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Chronic Insomnia and Objective Short Sleep Duration Associated with Increased Mortality in Men

Sep 3rd, 2010
by Dr. Lisa Shives.
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I was interviewd yesterday by Web MD (http://www.webmd.com/sleep-disorders/news/20100902/insomnia-death-risk) about an important, a new study published in the journal Sleep, chronic insomnia in men with objectively measured short sleep duration is associated with a risk of death that is four times higher  than men who do not suffer from chronic insomnia with objective short sleep duration.

Symptoms of insomnia include difficulty falling asleep or staying asleep, poor quality of sleep and early awakening. In this study, symptoms of insomnia were considered chronic if they persisted for more than a year.

The study, conducted at Pennsylvania State University College of Medicine, was led by Dr. Alexandros Vgontzas. Vgontzas believes the study is unique in that it differentiated the subjective symptoms of insomnia from the objective duration of sleep, which was measured through a sleep test (polysomnogram) in a sleep laboratory.

The study included 1,000 women with an average age of 47 years, and 741 men with an average age of 50 years. Participants provided a comprehensive sleep history, completed a physical exam and slept one night in a sleep laboratory.

Women who participated in the study were followed for approximately 10 years and men involved in the study were observed for 14 years. During the follow-up period, 248 (or 14 percent) of all participants died; 145 (21 percent) were men and 103 (five percent) were women. Mortality rate for men was 9.1 percent for those without chronic insomnia who slept for at least six hours a night, and 51.1 percent for those with chronic insomnia who slept for less than six hours per night.  No association between mortality and insomnia with short sleep duration existed among the female participants.

According to Medical News Today, additional studies using this data found that chronic insomnia with short sleep duration are linked to higher risk of type 2 diabetes and hypertension.

Researchers involved in the study hope that findings will highlight the importance of identifying and diagnosing insomnia during the early onset of the condition.  it also offers new evidence that sleep physicians need to get objective data about the sleep of patients who complain of persistant insomnia.  To that end,  I will start using an actigraph to measure the sleep if patients with insomnia who are not appropriate candidates for a sleep study.

Keep in mind that many patients think they have insomnia but in fact they have another sleep disorder such as obstructive sleep apnea or periodic limb movement disorder that is waking them up repeatedly and disturbing their sleep.  This study shows the importance of finding out exactly what is the problem that prevents a patient from getting those badly needed 6 hours (minimum) of sleep.

Principal investigator Alexandros N. Vgontzas, MD, will discuss the study “Insomnia with short sleep duration and mortality: the Penn State Cohort” on the Sept. 3, 2010, radio broadcast of “Science Friday” on NPR.  You can listen live online from 2 p.m. to 4 p.m. EDT

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Posted in: Dr. Shives in the News, Insomnia, Sleep, Sleep Apnea, Sleep Disorders, Your Health and Sleep.
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Help Your Kids Succeed in School by Helping Them Get the Sleep They Need

Sep 1st, 2010
by Dr. Lisa Shives.
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Now that the 2010 school year has begun, you may already be fighting the up-hill battle to get your child to adhere to his or her bedtime.

Although sleep schedules tend to be more relaxed during the summer, it is important that children get the sleep they need during the school year. According to ABC news, getting a good night’s sleep may be the most powerful predictor of children’s performance in school. New research shows that children who had established bedtimes had higher math and literacy skills.

The American Academy of Sleep Medicine also reports that poor sleep in children can also lead to emotional and behavioral problems. According to a study published in the Archives of Pediatrics & Adolescent Medicine,  children who get less sleep than their peers have a higher risk of anxiety, depression and aggressive behavior towards adults.

Sleep deprivation in children is also associated with increased risk for heart problems, including obesity, diabetes and heart disease.

As children age, their nightly sleep needs change.

Children between the ages of 3 to 11 months require 14 to 15 hours

Toddlers: 12 to14 hours

Preschool children: 11 to 13 hours

School-age children: 10 to 11 hours

In order to ensure that your child gets the sleep he or she needs, it may be helpful to establish and enforce a regular bedtime routine. Children should go to bed and wake up at the same time every day, even on the weekends. The National Sleep Foundation recommends that parents teach school-age children about the importance of sleep and keep electronics such as television, video games, cell phones and MP3 players out of the bedroom.

Although it’s common for children to resist going to bed at bedtime, it is not normal for them to be incapable of falling asleep on their own.  If your child consistently struggles to fall asleep at night, she or he may be suffering from a sleep disorder. Visit our new pediatric sleep page to learn more about how sleep disorders can affect children.

