Physical Activity & Improved Sleep in Children

Do children really sleep better if they’ve been more active during the day? A new study from New Zealand may confirm what parents have long suspected.

The study involved 519 children who were 7 years old. Their activity was measured for 24 hours by an actigraph that they wore on their waist.

Results show that children who were more active during the day fell asleep faster at night. As their mean daytime “activity count” increased, their time to fall asleep decreased.

Overall, the children took 26 minutes to fall asleep on average. Each hour of daytime inactivity increased the time it took children to fall asleep by 3.1 minutes.

Children who fell asleep faster also slept longer, reports the BMJ Group. Every 11-minute drop in the time it took to fall asleep was associated with an extra hour of total sleep time.

In the journal Sleep in 2008, the same research team published an early analysis of the same sample of 7-year-old children. The study found that their average sleep time was about 10 hours.

Their average bedtime was 8:15 p.m.; their average rise time was 7:07 a.m. Children who went to bed after 9 p.m. slept about 41 minutes less than other children.

On weekend nights the children slept about 27 minutes less than on school nights; although they went to bed about 30 minutes later on weekends, their morning rise time was only slightly later.

There also was a seasonal effect, with children getting the least sleep in summer. They slept about 40 minutes longer in winter, 30 minutes longer in fall and 15 minutes longer in spring.

The study also found that children who slept less than nine hours at night were three times more likely to be overweight or obese. The increased risk remained even after controlling for factors such as TV watching and sedentary activity.

The AASM recommends that school-aged children get about 10 to 11 hours of sleep each night. Learn more about sleep and children on SleepEducation.com.

Image by Elke Noda

Sleep Apnea & Bariatric Surgery Risk

Last week the Sleep Education Blog reported that bariatric surgery may reduce the severity of obstructive sleep apnea; but it doesn’t cure the problem.

What about safety? Is weight-loss surgery a risky procedure?

A study published today examined the short-term risks of bariatric surgery. It measured adverse outcomes in the 30 days after surgery.

People in the study had an average age of 44.5 years; 79 percent were women. Their median body mass index (BMI) was 46.5; a BMI of 30 or higher is considered “obese.”

The study analyzed 4,610 surgeries: 3,412 were a Roux-en-Y gastric bypass; 1,198 involved laparoscopic adjustable gastric banding.

Results show a 30-day rate of death of 0.3 percent; 15 of the people died within a month after surgery, CNN reports.

About 4.3 percent of people had at least one major adverse outcome. Complications included blood clots or the need for another surgery.

But obstructive sleep apnea made surgery riskier; people with OSA were more likely to have a major problem in the month after surgery. About half of the people in the study had OSA.

The NIDDK warns that long-term complications also can occur with bariatric surgery. These include malnutrition and hernias.

There also is a 10 percent chance of unsatisfactory weight loss. Some people also regain much of the weight they lose after surgery.

The AASM recommends bariatric surgery as an optional treatment for severe obesity and sleep apnea. But it should only be used along with CPAP therapy, the treatment of choice for OSA.

Contact an AASM–accredited sleep center to discuss all treatment options for OSA.

Sleep Paralysis: The Devil, the Ghost & the Old Hag

You’re waking up or falling asleep, and suddenly you’re unable to move. Your body becomes paralyzed as if an unseen weight is upon you.

You may be unable to move your arms or legs, body and head. You can breathe and think, but you may be unable to speak.

The paralysis may last for only seconds or a few minutes. Then it disappears and you are able to move again.

This describes a typical episode of sleep paralysis. It is a common sleep disorder that is classified as a “parasomnia.” Episodes can cause you to feel intense anxiety.

Sleep paralysis occurs when the line between sleep and wakefulness is blurred. Normally your brain paralyzes many of your muscles during the stage of rapid eye movement sleep – or REM sleep. This paralysis is called “atonia.”

You may experience sleep paralysis if atonia lingers as you wake up from REM sleep; it also may occur if you transition quickly from wakefulness into REM sleep.

Sleep paralysis may occur together with hallucinations. You may imagine that you see or hear something; you even may think that someone else or something is in the room with you.

Across cultures the strange sensation of sleep paralysis has evoked some vivid descriptions. In 1664 a Dutch physician published a case history of a woman with sleep paralysis. “'The devil lay upon her and held her down,” he wrote.

In Japan sleep paralysis is called “kanashibari.” The term is rooted in Buddhism; long ago it was believed that Buddhist monks could use magic to paralyze others.

In Newfoundland sleep paralysis has been called an attack of “Old Hag.” In China it has been labeled “ghost oppression.” A new study reports that in Mexico people may say that sleep paralysis feels like “a dead body climbed on top of me.”

Sleep deprivation may trigger an episode of sleep paralysis. Other related factors may include stress and sleep related leg cramps.

Sleep paralysis tends to be only a mild problem; there are no medical complications. But it also can be one symptom of narcolepsy.

Learn more about recurrent isolated sleep paralysis on SleepEducation.com. Get tips for preventing parasomnias.

Sleep in Space

Space shuttle Endeavour launched on Wed., July 15, from NASA's Kennedy Space Center in Florida. Today the shuttle undocked from the International Space Station.

