Sleep Books for Children

A new book helps children learn about snoring and obstructive sleep apnea.

Botts' Dots and the Rumble Line: How They Saved the Trees in Snordom was written by dentist Dr. Michael Simmons. He is a member of both the AASM and the American Academy of Dental Sleep Medicine.

The book involves a group of civilized boars who are planting trees in the town of Snordom. But all the trees keep falling down before they can take root.

Could it have anything to do with the boars’ snoring problem? The story tells how the boars solve the mystery.

Botts’ Dots is available from BookSurge Publishing. Learn more about the book at www.snordom.com.

In 2007 Scholastic Inc. published My Daddy Snores. Author Nancy Rothstein was inspired by her husband’s loud snoring.

The book tells how Mommy tries everything to escape Daddy’s snoring. She even spends a night in the doghouse. Finally she takes Daddy to the doctor. Will there be a solution for Daddy’s snoring?

Learn more about the book at www.mydaddysnores.com. Rothstein also hosts the online Sleep Radio Show.

Weight Loss, Sleep Apnea & Diabetes

A new study shows that weight loss may reduce the severity of obstructive sleep apnea in some people who also have type 2 diabetes.

The study involved 264 diabetic adults. They had an average age of 61 years; their mean weight was 226 pounds. They had an average body mass index of 36.7; a BMI of 30 or higher is considered “obese.”

They also had an average apnea-hypopnea index of 23.2. This means that they stopped breathing about 23 times per hour of sleep. An AHI of 15 to 30 is considered “moderate” sleep apnea.

Some participants were assigned to a behavioral weight-loss program; it involved portion-controlled diets and 175 minutes of exercise per week.

Other participants were assigned to a control group; they attended three sessions related to diabetes support and education. The two groups were compared after one year.

Results show that members of the weight-loss group lost an average of 24 pounds. Their average AHI decreased, and they were less likely than controls to have severe sleep apnea at the one-year follow-up. The average AHI increased in the control group.

“These results show that doctors as well as patients can expect a significant improvement in their sleep apnea with weight loss,” lead author Gary Foster said in a Temple University statement. “And a reduction in sleep apnea has a number of benefits for overall health and well-being.”

But about 86 percent of people in the weight-loss group still had sleep apnea at follow-up. The average severity of their OSA remained moderate with an AHI of 18.3, reports MedPage Today.

The AASM recommends dietary weight loss as one treatment strategy for people who are obese and have sleep apnea. But weight loss should be combined with another treatment such as CPAP or an oral appliance.

Read more about weight loss and sleep apnea. In May the Sleep Education Blog reported on another study led by Foster; it found that undiagnosed OSA is common in people with type 2 diabetes.

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

Image by Chris

Biggest Loser: Weight Loss, CPAP & Sleep Apnea

Season eight of the hit TV show “The Biggest Loser” has begun. Once again contestants are being screened and treated for obstructive sleep apnea.

“I have put in place a new policy that all contestants need to undergo a sleep study in future seasons,” the show’s medical expert Dr. Rob Huizenga said in a Philips Respironics statement. “The results have been astonishing after two seasons of testing.”

All 16 contestants were diagnosed with sleep apnea during preparations for the new season. Now they are being treated with CPAP therapy. AASM President Dr. Clete Kushida is working with the contestants to ensure that they receive the maximum benefit from ongoing treatment.

Contestants will continue to receive assistance once their time on the show comes to an end. Philips Respironics will help them find a sleep disorders center in their hometown.

In May the Sleep Education Blog reported that excess body weight is a major risk factor for OSA. Treating sleep apnea with CPAP helps some people bring their weight under control.

But research shows that that CPAP alone is unlikely to produce weight loss; CPAP users still need to take an active role in losing weight.

You should talk to your doctor to develop a healthy weight-loss plan that is right for you. For help with sleep apnea you should contact an AASM-accredited sleep disorders center in your area.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk.

Watch "The Biggest Loser" on NBC, Tuesdays at 8/7c.

Bedtime Battles: Helping Children Get Good Sleep

It is 9 p.m.; you are ready for your kids to go to sleep, but are they?

As the school year begins, parents may find themselves struggling to defeat the technological temptations that keep children awake late at night.