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Posted in: Child Sleep Problems, Sleep, Sleep Disorders, Your Health and Sleep.
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The Connection Between Sleep and Obesity

Aug 30th, 2010
by Dr. Lisa Shives.
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On Wednesday, June 30th, I presented a lecture entitled, “Was Atkins Right? The Debate about Carbs and Dietary Fat” at St. Francis Hospital.  And now we are about to start offering a weight loss program as part of the treatment of sleep apnea and other chronic medical disorders such as hypertension, diabetes and cardiovascular disease.

During the presentation, I discussed the importance of dietary balance and the consequences of consuming too much fat and too many carbohydrates.

You may wonder why a sleep specialist would be interested in speaking about weight loss. The answer is that sleep problems and obesity are closely tied.

According to the Center for Disease Control, more than one third of U.S. adults, or more than 72 million people and 16 percent of U.S. children are obese.  Another one third of Americans are over weight. 

Research shows that sleep deprivation is associated with weight gain. Obesity is associated with many serious health problems, including sleep apnea.

One study showed that teens who slept less than eight hours during the school week were more likely to be obese than their peers who did obtain eight hours of sleep or more during the school week.

Researchers believe that sleep deprivation interferes with hormones that affect your body mass index. Those who do not get enough sleep tend to have lower levels of leptin, a hormone that suppresses your appetite and increases your metabolism. As a result, people who are not getting the sleep they need may eat more. Additionally, studies have shown that people who are sleep deprived tend to crave more unhealthy food.

While getting enough sleep (typically seven to eight hours a night) will not result in instant weight loss, it is as important a factor as diet and exercise in improving your mental and physical health.

I believe that sound sleep, healthy food and adequate physical activity are the three pillars that support a long and healthy life.  To that end, I will begin offering weight loss as a treatment option for patients with sleep apnea and other chronic conditions that can be ameliorated with weight loss.  An essential tool that I will use is a bio-impedence machine to analyze body composition, i.e. the percentage of the body that is lean muscle, water and fat.  It is essential to know that when a patient is losing weight that indeed it is fat that is being lost and not muscle.  If muscle is lost, then the metabolic rate decreases and even if you consume the same amount of calories, you will start to gain weight.  This is why people yo-yo and end up larger and larger as they repeatedly try diets without monitoring what is being lost when they lose weight.  With each successive diet attempt, they end up having a larger percentage of their body being composed of fat and less of muscle.  As the lean muscle mass decreases, they would have to eat less and less just to remain the same weight because the metabolic rate goes lower and lower with each diet attempt.

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Posted in: Sleep, Sleep Disorders, Your Health and Sleep.
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Lack of Sleep Can Sabotage Your Workout

Aug 16th, 2010
by Dr. Lisa Shives.
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According to an article published in Chicago Now, for those of you not getting enough sleep at night you may be wondering why all the time you spend at the gym does not seem to be paying off.

Research shows that adults tend to need an average amount of seven hours of sleep per night; the number varies in individuals however, with some people needing as few as five hours and some needing as many as nine.

An insufficient amount of sleep interferes with your daily activities. You may feel fatigued, and thus you may not have the energy to finish your workout routine. Even if you do find the energy to exercise, when you have not obtained the sleep you need, your work out may be done ineffectively.

Research has shown that sleep deprivation can interfere with various hormones, which can lead to adverse health effects. Some of the hormones that are disturbed include cortisol (stress hormone) and leptin, a hormone that suppresses your appetite and regulates your metabolism.

While many people put sleep on the bottom of their priority list,  failing to get the sleep you need can affect your over-all mental and physical health. Sleep deprivation is associated with decreased job performance, poor memory and concentration, impaired cognitive performance, increased errors and slower reaction times.

The Tribune reports that results of a study conducted at Harvard University over a ten-year period on 70,000 women show sleeping six hours a night was associated with an 18 percent greater risk of heart attack, and sleeping fewer than 6 hours a night was associated with almost 40 percent higher risk of heart attack.  Women who slept for eight hours a night had the lowest risk for heart attack.

The American Academy of Sleep Medicine provides tips on how to increase and improve your sleep, including keeping a sleep schedule, even on the weekends and avoiding exercising within six hours of your bedtime.

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Posted in: Diet, Sleep, Sleep Medicine News, Sleep and Heart Health Facts, Your Health and Sleep.
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CPAP Restores Gray Matter in Patients with Severe OSA

Aug 13th, 2010
by Dr. Lisa Shives.
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According to findings of a study presented at the annual SLEEP meeting in San Antonio, patients who suffer from severe obstructive sleep apnea (OSA) experience a reduction in gray-matter volume in the brain. Results of the study show however, that after three-months of treatment with continuous positive airway pressure (CPAP) therapy, grey matter volume increases.

