AASM-Accredited Sleep Centers: From Alaska to Guam

In 1977 the AASM accredited the first sleep disorders center. Today there are 1,825 AASM-accredited sleep centers and labs.

They are providing trusted medical care for people with sleep problems in every part of the country. From coast to coast and Alaska to Hawaii, you can find an AASM-accredited sleep center near you.

Recently the AASM also has accredited a few sleep centers outside the U.S. This includes facilities in Canada and one in Guam.

What is the value of AASM accreditation? It lets you know that a sleep center or lab maintains the highest standards of quality. Applicants have to make the grade in areas such as testing procedures, patient safety and staff training.

AASM accreditation also ensures that you receive expert care. AASM-accredited sleep centers and labs are required to have a board-certified sleep specialist as the medical director.

What is the difference between a sleep center and a sleep lab? A sleep center provides testing and treatments for all sleep disorders. These include obstructive sleep apnea, restless legs syndrome and narcolepsy.

A sleep lab also provides testing for all sleep disorders. But labs only treat breathing problems such as sleep apnea and snoring.

How can you find an AASM-accredited sleep center or lab near you? The easiest way is to go to www.sleepcenters.org.

The Web site has a directory that enables you to search by state. Each center and lab in the directory has met the AASM’s high standards for accreditation.

On SleepEducation.com you can learn how People with Sleep Problems Benefit from Thirty Years of AASM Accreditation. You also can find out how A Sleep Study May be Your Best Investment for Long-Term Health.

Don’t Let Holiday Stress Disrupt Your Sleep

Although the holidays are a time for joy, they can also cause a great deal of stress. Between shopping, decorating and hosting parties, you may find that sleep has moved to the bottom of your priority list.

You may tell yourself that you will have time to catch up on sleep in the new year, but you may not realize the harm you can do by skimping on sleep.

Dentist and UCSF professor of restorative dentistry Steven Goldman told the San Jose Mercury News that when people are under stress and not sleeping well they are at higher risk for developing bruxism, or night-time teeth grinding.

Bruxism is not always serious. However, severe bruxism can lead to tooth damage, muscle pain and headaches. You can use an oral appliance to protect your teeth while you sleep if you frequently grind your teeth.

Planning holiday activities in advance can help alleviate your stress. Knowing your limits can also prevent you from over scheduling and cutting into your sleep time.

Holidays are a time for enjoying family and friends, but it is also important during this time to manage your stress and health. To make this an enjoyable and healthy season, make sure to leave time for a good night’s sleep.

Sleep experts recommend that adults sleep between seven and eight hours each night. Learn more about healthy sleep habits.

Image by Andreas Nilsson

Sleep & Memory: Sleeping “Soundly”

A new study examined how sounds affect memory consolidation during sleep.

Participants were taught to associate 50 images with a random location on a computer screen. Each object was paired with a corresponding sound.

About 45 minutes later they took a nap of 90 minutes or less. This was long enough to enter deep, slow-wave sleep. But they didn’t nap long enough to enter rapid eye movement sleep – or REM sleep.

Twenty-five of the sounds were replayed as they slept. Participants were unaware of the sounds. Then they were tested again after waking from the nap.

Results suggest that the sounds improved their memory. Their performance was more accurate for the 25 objects that had been reinforced by sounds as they slept.

"The research strongly suggests that we don't shut down our minds during deep sleep," lead author John Rudoy said in a Northwestern University news release. "Rather this is an important time for consolidating memories."

Senior author Ken Paller told the New York Times that the method probably isn’t useful for teaching new information. But it may reinforce what you’ve already learned.

“One of our speculations is that SAT scores could be improved,” he said. He added that the technique might be able to help football players learn a playbook.

Recently the Sleep Education Blog reported that what you smell during sleep can affect your dreams. Learn more about sleep and memory.

Caffeine & Alcohol: “Caffeinated Cocktails” in College

Campus life at college tends to involve poor sleep and sleep deprivation. Often caffeine and alcohol are a part of the problem.

Each substance by itself can be disruptive to sleep. Now a popular trend among college students is to combine the two together.

Some make their own “caffeinated cocktails” by mixing alcohol with high-caffeine energy drinks. Others simply buy caffeinated beer.

A 2007 study surveyed 496 college students. Results show that 54 percent of energy drink users consumed the drinks with alcohol while partying.

In 2008 more than 4,200 college students completed a Web-based survey. Results show that 24 percent of current drinkers reported mixing alcohol with energy drinks.

The belief is that caffeine blunts the negative effects of alcohol intoxication. But is this true?

In a study published last May rats were given rum mixed with a soft drink. The caffeine did not reduce the metabolic effects of alcohol.

In another recent study women consumed an energy drink with alcohol. The mixture had a negative effect on cognitive performance.

A 2006 study found that caffeine had no effect on the degree to which alcohol increased errors. But caffeine did reduce how people perceived their alcohol intoxication.

