to wind down at the end of the day?

Today the challenge seems greater. So it’s even more important for parents to create a calming bedtime routine for their children. This includes a consistent “lights out” bedtime each night.

The bottom line: Are you giving your child the opportunity to get enough sleep each night? Roughly 11 to 12 hours for a preschooler? About 10 to 11 hours for an elementary-school student? Around nine to 10 hours for a middle-school student?

If not, the cost can be great for your child’s health and well-being. And it can make your life miserable as a parent. Tantrums. Outbursts. Crying. All-around meltdowns. You know that it can get ugly.

So how are you doing in the bedtime battle? Do you feel like you’re on the losing side? Or do you have an award-winning bedtime routine for your children?

Learn more about sleep and children.

An Economic Upturn for Makers of Sleeping Pills

Another sign that the economy is affecting our sleep: We’re taking more sleeping pills.

Advertising Age reports that sleeping-pill prescriptions increased seven percent last year. Sales rose even though ad spending dropped by hundreds of millions of dollars.

Sepracor had revenues of $161.9 million for the fourth quarter of 2008 from sales of Lunesta. This was up from $149.8 million for the same quarter in 2007. Full-year revenues were a little more than $600 million in both 2007 and 2008.

But sales aren’t up across the board.

Fourth-quarter net sales of Ambien CR (controlled release) in the U.S. were $170 million for sanofi-aventis. This was down from $190 million in the same quarter of 2007. Full-year sales dropped from $751 million in 2007 to $681 million in 2008.

Full-year net sales for Ambien IR (immediate release) fell to $125 million in 2008. The sanofi-aventis patent for this drug expired in April 2007. Many other companies then received FDA approval to sell less expensive, generic versions of Ambien.

The Boston Globe points out two other reasons why prescriptions may be up.

One reason has to do with safety. Older types of sleeping pills were limited to short-term use for one or two weeks. There was a risk that long-term use could cause addiction. There also was a risk that your body would develop a tolerance to the drug.

But sleeping pills introduced in the last two decades are considered to be safer. Ambien CR, Lunesta and Rozerem all have been approved for long-term use.

A study in the journal Sleep in 2008 found that regular use of Ambien CR for six months is safe and effective. The study was funded by sanofi-aventis.

In 2007 a study in the journal Sleep confirmed the long-term effectiveness of Lunesta. A nightly dose of 3 mg remained effective after six months. The study was funded by Sepracor.

A study in the Journal of Clinical Sleep Medicine in 2007 showed that nightly use of Rozerem was safe and effective over five weeks. The study was funded by Takeda.

The Globe also reports that more doctors are taking insomnia seriously. They recognize that treatment can promote both physical and mental health.

In 2008 a study in the journal Sleep affirmed that primary insomnia is a legitimate disorder. It linked primary insomnia to low levels of the brain chemical GABA. Many of the most effective sleeping pills increase brain activity at the GABA neurons. The study was funded in part by Sepracor.

Read the Guidelines for Taking Sleep Medications from the AASM.

When Dreams Come Alive: “Bizkit the Sleep Walking Dog”

By now you may be one of the millions of people who have seen “Bizkit the Sleep Walking Dog.” The dog is the latest YouTube sensation.

What can we learn from Bizkit?

Well, the video is pretty good evidence that dogs have dreams. In fact, YouTube is littered with similar videos. They all show sleeping dogs in various states of twitching, whimpering and moving. But few of them can match Bizkit’s full-throttle “sleep sprint.”

Of course, we may never know for sure that dogs dream like we do. They can’t exactly tell us about their dreams after they wake up. Unless your dog is Scooby Doo or Astro, that conversation is unlikely to happen.




But there is something even more important that we can learn from Bizkit. The dog’s behavior is an example of what can happen when dreams come alive.

Normally the brain paralyzes most of our muscles during the stage of rapid eye movement (REM) sleep. This prevents us from jumping out of bed and acting out our dreams.

Cats and dogs have a sleep stage that is similar to REM sleep. Sometimes it is called “paradoxical sleep.” This is the paradox: The animal appears to be asleep; but brain waves and eye movements look like the animal is awake.

Studies have found movement disorders during sleep in cats and dogs, as well as a disorder of REM sleep in a cat. Early studies also found that cats with lesions in certain brain areas would display complex behaviors during sleep. While sleeping they might even search for and attack an imaginary prey.

This animal research led to the discovery that some people have REM sleep behavior disorder (RBD). They act out vivid, action-packed dreams while remaining asleep.