While OSA can occur in men and women of any age, it is commonly found in middle-aged, overweight men. Symptoms of the disorder include snoring, excessive daytime sleepiness, un-refreshing sleep, unintentionally falling asleep and insomnia. People with untreated OSA also often experience decreased awareness during the day and lower productivity.

Web-MD reports that results of the study show that patients with OSA had reductions in gray matter volume and a decrease in neuropscyhologic performance. After receiving CPAP therapy for three-months, these patients had a significant increase in both gray matter volume and great improvement in their scores on neuropsychologic testing.

No further improvement in gray matter volume was seen when patients were re-evaluated after one year of receiving CPAP therapy.

Findings of this study highlight the importance of adherence to CPAP therapy, as use results in significant improvements in patients’ overall well-being and contributes to the restoration of brain areas that are adversely affected by OSA.

The most common signs or symptoms of Sleep Apnea are snoring and excessive daytime sleepiness.

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Posted in: Sleep Apnea, Sleep Disorders, Your Health and Sleep.
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Early School Start Times Associated with Higher Incidents of Automobile Crashes in Teens

Aug 12th, 2010
by Dr. Lisa Shives.
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Evidence presented in a study at SLEEP 2010 shows that teens who begin school earlier are more likely to be involved in car accidents, according to Sleep Review Magazine.

The study showed that,  in 2008,  the teen crash rate in Virginia Beach, Va was about 41 percent higher than in Chesapeake, Va. Students began classes at 7:20 a.m. in Virginia Beach and at 8:40 a.m. in Chesapeake. Researchers indicate that the two cities have similar demographics, including racial composition and income levels.

Information was obtained by the Virginia Department of Motor Vehicles. In Virginia Beach, there were 12,916 drives between 16 and 18 years of age in 2008. These drivers were involved in 850 crashes. In Chesapeake, there were 8,459 teen drivers and 394 car accidents in this age group.

Research shows that teenagers typically require at least nine hours of sleep in order to perform effectively during the day. Many teens experience a biological shift in the sleep schedule, known as delayed sleep phase which results in going to sleep later at night and sleeping in later during the day if left unregulated. Unfortunately, because of early school start times, this shifted sleep schedule results in chronic sleep deprivation for teens.

According to MedPage Today, An estimated 100,000 car crashes every year in the U.S. are associated with driver drowsiness and falling asleep, and more than half of those are in drivers 25 and younger.

Authors of the study believe that a delayed high school start time may increase driver alertness by reducing chronic sleep restriction, which is a common problem in adolescents.

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Posted in: Child Sleep Problems, Sleep, Sleep Disorders.
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How Your Brain Determins if you are a Heavy or Light Sleeper

Aug 11th, 2010
by Dr. Lisa Shives.
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I was recently quoted by USA Today in an article that discusses how the amount of sleep spindles you produce each night determines if you will be a light or heavy sleeper.

According to a study published in Current Biology, sleep spindles, or bursts of brain activity protect your brain from noise disruptions while you sleep. Results of the study show that the more sleep spindles you have, the more likely you are to sleep soundly, despite potential noise interruptions.

Brain patterns of 12 participants were monitored for three consecutive nights while they slept. Volunteers ranged between 20 and 46 years, and had no diagnosed sleep disorders. The first night was used as a control, while noises that often interrupt sleep were added on the second and third nights.

Results show that participants who produced more sleep spindles were more likely to sleep through the noises, while those who produced less were more likely to be awakened by the noises.

Although sleep experts do not know what causes people to produce increased level of sleep spindles, the information discovered during the study is expected to be extremely useful. Doctors will now be able to determine who is more likely to be woken by noise at night, which is important in noisy environments, such as hospitals.

According to the National Institute of Neurological Disorders and Stroke, at least 40 million Americans suffer from sleep disorders every year. The majority of Americans regularly fail to get the sleep they need, either because of a sleep disorder or because sleep lands at the end of their priority list.

Although many believe that they can catch up on sleep when they have more free time, research shows that sleep deprivation is associated with increased risk for weight gain, heart disease, diabetes and stroke.

The American Academy of Sleep Medicine recommends that people go to sleep and wake up at the same time every day, even on weekends, in order to improve the quality and quantity of sleep.

People who have trouble staying asleep should take a hot bath or shower one hour before bed. This makes the body temperature rise and then fall, which causes a drowsy effect. People should also avoid eating sugary foods before going to bed.  For serious persistant insomnia, the best treatment is Cognitive Behavioral Therapy which teaches cognitive strategies and relaxation techniques.

