Ear Tubes, Snoring & Sleep Apnea in Children

A recent study examined the risk of sleep-disordered breathing in children who had ear tubes inserted.

The study from Israel involved 352 children with ear tubes. Another 105 children were included as controls. Parents were interviewed by phone.

Results show that sleep-disordered breathing was common in children who had ear tubes inserted. Twenty-two percent of parents reported that their child snores.

Tonsils had been removed from 18 percent of children with ear tubes. This surgery is a common treatment for obstructive sleep apnea in children. Thirty-four percent of children snored or had their tonsils removed after the ear tubes were inserted.

Children with ear tubes were four times more likely than controls to have future tonsil removal. Their risk for snoring was three times higher.

The authors reported that sleep-disordered breathing shares common mechanisms with Eustachian tube dysfunction. This tube extends from the middle ear to the throat.

They concluded that children who need ear tubes inserted are at risk for sleep-disordered breathing. Doctors should regularly check these children for symptoms of sleep apnea. This will allow for early detection and treatment.

MedlinePlus reports that ear tube insertion helps relieve fluid buildup behind a child’s eardrum. The tubes allow the fluid to drain so that the ears can function normally. Another name for the procedure is “tympanostomy tube insertion.”

It may be recommended when excess fluid in the ear does not go away after four months or longer. Tubes also may be inserted if an ear infection does not go away or if a child has many ear infections.

The AASM reports that about two percent of healthy young children have OSA. It occurs when soft tissue in the back of the throat collapses and blocks the airway during sleep.

Most children with OSA have a history of loud snoring. This may include obvious pauses in breathing and gasps for breath. Parents often notice that the child seems to be working hard to breathe during sleep.

Read more about obstructive sleep apnea in children. Get help at an AASM-accredited sleep center near you.

Image by Travis Isaacs

How Common is Restless Legs Syndrome?

A recent study investigated the prevalence of restless legs syndrome.

The study involved patients from 312 primary-care practices in Germany. A total of 16,543 people participated.

Results show that leg problems were common. About 47 percent of people reported having “unpleasant sensations in the legs.”

Nearly 11 percent of participants were diagnosed with RLS. Fifty-three percent of these people had contacted their doctor in the past to discuss their leg problems. But only 20 percent had received the correct diagnosis of RLS.

Another common cause of unpleasant leg sensations was osteoarthritis. Other causes were disc lesion, varicose veins and leg cramps.

RLS is classified as a sleep-related movement disorder. It involves an intense urge to move the legs. And it often involves other burning, prickly, itching or tingling sensations in the legs.

These symptoms begin or worsen during periods of rest or inactivity. And the sensations worsen or only occur in the evening or at night. Partial or total relief occurs by moving the legs, stretching or walking.

RLS can have a severe effect on your sleep. It may prevent you from falling asleep. It also may keep you from returning to sleep if you wake up during the night.

Read more about RLS. Learn about the genetics of RLS on SleepEducation.com.

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

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Narcolepsy & “Fainting Spells”

Recently in the New York Times Dr. Lisa Sanders described the mysterious case of a woman’s fainting spells. For several months the 49-year-old nurse had been fainting almost daily.

She would feel a “fluttering sensation” in her stomach. Then suddenly she would fall out on the floor.

She spent two nights in the hospital undergoing tests. But everything was normal. Her heart rhythms and blood pressure were fine.

The results baffled her physician. So he sent her to see specialists.

One of them thought the fainting spells might be seizures. But further testing found no unusual brain activity.

The case was solved when she suddenly collapsed while meeting with one of her doctors.

“Her sudden collapse looked as if a switch had been thrown and all her muscles just turned off,” wrote Sanders.

The doctor realized that she hadn’t actually fainted. She never lost consciousness during the episode. She was aware of her surroundings and could hear him speak. And the episode ended quickly. As soon as it was over, she felt fine.

He concluded that she was suffering from “cataplexy.” It is a unique symptom of narcolepsy.

Cataplexy involves a sudden loss of muscle tone while you are awake. Your head may drop, or your knees may buckle. You may completely fall out on the floor. Episodes of cataplexy tend to be triggered by a strong emotion such as laughter or surprise.

Narcolepsy also tends to involve excessive daytime sleepiness. Frequent naps are common. And sudden, irresistible “sleep attacks” may occur in unusual situations. Narcolepsy may occur without cataplexy.

Today the Boston Globe described how 26-year-old Julie Flygare is battling narcolepsy and cataplexy. In three weeks she plans to run the Boston Marathon.

She is one of four women who will be running to raise funds for Wake Up Narcolepsy. Flygare is sharing her story on the REM Runner blog.

