Fall Back to Sleep & Standard Time

Tonight marks the end of daylight saving time. The return to standard time officially occurs at 2 a.m. Sunday morning.

This means you get an extra hour in your day. This is a great opportunity to catch up on your sleep!

To get an extra hour of sleep, you should go to bed at your normal bedtime. Then set all your clocks back an hour just before getting into bed.

Lifestyle choices, personal obligations and occupational demands can cause you to become sleep deprived. Ongoing sleep disorders or medical conditions can also cause sleep deprivation. When you are constantly getting less sleep than you need, you develop what is known as a ‘sleep debt’.

Sleep deprivation is linked with increased risk for obesity, illness and death. It can also lead to decreased alertness and performance during the day.

According to a study presented at SLEEP 2009, watching television is currently the most influential cue people use to decide when to go to bed.

Authors of the study say that people can reduce their sleep debt by watching less TV at night and going to bed earlier. You can also eliminate your sleep debt by sleeping for longer time periods each night and improving your sleep hygiene.

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

Learn more about sleep deprivation at Sleep Education.com.

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

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Sleep Across America

Today the CDC released new survey data about the sleep of people in the U.S. It examined the rate of “insufficient rest or sleep” in 2008.

The Behavioral Risk Factor Surveillance System is the world’s largest, ongoing telephone health survey. It collects data on risk behaviors and health conditions. One question on the 2008 survey was, “During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?"

Nearly 404,000 people participated; they were 18 years of age or older.

Results show that about 31 percent were sound sleepers; they reported no days of insufficient rest or sleep in the preceding 30 days.

Who were these sound sleepers? They were more likely to be male, Hispanic, 65 years of age or older, and retired.

The results also suggest that island life promotes sound sleep. The age-adjusted percentage of people who always got enough sleep was highest in: Puerto Rico (51%), Guam (46%), U.S. Virgin Islands (36%) and Hawaii (36%). Louisiana was close behind at 35 percent.

At the other end of the spectrum were the problem sleepers. About 11 percent of respondents never got enough rest or sleep during the past 30 days.

Almost 26 percent of people who reported being unable to work were problem sleepers. Sixteen percent of people who were divorced, widowed or separated also felt that they never got enough sleep.

Southern states had higher percentages of problem sleepers. The age-adjusted percentage of people who never got enough sleep was highest in: West Virginia (19%), Tennessee (15%), Kentucky (14%) and Oklahoma (14%).

Everyone else had varying degrees of insufficient sleep. About 17 percent reported insufficient sleep ranging from 14 to 29 days; about 41 percent had anywhere from one to 13 days during which they did not get enough rest or sleep.

The authors conclude that doctors should ask patients about their sleep during routine office visits. Then they can make needed interventions or referrals to sleep specialists.

You can get help for a sleep problem at one of more than 1,800 AASM-accredited sleep centers near you.

Earlier this year the Sleep Education Blog reported on two other sleep surveys: the American Time Use Survey and the Sleep in America Poll.

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Sleep Duration & Obesity in Children

A new study examined the relationship between sleep duration and obesity in children.

The study involved 5,159 children from 13 schools in Hong Kong; they had a mean age of 9 years. Sleep times and other data were collected using questionnaires.

Results show that children with shorter sleep durations had higher body mass index scores. Children slept for more than 10 hours at night on weekends and holidays; but they slept for only a little more than nine hours on school nights.

Children who slept less than eight hours during weekdays were more than two times more likely to be overweight or obese. The risk was highest in children who did not compensate for weekday sleep loss by sleeping longer on weekends and holidays.

The Sleep Education Blog has reported on a variety of factors that contribute to sleep loss in children. These include family status, prenatal influences, inactivity and watching TV.

Other studies also have linked sleep duration to the risk of obesity. So what is a parent to do?

Don’t wait for your child to “catch up” on sleep over the weekend; help him or her get more sleep during the week to avoid building up a sleep debt.

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

So make sure your child has time to wind down and get in bed before 9 p.m. each night. One way to help is to turn off the TV and the computer earlier in the evening.

What helps your children get to bed early on school nights?

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Sleep Apnea & Surgery: Caught on Camera

Surgery is one treatment option for people who have obstructive sleep apnea. Procedures tend to be “site-specific;” they will seek to eliminate the cause of the obstruction.

The challenge is finding the right site for surgery. Problem areas related to OSA include the tonsils, tongue, soft palate, throat, jaw and nose.