Research shows that children who don’t get enough sleep are at higher risk for emotional and behavioral problems. Distractions like computers, T.V. and video games can keep children from getting the sleep they need to stay healthy.

A study presented in June at SLEEP shows that adolescents who use technology (cell phone, DVDs, or computer games) and drink caffeine at night struggle to stay awake and alert during the day.

Parents can help children get the sleep they need by changing their nighttime behavior. Limiting use of technology at night and developing a nightly bedtime routine can lead to better sleep. Although it can be difficult to say no to your children, it is important to set limits and enforce bedtime.

In May, the Sleep Education blog reported that using a bedtime routine for children between the ages of 7 months and 3 years helps them sleep better and improves their mother’s mood.

Experts recommend the following amounts of sleep for children:

• Infants (3 to 11 months): 14 to 15 hours
• Toddlers: 12 to 14 hours
• Preschoolers: 11 to 13 hours
• School-age children: 10 to 11 hours

Parents can find tips to help their child sleep better at Sleep Education.com.

William Wordsworth’s Sleepless Nights

It seems that William Wordsworth was well acquainted with insomnia. His poem “To Sleep” describes how he wrestled sleep – and lost – across three restless nights.

Poet Christopher Nield recently wrote an essay about the poem for the Epoch Times. It’s the latest in his series on “Classic Poetry for Modern Life.”

In the opening lines of the poem Wordsworth describes the futility of his attempts to capture sleep “by any stealth.” Counting sheep. Listening to the imaginary sound of rain. Visualizing a pleasant scene.

“He looks for that elusive key to rest,” comments Nield.

The result? “Still I lie sleepless.”

With dread Wordsworth anticipates hearing the sounds that will signal day’s return. For him the blessing of sleep has become a curse.

He concludes with a desperate, hopeful plea for sleep to come this time:

So do not let me wear tonight away:
Without Thee what is all the morning's wealth?
Come, blessed barrier between day and day,
Dear mother of fresh thoughts and joyous health!

Nield suggests that the poem remains as relevant today as when it was written.

“How many of us can identify with Wordsworth’s description of lying awake until the birds twitter their dawn chorus?” he asks.

What about you? Are you all too familiar with the struggle Wordsworth describes? Do you find comfort in the words of his poem?

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

Sleep Loss & Alzheimer’s Disease

A new study provides some of the first indications that chronic sleep loss could play a role in the development of Alzheimer’s disease.

The researchers analyzed the levels of “amyloid beta” in the brains of mice. Amyloid beta is a protein fragment.

The study reports that the accumulation of amyloid beta in the brain is a hallmark of Alzheimer's disease; the mice in the study were genetically engineered to develop the disease.



Results show that brain amyloid beta levels correlated with wakefulness. Levels increased at night when the mice were mostly awake; they decreased during the day when the mice were mostly asleep.

The study also found that brain amyloid beta levels increased during chronic sleep deprivation; mice that stayed awake longer had levels that were 25 percent higher.

“We may need to prioritize treating sleep disorders not only for their many acute effects but also for potential long-term impacts on brain health," senior author Dr. David M. Holtzman said in a Washington University School of Medicine in St. Louis news release.

The researchers also report that brain amyloid beta levels increased when they injected orexin into the brains of the mice; the levels decreased when the mice were injected with a drug that blocks the orexin receptors.

Orexin is a protein that helps regulate the sleep cycle; it is also called hypocretin.

"Orexin or compounds it interacts with may become new drug targets for treatment of Alzheimer's disease," said Holtzman.

But orexin inhibitors may not be a viable treatment option, cautions a Science News article. The drugs may cause severe sleepiness.

Research has found that that people with the sleep disorder narcolepsy lack brain cells that make orexin. Narcolepsy involves repeated episodes of excessive daytime sleepiness.

In August the Sleep Education Blog reported that treating obstructive sleep apnea with CPAP therapy may slow the cognitive decline of people with Alzheimer’s disease. OSA is more common between middle age and older age; symptoms of Alzheimer’s disease tend to appear after the age of 60.

Get sleep tips for older adults on SleepEducation.com.

Insomnia, Sleep Loss & Diabetes Risk

A new study suggests that people suffering from chronic insomnia and sleep loss may be at risk for type 2 diabetes.