Earlier this week the FDA reported that it is going to look into the safety and legality of caffeinated alcoholic beverages. It notified 30 companies that make the drinks.

In the past year both Anheuser-Busch and Miller agreed to discontinue their caffeinated alcoholic beverages. They also agreed that they would not produce these drinks in the future.

Earlier this year the Sleep Education Blog reported that adults between the ages of 18 and 24 are using more sleeping pills. Some students also are taking “smart drugs” to improve their academic performance.

Talking Turkey Sleep

A lot of turkeys will be sleeping well today. They can finally get some rest now that the Thanksgiving season is ending.

So how do turkeys sleep? Researchers in Mexico studied wild turkeys - Meleagris gallopavo - to find out.

The study shows that the turkeys had a “polyphasic” sleep pattern. They slept multiple times in a 24-hour period. But these sleep periods tended to concentrate between 9 p.m. and 9 a.m.

Overall, the sleep period of turkeys occupied about 46 percent of the day-night cycle. Almost all of the sleep period involved slow wave sleep.

The turkeys had very short episodes of rapid eye movement sleep – or REM sleep. The average duration of the REM sleep phase lasted about 7.7 seconds.

But the frequency of REM sleep periods was high. Turkeys had an average of 268 phases of REM sleep during the day-night cycle.

The authors report that the sleep characteristics of turkeys are similar to other bird species. Learn more about sleep and birds.

Read more about sleep and animals. Find out how much other animals sleep on the Neuroscience for Kids Web site.

Image by Matt Knoth

Cancer, Chemotherapy & Insomnia

A new study examined the link between insomnia and cancer.

The study involved 823 people with cancer; all of them were receiving chemotherapy. Their average age was 58 years; about 73 percent were women.

Results show a high rate of insomnia in people with cancer. Forty-three percent had insomnia during day seven of cycle 1 of chemotherapy. Another 37 percent reported insomnia symptoms.

“Our research shows that insomnia is very common among patients undergoing cancer treatment,” lead author Oxana Palesh, PhD, said in a news release.

Insomnia persisted during the first two cycles of chemotherapy. Sixty percent of participants reported that their insomnia symptoms remained unchanged from cycle 1 to cycle 2.

People who were younger than 58 years were more likely to have insomnia. Participants with breast cancer had the highest number of overall insomnia complaints. People with insomnia had more depression and fatigue than good sleepers.

“The good news for people with cancer is that there are many effective treatment options that can help,” Palesh said. These include cognitive behavioral therapy and medications.

Earlier this year another study suggested that sleep problems may lead to an increase in pain in people with cancer. Read more about sleep and cancer.

Learn about insomnia due to medical condition on SleepEducation.com. Get help for a sleep problem at an AASM-accredited sleep center near you.

NOVA Explores Dreams Tonight on PBS

The TV program NOVA will explore the world of dreams tonight. “What Are Dreams?” will premiere on your local PBS station.

Leading dream researchers will explain how they study the world of sleep and dreams. And they’ll attempt to answer some of the most intriguing questions about why we dream.

Do dreams improve memory? Do they enhance our creativity? Do they help us solve problems? Are they crucial to our survival?

The program also will focus on the sleep disorders that seem to bring dreams to life. Nightmare disorder. Sleepwalking. REM sleep behavior disorder.



You can watch a two-minute preview of the program online. You also can read a transcript of the program.

NOVA also accepted questions about sleep and dreams. Harvard sleep researcher Robert Stickgold, PhD, provided answers on the NOVA Web site.

Earlier this month the Sleep Education Blog reported that a researcher had proposed a “theory of protoconsciousness” to explain dreams. Studies also have provided some support for the “threat simulation theory.”

Learn more about dreaming and dream theories.

Insomnia & Depression in Women

A new study examined why insomnia is more common in women than men.

The study analyzed data from the National Health and Nutrition Examination Survey. The survey is unique in that it combines interviews and physical exams.

The sample involved 5,469 young adults; their age ranged from 20 years to 39 years.

Results show that 16.7 percent of women reported insomnia symptoms; 9.2 percent of men had an insomnia complaint.

Why are women more likely than men to have insomnia? The study suggests that mental health is a key factor.

The gender difference in the odds of insomnia was no longer significant after adjusting for history of mental health conditions. The authors concluded that the higher rate of insomnia in women may be linked to mental health problems such as depression.

The NIMH reports that depression is also more common among women than men. This may be explained in part by hormonal factors that are unique to women.

The AASM reports that insomnia is seen in up to 85 percent of people with a major depressive episode. Frequent awakenings during the night are typical; waking up early in the morning and being unable to go back to sleep also is common.

Often the insomnia complaint is among the earliest symptoms to appear in a person with a mental health disorder. People often attribute their mental symptoms to poor sleep.

Read more about sleep and depression. Learn more about insomnia due to mental disorder on SleepEducation.com.