Learn more about narcolepsy. Read a narcolepsy case study on SleepEducation.com.

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

Twitter: Sleep & Tweets

You can learn a lot about a person in 140 characters or less. You can learn a lot about their sleep too.Twitter let’s you answer the question, “What’s happening?” The Web site at www.sleepingtime.org has responded by asking, “When do they sleep?”

The one-click site simply asks you to provide the username of a person who is on Twitter. Then in a second the site’s algorithm will analyze the timing of hundreds of that user’s tweets.

It will identify the time of day when the user is least active on Twitter. From this activity analysis it calculates the hours when the person is more likely to sleep.

The site was developed by Amit Agarwal, a personal technology columnist in India. He writes the Digital Inspiration blog and is on Twitter as @labnol.

So when does Amit sleep? According to sleepingtime, he typically gets about seven hours of shut-eye from 1 a.m. to 8 a.m. in the New Delhi time zone.

Amit also used the site to compile estimated sleep times for some “Tech Superstars.” For example, sleepingtime determined that Bill Gates is more likely to get eight hours of sleep from midnight to 8 a.m.

Last year the Sleep Education blog reported that there can be little time for White House staffers to sleep. What does sleepingtime say?

It reports that @whitehouse is more likely to sleep for eight hours from 11 p.m. to 7 a.m. And @barackobama is more likely to sleep for seven hours between 1 a.m. and 8 a.m.

So it’s not an exact science. But if you use Twitter regularly, the site can give you a quick snapshot of your typical “sleep window.”

After all, you can’t tweet in your sleep. Or can you?

Episodes of sleepwalking can involve routine behaviors such as making phone calls. Last year a case report even described a woman who sent some strange e-mails while she was asleep.

But sleeptweeting? It’s possible. And it’s another good reason to keep your cell phone away from your bed at night.

Exploding Head Syndrome: Sounds in Sleep

You’re in bed and feeling drowsy as you begin to fall asleep. Suddenly in your head you have the sensation of a loud, violent explosion.

It may seem like a loud bang, a clash of cymbals or a bomb exploding. You also may have the impression that a flash of light occurred. As a result you jolt awake with a sense of fright.

This describes a typical episode of a sleep disorder called exploding head syndrome. It is one of the sleep disorders that are classified as “parasomnias.” These disorders all involve undesired behaviors during sleep.

Exploding head syndrome can be very disturbing. When it first occurs you may think that you are having a stroke. And frequent events can cause you to have insomnia.

But the good news is that exploding head syndrome tends to be harmless. And unlike headaches, it is usually painless. Treatment should not be required.

Exploding head syndrome may be a variant of another sleep disorder called sleep starts. This involves a brief, strong jerk – or contraction – of your body while you are drowsy.

The clinical features of exploding head syndrome were first identified in the U.K. In 1989 a study described 50 people who had the problem.

In 1991 a Swedish study in the journal Sleep described nine people with exploding head syndrome. The authors concluded that the symptoms “may be an expression of emotional stress in the awake state.”

This year a new case report from Japan described a woman with a long history of both migraine headaches and exploding head syndrome. An overnight sleep study revealed that she also had obstructive sleep apnea.

She was prescribed an oral appliance to treat the sleep apnea. After beginning treatment the episodes of exploding head syndrome no longer occurred.

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

Image by Antonio Blay

Teen Smoking & Sleep Problems

A new study from Hong Kong examined the relationship between smoking and sleep problems in teens.

The study involved 29,397 Chinese students. They were between 12 and 18 years old. The students completed a health survey that included questions about sleep.

Results show that current smokers were three times more likely to report snoring than teens who never smoked. They also were three times more likely to have difficulty breathing during sleep.

Current smokers were 45 percent more likely to have trouble maintaining sleep during the night. Teens who smoked only once or a few times were 39 percent more likely to report having insomnia.

In the U.S. the rate of teen smoking has dropped since it peaked in the late 1990s. But it is still a significant problem. Tobacco use is the leading preventable cause of disease, disability and death in the U.S.

The NIDA reports that 20 percent of 12th-graders surveyed in 2008 said they had used cigarettes in the previous month. Smoking also was reported by nearly seven percent of 8th-graders.

Last year a study reported that childhood sleep problems were more likely to predict early onset of substance use in boys than girls. Sleep problems between 3 and 8 years of age predicted the onset of cigarette use.

The AASM reports that smokers may be at higher risk for obstructive sleep apnea. Teens can get help for an ongoing sleep problem at an AASM-accredited sleep center.

Information about youth and tobacco is available from the CDC. Read more about sleep and teens.