The study involved 1,741 men and women from central Pennsylvania. They were randomly selected for the study. Their sleep was monitored by overnight sleep study in a sleep lab.

Results show that having chronic insomnia for a year or longer was associated with a higher risk for diabetes; the risk was not increased in people with milder insomnia.

The highest risk of diabetes was in people with chronic insomnia who slept for five hours or less; they were almost three times more likely to have diabetes. People with chronic insomnia who slept five to six hours were two times more likely to have diabetes.

The research team also has performed other analyses of this group of people. Their studies have linked chronic insomnia and sleep loss with an increased risk of hypertension; in men they also have found an increased risk of death.

In August the Sleep Education blog reported on the link between sleep loss and diabetes.

Proven treatments for insomnia are available. Both cognitive behavioral therapy and medications are effective.

A board-certified sleep specialist can determine which treatment is best for you. Contact an AASM-accredited sleep disorders center if you have an ongoing problem with insomnia.

Couples & Sleep: Separated by Snoring?

On Sunday the Sleep Education blog reported that one sleep researcher recommends separate sleep arrangements for some couples.

What about women who sleep with a snoring bed partner? Will they sleep better by sleeping alone?

A new study from France provides mixed results. It involved 23 women who complained that they were having sleep problems because of their bed partner’s snoring.

Each woman’s sleep was monitored for one night as she slept together with her bed partner; then the women were monitored on a separate night as they slept alone.

Results suggest that sleep quality was decreased in females sleeping with male snorers; they spent a higher percentage of their sleep time in one of the stages of “light” sleep. Their sleep also was more fragmented; they had a higher “awakening index” when sleeping with their bed partner.

But the study also found no substantial improvement in objective sleep quality when the women slept alone. Their total sleep time, sleep efficiency and arousal index were about the same as when they slept with their bed partner; they also spent a similar percentage of time in the stages of “deep” sleep and REM sleep.

The study even found that some of the women had sleep problems of their own. Six of the women snored and one had obstructive sleep apnea.

The AASM reports 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.

So what is the best thing to do when you have a snoring spouse or bed partner? You should contact an AASM-accredited sleep center near you for help.

Learn more about snoring solutions.

Women & Sleep Apnea Risk

A new study estimated the risk for obstructive sleep apnea among women in the U.S.

The study involved telephone survey responses from 1,254 women; OSA risk was estimated using the Berlin Questionnaire.

Results indicate that one in four women in America is at high risk of having OSA. Habitual snoring was reported by 61 percent of women with a high risk; 24 percent reported daytime sleepiness. Insomnia and restless legs syndrome also were frequently reported.

The risk for sleep apnea increased with age, obesity, and menopause. Women at high risk also were more likely to report having a chronic medical disorder.

In June the Sleep Education Blog reported that women may be surprised by sleep apnea. A recent study examined the signs of OSA in women.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk.

Learn more on SleepEducation.com about snoring and sleep apnea in women.

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

Analyzing the Sleep of Women

A new study sought to define normal values for the sleep of women. It also looked at the factors that are most likely to reduce the quality of a woman’s sleep.

The study involved 400 Swedish women; they were between 20 and 70 years of age. Their sleep was monitored by home sleep testing.

Results show that they slept for only about 6.5 hours per night. It took the women an average of 22 minutes to fall asleep.

Participants slept on their side for 50 percent of their total sleep time; side sleeping was more common in women over the age of 45 years.

The women slept on their back 41 percent of the time; only nine percent of total sleep time involved stomach sleeping.

In women who were older and in those with high blood pressure, sleep efficiency was lower. This is the percentage of time in bed that you are asleep. A low efficiency means that you were awake for much of your time in bed.

Older women and those with a higher body mass index (BMI) had less of the sleep stages of deep, slow-wave sleep. Sleep quality also was reduced in women who smoke, drink or have high blood pressure; it took them longer to fall asleep.

The AASM reports that there are many complex factors that can affect how a woman sleeps. These include sleep disorders, medical problems, pregnancy and menopause.

Learn more about sleep and women on SleepEducation.com. Sleep better with these sleep tips for women.

Couples & Sleep: Together or Apart?

Many couples may enjoy cuddling before falling asleep; but researcher Dr. Neil Stanley suggests that sharing a bed can lead to poor sleep and hurt your relationship.