The Importance of Getting Your Beauty Rest

Many women know that a sleepless night can take a toll on the way you look. The next morning you may see dark circles under your eyes or newly formed fine lines on your face. You also may have a sickly complexion.

Board-certified dermatologist Dr. Howard Murad told the Los Angeles Times that with age, sleep loss can affect skin more visibly because of progressive loss of cellular water.

Sleep allows your body to restore and prepare for the next day. Sleeping well enables you to feel, think and perform at your fullest potential.

According to the article, cell and tissue repair occurs during deep sleep, known as slow-wave sleep. Sleep deprivation can compromise this restorative phase.

Murad stated that a lack of sleep suppresses the immune system. This can lead to skin-related problems, including rashes and eczema.

Both men and women are negatively affected by sleep loss. However, there are unique factors that can interfere with a woman’s sleep. These include pregnancy and menopause. Sleep disorders, medical problems and day-to-day responsibilities also can cause women to lose sleep.

Earlier this year the Sleep Education Blog noted that a Swedish study of 400 women found that subjects slept for only about 6.5 hours per night. It took the women an average of 22 minutes to fall asleep.

Another post said that people who are constantly sleep deprived but do not suffer from a sleep disorder can use willpower to create a regular sleep schedule.

Sleep experts recommend that adults sleep between seven and eight hours each night.

Visit an AASM-accredited sleep disorders center if you are suffering from an ongoing sleep problem.

The Insomnia Paradox

A new study from Italy investigated paradoxical insomnia.

What’s the paradox? Some people perceive that they have severe insomnia; but their sleep appears to be normal when measured by a sleep study.

The study involved 20 people with paradoxical insomnia and 20 controls. They were monitored during an overnight sleep study.

Results show that the people with paradoxical insomnia estimated that they slept for less than five hours; but the sleep study found that they slept for about 7.75 hours.

They perceived that it took about 51 minutes to fall asleep; but they actually fell asleep in about nine minutes.

The authors suggest that the problem may have to do with “arousal instability.”

The people with paradoxical insomnia estimated that they woke up four times during the night; but the sleep study showed that they had an average of 11 awakenings.

They may have subjectively grouped these arousals together as a single, prolonged event. They thought that they were awake for one long period of time; instead they briefly woke up numerous times.

Learn more about insomnia.

ADHD & Sleep Disorders in Children

A new study examined sleep problems in children with attention-deficit/hyperactivity disorder.

The Italian study involved 55 children with ADHD. They had an average age of about 9 years. They completed a sleep interview and were monitored during an overnight sleep study.

Results show that most of the children had disturbed, fragmentary sleep at night. The authors found a significant difference in almost all sleep variables between ADHD children and controls.

Fifty percent of the children struggled with restlessness; 21 percent had a complaint of snoring; and about 12 percent had leg discomfort at night related to restless legs syndrome.

Many of the children also had parasomnias. About 48 percent were sleepwalkers; 38 percent had sleep terrors; and almost 29 percent had confusional arousals.

In 52 percent of the children the authors also found an abnormality of the arousal process in slow-wave sleep. Sleepwalking, sleep terrors and confusional arousals typically involve arousals from slow-wave sleep.

The authors suggest that sleep studies should be part of the diagnostic screening for ADHD.

In May the Sleep Education Blog reported that sleep problems also are common in older children and teens with ADHD.

Learn more about sleep and ADHD.

Sleep Problems in Older Adults

Two new studies examined the link between sleep and frailty in older adults.

One study involved 3,133 men from six U.S. centers. They were 67 years of age and older.

Results show that sleep problems were highest in frail men. Statistical adjustment found that certain sleep problems were associated with an increased risk of frailty.

Men who took at least 60 minutes to fall asleep were 42 percent more likely to be frail. The risk of frailty also was elevated in men with either poor sleep quality or sleep-disordered breathing. The odds of being frail were increased in men who were awake for a high percentage of their time in bed.

A smaller study involved 374 adults in Connecticut. They had an average age of 84 years.

Results show that 24 percent were drowsy; 10 percent had clinical insomnia; and 41 percent were frail.

There was a significant association between drowsiness and frailty. Adults who were drowsy were nearly four times more likely to be frail.

In May an expert consensus statement addressed the topic of sleep and aging. It noted that sleep disorders are most common in older adults.

The experts added that aging can involve a profound change in your daily sleep-wake cycle. But most of these changes occur by the age of 60.

As a result, sleep problems in older adults shouldn’t be considered a normal part of aging. Often these problems are related to other medical conditions or frequent medication use.

The statement noted that this relationship is “bidirectional.” People with sleep disorders are more likely to have serious medical problems such as heart disease and depression. At the same time, people with these problems have a higher risk of developing a sleep disorder.

In August a study in the journal Sleep linked insomnia symptoms and daytime sleepiness with quality of life in older adults. Another study reported that other sleep disorders such as leg cramps and sleep apnea are common in older adults.

