Sleep deprivation prompts quick improvements with chronic insomnia therapy

Sleep deprivation added to traditional therapy resulted in a superior treatment response for chronic insomnia, a new study shows.

Intensive Sleep Retraining (ISR) uses sleep deprivation over a 25-hour period to counteract insomnia. Sleep deprivation facilitates a series of quick sleep onsets, the study’s authors said. ISR has the potential to produce rapid improvements in sleep, daytime functioning and psychological variables.

The study looked at adding ISR to traditional therapy for chronic insomnia sufferers. The results showed rapid improvements in the time it took to fall asleep and in total sleep time. Other significant improvements were noted in sleep quality and daytime functioning. And 61 percent of patients participating in ISR-enhanced therapy reported “good sleeping” status. Researchers said treatment gains were largely maintained throughout the follow-up period to six months.

The study appears in the January issue of the journal SLEEP. Australian researchers treated 79 volunteers with chronic sleep-onset insomnia. The participants were randomly assigned treatments of either ISR, stimulus control therapy (SCT), ISR plus SCT, or a control group receiving sleep hygiene therapy. There were 20 participants in the group receiving ISR plus SCT.

Read more about insomnia and common sleep disorder treatments. Additional stories about insomnia and sleep deprivation can be found in the Sleep Education Blog.

A New Experimental Alternative to the CPAP

Continuous Positive Airway Pressure Treatment (CPAP) is the first-line treatment for sleep apnea. However, it does not work for all patients. The Medical University of South Carolina (MUSC) is testing an experimental alternative sleep apnea treatment that works by stimulating the muscles to keep the airway from closing.

The muscle stimulator resembles a pacemaker and is implanted beneath the skin in the chest. There are two leads extending from the stimulator. One goes to an electrode that is implanted on the nerve that leads to the tongue. A person’s breathing cycle stimulates the nerve.  The second lead goes to the chest muscles to detect breathing. When the person is ready for sleep, the stimulator can be turned on by a remote.

Dr. Gillespie, a sleep specialist, says that patients won’t feel the stimulation, but they may feel their tongue move forward. However, after a few days, it is not that noticeable.

The experimental surgery is being monitored as part of a trial by the Food and Drug Administration. It is only for those patients who have tried the CPAP treatment and it has not benefitted them.

To find out if you have sleep apnea, visit an AASM accredited sleep center to have a sleep study done.

Photo by: Robbie Kennedy

Cooling Cap Could Provide Insomnia Relief

There is no easy cure for insomnia. Sleeping pills appear to be a quick fix, but the potential for psychological attachment and rebound insomnia make medication for insomnia a solution for short-term problems only. Alternatively, you can seek cognitive behavioral therapy to help eliminate the harmful thoughts and bad habits that promote extended periods of insomnia. This solution is very effective but also time-consuming and requires effort and dedication.

New research presented at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS), suggests another treatment choice for insomnia may be on the horizon. The potential treatment would use a cooling cap that would lower your brain temperature to help you fall asleep.

Normally, a reduction in brain metabolism occurs as you fall asleep. However, during insomnia, the brain metabolism increases, keeping you awake. The cap helps reduce metabolic activity by cooling the front half of the brain.

The study involved 24 people. Half of the participants had insomnia. Each was subjected to several overnight sleep studies while wearing the cooling cap. The settings for the cooling cap differed each night, ranging from maximum amounts of water cooling to not wearing the cap at all.

Results show patients who wore the cooling cap set to its maximum level slept nearly as well as the subjects who didn’t have insomnia. These findings suggest the device could be a new promising therapy for insomnia sometime in the future. The treatment is still a long ways off; more studies will need to be conducted before the device can hit the marketplace.

Sleep Apnea Treatment: What Works Best?

A story today on NPR’s “Morning Edition” discussed treatment options for obstructive sleep apnea and snoring.




What is the best treatment for OSA? In June the AASM released a clinical guideline for the evaluation and treatment of sleep apnea; it was published in the Journal of Clinical Sleep Medicine. Here is a summary of the AASM recommendations:

1. CPAP Therapy
CPAP therapy is the “treatment of choice” for OSA. It is effective for all severity levels of sleep apnea. CPAP should be the first treatment that a doctor offers to someone with OSA.

CPAP stands for “continuous positive airway pressure.” It provides a steady stream of air through a mask that you wear during sleep.

2. Oral Appliance Therapy
An oral appliance is an alternative treatment option for people with mild or moderate OSA; people with severe OSA should be treated with CPAP. Oral appliance therapy also can help a person who has primary snoring.

An oral appliance is a dental mouth piece that you wear during sleep. It fits much like a sports mouth guard or an orthodontic retainer. It either holds the tongue or supports the jaw in a forward position. An oral appliance should be customized to fit you by a dentist who has been trained in dental sleep medicine.

3. Surgery
A surgical procedure is an alternative treatment option for some people with OSA. It may be required to correct a physical abnormality; it also may be performed if you are unable to have success with CPAP or an oral appliance.

There are a variety of surgeries that can help correct a specific problem. Targeted areas include the throat, tonsils, jaw and nose. Surgery may not cure OSA; you may need to continue with another treatment such as CPAP. Positive results also may not be permanent; symptoms may reappear at a later time.

4. Behavioral Strategies
Weight loss is recommended for everyone with OSA who is overweight. But it rarely cures sleep apnea. It should be combined with another treatment. Positional therapy – side sleeping – may help some people with less severe OSA.