After 13 days in space, how has the shuttle’s crew been sleeping? Surprisingly well, MSNBC reports.

"We sleep very well in space,” Endeavour astronaut Julie Payette told reporters. “Can you imagine? We have a sleeping bag each, and when you get into it you float in the sleeping bag...So all you have to do is just attach it somewhere."

Astronauts haven’t always slept so soundly in space. A 2001 study of five astronauts found that their average sleep duration was only about 6.5 hours per day.

Subjective sleep quality also was poor. They had less of the deep stage of slow-wave sleep during the last third of their sleep period.

One challenge that can hinder sleep in space is the highly variable light-dark cycle. NASA reports that the sun rises every 90 minutes during a mission.

Long missions can be especially challenging. A 2001 case study found that space missions lasting more than three months may lead to more sleep problems.

What about waking up in space? That’s when the Mission Control Center in Houston, Texas, gets involved.

It sends wake-up music to the space shuttle crew. This morning the wake-up song was “Proud to Be an American” by Lee Greenwood.

STS-127 is the 127th space shuttle flight; it is the 29th shuttle mission to the International Space Station.

Endeavour is scheduled to land at Kennedy Space Center on Friday at 10:47 a.m. EDT.

Learn more about space sleep from NASA. Read more about sleeping provisions for astronauts.

Image courtesy of NASA

Child Sleep Problems & Early Substance Use

Are children with sleep problems more likely to begin drinking, smoking or using drugs? A new study provides some insight.

The ongoing, longitudinal study involved children selected from a community sample of “high-risk” families; 292 boys and 94 girls participated.

Results show a gender difference; childhood sleep problems were more likely to predict early onset of substance use in boys than girls.

Sleep problems between 3 and 8 years of age predicted the onset of alcohol, cigarette and marijuana use among boys; in girls the only link was between sleep problems and the onset of alcohol use.

The authors conclude that parents should pay close attention to sleep problems in children and teens. Helping children sleep better can improve their health and behavior.

Sleep problems in children are common; about 25 percent of all children have some type of sleep problem at some point during childhood.

How common is substance use by children?

The NIAAA states that 34 percent of 8th-grade students reported drinking in the past year. A recent survey showed that more girls than boys between 12 and 17 years of age reported drinking alcohol.

A 2008 survey found that 6.8 percent of 8th-graders reported using cigarettes in the previous month. According to the NIDA, tobacco use is the leading preventable cause of disease, disability and death in the U.S.

The NIDA also reports that marijuana is the most commonly used illegal drug in the U.S. A recent survey found that 15.7 percent of 8th-graders have tried marijuana at least once.

Get help for your child’s sleep problems at an AASM-accredited sleep center near you. The Cool Spot is an NIAAA Web that provides facts about alcohol for young teens.

Image by Raul Lieberwirth

How to Help Your Child Sleep Better

A new study confirmed that poor “sleep hygiene” has a negative effect on the sleep patterns of young children.

The study analyzed data from a national poll of 1,473 parents and caregivers; their children ranged in age from newborns to 10-year-olds. The poll included questions on sleep habits and sleep patterns.

Having a late bedtime after 9 p.m. was associated with sleep problems across all ages. Children who went to bed late took longer to fall asleep; they also had a shorter total sleep time.

Having a parent present when the child falls asleep also affected all age groups; these children woke up more often during the night.

Children 3 years of age and older had a shorter total sleep time if they had a TV in the bedroom; they also obtained less sleep if they had no consistent bedtime routine.

Children 5 years of age and older slept less if they regularly consumed caffeine.

The authors concluded that good sleep hygiene helps young children sleep better. Basic tips that parents should put into practice include:

- Letting children fall asleep independently
- Putting children to bed before 9 p.m.
- Establishing a bedtime routine that includes reading
- Helping children avoid caffeine
- Keeping a TV out of the bedroom

In May the Sleep Education Blog reported that a simple, four-step nightly routine helps children sleep better. Children fell asleep faster, and they had fewer and shorter night wakings.

In March the blog reported on TV, children and bedtime. Studies indicate that watching TV can have a negative effect on children’s sleep.

Learn more about sleep and children on SleepEducation.com.

A Gluten-Free Diet for Restless Legs Syndrome?

A small study reports that celiac disease is a possible cause of low iron levels in some people who have restless legs syndrome.

The study involved four people with RLS and low iron stores in the body. They also tested positive for celiac disease.

Results show that a gluten-free diet reduced RLS symptoms in all four people. Two of the people were able to stop taking their RLS medication; the other two responded without any medication.

The authors conclude that treating celiac disease is likely to improve RLS symptoms in some people.

The NIDDK reports that celiac disease is a digestive disease that damages the small intestine; it interferes with the absorption of nutrients from food.

People who have celiac disease are unable to tolerate gluten; this is a protein in wheat, rye and barley. It is found mainly in foods such as bread, pasta and cereal.

More than two million people in the U.S. have celiac disease. The only treatment is a gluten-free diet.

According to the AASM, RLS is a common sleep disorder that produces an intense urge to move the legs. The intensity of this urge increases at night and as you lie or sit still. It is relieved only by walking or moving the legs.