Another recent study linked excessive daytime sleepiness in older adults with an increased risk of death.

Learn more about sleep and aging. Get help for a sleep problem at an AASM-accredited sleep center near you.

Work & Insomnia: Sleepless Off the Job

A new study from Japan shows that insomnia may be linked to your job.

The study involved 1,022 workers; they had an average age of 39 years. They were evaluated across two years.

Results show that some workers were more likely to have insomnia for the length of the study. Employees with low social support at work were twice as likely to have persistent insomnia. Those who had an “effort-reward imbalance” also were more than two times as likely to have ongoing insomnia.

The study also found that some workers were more likely to develop insomnia by the end of the study. The risk of having a new case of insomnia was 75 percent higher in people who were overcommitted to work. Good sleepers were 72 percent more likely to develop insomnia if they had high job strain.

In September the Sleep Education Blog reported that people with a low-strain job had the highest sleep quality; exposure to a high-strain work environment was associated with elevated levels of sleep complaints.

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.

Deep Sleep: Alzheimer’s, CPAP & OSA

A new study examined the effect of CPAP therapy on sleep in people with obstructive sleep apnea and Alzheimer’s disease.

The study involved 52 adults with OSA and Alzheimer’s disease; they had an average age of 78 years. The effect of CPAP therapy was compared with fake, placebo CPAP. Sleep was measured by overnight sleep study.

Results show that even one night of CPAP therapy had a positive effect on sleep. People in the CPAP group had a lower percentage of stage 1 sleep than the placebo group; they also had a higher percentage of stage 2 sleep.

The AASM reports that stage 1 sleep tends to occur when you first fall asleep and after awakenings during the night. This sleep is very light; a slight sound can wake you up.

It is not as easy to wake you up during stage 2 sleep. During this sleep stage your muscles are more relaxed.

Three weeks of CPAP therapy also provided sleep benefits. Participants spent less time awake during the night after first falling asleep. They had a lower percentage of stage 1 sleep and fewer arousals.

They also had a higher percentage of stage 3 sleep. This is known as “slow-wave sleep” or “deep sleep.”

The authors report that disrupted sleep is common in people with Alzheimer’s disease and OSA. CPAP therapy can help them reach and maintain deeper stages of sleep.

In August the same research team reported that CPAP therapy produced long-term benefits for people with Alzheimer’s disease and sleep apnea. There also is evidence that chronic sleep loss could play a role in the development of Alzheimer’s disease.

The AASM reports that OSA can occur in any age group; but it is more common between middle age and older age. The severity of untreated OSA also tends to progress over time.

On SleepEducation.com you 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.

Sleep in the City: Sweet Dreams for Kids

A non-profit organization in Detroit is educating at-risk children about sleep. It’s also giving them resources to make their sleep environment more comfortable.

Sweet Dreamzzz Inc. partnered with the National Center on Sleep Disorders Research to develop the R.E.M. (Rest. Educate. Motivate.) Sleep Program.

The interactive program involves hands-on activities, games and songs. Trained volunteers go into local schools to teach children about the benefits of healthy sleep habits and a bedtime routine.

The goal is to help the children get a good night’s sleep in preparation for classroom learning. But sleep can be a challenge for children in Detroit’s most impoverished communities. Many children in the city may not have a warm, comfortable place to sleep at night.

In April the Children’s Health Fund reported that nearly half of Detroit children live in families with incomes below the federal poverty level. Detroit’s poverty rate of 33.8 percent is the highest of any large U.S. city.

So Sweet Dreamzzz also provides the kids with a sleep kit. It contains a sleeping bag, nightshirt, socks, toothbrush, toothpaste, stuffed animal and other bedtime items. So far the group has given a kit to more than 25,500 children.

Program director Josephine Long recently told the Detroit Free Press that too many children get too little sleep. Ongoing sleep loss puts them at risk for both learning problems and health problems.

"We're not saying sleep is the answer, but it is the core," she said.

Earlier this year the Sleep Education Blog reported that long-lasting sleep problems in children can affect their cognitive development. Living in a “fragile family” also can affect how children sleep.

Learn more about sleep and children.

Sleep is for the Birds

You may have never come across a sleeping bird. And that’s the way that birds like it.

Nature writer and bird surveyor Val Cunningham recently wrote about the life of sleeping birds for the Star Tribune.

Most birds keep their sleeping spots well hidden. They’re fearful of becoming a predator’s late-night snack. So they may roost in the same kind of secluded areas that they would use for a nesting site.

But there is great variety in where they choose to sleep. They may lock their feet onto a branch in a dense shrub. Other birds make their bed in a hole inside a tree.

They may doze alone in a tall chimney. Or they may sleep in a group at the top of a tree.

Cunningham also describes some intriguing sleep habits of birds.

Some birds can sleep with one eye open and half of their brain awake. This enables them to detect danger.