Stanley told attendees of the British Science Festival that couples should consider sleeping apart, reports the Press Association. He said there is a 50-percent chance that your bed partner’s movements will disturb your sleep.

BBC News reports that Stanley follows his own advice: He and his wife sleep in separate rooms.

“Don’t be afraid to do something different,” Stanley said.

Stanley added that a couple’s sleep arrangement should be based on what makes them comfortable. If a couple sleeps well together, then there is no need to trade in a queen-sized bed for twin beds. But you may find that you are happier and healthier sleeping alone.

There is some support for this idea. A 2004 study in the journal Sleep involved 405 married couples; it found that an individual’s sleep problems can have a negative impact on his or her spouse’s health and well being.

But are separate bedrooms the solution? Maybe not; it may avoid the problem instead of solving it.

Last month the Sleep Education Blog reported that people who have a sleep disorder may be unaware of the problem. But the symptoms may be obvious to their bed partner.

People with a sleep disorder may wake their partner at night by snoring or making choking and snorting sounds; they also may grind their teeth, thrash their legs or punch and kick during sleep.

There are effective treatments for these sleep disorders; treatment can help both you and your bed partner sleep better. Get help for your partner’s sleep problem at an AASM-accredited sleep center near you.

These sleep tips for couples also may help you and your bed partner sleep better together.

Ballet Dancers: So You Think You Can Sleep

The hit TV show “So You Think You Can Dance” confirms that some amateur dancers have all the right moves. But for pros who already know they can dance, the question is: Can they sleep?

The authors of a new study report that professional ballet dancers undergo a rigorous training regimen during rehearsal. The work can involve extreme physical and mental stress; long days and irregular schedules are common. These conditions can make it hard to sleep.

The study involved 24 classical ballet dancers. Participants were studied for 67 days before a premiere performance. Their sleep was measured by wrist actigraphy; they also completed sleep diaries.

Results show that the dancers’ average sleep duration was already low when the study began; they slept for just under seven hours.

This sleep duration decreased significantly over the course of the study; by the end of the rehearsal they were sleeping only about 6.5 hours per night.

Their sleep efficiency and time in bed decreased during the study; time spent awake after first falling asleep increased. The amount of time it took them to fall asleep did not change.

The study also measured the cognitive performance and health status of the dancers. Results indicate that their mental sharpness, concentration and speed were impaired.

The authors conclude that sleep deprivation caused the dancers’ health to deteriorate during rehearsal. They suggest that daytime naps may be helpful during the stressful training period.

In June the Sleep Education Blog reported that sleep deprivation affects some people more than others. A study found that it has to do with your brain’s response to sleep loss.

Are you sleep deprived? Check out the seven signs you need sleep on SleepEducation.com.

Image by Damon White

Sleep Reduces False Memories

A new study shows that sleep may improve the accuracy of your memory. Lead author Kimberly Fenn said that this is the first study to examine sleep and memory errors.

The research involved college students who studied lists of words; 12 hours later they were tested. From a list with new words mixed in, they had to identify words that they had studied 12 hours earlier.

Some students studied the original word list at 10 a.m.; they were tested at 10 p.m. after spending the day awake. Other students studied the words at night; they were tested in the morning after at least six hours of sleep.

Results show that false recognition of non-studied words was reduced after sleep; there was no change in correct recognition of studied words.

“It’s easy to muddle things in your mind,” Fenn said in a Michigan State University news release. “This research suggests that after sleep you’re better able to tease apart the incorrect aspect of that memory.”

How does this process work? Fenn suggested that sleep may strengthen the source of a memory. Or a long period of wakefulness may hinder your ability to remember; your memories may be confused with other information that you gathered while awake.

In a video statement Fenn added that the findings could be important for students. After a full night of sleep you might be more likely to pick out the wrong answers on a multiple-choice test.

Sleep also could help you take medications safely; you might be less likely to confuse medications or have a false memory of taking them.

A recent article in the New Zealand Herald examined the impact of false memories on the legal system. It reports that eyewitness error is a factor in 75 percent of wrongful convictions in the U.S.

The article suggests that false memories are easily created. These false memories can be powerful; people with false memories tend to have absolute confidence that they are right.