Image by David Hegarty

Sleep & IQ: Are Kids Smarter if They Sleep Longer?

A new study from Canada examined the relationship between sleep duration and intelligence in children.

The study involved 39 healthy children. They were between 7 and 11 years old. Their sleep was measured at home by actigraphy for four nights. This identified their habitual sleep duration on weeknights.

Intelligence was measured using the Wechsler Intelligence Scale for Children — Fourth Edition. The WISC-IV provides four index scores and a full-scale IQ score.

Results show that children who slept longer performed better on the WISC-IV. Longer habitual sleep duration was associated with higher overall IQ scores.

Getting more sleep also was related to better perceptual reasoning. This involves solving problems using visual, non-verbal information. And reported competence and academic performance were higher in children who slept longer.

Last year the Sleep Education Blog reported on how you can help your child sleep better. The AASM recommends that children between the ages of 7 and 11 get about 10 hours of nightly sleep.

Basic tips that parents should put into practice include:

• Letting children fall asleep independently


• Putting children to bed before 9 p.m.


• Establishing a bedtime routine that includes reading


• Helping children avoid caffeine


• Keeping a TV out of the bedroom

Research also has shown that long-lasting sleep problems in children can affect their cognitive development. Get help for your child’s ongoing sleep problem at an AASM-accredited sleep center near you.

Read more about sleep and children.

Your Sleep Personality Type

A new study examined how your natural sleep preference may be related to your personality type.

The study from Spain involved 862 college students. They were between the ages of 18 and 30.

They completed a short version of the Morningness-Eveningness Questionnaire (MEQ). It measures your circadian “chronotype” – your preferred sleep schedule.

Some people have a circadian clock that makes them “evening types.” These “owls” have a natural tendency to stay up late at night and sleep late in the morning. In contrast “morning types” are “larks” who prefer to go to bed early and wake up early.

The students also completed a short version of the Temperament and Character Inventory (TCI). It measures seven dimensions of personality.

Results show that women had higher TCI scores for harm avoidance, reward dependence and cooperativeness. Men had higher scores for novelty seeking.

How did sleep preference and personality type interact? Evening types had higher scores for novelty seeking. People with this personality type tend to be curious, impulsive and easily bored.

Only men who were evening types had both a lower harm avoidance score and a higher novelty-seeking score. People who are low in harm avoidance tend to be carefree, energetic and outgoing.

Last year a study reported that people who are “evening types” have a higher risk of severe depressive symptoms. Another study suggested that morning types may never reach a level of maximum performance during the day.

Learn more about the lark and owl chronotypes.

Sleep Parenting Across Cultures

Last week a Salon article addressed the controversial topic of sleep parenting. Ada Calhoun shared how she and her husband grappled with conflicting advice about what was best for their newborn.

“Cry it out” sleep training. Attachment parenting. Baby management. New parents can become overwhelmed by all of the advice offered by parenting books.

Now Calhoun is joining the debate with her own book. Instinctive Parenting advises parents to “find what works for you and your family and ditch the anxiety and judgment.”



But sleep parenting can vary widely across cultures. A recent study compared countries that are mostly Caucasian with those that are primarily Asian.

The study involved parents of 29,287 infants and toddlers. Seventeen countries were represented. Parents completed a questionnaire on the Internet.

Results published in March show that young children in Asian countries went to bed later and slept less. Bed sharing and room sharing also were more common in their homes.

Bedtimes ranged from 7:27 p.m. in New Zealand to 10:17 p.m. in Hong Kong. Total sleep time ranged from 11.6 hours in Japan to 13.3 hours in New Zealand.

In New Zealand only 5.8 percent of parents reported sharing a bed with their infant or toddler. In contrast bed sharing was reported by 83.2 percent of parents in Vietnam.

The initial results of the study were presented at SLEEP 2008. Another report based on the research will be published in April.

It shows that 57 percent of parents in Caucasian countries reported that their child falls asleep independently in his or her own crib or bed. This was reported by just four percent of parents in primarily Asian regions.

In 2006 the AASM published practice parameters for bedtime problems and night wakings in young children and infants. A task force of experts reviewed all of the current research on this topic.

The report recommends sleep training to help infants and toddlers learn to fall asleep on their own. You can read a summary of the report on SleepEducation.com.

Discuss any ongoing sleep problems with your child’s doctor. He or she may refer you to an AASM-accredited sleep center for help.

Read more about sleep and children.

Social Networks: Teen Drug Use & Sleep Loss

A new study examined the relationship between sleep loss and marijuana use among teens and their friends.