Most songbirds travel at night during migration. This can cause them to become severely sleep deprived. As a result they may take brief “power naps” during the day.

“Sleep talking” even occurs among some birds. They might make soft sounds or quietly rehearse songs as they sleep.

Learn more about sleep and animals.

Image by shapour bahrami

How Moms Influence Teen Sleep

A new study looked for similarities in the sleep patterns of teens and their parents.

The Swiss study involved 293 teens with an average age of almost 18 years; 73 percent were female.

They completed a seven-day sleep log; they also completed questionnaires about their psychological functioning. The teens rated their parents’ sleep and parenting styles.

Results show a correlation between the sleep patterns of the teens and their parents. The study also found that how mothers sleep may have an indirect effect on the sleep of their teens.

Mothers’ poor sleep had a direct impact on their parenting style. This affected the psychological functioning of teens. Parenting style and teens’ mental functioning combined to influence how teens sleep.

The authors concluded that teen sleep problems may mirror an unfavorable parenting style and sleep complaints among mothers. Understanding this relationship could improve family counseling and treatment of teen sleep complaints.

In August the Sleep Education Blog reported that a teen’s sleep pattern may be a marker of his or her risk for developing depression. Another recent study found that technology use may be taking a toll on the sleep of teens.

Get parent tips for teen bed times on SleepEducation.com.

Image by Michael Porter

Delaying High School Start Times in England

One high school in England has delayed its start time by an hour to help students get more sleep, reports The Independent.

The school’s original start time was at 9 a.m. This would seem like a luxury to many U.S. teens who start school before 8 a.m.

Now classes begin at 10 a.m. The school day ends 30 minutes later in the afternoon.

“Here is something that schools can do to improve the health and mental health of their pupils,” headteacher Dr. Paul Kelley told The Independent.

The school doors remain open from 8 a.m. to 5 p.m. This allows extra time for the supervision of students whose parents are at work.

Kelley was advised by Oxford sleep expert Russell Foster, PhD. Foster emphasized that teens have a biological need for more sleep than adults. And they are wired to perform better in the afternoon hours than in the early morning.

"It is time we stopped ignoring the sleep patterns of young adults," Foster told The Independent. “It is cruel to impose a cultural pattern on teenagers that makes them underachieve. Most school regimes force teenagers to function at a time of day that is sub-optimal.”

Earlier this year the Sleep Education Blog reported that teens in Kansas and Minnesota have benefited from starting school later. A proposal to delay high school start times in one Virginia county stirred a strong debate before being rejected.

Learn more about teens and sleep loss and your teen’s bed time on SleepEducation.com.

Why Do We Dream?

A new paper suggests that the purpose of dreams may be more than just psychological.

Author Dr. J. Allan Hobson proposes a “theory of protoconsciousness.” He is a professor of psychiatry at Harvard Medical School.

Hobson writes that REM sleep provides “a virtual reality model of the world.” Most dreams occur during this sleep stage.

He thinks that dreams have a functional use. They allow the brain to get tuned up for wakefulness.

“It helps explain a lot of things, like why people forget so many dreams,” Hobson told the New York Times. “Dreams are tuning the mind for conscious awareness.”

This dream theory fits within his broader concept of the purpose of sleep. He summarized his perspective in the title of a 2005 paper: “Sleep is of the brain, by the brain and for the brain.”

Recently Hobson was the co-author of a study in the journal Sleep that investigated lucid dreaming. Results suggest that lucid dreaming is a “unique, hybrid state of sleep;” it involves features of both REM sleep and wakefulness.

In 2008 Hobson and colleagues explored similarities between the normal mental state of dreaming and the abnormal mental state of psychosis. They reported that normal dreaming and schizophrenic thinking share a common degree of “cognitive bizarreness.”

Other dream theories abound: Dreams depict your emotions. They reflect the issues and concerns of your life. They act as a defense mechanism by simulating waking threats.

Read more about interpreting dreams and why we sleep on the Sleep Education Blog. Learn more about dreams and nightmares on SleepEducation.com.

Image by Cornelia Kopp

Sleep May Help You Eat Healthier

A new study examined the relationships between sleep, job strain and food choices.

The Harvard study involved 542 men; their average age was 49 years. They were all motor freight workers who often work long hours and have irregular shifts.

Results show that 51 percent reported getting adequate sleep. Almost 88 percent were satisfied with their job; about 30 percent reported job strain.

Statistical analysis found that adequate sleep was associated with lack of job strain and healthful eating choices. Work experiences also were related to healthful food choices; but the effect was no longer significant when adequate sleep was included in the model.

The authors concluded that adequate sleep is associated with more healthful food choices; sleep also may mediate the effects of workplace experiences. As a result workplace health programs should be responsive to workers' sleep patterns.

“Our findings suggest that sleep adequacy, by enhancing helpful dietary choices, is one means by which workplace factors may influence chronic disease risk,” they wrote.