People with RBD may shout, punch, kick, run and even jump out a window. Usually their eyes remain closed during the episode. Once they are awake they often report having a dream that describes their unusual actions.

Injuries may result from an RBD episode. Both the dreamer and a bed partner are at risk of being hurt. This is why it is important to seek medical help at an AASM-accredited sleep center if you suspect that you or a loved one may suffer from RBD.

As for Bizkit, the dog’s behavior looks a lot like RBD. It wouldn’t be the first time; a 2004 study reported on the diagnosis of RBD in a dog.

In fact Bizkit may be the latest in a line of famous dogs with RBD. It has been suggested that dogs in the movies “Cinderella,” “Lady and the Tramp,” and “The Fox and the Hound” all may have had RBD.

Sleep and High School Start Times: Lessons from Fairfax County

An editorial in today’s Washington Post examines the debate over school start times. It shows just how complex it can be to make changes to daily school schedules.

A proposal in Fairfax County, Va., would change the start time of most high schools in the county from 7:20 a.m. to 8:30 a.m. It appears that there is strong support for a change. But there are also many obstacles.

Money is one concern. In Fairfax County, 169,000 students must be transported to and from school each day. This is both complicated and costly.

The Post reports that Fairfax school officials once estimated that a schedule change could cost up to $40 million. But they found ways to make bus routes more efficient. This led to the current “no-cost” proposal.

Teens and parents may have concerns about starting and ending school later. Will some teens still have time to work on school nights? How will after-school activities be affected? Will the new schedule allow enough time for school teams to practice and play games?

In Fairfax County the group Worried About Keeping Extra-curriculars (WAKE) formed around this issue. Another group called Save Our Sport formed to represent the needs of high-school swim teams and dive teams.

Another huge hurdle for many parents is the issue of day care. Changing the schedule may cause younger children to start and end school earlier. Working parents may have to make new arrangements for the supervision of these children after school.

There also is a debate over the merits of the problem. Scientists report that a biological change causes teens to feel sleepy later at night. Early school start times may prevent them from getting the sleep they need.

Others may argue that teens just need more discipline. They could get more sleep if they would get off the Internet and put down their cell phones earlier at night.

What do you think? Is it worth the effort to change school schedules so teens can get more sleep? Or does making a change cause more problems than it solves?

Update 3/20/09: The Washington Post reports today that the Fairfax County School Board rejected the proposal to delay high school start times by a vote of 10 to 2. According to the article, the board decided that changing the school start times would create too much stress for students and parents.

Childhood Sleep Disorders May Affect Cognitive Development

Long-lasting sleep problems in children can affect their cognitive development. This is the finding of a new study in the journal Sleep.

It links ongoing sleep problems through childhood with cognitive problems at age 17. Results show that long-lasting sleep problems may affect “executive functioning.”

These functions are a part of how the brain regulates thoughts and actions. One example is the ability to shift between two tasks. Another example is the ability to update the contents of working memory.

The study involved 916 twins. About 70 percent of them had more than one sleep problem at age 4. The majority of these sleep problems went away by the time the children reached the teen years.

But 33 percent of the children still had sleep problems at age 16. These children had lower scores on a computerized test of executive functions at age 17.

What does this mean for parents?

First, you should realize that sleep problems are very common in young children. Examples include nightmares, sleepwalking and behavioral insomnia.

These sleep disorders tend to go away as a child grows and develops. Often there is no negative impact on your child’s health.

But you should pay special attention to any problems that persist through the years. In the study, children who still had sleep problems around age 13 were more likely to have cognitive problems at age 17.

Watch for signs of obstructive sleep apnea. This sleep disorder can have a severe effect on your child’s health.

At all ages, you should observe how your child functions during the day. In some children behavioral problems may be related to an untreated sleep disorder.

Talk to your child’s doctor about any ongoing sleep problems. Early treatment will promote your child’s long-term health and well-being.

Daylight Saving Time Begins: Spring Forward Before You Go to Sleep

For most of the U.S. daylight saving time has arrived again. Officially it begins late tonight at 2 a.m.

If you live in Hawaii or in most parts of Arizona, you get to ignore the time change. Your states already enjoy plenty of daylight.

For the rest of the country, the AASM recommends that you set your clocks ahead one hour in the early evening. Then go to sleep at your normal bedtime. This will help prevent the loss of an hour of sleep.

You can help your body prepare for the early bedtime by changing other routines during the day. Meal times are an important timing cue for your body. Eating lunch and dinner an hour earlier than normal may help adjust your body’s schedule.