RLS often involves other burning, prickly, itching or tingling sensations deep in the legs. The RLS sensations can make it very hard for you to fall asleep. Symptoms of RLS tend to become more intense and last longer over time.

Other conditions that produce low iron levels increase the risk of RLS. Treatment options for RLS include exercise, medications and iron treatment.

In 2008 the FDA approved the first generic versions of Requip (ropinirole hydrochloride); this drug is approved for the treatment of moderate to severe RLS.

Learn how research is cracking the genetic code for RLS on SleepEducation.com.

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

High Blood Pressure & Obstructive Sleep Apnea

A new study adds to the evidence linking obstructive sleep apnea to an increased risk of high blood pressure.

The study involved 529 men and 207 women with OSA. The severity of their sleep apnea varied widely.

Their average apnea-hypopnea index (AHI) ranged from five to 197 breathing pauses per hour of sleep; the mean AHI was 36. An AHI of more than 30 is considered “severe” OSA.

Participants with sleep apnea were compared with a control group; it comprised 154 men and 161 women who did not have OSA.

Results show that the odds of high blood pressure increased with increasing AHI; the risk also rose with increasing age and average body mass index (BMI). Among the most obese subjects, men were almost twice as likely as women to have high blood pressure.

The NHLBI reports that about one in three adults in the U.S. has high blood pressure. It can damage the heart, blood vessels, kidneys and other parts of the body. Another name for high blood pressure is “hypertension.”

High blood pressure is treated with lifestyle changes and medicines. Lifestyle changes include eating a healthy diet, getting plenty of exercise and quitting smoking. Most people with high blood pressure will need lifelong treatment.

In 2008 a scientific statement reported that about 30 percent of people with high blood pressure also have sleep apnea. According to the AASM, OSA occurs when the muscles relax during sleep. As a result soft tissue in the back of the throat collapses and blocks the upper airway. Breathing pauses can last from 10 seconds to a minute or longer.

These pauses can produce a severe drop in oxygen levels; they also can cause blood pressure to soar.

The AASM recommends CPAP therapy as the treatment of choice for mild, moderate and severe OSA. Research shows that CPAP can reduce blood pressure in people with sleep apnea.

Learn more about how CPAP helps the heart on SleepEducation.com.

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

Acupuncture for Insomnia: Another Review

Is acupuncture an effective treatment for insomnia? In February the Sleep Education Blog reported on a scientific review of the evidence.

The researchers were from Emory University; they found that acupuncture has potential as an insomnia treatment. But there is only limited evidence to support its use.

A new review from Hong Kong provides another perspective. The review looked at both Chinese and English studies.

Data from 20 studies were analyzed; the studies compared traditional needle acupuncture against “benzodiazepines.” These hypnotic sedatives are one type of medication used to treat insomnia; but newer “nonbenzodiazepines” are more commonly used today.

The majority of the studies concluded that acupuncture was more effective than benzodiazepines. Acupuncture was effective at a rate of 91 percent; the rate for benzodiazepines was only 75 percent.

But like the Emory review, the Hong Kong review also found problems with the research. The studies were poorly designed.

The diagnostic procedures were imprecise; there also were problems with randomization and blinding.

The authors wrote that the study results are “somewhat promising.” But they were unable to make a clear conclusion about the benefits of acupuncture for insomnia.

Contact an AASM-accredited sleep disorders center if you have an ongoing problem with insomnia. Effective treatment options include cognitive behavioral therapy and medications.

Regular Exercise & Teen Sleep

A new study suggests that regular exercise can lead to multiple improvements in the sleep of teens.

The study involved 12 teen athletes who got about 14 hours of vigorous exercise per week. They were compared with 12 controls who exercised for only 1.5 hours per week. Their sleep was evaluated following a day without exercise.

Results show that the athletes took less time to fall asleep. They also woke up fewer times during the night.

Overall their sleep was more efficient; a higher percentage of their time in bed was spent sleeping. The athletes also spent more time in the stage of deep, slow-wave sleep.

Their also was less variation between the weeknight and weekend sleep of teen athletes. Often teens sleep longer on weekends to make up for sleep loss during the week.

Sleeping better at night also had a daytime effect; the athletes reported better daily performance.

Is your teen getting enough sleep? Check out the signs your teen needs sleep on SleepEducation.com.

Image by Alpharetta CVB

Obstructive Sleep Apnea & Depression

A new study examined the rate of obstructive sleep apnea in people with major depressive disorder and insomnia.

The study involved 51 people with both depression and insomnia; they were evaluated by an overnight sleep study.

Results show a high rate of OSA in people with depression and insomnia; 39 percent of the people had an apnea-hypopnea index (AHI) of 15 or more breathing pauses per hour of sleep. An AHI of 15 to 30 is considered “moderate” sleep apnea.

Men were more likely than women to have OSA. People with sleep apnea also were older and had a higher body mass index (BMI).

Previous studies also have linked sleep apnea to depression.

A 2008 study in the Journal of Clinical Sleep Medicine involved 1,106 adults with sleep apnea. About 19 percent of the men and 37 percent of the women had depression.

A 2006 study involved 788 men and 620 women. Results show that people with mild sleep apnea were two times more likely to have depression than people without OSA. The risk of depression was even higher in people with moderate or severe sleep apnea.