In September the Sleep Education Blog reported that eating when you should be sleeping may lead to weight gain.

Other studies also have found that how long you sleep may affect how you eat. You may crave more high-calorie, high-carbohydrate foods when you are tired.

What about you – do you eat healthier foods when you are well rested?

Image by barbarina

Changing Nightmares: Imagery Rehearsal Therapy

“Your Health” columnist Kim Painter reports in USA Today that imagery rehearsal therapy is helping some people change their nightmares.

This method is just one form of cognitive behavioral therapy. A variety of CBT techniques have been used to reduce nightmare frequency.

One method is to record your nightmares in a diary. Relaxation exercises also may be helpful. Exposure techniques involve “reliving” a nightmare in your imagination during the daytime.

Cognitive-restructuring techniques involve changing a nightmare. One technique is lucid dreaming treatment; you change the nightmare as it occurs during sleep.

Imagery rehearsal therapy involves changing the nightmare while awake; you “rehearse” the new version in your mind during the day.

The first step is to write down a recent nightmare. Then you change the nightmare. Usually you change it to a more positive version.

You write down this new version. Then you rehearse it in your mind daily; you imagine the imagery of the changed nightmare.

In 2008 a review in the Journal of Clinical Sleep Medicine noted that CBT has become the treatment of choice for nightmares. It reported that imagery rehearsal therapy and exposure are effective at reducing nightmares; the methods also reduce other sleep complaints and mental distress.

The authors noted that the drug prazosin also may be effective at reducing nightmares. But it appears that treatment requires ongoing use of the drug; nightmares may return after drug withdrawal.

One of the review’s co-authors was sleep specialist Dr. Barry Krakow. He is founder of the Maimonides International Nightmare Treatment Center in Albuquerque, N.M.

In 1992 Krakow and colleagues at the University of New Mexico published a study of imagery rehearsal therapy in the journal Sleep. They found that the therapy reduced nightmare frequency by 72 percent.

Nightmare rehearsal was first reported as an effective treatment option in a 1978 case study. The method was adapted into an imagery rehearsal technique at the University of New Mexico; the first case studies were reported in 1991.

In June the Sleep Education Blog reported that imagery rehearsal therapy also can be helpful for children with nightmares. Learn more about dreams and nightmares on SleepEducation.com. Get help for nightmare disorder at an AASM-accredited sleep center near you.

Image by Cornelia Kopp

Improve Your Golf Game with CPAP for Sleep Apnea

According to ABC News, people suffering from obstructive sleep apnea often ignore its serious effects. However, some people seek treatment when they discover that it can improve their performance during their favorite activities.

A recent study abstract found that treating OSA in golfers improved their game by up to three strokes off their handicap in 20 rounds of golf.

The study included 24 golfers. Twelve were treated for OSA, while 12 were not. Results show that golfers who received treatment used their CPAP 90 percent of the time. CPAP therapy is most effective when it is used all night, every night.

Other hobbies can benefit from CPAP therapy too. Solving crossword puzzles, bowling, and even driving may become less challenging and more enjoyable.

People with moderate to severe OSA may wake up hundreds of times per night without knowing it. Untreated OSA can cause daytime sleepiness and decreased daytime functioning. More serious problems include increased risk for high blood pressure, heart disease, obesity, diabetes, stroke and even death.

How do you cure OSA?

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.

CPAP keeps the airway open to prevent breathing pauses during sleep. This improves your sleep quality, allowing you to think more clearly and work more efficiently during the day.

Visit an AASM-accredited sleep disorders center if you have an ongoing sleep problem.

Image by Robert V

Sleep & Willpower

Is sleep the secret to success at whatever you do? Stanford health psychologist Kelly McGonigal, PhD, thinks so.

She focused on our need for sleep – and our frequent avoidance of it - in a recent blog post for Psychology Today. She also described the “Science of Willpower” course she teaches at Stanford.

“I make a strong case for sleep as the most powerful resource for greater self-control and better performance at whatever matters most to you,” she wrote.

The problem is that too often we fail to tap into this power source. Without enough sleep we’re tired, stressed and unable to fulfill our potential.

We walk about in a state of voluntary – but unintentional – sleep deprivation. It’s called behaviorally induced insufficient sleep syndrome.

According to McGonigal, for many of us it’s simply a matter of willpower. We have to make it a priority to maintain our natural sleep cycle.

“Getting enough sleep, on a regular cycle, may make us a better version of ourselves,” she wrote. “I'd rather feel good and perform well than get to be a crankier, impulsive, sick version of myself for a few extra hours a day.”

But even willpower may be powerless when you have a sleep disorder. Willpower won’t prevent you from acting out violent dreams while asleep. It won’t open your airway to prevent breathing pauses during sleep.

And willpower can be part of the problem when you have insomnia. The harder you try to fall asleep, the more elusive sleep becomes.