Learn more about sleep and memory.

Sleep & Long-Term Memory: A “Sharp” Discovery

Researchers report that they have discovered how sleep plays a role in memory consolidation.

The process involves “sharp wave ripples.” These are short, intense, compressed oscillations in the brain; they occur during the sleep stage of slow-wave sleep.

The research team suggests that these events are responsible for consolidating memory. The sharp wave ripples transfer learned information to the brain region where long-term memories are stored.

“This specific brain pattern is the cause behind long-term memory formation,” study co-author György Buzsáki said in a Rutgers news release.

Buzsáki explained that the sharp wave ripples “teach” the brain to form a long-term memory. The ripples occur hundreds to thousands of times during sleep; this helps explain how a momentary event can be ingrained in the memory for a lifetime.

The finding may aid the development of effective treatments for memory disorders.

Learn more about sleep and memory.

Children & Sleep: Fragile Bedtimes

A new study examined the bedtimes of young children in “fragile families.” It presents the latest findings from the ongoing Fragile Families and Child Wellbeing Study.

What is a fragile family? The researchers use this term for unmarried parents and their children; these families are at greater risk of breaking up and living in poverty than more traditional families.

The study involved 3,217 children who were 3 years of age; all of them were born in large U.S. cities. The presence, time and consistency of bedtime routines were measured by parent report.

Results show that more than 80 percent of the children had a bedtime; but this bedtime was enforced for only two-thirds of the children. And only about half of these children went to bed before 9 p.m., reports CNN.

The study found that black and Hispanic children had later bedtimes than white children; they also had reduced odds of using regular bedtimes and bedtime routines.

Bedtime routines were less common in larger families and poor families; mothers with a lower level of education also were less likely to practice a bedtime routine with their young children.

The authors suggest that children who lack a bedtime and bedtime routine may fail to get enough sleep; the quality of their sleep also may be poor. This can increase their risk for behavioral and cognitive problems.

"What we find is that disadvantaged populations or lower-education populations have worse health outcomes,” lead author Lauren Hale, PhD, told CNN. “And it turns out they have worse sleep problems. Sleep patterns and sleep routines matter because they have both long-term and short-term implications for health and cognitive development."

In July the Sleep Education Blog reported that children who go to bed after 9 p.m. take longer to fall asleep; they also have a shorter total sleep time.

Another recent study showed that a simple, nightly bedtime routine helps young children sleep better.

On Sunday the San Francisco Chronicle published a review of the new book NurtureShock. One chapter of the book describes how sleep loss is affecting child development. You can read and comment on this chapter online.

Learn more about sleep and children on SleepEducation.com.

Lucid Dreaming: A Sleep-Wake Hybrid

A new study in the Sept. 1 issue of the journal Sleep investigated lucid dreaming.

What is lucid dreaming? It involves the conscious awareness of dreaming while you are still asleep.

Lucid dreaming combines aspects of waking and dreaming. You have hallucinatory dream activity along with reflective awareness; you realize that you are not awake and are dreaming. In contrast, during non-lucid dreams you mistakenly think that you are awake. Lucid dreaming also can involve the ability to control what happens during the dream.

Lucid dreams tend to occur after several hours of sleep; they are more common during later periods of rapid eye movement sleep – or REM sleep. The longest period of REM sleep may last for an hour near the end of the night. REM sleep makes up about 25 percent of total sleep time in normal adult sleep.

According to the authors, spontaneous lucidity is rare. But people can be trained to become lucid. A special electronic device can help induce lucidity; these devices emit specific light or sound signals.

But most often the training is done through pre-sleep “autosuggestion.” Before going to sleep, you tell yourself to recognize when you are dreaming; you prepare yourself to notice the bizarre events of the dream.

The authors also report that it is possible for you to communicate that you have become lucid during sleep; you can make a sequence of voluntary eye movements as a signal.

The study preparation involved 20 college students in Bonn, Germany. They took part in weekly lucidity training sessions. After four months, six people claimed to be lucid more than three times per week.

These six volunteers participated in the study. Their sleep was monitored during multiple overnight sleep studies.

Results show that three of the six volunteers were able to have a lucid dream in the sleep lab. In each case, lucidity occurred in the morning hours.