The good news is that treating sleep apnea can reduce the symptoms of depression.

A 2007 study in the Journal of Clinical Sleep Medicine examined the effects of CPAP therapy on depression. The AASM recommends CPAP as the treatment of choice for people with sleep apnea.

The study involved 50 adults with severe sleep apnea. Four to six weeks of CPAP therapy lowered depression symptoms in 94 percent of the group.

This improvement was long lasting; after one year of CPAP therapy, 88 percent of the group still had lower symptoms of depression.

Get help for sleep apnea at an AASM-accredited sleep center near you. Learn more about the link between sleep apnea and depression on SleepEducation.com.

Do All Animals Sleep?

Over the weekend a New York Times editorial longingly observed how “effortlessly” farm animals seem to sleep. In contrast, people seem to work at sleeping – or at avoiding sleep as much as possible.

“What a lot of shut-eye all the other species get, and how sleep-deprived humans seem in comparison!” the editorial lamented. “To grasp the force of human culture, all you have to do is consider how hard we try to organize our sleeping.”

One way researchers try to unlock the mysteries of human sleep is by studying sleep in other species. Results show a diversity of sleep habits.

A 2008 study involved brown-throated, three-toed sloths. The results emphasized the importance of studying animals in their natural environment.

In captivity sloths sleep for more than 16 hours per day, BBC News reported. But the study found that they only slept for 9.6 hours in the wild.

Last month BBC News reported on a study of fire ants. It found that queen ants fell asleep 90 times a day; these sleep periods lasted a little longer than six minutes. Their total daily sleep was more than nine hours.

In contrast, a single worker took 250 naps per day; each nap lasted just longer than a minute. Their total sleep was only 4 hours and 48 minutes a day.

The article added that this productivity may come with a cost: The worker ants only live for months; the queen ants live for years.

A 2009 study examined the sleep of dolphins. A dolphin only sends half of its brain to sleep; the other half remains conscious.

The dolphins in the study were able to remain vigilant over a five-day period, MSNBC reported. They also showed no signs of sleep deprivation.

It’s often assumed that every animal sleeps in one way or another. But is this true? Do all animals sleep?

It’s a difficult question to answer; it can be hard to tell whether an observed animal is sleeping or in a state of “quiet rest.”

UCLA’s Jerome Siegel published a review of the evidence in 2008. According to Siegel, we may be wrong to assume that there is a “universal state of sleep” among all animals.

“The evidence that all animals have a state that meets the accepted definitions of sleep is quite poor,” he concluded.

How much do animals sleep? Find out on the Neuroscience for Kids Web site.

Image by Alfonso Gonzalez

Does Bariatric Surgery Cure Sleep Apnea?

In February the Sleep Education Blog reported on the use of bariatric surgery to treat obstructive sleep apnea. A small study found that surgery did provide some benefits; but it wasn’t a cure for OSA.

Now a new study takes a broader look at the evidence. The systematic review analyzed 12 studies involving 342 people.

Bariatric surgery did reduce the severity of obesity; the average body mass index (BMI) dropped from 55 kg/m2 to 38 kg/m2. A BMI of 30 or higher is considered “obese.”

Surgery also reduced the severity of sleep apnea; but it didn’t cure the problem.

The average apnea-hypopnea index (AHI) dropped from 55 breathing pauses per hour to 16 per hour. An AHI of 15 to 30 is considered “moderate” sleep apnea; an AHI of more than 30 is considered “severe” OSA.

The AASM recommends bariatric surgery as an optional treatment for severe obesity and sleep apnea. But it should only be used along with a first-line treatment such as CPAP therapy.

Contact an AASM–accredited sleep center to discuss all treatment options for OSA.

Sleep Music: A Jewel “Lullaby” & Relaxation CDs

The new 15-track CD “Lullaby” from three-time Grammy nominee Jewel is an acoustic ode to sleep.

Released in May, the self-produced release features 10 original songs such as “Sweet Dreams.” The other songs are classic lullabies such as “Twinkle, Twinkle” and “Brahms’ Lullaby.”

“This isn’t just a ‘kids’ album, it’s really a mood album – perfect to relax to at the end of a long day,” Jewel said in a prepared statement. “It will soothe and lull children, but was also written and sung for adults to enjoy and unwind with.”

Currently the CD is the top-selling compilation of lullabies on Amazon.com.

But it’s not just parents who are hoping that music can promote a good night of sleep. Two of the top five recordings on Amazon’s best-selling “Self-Help” list also are sleep related.

At #2 is “Delta Sleep System” by Dr. Jeffrey Thompson. Released in 1999, it seeks to promote the delta waves that increase during deep, slow-wave sleep. It combines music, nature sounds and embedded “pulses” of sound.

At #5 is “Sleep Soundly” by Steven Halpern. Released in 1994, it is a collection of New Age music from the 1980s. The songs combine piano-based “sonic textures” with “subliminal, sleep-encouraging affirmations.”

In May the Sleep Education Blog reported that there is some research to support using music to sleep better. The U.S. Department of Homeland Security is even studying the use of “brain music.” The goal is to help emergency responders sleep well when they end a stressful shift.