So where does willpower fit into your sleep? Maybe you need to stop cutting back on sleep and start going to bed earlier.

Or maybe you need to stop ignoring your sleep problem and seek medical help. You can contact an AASM-accredited sleep disorders center near you.

Sleep & Observational Learning

Sleep enhances the performance of motor skills that have been learned through physical practice. Can it also improve skills that have been learned through observation?

A new study involved 64 healthy people. They were shown a video of a hand performing a finger-tapping task, reports the LA Times.

They were only allowed to watch; they couldn’t practice the movements. EMG monitoring verified the absence of hand muscle movements during observation.

Some participants slept right after the observation period; others slept after a delay of more than 12 hours. Then they were asked to perform the finger-tapping task.

Results show that immediate sleep is necessary for the enhancement of a motor skill through prior observation. There was no performance benefit when sleep occurred more than 12 hours after observation.

Sleeping right after observation improved performance speed by 22 percent; it also reduced the error rate by 42 percent.

The authors conclude that people can transfer observational learning into physical movements without practice. But an “early sleep window” is required to consolidate the procedural memory.

They suggest that this learning method could help athletes or children master new motor skills. It also could help people who have to relearn skills after a stroke or injury.

Image by Bernardo Borghetti

Caffeine & the Night Shift

A recent study examined the effect that consuming caffeine at night may have on daytime sleep.

The sleep of participants was monitored during a night in a sleep lab. Then they stayed awake in the lab for 25 hours. While awake they were given caffeine capsules. Then their sleep was monitored again as they slept during the day.

Results show that daytime sleep was worse after taking caffeine. Measures such as sleep efficiency and sleep duration were lower.

So does this mean that people who work the night shift should avoid caffeine? Not necessarily.

The participants were given caffeine late during the night. They took a 100-mg dose three hours before attempting to sleep during the day; they were given another 100-mg dose only one hour before daytime sleep.

The stimulating effect of caffeine can last for hours. So it’s no surprise that their sleep was affected.

But an AASM task force report concluded that your sleep is unlikely to be disrupted if you take caffeine at least eight hours earlier. And other studies show that caffeine helps improve the performance and alertness of night-shift workers.

A study in the journal Sleep in 2006 found that combining caffeine with an evening nap provided the greatest benefit. Before a simulated night shift, participants were given a nap opportunity at 7:30 p.m. Their average nap duration ranged from 73 to 99 minutes.

At about 10:30 p.m. they were given 4 mg/kg of caffeine. The authors reported that this dose has been shown to be effective without interfering with daytime sleep.

A 4 mg/kg dose means that you take 4 mg of caffeine for each kg of body weight. So the dose would be about 272 mg if you weigh 150 pounds, 318 mg if you weigh 175 pounds, and 363 mg if you weigh 200 pounds.

A second part of the study involved actual night-shift workers who took 300 mg of caffeine at the start of each night shift. It also found that caffeine and napping improved performance and reduced sleepiness.

On Tuesday the Sleep Education Blog reported that another option for night-shift workers is to follow a “compromise” sleep schedule.

Read about sleep & caffeine on SleepEducation.com to find out how much caffeine is in your coffee, soda or tea. Learn about shift work sleep disorder.

Thermal Infrared Imaging to Detect Sleep Apnea

The Nov. 1 issue of the journal Sleep contains the first reported study of “thermal infrared imaging” to monitor airflow during an overnight sleep study. Can this technology be used to detect obstructive sleep apnea?

Typically, contact sensors are placed around your nose and mouth to measure airflow during a sleep study. The authors report that these sensors and wires may cause discomfort during sleep.

The advantage of thermal infrared imaging is that it uses “non-contact” sensing to detect airflow abnormalities. It is unobtrusive and doesn’t touch your body while you sleep.



The automatic thermal moni­toring system (ATHEMOS) uses an infrared camera to record your sleep from a distance. It acquires ther­mal information as heat radiates from your nostrils.

The thermal signature of the nostrils varies. It is cooler as you inhale, and warmer as you exhale air from the lungs. This thermal signal provides information about your breathing.

But is it effective? The small pilot study found a high degree of agreement between thermal infrared imaging and conventional airflow sensors.

But the system wasn’t tested during a full night of sleep. The average recording time was less than two hours per person.

This is because the method produces massive data sets. Recording a full night of sleep would require an investment in upgraded computer systems for data management and storage.

Thermal infrared imaging also involves another major expense: the camera. The authors note that an entry-level, thermal camera can cost about $60,000 at this time.

The benefit of this system is that it doesn’t require the sterilization or replacement of sensors; this minimizes the operating costs over time.

The automatic thermal monitoring system is a unique prototype that is still in development. The authors are optimistic that it could be useful in the detection of obstructive sleep apnea. But much more testing is needed to validate its effectiveness.