The study used data from the National Longitudinal Study of Adolescent Health. The researchers mapped the social networks of 8,349 teens. The students filled out questionnaires. They also named up to five male and five female friends in their social network.

Students had an average age of 16 years at the start of the study. They reported that they usually got an average of 7.8 hours of sleep per night.

Results show that a teen was 11 percent more likely to report sleeping seven hours or less if a friend usually slept for seven hours or less. This effect increased to 20 percent when the friendship was mutual.

Further analyses found that a teen was 19 percent more likely to use marijuana if a friend usually slept for seven hours or less. Twenty percent of this effect came from the spread of sleep behavior from one person to another.

This effect was additive. The rate of marijuana use increased with each additional friend who was a short sleeper.

"The evidence suggests that poor sleep leads to drug use in adolescents, and that both sleep and drug use spread through social networks,” the authors concluded.

They suggested that poor sleep may promote drug use by affecting how teens make decisions. Poor sleep in teens has been shown to reduce impulse control. They also wrote that poor sleep may affect teen alcohol use in similar ways.

The NIDA reports that marijuana is the most commonly used illegal drug in the U.S. A recent survey found that 42 percent of 12th-graders had tried marijuana at least once. Eighteen percent of 12th graders and 14 percent of 10th graders had used it within the past month.

Last year a study found that childhood sleep problems were more likely to predict early onset of substance use in boys than girls. Sleep problems between 3 and 8 years of age predicted the onset of alcohol, cigarette and marijuana use among boys.

Get help for your teen’s sleep problems at an AASM-accredited sleep center near you. Get Facts Parents Need to Know and Facts for Teens about marijuana from the NIDA.

Read more about sleep and teens.

Image by Spencer Finnley

“The Nation of Walking Zombies” – Sleep Deprivation in America

In the first of a four-part series, “The Science of Sleep,” New York 1 reports that sleep deprivation, exhaustion and insomnia are common problems in New York and across America.

Many people think that their addiction to caffeine is normal, but if you constantly wake up feeling unrefreshed and are excessively sleepy throughout the day, you are probably not getting the sleep you need.

Last month, Prevention and msn listed five signs that you might be sleep deprived. These signs also may indicate that you have a sleep disorder.

More than 70 million people in the U.S. have a sleep disorder. According to AASM member Dr. Carl Bazil, sleep disorders often go unnoticed by patients and doctors: “Sleep problems are the most underdiagnosed of any medical illness.”

The International Classification of Sleep Disorders, Second Edition documents 81 sleep disorders. Common sleep problems include insomnia, obstructive sleep apnea and restless legs syndrome. Sleep disorders can have a negative impact on physical and mental health if left untreated.

There are steps you can take to improve your sleep on your own:

• Wake up at the same time each day, even on weekends.
• Avoid naps if you can during the day.
• Don’t drink caffeine in the afternoon.
• Don’t read, write, eat, watch TV, talk on the phone, or surf the web in bed.
• Make your bedroom quiet, dark, and a little bit cool.

Find more tips about good sleep hygiene at Sleep Education.com. Contact an AASM-accredited sleep disorders center if improvements in your sleep habits do not resolve your sleep problem.

Is Acupuncture Safe?

Last year the Sleep Education Blog reported that acupuncture is growing in popularity in the U.S. One reason people receive acupuncture is for help with insomnia.

But is acupuncture safe? An editorial published this week in the British Medical Journal expressed concerns.

The authors are from the department of microbiology at the University of Hong Kong. They wrote that acupuncture can put patients at risk for infection.

Acupuncture involves inserting needles up to several centimeters beneath the skin. This process can transmit micro-organisms to the patient.

There have been more than 50 reported cases of bacterial infection caused by acupuncture. Five outbreaks of hepatitis B virus infection also have been reported.

The authors fear that acupuncture could transmit the hepatitis C virus and HIV. But no causal links have been established.

The authors also described a new clinical syndrome called “acupuncture mycobacteriosis.” The mycobacteria are thought to be transmitted to patients by contaminated equipment. Examples include cotton swabs, towels, hot pack covers and boiling tanks.

The NCCAM reports that acupuncture is relatively safe. Each year millions of people are treated with acupuncture. And few complications have been reported to the FDA.

The FDA requires that acupuncture needles be made of solid, stainless steel. They must be sterile and labeled for single use only.

But the editorial authors think that the problem may be worse than has been reported.

“The case reports and outbreaks of acupuncture transmitted infections may be the tip of the iceberg,” they wrote.

The NCCAM reports that infections can be prevented when acupuncture is performed properly. A new set of disposable needles should be taken from a sealed package for each patient. And treatment sites should be swabbed with alcohol or another disinfectant before the needles are inserted.