Relaxation training is one method of cognitive behavioral therapy for insomnia. Learn more about CBT on SleepEducation.com.

Image courtesy of Fisher-Price

A Melatonin Patch May Help Shift Workers Sleep During the Day

A nicotine patch is commonly used by people who want to quit smoking. A small dose of nicotine enters the blood by being absorbed through the skin.

Can this method of “transdermal delivery” be used for a sleep aid such as melatonin? A new report provides positive results from a small study.

The study involved eight people. They were given an eight-hour opportunity to sleep during the daytime. This simulated the sleep schedule of someone who performs shift work.

Some participants were given a patch with 2.1 mg of melatonin. These participants were able to sleep better during the day; their sleep was similar to natural nighttime sleep.

Melatonin is a natural hormone that is produced by the brain’s pineal gland. It is considered a “darkness signal” for your body and seems to play an important role in sleep.

Melatonin is widely available in the U.S. as a nutritional supplement. When taken at the proper time, it can produce a shift in the timing of your sleep period. Melatonin can be helpful in the treatment of shift work disorder, jet lag disorder and delayed sleep phase disorder.

But melatonin does have limitations. One is the short length of its effectiveness.

“Melatonin taken orally often wears off quickly, as it is rapidly removed from the body,” study co-author Daniel Aeschbach, PhD, said in a prepared statement.

Oral melatonin supplements may help you fall asleep during the day; but it may be difficult for you to get a full seven to eight hours of sleep.

The study found that the patch elevated melatonin levels gradually; these levels remained elevated for an extended duration.

“The peak concentration occurred in the early evening, during the latter part of the bed rest,” said Aeschbach. “We know – and shift workers know - that this is a time during which it is particularly difficult to remain asleep.”

Find sleep tips for shift workers on SleepEducation.com. Get help for a sleep problem at an AASM-accredited sleep center near you.

Understanding Unusual Ambien Side Effects

A new study may help explain why some people have unusual side effects when taking the sleep aid zolpidem – also known as Ambien.

Reuters reports that the drug can shut down brain circuits that normally inhibit some activity. This may release the brakes on other brain circuits while you sleep.

“In a way, Ambien is awakening other circuits because the brakes are not in place," study co-author Molly Huntsman told Reuters. “It's a population of neurons that is normally in place to stop activity. We find what Ambien does is inhibit their function to inhibit.”

Ambien is a sedative-hypnotic that is FDA-approved for the short-term treatment of insomnia in adults. The most common side effects include drowsiness and dizziness.

But other unusual side effects can occur. In 2007 the FDA requested changes to the product labeling of all sedative-hypnotics.

One of the proposed changes was to include a warning about the risk of “complex sleep-related behaviors.” Examples include sleepwalking and sleep eating. Rare cases of sleep driving also have been reported.

The FDA-approved Medication Guide for Ambien now states that, “You may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”

But why do these unusual side effects only occur in some people? Huntsman suggests that something may have happened to their brain circuitry.

It is possible that a previous experience changed their brain receptors. This could affect how they respond to a drug like Ambien.

“A lot of things can change your brain chemistry - stress, alcohol use," Huntsman told Reuters.

The AASM offers these Guidelines for Taking Sleep Medications. Contact your doctor or pharmacist if you have any other questions about taking sleeping pills.

You also should ask your doctor about cognitive behavioral therapy for insomnia. It is a safe and effective treatment option.

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

George Dawes Green’s Free-Running Circadian Rhythm Sleep Disorder

What would life be like if your sleep and wake times drifted later every day? How hard would it be if you began falling asleep in the morning, then in the afternoon, then in the evening as weeks went by?

Just ask George Dawes Green, best-selling author of The Juror. USA Today describes how he sleeps around the clock because of this rare sleep disorder.

It is a circadian rhythm sleep disorder that is known by many names. It is called “free-running type” or “nonentrained type.” Sometimes it is called “non-24-hour sleep-wake syndrome” or “hypernychthemeral syndrome.”

The disorder is closely related to light and darkness.

Normally people have a circadian rhythm that is longer than 24 hours. But during the day and at night regular timing cues reset the body clock to a 24-hour schedule.

One of these timing cues is light. The light-dark cycle has the strongest influence on the timing of the brain’s clock. Without light, it is likely that your sleep time would drift later and later each day.

This is why people who are totally blind are most likely to have free-running type. It is rare for the disorder to occur in a person like Green who has normal eyesight.

Green told USA Today that he gets eight hours of sleep per day. But his sleep-wake schedule drifts about 20 minutes later each day.

People with this disorder often become isolated. Their varying sleep schedules can make it hard to maintain relationships.

It also can be difficult to succeed in school and keep a job. Green dropped out of school because he couldn’t stay awake in class.

As an adult he tried shift work, getting a job as a night guard. Then he started his own business.

Bright light therapy and melatonin can help treat free-running type. But Green chose instead to live with the disorder and follow his own sleep schedule.

He credits this decision with helping to unleash his creativity. His new novel Ravens is out today.

Image by Russ Morris

Obama White House: No Time for Sleep?

An important speech in Russia on Tuesday. The G-8 Summit in Italy on Wednesday. A visit to the Vatican in Rome on Friday. Another speech in Ghana on Saturday. Back to the White House to introduce the nominee for the U.S. Surgeon General yesterday.