The dreamers were able to signal that they had become lucid with a pattern of horizontal eye movements. Lucidity also was confirmed by self-report after waking.

Brain-wave recordings confirmed that lucid dreaming occurs during sleep. But the recordings also showed that it differs from REM sleep.

The authors suggest that lucid dreaming is a “unique, hybrid state of sleep;” it involves features of both REM sleep and wakefulness. They conclude that lucidity requires a shift in brain activity during sleep.

Image by Cornelia Kopp

Groaning During Sleep

A new study evaluated five men and three women who have sleep related groaning.

They were monitored during an overnight sleep study. The number of groaning episodes during the night ranged from 40 to 182; the duration of these episodes lasted from two seconds to 46 seconds.

Almost 77 percent of the groaning episodes occurred during the sleep stage of rapid eye movement sleep – or REM sleep. About 63 percent of the episodes were associated with an arousal from sleep.

This may explain why some sleep groaners report having occasional restless sleep or mild daytime fatigue.

Four of the eight participants also had episodes of “bruxism” – or tooth grinding. In one person the episodes of bruxism and groaning appeared closely together.

The AASM reports that sleep related groaning is also known as “catathrenia.” It is classified as a parasomnia. These sleep disorders involve undesirable actions over which you have no deliberate control. You remain asleep or in a sleep-like state during an episode.

Groaning tends to occur nightly. An episode involves a deep breath followed by a long expiration; a monotonous, loud, groaning sound occurs as you exhale.

Moaning and “mournful sounds” also can occur. Some people have described hearing high-pitched or cracking sounds, as well as loud humming or roaring sounds.

A sleep groaner usually is unaware of the problem. It can be more disturbing for a bed partner, roommate or family member who hears the sounds.

The groaning usually stops whenever you change position in bed. But episodes are likely to resume again later.

Learn more about sleep related groaning on SleepEducation.com. Get help for a parasomnia at an AASM-accredited sleep center near you.

Sleep, Hot Flashes & Menopause

A new study shows that the drug gabapentin can improve sleep quality in menopausal women with hot flashes.

“It has minimal side effects and it is a generic drug,” lead author Dr. Michael E. Yurcheshen said in a prepared statement. “That makes it a very attractive treatment for these problems.”

The study involved 59 postmenopausal women; they experienced seven to 20 hot flashes daily.

The women were given 300 mg of gabapentin three times a day. Results show that subjective sleep quality was improved at both four weeks and 12 weeks.

Gabapentin is an anticonvulsant; it is FDA-approved for the treatment of partial seizures.

“We really are not sure which mechanism is responsible,” said Yurcheshen. “But this study suggests that it does work to improve sleep quality.”

A 2008 study in the journal Sleep examined sleep during the menopausal transition. It found that hot flashes were an independent predictor of sleep quality.

The AASM reports that sleep disturbances are more common during and after menopause. Insomnia related to menopause often occurs.

Learn more about sleep and women on SleepEducation.com.

Is Ambien a Miracle Cure for Severe Brain Damage?

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

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

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

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

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

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

Some previous studies of zolpidem have yielded dramatic results.

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

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

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

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

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

Dreams, Nightmares and 9/11

Today marks the eighth anniversary of the terrorist attacks against the U.S. on Sept. 11, 2001.

“Nearly 3,000 days have passed -- almost one for each of those taken from us,” President Obama said at a wreath-laying ceremony at the Pentagon. “But no turning of the seasons can diminish the pain and the loss of that day.”

Did that pain and loss affect our dreams in the days and weeks after 9/11? A study published in the journal Sleep in 2008 offers some answers.

The study involved 11 men and 33 women. For years they had been keeping a written record of all their dreams. Each participant submitted written accounts of 20 dreams for the study. These were the last 10 dreams they recorded before 9/11 and the first 10 dreams recorded after the attacks.

The 880 dreams were analyzed for features such as central image, intensity, emotion and vividness. They also were scored for content involving attacks, tall buildings and airplanes.

Results show a significant increase in the presence and intensity of a central image in dreams after 9/11. The researchers conclude that this change springs from an increased emotional arousal after 9/11.

Surprisingly, there was no increase in dream content involving airplanes or tall towers. There also were no “replay dreams.” None of the 440 post-9/11 dreams portrayed the events that were replayed time and again on television.