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.

Read more about acupuncture for insomnia.

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FDA Approves Silenor for Insomnia

The makers of sleeping pills such as Ambien, Lunesta and Rozerem will soon have new competition. On March 17 the FDA granted approval to Somaxon Pharmaceuticals for its drug Silenor. Somaxon reports that the insomnia medication should be available in the second half of 2010.

But Silenor isn’t for people who have trouble falling asleep. It takes about 3.5 hours for the drug to reach its peak concentration in the blood.

So the FDA approved Silenor to help people who struggle with “sleep maintenance.” It may benefit people who tend to wake up during the night or early in the morning and struggle to return to sleep.

The drug that Silenor contains is called “doxepin.” For years this histamine-blocking drug has been used at high doses as an antidepressant.

It has been known that doxepin also improves sleep. But at high doses it may cause severe side effects. This prevented the drug from being used as a common sleep aid.

Now studies have shown that doxepin can reduce the symptoms of insomnia at doses as low as 3mg or 6 mg. Side effects are minimal at these low doses. The FDA recommends that older adults start with the 3 mg dose.

One of these studies was published in the journal Sleep in 2007. It involved 66 adults with chronic primary insomnia. They had a mean age of 42 years, and 70 percent were women. Both 3 mg and 6 mg doses of doxepin were compared with a placebo.

Results show that doxepin reduced the time spent awake after falling asleep by about 22 to 23 minutes. It increased total sleep time by about 26 to 29 minutes. But it did not reduce the number of awakenings during the night.

Last year the Sleep Education Blog reported an increase in prescriptions for sleeping pills. The use of sleeping pills by young adults also rose dramatically.

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

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

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

Sleep Deprivation Impairs the Recognition of Emotions

A new study investigated the impact of sleep deprivation on the ability to recognize the emotional intensity of human facial expressions. The results were published this month in the journal Sleep.

The study involved 37 healthy adults between 18 and 25 years of age. Seventeen participants were assigned to the control group. They slept normally at home for a night. The other 20 participants were kept awake in a sleep lab for about 31 hours.

Then everyone performed an emotional face recognition task at about 4 p.m. Both groups returned home for a night of sleep. Then they repeated the task the next day.

The task involved the presentation of black and white photos of the same man. The images were taken from Dr. Paul Ekman’s Pictures of Facial Affect set. In the photos the man made happy, sad, angry and neutral expressions.

Each of the three emotional pictures was morphed to the neutral face using computer software. This produced a set of 10 images for each emotion representing an equal gradient of change.

For each emotion the 10 images were presented in random order on a laptop computer screen. Participants had to rate the strength of emotion for each face.

Results show that the ability to recognize angry and happy facial expressions was blunted in the sleep-deprived group. They were able to detect extreme emotions. But they struggled to detect expressions of moderate intensity. There was no change in the recognition of sad expressions.

These differences were most reliable and significant in women. The impairment was corrected by one night of recovery sleep.

The authors suggested that facial expressions may be the most significant visual cue in human communication. Abnormal face processing can lead to impaired social interactions.

They also wrote that accurate emotional face judgments are of critical importance for many professionals. Examples include emergency responders, medical staff and soldiers. This ability also is vital for new parents.

The results also suggest that healthy young women may be more sensitive to some effects of sleep loss. This may help explain why women are more likely than men to develop major depression.

Last year the Sleep Education Blog reported that being awake for 12 hours or more may impair the ability to recognize a familiar face. Read more about sleep deprivation.

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Treating REM Sleep Behavior Disorder: Best Practices

People with REM sleep behavior disorder act out vivid, action-packed dreams while remaining asleep. They may shout, punch, kick, run and even jump out a window.

RBD was first reported in the journal Sleep in 1986. Sixteen years later a follow-up report was published by the same research team.

Recently the AASM reviewed all of the current research and developed a best practice guide for the treatment of RBD. It was published last month in the Journal of Clinical Sleep Medicine.

The guide recommends two steps in the treatment of RBD. The first step is injury prevention. The second step is the ongoing use of medication to control the symptoms.

People with RBD often injure themselves or their bedpartner during sleep. So it is important to create a safe sleeping environment.

The bedpartner may need to sleep in another room. Other examples of how to modify the sleep environment include:

• Placing your mattress on the floor
• Using a sleeping bag
• Moving furniture away from the bed
• Adding soft padding to the corners of furniture
• Securing and blocking windows
• Removing weapons and sharp objects from the bedroom

These methods of injury prevention should be continued while taking medication. One drug that is suggested for the treatment of RBD is clonazepam.