Keeping up with President Obama is no easy task. It requires a pace that often leaves little time for White House staffers to sleep, the Washington Post reports.

The long days may come with the territory. But the need for sleep won’t go away.

“You have your coffee at five in the afternoon, and it just doesn't do anything," press secretary Robert Gibbs told the Post. "Because you realize you're so far behind [in sleep] that a jolt -- you don't even feel it."

Administration officials insist that adrenaline keeps them going. But sometimes the exhaustion is too hard to hide: Economic adviser Larry Summers was seen snoozing during a meeting in April.

But after six months in office, maybe White House staffers have trained their bodies to get by on less sleep. Does the body adapt to a schedule of restricted sleep?

A 2002 study in the journal Sleep put this question to the test. It examined the effects of “chronic sleep restriction.”

Participants slept for either 4 hours, 6 hours or 8 hours per night. They maintained this schedule for 14 days. Effects were compared with three nights of total sleep deprivation.

Results show that chronic restriction of sleep periods to 4 hours or 6 hours per night resulted in significant deficits in cognitive performance. The effects of sleep restriction were similar to those of up to two nights of total sleep deprivation.

So did participants adapt to the effects of sleep restriction? Not at all: Performance “progressively eroded.” It got worse over time, not better.

And participants didn’t seem to notice. Results suggest that they were largely unaware of these cognitive deficits.

“Claims that humans adapt to chronic sleep restriction within a few days…are not supported by the present findings,” the authors concluded. “It appears that even relatively moderate sleep restriction can seriously impair waking neurobehavioral functions in healthy adults.”

Official White House Photo by Pete Souza

Sleep Apnea: Microsoft Developing a Diagnostic Device

The 10th annual Microsoft Research Faculty Summit is taking place today and tomorrow in Redmond, Wash. The summit brings leading academic researchers and educators together with Microsoft® researchers.

The theme of the 2009 summit is “Addressing World-Scale Challenges.” One of the challenges on the agenda is the diagnosis of obstructive sleep apnea.

Tomorrow from 2:30 p.m. to 3:45 p.m. there will be a breakout session on, “Monitoring and Diagnosing Sleep Apnea in the Home.” The talk will focus on technology that the Microsoft Research hardware team is developing.

They are creating a device to generate predictions of sleep apnea. It is a “neck cuff” that contains diagnostic sensors. The goal is for it to be used in the home.

OSA is a common sleep disorder that affects millions of people worldwide. It occurs when the muscles relax during sleep.

As a result soft tissue in the back of the throat collapses and blocks the upper airway. A person with severe sleep apnea may have hundreds of breathing pauses per night.

Untreated OSA has been linked to other serious medical problems. These include heart disease, stroke, diabetes, obesity and depression.

It is estimated that about 80 percent of men and 90 percent of women with moderate to severe sleep apnea are undiagnosed.

An overnight sleep study at a sleep disorders center has always been the standard diagnostic tool for detecting OSA in children and adults. But recent advances have made home sleep testing another option for adults who have a high risk of OSA.

How do you know which method of diagnosis is right for you? You should schedule an appointment at an AASM-accredited sleep disorders center.

There you will meet with a board-certified sleep specialist. He or she will determine the best way to evaluate your sleep problem.

Image courtesy of Microsoft

Untreated Sleep Apnea Affects Job Performance

Two new studies show that untreated obstructive sleep apnea can have a negative impact on job performance.

A study in the June 1 issue of the journal Sleep involved 150 people; they were all referred to a sleep center in California for suspected sleep apnea. Their average age was 44 years; each of them was employed at the time of the study.

An overnight sleep study confirmed the presence of sleep apnea in 83 of the participants. Results show that work productivity suffered when people had sleep apnea and excessive daytime sleepiness.

They were almost 14 times more likely to have had job-performance problems in the past four weeks. Examples include falling asleep on the job or missing a day of work. They also were more likely to report decreased job effectiveness.

Results also show that people with OSA and EDS were almost four times more likely to have had their work duty modified in the past five years. Examples include taking a pay cut or missing a promotion. Other examples include changing jobs or a job schedule.

Another new study involved 957 people in Finland who were diagnosed with OSA; they were compared with 4,785 people who did not have sleep apnea.

Results show that the risk of lost work days was increased by 61 percent in men with OSA; it was increased by 80 percent in women with sleep apnea.

In women this risk was already increased five years before they were diagnosed; in men the highest risk appeared one year before the year of their diagnosis.

It is estimated that about 80 percent of men and 90 percent of women with moderate to severe sleep apnea are undiagnosed. Are you one of these people?

You can find out with an overnight sleep study. Contact an AASM-accredited sleep center near you for help.

On SleepEducation.com you can learn more about how a sleep study may be your best investment for long-term health. You also can answer these questions to learn more about your risk for sleep apnea.

Craig David: “Insomnia” from a Broken Heart

British R&B star Craig David is in love, and he can’t sleep – at least in his song lyrics. His single “Insomnia” spent nine weeks on the Billboard Pop 100 Airplay chart, peaking at #62.