But there was a trend in these dreams to more content involving attacks. The dreamer was almost always the victim or potential victim. Attacks involved animals or monsters, violent criminals or battle scenes.

In these results the authors find support for the Contemporary Theory of Dreaming. The theory states that dreams are guided by the emotion of the dreamer. The central imagery of the dream depicts the dreamer’s emotion.

Earlier this week the Sleep Education Blog reported that smells can affect the emotional content of dreams. In May the blog reported on treatments for recurring nightmares.

Read more about the study of dreams and 9/11 on SleepEducation.com. Learn about dreams and nightmares and nightmare disorder.

Image by Brian Boyd

Aromatherapy & Insomnia: The Good, the Bad and the Smelly

Yesterday the Sleep Education Blog reported that smells can affect the emotional content of dreams. What about insomnia – can smells improve the quality of your sleep?

Aromatherapy is one form of complimentary and alternative medicine - or CAM. It involves the use of fragrant, essential oils from plants. Most often the essential oils are inhaled or applied to the skin; they may be added to bathwater or to a lotion.

How does aromatherapy work? The National Cancer Institute reports that there are different theories. One theory involves smell receptors in the nose; these receptors may respond to the scent by sending chemical messages to the brain.

A 2006 review reported that essential oils may enter the bloodstream; it suggested that aromatherapy may act like a drug.

Is sleep-related aromatherapy effective? Conclusive scientific evidence is lacking. But in recent years more studies have been conducted as interest in CAM has grown. Most of these studies have focused on the herb lavender.

A 2008 study suggested that the aroma of lavender may promote sleep in very young infants. In Korea a 2006 study involved female college students; it found that lavender had a positive effect on insomnia and depression.

A 2005 study reported that lavender may be a “mild sedative;” it may promote deep sleep in young men and women. Another study in 2005 found that lavender improved sleep quality in people with insomnia; women and younger volunteers showed the most improvement.

But a 2006 study found no sleep benefits when children with autism were given a massage with lavender oil.

Are there any side effects or risks? The National Cancer Institute warns that lavender may have some “hormone-like effects;” as a result it is unclear if lavender is safe for women with a high risk for breast cancer.

The NCCAM reports that lavender can cause skin irritation; it also may be poisonous if taken by mouth.

Other proven treatments for insomnia are available. Both cognitive behavioral therapy and medications are effective. A board-certified sleep specialist can determine which treatment is best for you. Contact an AASM-accredited sleep disorders center if you have an ongoing problem with insomnia.

Image by David Turner

The Smell of Sleep & Dreams

A new study examined how your sense of smell may affect your dreams.

The small study from Germany involved 15 volunteers. They were studied using sensory stimulation during the sleep stage of rapid eye movement sleep – or REM sleep.

The study compared two smells with a control condition. One smell involved hydrogen sulphide – the smell of rotten eggs. The other smell involved phenyl ethyl alcohol – the smell of roses.

Results show that the “olfactory stimuli” significantly affected the emotional content of dreams. The smell of roses yielded dreams with a more positive tone; the smell of rotten eggs was followed by dreams that had a more negative tone.

But the smells were not directly included in the dream content; volunteers did not dream about smelling a rose or rotten eggs.

The authors report that smells are unlikely to wake you from sleep; so olfactory stimulation is likely to be included in dreams as the sleeping brain processes sensory information.

The authors conclude that it would be interesting to study the effect of pleasant smells on nightmares.

Image by Joe Penniston

Work & Sleep: A Hard Day’s Night

A new study shows that your job may be affecting how you sleep.

The Dutch study involved 1,163 employees. Sleep quality and fatigue were measured across a one-year time lag.

Results show that exposure to a high-strain work environment was associated with elevated levels of sleep complaints. In contrast, people with a low-strain job had the highest sleep quality; they also had the lowest level of fatigue.

The study supports the Demand/Control Model proposed by Karasek and Theorell. This model suggests that high-strain jobs can have a negative effect on both mental and physical health; job strain can cause fatigue, anxiety, depression and physical illness.

A high-strain job is psychologically demanding. It also restricts your “decision latitude;” this refers to the authority you have to make decisions and use all of your skills.