A board-certified sleep specialist can determine which treatment option is best for you. Contact an AASM-accredited sleep disorders center for help with sleep apnea.

Taming Violent Dreams: Treating REM Sleep Behavior Disorder

A new study in the Journal of Clinical Sleep Medicine reports that there are effective treatment options for people with REM sleep behavior disorder.

People who have RBD act out vivid, action-packed dreams while remaining asleep. Injuries to the dreamer or a bed partner are common.

RBD often is treated with clonazepam, a long-acting sedative. But the study reports that some side effects of this drug may be more prominent in older adults. Since RBD usually emerges after the age of 50 years, treatment can be problematic.

The small study involved a review of 39 people with confirmed RBD who were treated at a sleep center in the U.K.; 38 of the patients were men. They had an average age of 66 years; the youngest patient was 34 years old.

Thirty-six of the patients began treatment with clonazepam. Fifty-four percent took the medication successfully; but 58 percent reported moderate or severe side effects. The most common side effects were morning grogginess, confusion and cognitive impairment.

Zopiclone, a shorter-acting hypnotic, was used by 11 patients; nine used it alone, while two used it together with another medication. It was effective and well tolerated in eight of the 11 cases.

Two patients used melatonin; one used it while taking two other medications. Both people found it to be effective.

The authors conclude that it is important to consider the potential side effects when treating RBD in older adults. Shorter-acting hypnotics may be a useful treatment option.

Learn more about medications for sleep disorders on SleepEducation.com.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

Cooling the Brain to Treat Insomnia

A study presented last week at SLEEP 2009 proposed that “cooling the brain” may be a new way to treat insomnia.

The study states that insomnia is associated with increased metabolism in the brain’s frontal cortex. This occurs during the stage of non-REM sleep. Cooling the brain – “cerebral hypothermia” – has reduced metabolic activity in other medical conditions. Can it work for insomnia?

The small study involved eight people with primary insomnia. They wore a cooling device on the scalp. It covered the area where the frontal cortex is located.

The LA Times reports that the cap contains tubes that circulate cool water. Participants received a mild, cooling stimulus for 60 minutes before bedtime and during the first cycle of non-REM sleep.

Results show that cooling the brain was associated with a drop in core body temperature at sleep onset. It also reduced whole brain metabolic activity in five of the eight participants.

"They had increased slow-wave sleep, which is the deepest sleep," study author Dr. Eric Nofzinger told the LA Times.

Subjective benefits were reported by 75 percent of participants. These included fewer distracting thoughts and better sleep.

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

Much Ado About Snoring

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



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

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

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

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

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

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

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

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

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

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

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

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

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

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

Are Musical Instruments the Answer for Sleep Apnea?

Maybe you shouldn’t have dropped out of band class in junior high or high school. There has been some recent interest in using wind instruments as a possible treatment for obstructive sleep apnea.

The theory is that playing a wind instrument makes the muscles in the upper airway stronger. This could prevent soft tissue in the throat from collapsing and blocking the airway during sleep.

The idea gained support from a small study in 2006 in the British Medical Journal. Fourteen participants with sleep apnea learned how to play an acrylic plastic didgeridoo. They were given lessons and practiced at home for four months. They practiced for an average of about 25 minutes, 5.9 days per week.

Eleven people with sleep apnea were kept on a waiting list as a control. Results show that daytime sleepiness and sleep apnea severity improved in those who played the didgeridoo.



In a recent study researchers put this wind-instrument theory to the test. They surveyed professional orchestra members. Their risk of sleep apnea was assessed using the Berlin questionnaire.

A total of 1,111 orchestra members responded. About 31 percent (348) had a high risk of sleep apnea.

And those who play a wind instrument? Did they have a lower risk of sleep apnea?

Actually, they were more likely than non-wind players to be at high risk for sleep apnea. But this was not statistically significant when adjusted for age, body mass index and gender.

So wind instruments may not be the answer for sleep apnea. But each instrument requires a different rate of airflow and air pressure. Future research could find that specific instruments have more treatment potential than others.

But there’s no need to go to an orchestra hall to find a treatment for sleep apnea. A sleep specialist at an AASM-accredited sleep center can determine which treatment option is best for you. Effective treatments include CPAP and oral appliances.

More Young Adults Using Sleeping Pills

The New York Times reports that the use of sleeping pills by young adults has risen dramatically. The biggest increase from 1998 to 2006 came among adults between the ages of 18 and 24.

The report is based on an analysis by Thomson Reuters. It examined drug claims by adults under the age of 45. Overall sleeping pill use was highest among adults between the ages of 35 and 44.

The most popular sleeping pills were Ambien CR and Lunesta. The drugs were prescribed for an average of 93 days.

AASM president Dr. Mary Susan Esther told the Times that chronic insomnia often is linked to other problems. These include depression and anxiety. In these cases a sleeping pill won’t address the related problem.

Insomnia also can be caused by disruptions to the sleeping environment. This is called environmental sleep disorder. Dr. Esther pointed out that a noisy dorm is a common sleep disrupter for college students.

The report did not examine the use of other treatments for insomnia. One of the most effective treatments is cognitive behavioral therapy. Following the tips of good sleep hygiene also helps some people with insomnia.

Like any other drug, sleeping pills may cause some side effects. These side effects can include sleepwalking, sleep eating and other complex sleep behaviors. Some people also may experience memory problems.

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