In 2000 the 19-year-old David became the youngest British male solo artist to have a number-one single. But he’s still trying to build momentum for his music in the U.S.

“Insomnia” describes what happens to his heart and to his sleep when the woman he loves walks out on him:

Because I can't sleep til you're next to me
No I can't live without you no more
Oh I stay up til you're next to me
Til this house feels like it did before
Feels like insomnia ah ah, Feels like insomnia ah ah
Feels like insomnia ah ah, Feels like insomnia ah ah

Insomnia - Craig David

A recent study indicates that David isn't the only person to experience this kind of insomnia.

The study involved 360 women; it examined the link between relationship status and sleep. Results show that women who lost a partner during the eight-year follow-up period had the worst sleep.

Get insight about insomnia in this Q&A with a sleep specialist on SleepEducation.com.

Regis Philbin’s Sleep Study Results: It’s Sleep Apnea

Who wants to feel like a millionaire? Talk show and game show host Regis Philbin says that he does.

The Emmy Award-winning TV personality can’t get a good night’s sleep. Regis said that he wakes up multiple times during the night.

And after waking up it can be a struggle to get back to sleep. As a result he rarely feels his best during the day.

For years he’s been complaining about his sleep problems on “Live with Regis and Kelly.” And his wife Joy has her own sleep problem: His snoring keeps her awake at night.

But now Regis knows what’s causing his disturbed sleep. He spent the night at a sleep disorders center in New York. His experience was documented on Thursday’s show.



Results of his overnight sleep study show that he has obstructive sleep apnea. This common sleep disorder occurs when the muscles relax during sleep. As a result soft tissue in the back of the throat collapses and blocks the upper airway.

Breathing pauses can last from 10 seconds to a minute or longer. A person with severe sleep apnea may have hundreds of breathing pauses per night.

So what is going to help Regis sleep better? On the show he took a look at a CPAP unit and mask. CPAP therapy is the most common treatment for OSA.

The small unit plugs into the wall and sends air through a long, flexible tube. The tube connects to a mask that you wear during sleep. The stream of air keeps the airway open, preventing breathing pauses.

On SleepEducation.com you can learn more about how a sleep study may be your best investment for long-term health. You also can answer these questions to learn more about your risk for sleep apnea.

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

Drowsy Driving: Mercedes, SAAB Develop Prevention Systems

Car makers Mercedes-Benz and SAAB are both using high-tech systems to help prevent drowsy-driving accidents.

Mercedes introduced its Attention Assist system as a standard feature of the 2010 E-Class. Sensors measure more than 70 parameters to monitor your alertness.

They keep track of your speed and acceleration. The sensors record your use of turn indicators and pedals. They even take into account external factors such as wind.

But the system focuses on your steering behavior. It detects minor steering errors that often occur in the early stages of drowsiness.

Attention Assist then warns you when you are at risk of falling asleep behind the wheel. A chime sounds, and a message appears on the instrument display. It shows a coffee cup with the words, “Attention Assist: Time for a break?”

You can see the system in action in this interactive, online test drive of the new E-Class.

SAAB is taking a different approach. Its Driver Attention Warning System uses an infrared camera to keep an eye on your eyes.

Software analyzes the image and measures your rate of eye blinking. Warnings occur when it detects drowsy eye-lid closures.

First a chime sounds, and a warning appears on the instrument panel. Then verbal warning messages are played through the car’s sound system.

The camera also monitors movement of the head and eyes. If you look away from the road for too long, your seat cushion will vibrate.

“It is a fact that many drivers do not stop and get out of the car if they are feeling drowsy,” SAAB representative Arne Nabo said in a prepared statement. “So we are now trying to help drivers to help themselves.”

SAAB also is developing a TV ad called “Sleep Attack.” It shows a drowsy-driving accident from the driver’s point of view. See an online storyboard of the ad.

The ad’s message is simple and direct: “Sleep before you drive.”

Learn more about drowsy driving on SleepEducation.com.

Drowsy Sailing: Sleep Deprivation & the U.S. Navy Port Royal Accident

The Honolulu Advertiser reports that sleep loss and fatigue may have been factors in the Feb. 5 grounding of the USS Port Royal, a guided-missile cruiser.

The ship’s captain told the Navy Safety Investigation Board that he was tired when the ship got under way. He got less than five hours of sleep in the previous 24 hours; in the three days leading up to the incident he slept for a total of only 15 hours.

The ship ran aground in shallow waters off the coast of Honolulu. The 9,600-ton cruiser remained stuck for days before efforts to free the ship were successful. The AP reports that the accident caused an estimated $25 million to $40 million in damage to the $1 billion Port Royal.

In April the Sleep Education Blog reported that the U.S. Navy has been paying attention to sleep. There is concern that sleep deprivation can increase mistakes and accidents.

The National Transportation Safety Board also is concerned about safety on the open seas. For years the NTSB has sought to reduce marine accidents caused by human fatigue.

The NTSB is advocating for work-hour limits for mariners based on fatigue research and sleep needs. This was added to the NTSB’s “most wanted” list of safety improvements in 1999. But the NTSB reports that the U.S. Coast Guard has not taken action to address this issue.