A typical dose is 0.25 mg to 2.0 mg, taken 30 minutes before bedtime. But a dose as high as 4.0 mg has been reported.

There can be significant side effects when taking clonazepam. These may include morning sleepiness, confusion and memory problems. It should be used with caution in people with dementia.

Clonazepam also can increase the severity of obstructive sleep apnea. So it should be used with caution in people with OSA.

Melatonin also is suggested for the treatment of RBD. The effective dose may range from 3 mg to 12 mg at bedtime.

An advantage of melatonin is that there are few side effects. Dose-related side effects may include morning headache, morning sleepiness and hallucinations.

A variety of other medications may be useful in treating RBD. But the evidence is limited.

Treatment for RBD should be supervised by a board-certified sleep specialist. You can get help from a board-certified sleep specialist at an AASM-accredited sleep center near you.

Read more about REM sleep behavior disorder.

Sleep & Parkinson’s Disease

Today the American Academy of Neurology published new guidelines for treating nonmotor symptoms of Parkinson’s disease. The section on sleep dysfunction was endorsed by the AASM board of directors.

The NINDS reports that Parkinson’s disease is a motor system disorder. These disorders involve problems with muscle control.

One of the primary motor symptoms of PD is tremor. This is trembling or shaking in the hands, arms, legs, jaw or face.



But there are other nonmotor symptoms of PD. These include a variety of sleep-related problems.

The AAN guidelines report that people with PD often struggle with insomnia. They may be unable to fall asleep. They also may wake up frequently during the night.

Sleep aids such as melatonin may improve the perception of sleep quality in people with PD. But it is unclear if they produce an objective sleep improvement.

Deep brain stimulation also may cause sleep to improve. DBS is a surgical procedure that is used to treat the motor symptoms of PD.

Both restless legs syndrome and periodic limb movements are common in people with PD. These problems are classified as sleep related movement disorders.

Treating PD with carbidopa and levodopa may improve the symptoms of RLS and PLM. The drugs ropinirole (Requip) and pramipexole (Mirapex) are FDA-approved to treat PD and RLS. But it is unclear if they reduce RLS symptoms in people who also have PD.

The parasomnia REM sleep behavior disorder often occurs in people with PD. People who have RBD act out vivid dreams and nightmares as they sleep.

RBD can be treated with clonazepam or melatonin. But research needs to evaluate the treatment of RBD in people with PD.

People with PD often struggle with excessive daytime sleepiness. The stimulant modafinil (Provigil) may help them feel more awake. But it may not produce actual improvements in alertness.

Read a patient summary of the new guidelines on the AAN Web site. Get help for a sleep problem at an AASM-accredited sleep center.

Teens & Delayed Sleep Phase Disorder

Some people have a circadian clock that makes them “evening types.” These “owls” have a natural tendency to stay up late at night and sleep late in the morning.

Children tend to become night owls as teens because of a shift in the timing of their circadian clocks. This change causes them to feel sleepy later at night. As a result they also prefer to wake up later in the morning.

But as CNN reported last week, some teens may have an extreme change in the timing of their body clock. They may be unable to fall asleep until late at night or early in the morning. Then they may want to sleep until later morning or early afternoon. This problem is called delayed sleep phase disorder.



Insomnia symptoms can be severe when a person with DSP tries to go to sleep at a “normal” time. Excessive daytime sleepiness also can occur when he or she has to wake up early in the morning.

Teens with DSP can have a hard time in school. It can be difficult for them to conform to an early morning school schedule.

But there are effective treatments for DSP. It can be treated by taking melatonin in the afternoon or early evening. Another option is to use bright light therapy in the morning.

Both treatments can help “re-set” the body clock of a person with DSP. This can help normalize the timing of sleep.

“The way to treat delayed sleep phase is give light, in particular blue light like the light in the sky,” AASM member Dr. Jeffrey Durmer told CNN. “It activates a part of the eye that activates a part of the brain that keeps the circadian rhythm under control.”

DSP treatment should be supervised by a board-certified sleep specialist. It is important to determine the proper timing and dose of treatment that is required.

Get help from a board-certified sleep specialist at an AASM-accredited sleep center near you.

Last month a study reported that teen sleep patterns may be disrupted by a lack of exposure to morning sunlight. The researchers proposed that the problem can be solved by designing better school buildings.

Read more about sleep and teens.

Actress Gwyneth Paltrow Wakes Up to the Importance of Sleep

According to the Huffington Post, Gwyneth Paltrow is spreading an important message to friends, family and fans: We need to get more sleep!

In her GOOP newsletter, Paltrow touches on the negative cumulative effects of sleep deprivation. They range from issues with performance and memory to association with other medical conditions like diabetes and heart disease.