A Sleep Schedule that Works for the Night Shift

A series of studies have found that a “compromise” sleep schedule is effective for people who work night shifts. The results of the latest study were published in the Nov. 1 issue of the journal Sleep.

The sleep schedule improves alertness during the night shift and daytime sleep after the shift. But it also provides a “compromise” that helps night-shift workers on days off.

It enables them to get the sleep they need; but it also gives them more free time during the day.

“We think that most real shift workers want to be awake on their days off,” lead author Mark Smith, PhD, previously told the AASM.

Here’s the “compromise” sleep schedule for night-shift workers:

• Sleep from 8:30 a.m. to 3:30 p.m. after regular night shifts.


• Sleep from 8:30 a.m. to 1:30 p.m. after the last night shift before a weekend off.


• Sleep from 3 a.m. to noon on days off.

The studies also used three light-related strategies to increase the effectiveness of this schedule. Light is an important timing cue that helps your body regulate sleep and alertness.

First, workers received bright light therapy during simulated 11 p.m. to 7 a.m. night shifts. Light boxes were used during four, 15-minute sessions.

The first session began at 12:45 a.m. These sessions were repeated hourly, with the final session ending at 4 a.m.

Second, workers had to go outside within the first two hours after waking up. They needed to get at least 15 minutes of exposure to daylight.

Third, the workers wore dark sunglasses at all times when outside during the day. This was most important when traveling home after a night shift.

The current study found that workers had improved mood, fatigue and performance during night shifts when following the compromise sleep schedule. These levels were similar to daytime measurements obtained during “9 to 5” work days.

The authors caution that the participants were not real shift workers; they were young volunteers. The “night shifts” were conducted in a laboratory. So the compromise sleep schedule still needs to be tested in real night-shift workers.

Learn about shift work sleep disorder on SleepEducation.com.

Image by GaijinSeb

The Good Life: Sleep & Retirement

A study in the Nov. 1 issue of the journal Sleep suggests that your sleep may improve when you retire.

Results show that 24.2 percent of workers had disturbed sleep in the last year before retirement; this dropped to 17.8 percent in the first year after retiring. The odds of having disturbed sleep in the seven years after retirement were 26 percent lower than in the seven years before retiring.

The greatest reduction in sleep disturbances was reported by people who had depression or mental fatigue while they were working. Depressed workers were 45 percent less likely to have disturbed sleep in the years after retiring.

Men and night-shift workers also benefited greatly from retirement; their odds of having sleep disturbances dropped by 34 percent. In contrast, the odds of reporting disturbed sleep dropped by only 11 percent in women.

The authors link the sleep improvement to the removal of job stress. Sleep improved more in retired managers than in lower-level employees. It also improved more in workers who reported higher psychological job demands.

The odds of having disturbed sleep increased slowly with age. This occurred in both working and retired adults.

People who retired early because of an illness or disability were more likely to have disturbed sleep in retirement. They had a 46 percent increased risk of sleep disturbances after retiring.

The study involved 14,714 employees from the French national gas and electricity company. They retired between 1990 and 2006. The study authors noted that these workers enjoyed some highly favorable employment and retirement conditions.

Their job security was guaranteed. They retired at an average age of 55 years. And they received a company-paid pension that was 80 percent of their salary.

That may sound like a dream to many people in the U.S. But survey data released by the CDC last week suggest that U.S. workers also may enjoy a “sleep benefit” when they retire.

Forty-four percent of retired adults were sound sleepers; they reported getting enough rest or sleep every day in the past month. In contrast, only 29 percent of employed adults were sound sleepers.

In September the Sleep Education Blog reported that your job may be affecting how you sleep. Learn more about sleep and work.

Children, Media Violence & Nightmares

Just in time for Halloween, the thriller Paranormal Activity and horror flick Saw VI topped the box office charts last weekend. The House of the Devil opened on Friday.

They’re the kind of movies that the American Academy of Pediatrics wants parents to help their children avoid. The AAP has just released a revised policy statement on media violence.

It reports that the average young person will have viewed an estimated 200,000 acts of violence on TV by the age of 18 years. That doesn’t include exposure to violence in movies, music and video games.

Does this exposure to violence have an effect? The statement reports that it has been linked to a variety of physical and mental health problems in children and teens. This includes fear, depression, nightmares and sleep disturbances.

The AAP recommends that parents make thoughtful media choices that limit violent content. Parents should view and discuss programs together with their children.

Parents also are encouraged to limit their children’s screen time to one or two hours per day. This includes time watching TV and videos, playing video games and surfing the Internet.

The AAP also advises parents to keep the TV, computer and video games out of children’s bedrooms. It reports that children with a TV in their bedroom watch an additional hour of TV per day.

Children also are likely to sleep better in a media-free room. In March the Sleep Education Blog reported that sleep problems often occur when children have a TV in their bedroom.

When nightmares do occur, parents can provide comfort and reassurance. Learn more about nightmares and children.