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Posted in: Dr. Shives in the News, Sleep, Your Health and Sleep.
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Drinking Cherry Juice May Improve Insomnia in Older Adults

Aug 2nd, 2010
by Dr. Lisa Shives.
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A new study shows that drinking cherry juice is a natural way to ease insomnia symptoms in older adults, according to the National Sleep Foundation.

Because cherries contain melatonin, consistently consuming tart cherries may help regulate the body’s natural sleep cycle and increase sleep efficiency.  Although drinking cherry juice is not as effective as prescription or over-the-counter sleep aids, it may increase the body’s natural supply of melatonin.

Fifteen people were included in the study, and they drank eight ounces of a tart cherry juice drink in the morning and evening for two weeks. Participants experienced significant reductions in insomnia severity. Compared to when they were not drinking the juice.

Insomnia symptoms include difficulty falling or staying asleep, un-refreshing sleep or waking up too early. These problems can be caused by anxiety, a change of routine or travel. Often, neither the patient nor the physician can pinpoint exactly what instigated the insomnia.

If you are having difficulty sleeping, making small changes in your sleep habits may help. Going to bed and waking up every day at the same time, avoiding exercise and alcohol before bed and cooling the temperature in your bedroom may improve the quality of your sleep.

If  the sleep problem persists for more than six weeks, you should visit a sleep specialist, who will be able to provide you with the best treatment options. The doctor may prescribe sleep aids, or may advise that you partake in cognitive-behavioral therapy.

Untreated insomnia is associated with decreased attention and awareness and increased risk for weight gain, extreme mood changes, and even increased mortality risks over the long run.

Insomnia can be challenging to both the patient and the physician, but if they work together with a creative approach, then the patient usually can make great improvements.

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Posted in: Insomnia, Natural Sleep Remedies, Sleep.
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Alcohol Use Tied to Sleep Problems in Teens

Jul 29th, 2010
by Dr. Lisa Shives.
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A new study published in the journal Alcoholism focused on sleep behaviors and alcohol use in teenagers. Findings show that many children develop sleep problems during or before puberty, and in an attempt to self-medicate, some begin to use alcohol, which can lead to alcohol abuse.

The study included 236 girls and 195 boys between the ages of 11 and 14. Results indicate that an association exists between early use of alcohol among teens and a tendency to suffer from Delayed Sleep Phase Syndrome (going to sleep very late) and  insomnia (problems falling asleep and staying asleep.)   Also, teens who matured earlier tended to stay up later, have greater sleeping problems and were more likely to use alcohol.

Alcohol is known to interfere with the rapid eye movement stage of sleep, which results in un-refreshing sleep. The American Academy of Sleep Medicine states that alcohol should not be consumed within six hours before going to bed.

According to a study published in the journal Sleep, up to 14 percent of 11 to 17 year olds do not get sufficient sleep. Lack of sleep in children can contribute to lower grades, mental illness, behavioral problems and difficulty creating and maintaining relationships.

In order to improve sleep, children and adults should go to sleep and wake up at the same time every day, even during the weekends.   They should avoid taking naps; they should refrain from exercising and eating  3 hours before bedtime;  and they should  keep technology out of the bedroom.  That is a real challenge for today’s teens and for the adults who care about them.

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Posted in: Child Sleep Problems, Insomnia, Sleep, Sleep Disorders.
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Consequences of Obstructive Sleep Apnea in Children

Jul 26th, 2010
by Dr. Lisa Shives.
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According to the National Sleep Foundation, a new study shows that obstructive sleep apnea (OSA) is associated with inattention and poor study skills, which leads to poor academic performance in children with the disorder. Children with moderate to severe OSA have worse grades than students who do not have sleep-disordered breathing. None of the students with OSA had an “A” average, and 30 percent of them had a “C” average or lower.

The study included 163 children and adolescents between the ages of 10 and 17 years of age. Results indicate that moderate to severe OSA is linked to both lower academic grades and behavioral problems observed by both parents and teachers.  Students who had OSA averaged a half-letter grade lower than those without the condition.

The American Academy of Sleep Medicine states that other problems associated with untreated OSA in children include aggressive behavior, attention-deficit/hyperactivity disorder (ADHD) and delays in development.  If left untreated, OSA can negatively affect a child for the rest of his or her life.

The good news is that sleep apnea in kids is easily diagnosed by a sleep test and is easily treated,   often by tonsillectomy/adenoidectomy, or is that is not successful, we do CPAP (continuous Positive Airway Pressure).  Believe it or not, children often take to it easier than adults.  Be sure that you seek out a sleep medicine specialist that has significant experience testing and treating children.  There is an extra monitor that we put on children (CO2 monitor) that is not part of the standard polysomnography (sleep test) but which is essential in detecting if the child is hypoventilating.

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Posted in: Child Sleep Problems, Sleep Apnea.
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