How do you know if you are sleep deprived? The AASM reports that individual sleep needs vary. But most adults need about seven to eight hours of nightly sleep.

Common symptoms of chronic sleep deprivation include:

·Daytime sleepiness
·Irritability/ symptoms of depression
·Lack of motivation
·Shortened attention span
·Impaired judgment

Last month, the Sleep Education blog reported that getting even one extra hour of sleep can improve your health and quality of life.

According to Dr. Oz, you can improve your sleep and recapture your youth by making small changes to your bedroom and nighttime routine.

Visit an AASM-accredited sleep center for help with sleep problems that continue after you have taken steps to improve your sleep hygiene.

Image courtesy of The Huffington Post

Daylight Saving Time: Spring Forward Tonight

Remember to turn your clocks ahead one hour tonight. For most of the U.S. daylight saving time officially begins late tonight at 2 a.m.

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

Why did we ever implement daylight saving time in the first place? Last year author David Prerau shared the story of daylight saving time on NPR’s All Things Considered. He traces its roots to World War I.



Earlier this week Katie Couric reminded viewers of one benefit of daylight saving time.



The longer hours of daylight in the spring reduce the symptoms of seasonal affective disorder. SAD is common during winter because there is much less sunlight than in the summer months.

Light plays an important role as a visual timing cue for your body. Sunlight signals to your brain that it is time for your body to be awake and alert.

Your brain responds by adjusting your body temperature and certain hormone levels. In general, the dark months of winter throw off your body’s timing. As a result, you are more likely to be sleepy and sluggish during daytime hours.

Regardless of the season or the time, do you struggle with an ongoing sleep problem? Get help at an AASM-accredited sleep center near you.

New PTSD Sleep Clinic Opens in New Mexico

A new PTSD Sleep Clinic is opening today in Albuquerque, N.M. The clinic will target the sleep problems that plague people who have post-traumatic stress disorder.

The clinic is directed by AASM member Dr. Barry Krakow. He is the founder of the Maimonides International Nightmare Treatment Center.

Krakow notes that antidepressant medications may not be the best option for people who have PTSD. And many people with PTSD also have obstructive sleep apnea. This can make their PTSD symptoms even worse.



The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Krakow says that treating sleep problems can greatly reduce PTSD symptoms. Daytime fatigue and sleepiness decrease, and energy levels increase. This provides a boost for the coping skills and motivation needed to tackle the problems related to PTSD.

His clinic uses a variety of techniques to treat PTSD. These include cognitive behavioral therapy, imagery rehearsal therapy and sleep-related emotion-focused therapy.

Last year the Sleep Education Blog reported that imagery rehearsal therapy is helping some people change their nightmares. Yoga also is being used to help soldiers who have PTSD. And a recent study showed that old fear memories can be “updated” to prevent the return of fear.

Read more about PTSD and nightmares.

World Kidney Day: Sleep & Kidney Disease

Today is World Kidney Day to focus attention on chronic kidney disease.

The NIDDK reports that chronic kidney disease affects about 23 million adults in the U.S. Damaged kidneys fail to properly remove waste and extra water from the blood. The most advanced stage of the disease is kidney failure. This also is called end-stage renal disease.

Diabetes is the leading cause of chronic kidney disease and kidney failure. High blood pressure is the second-leading cause.

Chronic kidney disease also runs in families. Your risk is higher if a family member has it. And the risk is much higher in African-Americans, Native Americans and Hispanics.

Kidney disease also is a “silent” disease. You are unlikely to notice any symptoms in the early stages. But your doctor can detect it with a blood or urine test.



Research has found many links between sleep problems and kidney disease.

A study published last month indicated that self-reported "poor" sleep quality was common in people with chronic kidney disease. Poor sleep also was linked to lower quality of life scores.

In January a study reported that impaired sleep quality, mood and alertness were associated with advanced chronic kidney disease. They also were linked to dialysis dependency. The dialysis population demonstrated the highest day-to-day variability in these scores.

Last September a study found that nearly 40 percent of children with chronic kidney disease had a sleep disorder. Restless legs syndrome and periodic limb movements were most common.

In August a study found that people with kidney failure had frequent periodic limb movements during sleep. These movements caused almost 15 arousals per hour of sleep.

Previous research also has found that obstructive sleep apnea is very common in people with kidney failure. One review estimated that the rate of sleep apnea in people with kidney failure is 10 times greater than in the general population.

Treating kidney failure by dialysis can be exhausting. Last year the Sleep Education Blog reported that some dialysis clinics now offer to perform the treatment while you sleep.