Light is another important timing cue. Your body produces more melatonin as it gets dark at night. This signal lets your body know that it is time to sleep.

So be sure to avoid bright lights this evening and tonight. Close the curtains and dim the lights a little earlier than usual.

If the time change disrupts your sleep tonight, then take it easy tomorrow. It may take your body some time to adjust to the new schedule.

Be careful if you struggle with daytime sleepiness after the time change. Take precautions to avoid drowsy driving.

Parents: Pay Attention to Sleep Problems & ADHD

New research continues to examine the link between sleep and attention-deficit/hyperactivity disorder in children.

The latest study appears in the March 1 issue of the journal Sleep. It finds that children with ADHD get about 33 minutes less sleep per night than other children. They also get less rapid eye movement (REM) sleep.

The authors suggest that there may be an underlying sleep problem that is specific to ADHD. So does this mean that sleep problems are the cause of ADHD? Not quite.

“I do not believe that sleep per se is the cause of ADHD, but it may make the symptoms worse in children with sleep problems," said lead author Reut Gruber, PhD.

So sleep problems may cause ADHD-like symptoms. Sleep problems also can make ADHD symptoms more severe. But not every child with ADHD has a sleep disorder.

A common link between sleep problems and ADHD may be sleep deprivation. Children often respond to sleep loss in a different way than adults.

Sleep-deprived adults tend to be sleepy and sluggish during the day. But sleep-deprived children may be hyperactive.

This is one key symptom of ADHD. Children with ADHD also may be inattentive or impulsive.

A recent study in the Journal of Clinical Sleep Medicine reviewed the evidence linking sleep problems to ADHD. Here is what it found.

Restless legs syndrome and periodic limb movements often occur in people with ADHD. Snoring and sleep apnea may contribute to some mild ADHD-like symptoms.

Disorders of “partial arousal” appear to be common in children with ADHD. These include sleepwalking, confusional arousals and sleep terrors.

ADHD seems to be more common in children with rhythmic movement disorder. But this needs to be confirmed by larger studies.

ADHD often involves symptoms of “sleep-onset” insomnia. Children with ADHD may have a hard time falling asleep.

So parents, make sure that your child gets enough sleep for his or her age. Observe how your child sleeps. Discuss any problems with your child’s doctor.

Your child should be screened for a sleep disorder if he or she has ADHD symptoms. Treating an underlying sleep disorder may help your child function better during the day.

Contact an AASM-accredited sleep center for help.

Much Ado About Snoring

Segments of today’s Morning Edition on NPR focused on snoring in adults and children.



Snoring is a common problem. But what can be done about it?

First, you need to be aware that snoring is a common sign of obstructive sleep apnea. Most often this kind of snoring is loud and frequent. It tends to be followed by silent pauses in breathing. These pauses may end with a loud choking or snorting sound.

Sleep apnea is a serious health problem that requires medical attention. CPAP and oral appliances are the two most common treatments. Another option is surgery, which is a common solution for children with sleep apnea.

But what about a milder case of snoring that is unrelated to sleep apnea? Are there any solutions?

Well there are hundreds, if not thousands, of products that are marketed to “cure” snoring. This is true of most other health problems as well. The FTC reports that consumers may spend billions of dollars on “unproven, fraudulently marketed, often useless health-related products, devices and treatments.”

So be careful. If it sounds too good to be true, then it probably is.

One option that can work is an oral appliance. It keeps the airway open when you wear it as you sleep. It should be fit by a specialist in dental sleep medicine.

Wearing a nasal strip may have a mild effect on snoring. Using a lubricant nasal spray also may help.

A steroid nasal spray may help for snoring related to nasal congestion. Regular nasal decongestants may not work as well. They may have a “rebound” effect that could worsen nasal breathing later in the night.

There are two other treatment options for snoring that involve behavioral changes.

One is weight loss, if your snoring is related to being overweight or obese. Of course, this is easier said than done. Weight loss also takes time, so it certainly isn’t a quick fix.

Another option is “positional therapy.” Basically, this means that you sleep on your side instead of on your back. Certain types of pillows can help you do this. Or you can try the old home remedy of sewing a tennis ball in the back of your pajamas.

Just keep in mind that you need to find out if your snoring is a sign of sleep apnea. Contact an AASM-accredited sleep center near you for help.

Read the AASM’s summary of common cures for snoring. Or read the full report from the journal Sleep.