Sleep deprivation also may have been a factor in the famous grounding of another ship – the Exxon Valdez. The oil tanker ran aground on March 24, 1989. About 11 million gallons of oil were spilled into Alaska’s Prince William Sound.

The Alaska Oil Spill Commission published a final report on the incident in 1990. It states that the ship’s third mate failed to maneuver the vessel properly.

The mistake may have been caused by fatigue; testimony suggests that he may have been awake and at work for up to 18 hours before the accident.

“It is conceivable that excessive work hours (sleep deprivation) contributed to an overall impact of fatigue, which in turn contributed to the Exxon Valdez grounding," the report concluded.

Image by the U.S. Navy

Online CBT for Insomnia: Using the Internet to Get Some “SHUTi”

Research continues to show that online cognitive behavioral therapy may be an effective treatment for adults with ongoing insomnia.

A new study involved 44 people with an average age of 45 years. They had struggled with insomnia for an average of more than 10 years; most of the participants were women.

Half of the group was put on a wait list as a control; the other half completed a nine-week, online CBT program called “Sleep Healthy Using the Internet” – or SHUTi.

Results show that insomnia severity improved significantly for the Internet group; there was only a slight improvement for the control group. Members of the treatment group spent less time awake during the night. Their sleep also was more efficient; a higher percentage of their total time in bed was spent sleeping.

The online treatment also had a long-lasting effect; members of the Internet group were still sleeping better at a six-month follow-up.

SHUTi was developed at the University of Virginia Health System. The lead author of the new study was SHUTi creator Lee Ritterband, PhD. He also is the co-founder of the International Society for Research on Internet Interventions.

The AP reports that SHUTi is highly interactive; it uses stories, quizzes and games to teach healthy sleep habits. It also gives personalized advice based on a completed sleep diary.

The content is divided into core units that focus on specific methods for improving sleep. These include sleep restriction, stimulus control, sleep hygiene, cognitive restructuring and relapse prevention.

These methods are based on traditional, face-to-face CBT. The AASM recommends CBT as an effective treatment for chronic insomnia in adults.

In June the Sleep Education Blog reported on a study of another online CBT program. The five-week program helped most people in the treatment group; 81 percent reported at least mild improvement in their sleep.

Contact an AASM-accredited sleep center near you for help with insomnia.

Bedwetting & Obstructive Sleep Apnea in Children

A new study shows that “nocturnal enuresis” – bedwetting – is common in children with obstructive sleep apnea.

The study involved 149 children with some degree of sleep apnea – from minimal to severe. They were compared with 139 children in a control group. All children were between 5 and 15 years of age.

Results show that 80 percent of children with a bedwetting problem had some degree of sleep apnea. Children with a bedwetting problem were five times more likely to have sleep apnea.

Typically bedwetting is considered to be a problem if it persists beyond 5 years of age. Bedwetting can occur at any age when it is caused by another problem such as sleep apnea.

The study also found a link between a child’s weight and sleep apnea. Children who were overweight were four times more likely to have sleep apnea.

About two percent of young children have sleep apnea. In June the Sleep Education Blog reported that the causes of sleep apnea in children are complex.

Sleep apnea often occurs when a child has large tonsils and adenoids. But weight and nasal problems also can play a role.

Most children with sleep apnea have a history of snoring. It tends to be loud and may include obvious pauses in breathing and gasps for breath.

In addition to snoring and bedwetting, these are other warning signs that your child may have sleep apnea:

- A rib cage that moves inward as the child inhales
- Body movements and arousals from sleep
- Sweating during sleep
- Sleeping with the neck overextended
- Excessive daytime sleepiness
- Hyperactivity or aggressive behavior
- A slow rate of growth
- Morning headaches

Your child can get help for sleep apnea at an AASM-accredited sleep center near you.

Sleep Duration & Risk of Death

The AASM reports that most adults need about seven to eight hours of nightly sleep to feel alert and well rested during the day. But is it dangerous if you regularly get less sleep or more sleep? Does “short sleep” or “long sleep” increase your risk of death?

A new study took a look at the evidence. The systematic review analyzed data from other studies. In each study sleep duration was measured by self-report.

Sixteen studies measured short sleep and mortality. The combined results show that having a short sleep duration was associated with a 10 percent increase in the risk of death.

Why? Other research offers possible explanations. Studies have linked short sleep to an increased risk of diabetes, obesity and hypertension.

What about long sleep duration? Seventeen studies reported data on long sleep duration and mortality. The risk of death for long sleepers was increased by 23 percent; their risk of cardiovascular-related death was increased by 38 percent.

A 2008 study in the journal Sleep suggested a possible explanation for this relationship. The study involved 9,789 U.S. adults between 32 and 86 years of age.

There was no link between sleep duration and mortality in middle-aged adults between the ages of 32 and 59. But in elderly adults between 60 and 86 years of age, both short sleep and long sleep were associated with an increased risk of death.

The mortality risk was increased by 27 percent in elderly adults who reported that they usually sleep five hours or less; the risk was increased by 36 percent in older adults who reported sleeping nine hours or more.

“The relationship between sleep duration and mortality is largely influenced by deaths in elderly subjects,” the authors concluded. “Long sleep duration is unlikely to contribute toward mortality.”