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

Daylight Saving Time: Spring Forward Before March 14

It may not feel like spring is on the way. Much of the South is still shivering after one of the coldest months in recorded history.

And people in the Northeast are recovering from winter storms that battered them with record snowfall. In fact Hawaii was the only state in the U.S. that had no trace of snow Feb. 13.

But the March 14 change to daylight saving time is almost here. It’s an early sign that spring is coming before the official first day of spring, which is March 20.

The time change can cause you to lose an hour of sleep this Saturday night. Research shows that this disruption can have a lasting effect on your sleep.

One way to reduce the negative impact of the time change is to plan ahead. You can go to bed 15 or 20 minutes earlier each night for the rest of this week. This will give your body more time to adjust.

On SleepEducation.com you can learn more from the AASM about planning ahead for daylight saving time.

Dr. Oz: One Minute of Sleep Apnea Advice

Dr. Oz recently gave advice for obstructive sleep apnea in a segment called “1 Minute to Better Health.”

First he outlined some of the ways that OSA can have a negative effect on your health and performance. It can cause daytime fatigue, poor mood, memory loss, heart disease, stroke and even death.



Then he described who is most likely to have sleep apnea. It often occurs when extra fatty tissue in the throat keeps air from flowing freely as you sleep.

“People with sleep apnea are usually overweight,” he said.

What can be done about sleep apnea?

He said that becoming a side sleeper may help. But he recommended weight loss as a better option.

According to Dr. Oz, most people tend to lose weight in their face and neck first. This means that dropping some extra weight could possibly cure sleep apnea.

“So remember, if you want to get rid of that extra sleep apnea problem you’ve got, just lose a little bit of weight,” he said.

If only it were that easy. Studies show that weight loss often reduces the severity of sleep apnea. But it rarely solves the problem.

One recent study found that a very low-energy, liquid diet cured sleep apnea in 17 percent of participants. Another study found that participants still had moderate OSA after a 16-week diet and exercise program.

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.

Why? As Dr. Oz pointed out, sleep apnea can have a severe effect on your health. It requires immediate and effective treatment.

But weight loss takes a long time, and it may not be enough to cure the problem. Weight loss also is difficult to maintain. Excess weight often returns over time.

And it is important to point out that OSA also occurs in people who maintain a healthy weight. A study presented at SLEEP 2009 found a high rate of sleep apnea in non-obese adults.

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.

Read more about obstructive sleep apnea and weight loss and OSA.

Sleep & Race in America

Author Studs Terkel called race “the American obsession.” In the U.S. race colors almost everything we do – even sleep.

Today the National Sleep Foundation released the results of the 2010 Sleep in America Poll. It focused on the relationship between sleep and race.

Telephone interviews were conducted with 1,007 adults between the ages of 25 and 60. The sample was equally divided among four groups: Asians, blacks, Hispanics and whites.

Results show that the average reported nightly sleep time on workdays or weekdays was less than seven hours in each group. Blacks had the lowest average of 6.2 hours, and whites had the highest average of 6.9 hours.

About 60 percent of blacks were “short sleepers” who reported sleeping less than seven hours per night during the week. Fifty percent of Hispanics, 41 percent of Asians and 34 percent of whites also were short sleepers.

The AASM reports that individual sleep needs vary from one person to another. But most adults need about seven to eight hours of nightly sleep.

Other surveys also have found that self-reported sleep durations differ by race. A recent analysis of time-use surveys found that African-Americans had higher odds of short sleep. Asians and Hispanics were less likely to be short sleepers. Survey data released by the CDC last year suggested that Hispanics were more likely to be sound sleepers.

Research also has been linking short sleep with health problems such as obesity and type 2 diabetes. Habitual sleep duration may help explain why the rates of these problems can vary widely by race.

The CDC reports that blacks are 51 percent more likely to be obese than whites. Hispanics are 21 percent more likely to be obese than whites.

And last year a study found that blacks had a 78 percent increased risk of obesity related to short sleep. The risk of obesity related to short sleep in whites was increased by 43 percent.

So where do you fit in these statistics? Regardless of your race, are you getting enough sleep?

Maybe you need to make it a priority to get more sleep. Perhaps you can turn off the TV or the computer 30 minutes earlier at night.

Or maybe you have a problem that prevents you from sleeping well. Insomnia. Sleep apnea. Restless legs. Or one of the many other sleep disorders. In this case it may be time for you to contact an AASM-accredited sleep center for help.

Getting enough sleep – and sleeping well – will help you feel, think and perform your best. Maybe sleep should become the new American obsession.

Read about other recent sleep surveys and learn more about sleep and race.