Last week the Sleep Education Blog reported that workplace bullying increases the risk of disturbed sleep. The study measured 45 forms of bullying such as verbal aggression, criticism, gossiping and threats of physical violence.

In April the Sleep Education Blog reported that female executives may be more prone to sleep problems than male executives. The risk is greatest for women who have isolated, demanding jobs.

How can you prevent job stress from disturbing your sleep? One way is to avoid “bedwork.” Never bring any work to bed with you; instead you should make your bed a refuge from your job.

Get other helpful tips and learn more about job stress and sleep at SleepEducation.com.

Sleep is for the Dogs

It’s Labor Day, so it’s a good time to catch up on some sleep. Maybe you can find an unoccupied room where you can sneak away for a nap.

If you need inspiration, you can check out the photos of these dogs. Visitors to LATimes.com caught their dogs napping everywhere from the shower stall to the flower pot.

Does your dog have a serious case of daytime sleepiness? If so, maybe it’s because of your sleep apnea.

A recent post on the Sleep Better Blog by AASM spokesperson Dr. Lisa Shives tells of a patient with severe obstructive sleep apnea. Often his dog would paw at him and wake him up during the night.

But now he is using CPAP therapy to treat his sleep apnea. The result? He and his wife – and even their dog – are all sleeping better.

Of course, there is one dog that may not be sleeping well today. Bizkit the Sleep Walking Dog would like to remind you that dogs can have sleep problems too.

Image by Cristiano Baro

Sleep & Weight Gain: Watch When You Eat

A new study of mice provides the first causal evidence that links meal timing and increased weight gain, reports Northwestern University. The study suggests that eating when you should be sleeping may lead to weight gain.

It might seem easy to eliminate a late-night snack; but meal timing can be a problem for shift workers.

"One of our research interests is shift workers, who tend to be overweight," said lead author Deanna M. Arble. "Their schedules force them to eat at times that conflict with their natural body rhythms.”

The researchers fed mice a high-fat diet over a period of six weeks. Some ate during naturally wakeful hours; others ate when they normally would be asleep.

Mice that ate during normal sleeping hours had a 48-percent weight gain; mice that ate the same type and amount of food during naturally wakeful hours had only a 20-percent weight gain.

A 2008 review by Northwestern researchers explored the links between sleep and energy metabolism. The review suggests that sleep loss and obesity may be "interacting epidemics." It also indicates that the circadian clock system plays a fundamental role in energy metabolism.

Earlier this year the Sleep Education Blog reported that a “sleep diet” may be one way to lose weight. Learn more about the links between sleep and weight on SleepEducation.com.

Image by Matthew

Violent Dreams: RBD May Intensify Over Time

A small study in the Sept. 1 issue of the journal Sleep involved the long-term follow-up of 11 people with REM sleep behavior disorder – or RBD.

What is RBD? It is a sleep disorder that causes you to act out vivid dreams as you sleep. Normally your brain paralyzes most muscles during the sleep stage of rapid eye movement (REM) sleep. RBD occurs when the brain fails to keep the muscles still.

Does this excessive muscle activity during sleep increase over time? To find out the researchers from Spain studied nine men and two women with RBD.

The participants were evaluated by two overnight sleep studies: once at diagnosis and again after two to eight years. At follow-up, they had an average age of 73 years; their RBD symptoms had been present for an average of 11 years.

The study measured “tonic” and “phasic” muscle activity during REM sleep. Tonic activity involved sustained muscle tone in the chin; phasic activity involved intermittent muscle twitches of the chin, arms and legs.

Results show that after an average of five years, tonic activity in the chin increased from 30 percent to 54 percent; in two people it was higher than 93 percent. Phasic activity in the chin, arms and legs increased from 38 percent to 59 percent.

The results indicate that RBD involves a progressive dysfunction of the brain structures that suppress muscle activity during REM sleep. A greater extent of brainstem impairment may occur over time.

The authors suggest that RBD may represent an early stage of a neurodegenerative disease. Many people with RBD go on to develop other neurologic diseases; these include Parkinson’s disease, dementia with Lewy bodies and multiple system atrophy.

In June the Sleep Education Blog reported that there are effective treatment options for people with RBD. Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

Sleep Apnea, CPAP & Brain Activity

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

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

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

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

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

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

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

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

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

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

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

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