As a result, surgery isn’t a “one size fits all” treatment. In fact, the AASM’s clinical guidelines list more than 20 common surgical procedures for OSA.

Yesterday the Baylor College of Medicine reported that one way to address this challenge is to use an “endoscope;” this is a small flexible device with a camera on the end.

Doctors at the BCM are using it to help identify the cause of obstructions that happen during sleep apnea. They insert the endoscope into the back of the nose to view the throat while the patient is sedated and sleeps.

The camera gives them a front-row seat when an episode of OSA occurs. By finding the cause of the problem, they can develop a more precise treatment plan. This helps prevent unnecessary surgery.

The AASM reports that CPAP therapy is the treatment of choice for all severity levels of OSA. An oral appliance and surgery are alternative treatment options that may help some people with sleep apnea.

The AASM clinical guidelines report that “maxil­lary and mandibular advancement” is one surgical procedure that is often effective. Cuts are made into the bones of the upper and lower jaws. The jaws are pulled forward to enlarge the entire upper airway.

Most other sleep apnea surgeries will rarely cure OSA; you may need to continue with another treatment such as CPAP. But surgery may help reduce symptoms and improve quality of life.

Positive results also may not be permanent; symptoms may reappear at a later time after surgery.

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

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Sleep Apnea May Trigger Abnormal Heart Rhythms

A new study suggests that episodes of obstructive sleep apnea may trigger two types of “cardiac arrhythmias,” which are abnormal heart rhythms.

The study involved 2,816 people. Their sleep was evaluated during an overnight sleep study.

The sleep study results were examined for two types of abnormal heart rhythms: ventricular tachycardia and atrial fibrillation – or AF.

Results show that the overall rate of arrhythmias was low; 62 abnormal heart rhythms occurred in 57 people.

But the relative risk of an abnormal heart rhythm was much higher after a breathing disturbance; people were nearly 18 times more likely to have an arrhythmia after a breathing pause than after normal breathing.

“Do these events act as a trigger for cardiac abnormalities?" study co-author Dr. Susan Redline said to HealthDay News. “We established that there is a close temporal relationship.”

The study also found that abnormal heart rhythms occurred even when OSA was less severe.

“Most of the arrhythmias occurred in people with mild-to-moderate sleep apnea," said Redline.

AF is the most common type of serious arrhythmia; long-term AF can lead to stroke and heart failure. AF is a very fast and irregular contraction of the atria.

The atria are the two upper chambers of the heart. They collect blood as it comes into the heart.

Ventricular tachycardia is a fast, regular beating of the ventricles. These are the two lower heart chambers. They pump blood out of the heart to the lungs and other parts of the body. Ventricular arrhythmias can be very dangerous.

In June the Sleep Education Blog reported on the link between sleep apnea and abnormal heart rhythms in older men.

Find out more about cardiac arrhythmias on the NHLBI Web site. Get help for sleep apnea at an AASM-accredited sleep center near you.

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Infant Sleep Apnea

Obstructive sleep apnea is common in adults; OSA also occurs in children, especially in preschoolers. Central sleep apnea is most common in middle-aged and older adults. But did you know that infants can have sleep apnea too?

Primary sleep apnea of infancy is most common in small, preterm infants; it is rare in full-term newborns.

During the first month after birth it may occur in about 84 percent of infants who weigh less than 2.2 pounds. The risk decreases to about 25 percent for infants who weigh less than 5.5 pounds.

Apneas that occur in larger premature infants and full-term infants tend to be “central” apneas. These apneas occur when the body decreases or stops its effort to breathe.

The majority of apneas that occur in small, premature infants are “mixed” apneas. These breathing pauses involve an obstructive apnea that directly follows a central apnea.

An obstructive apnea involves a halt in airflow despite an ongoing effort to breathe. It occurs when soft tissue in the back of the throat collapses and blocks the upper airway.

Primary sleep apnea of infancy may be a developmental problem; it may be related to the immaturity of the brain.

It also may be caused or made worse by a variety of medical problems. These include anemia, an infection, acid reflux and chronic lung disease.

In most cases short-term treatment is required. The good news is that primary sleep apnea of infancy tends to go away as the child grows and matures. Long-term complications are rare for most children with primary sleep apnea of infancy.

Learn more about primary sleep apnea of infancy on SleepEducation.com.

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To Sleep, Perchance to Dream: Or Stroll or Snack...

Former "American Idol" judge Paula Abdul told Fox News that while they were living together, her former co-star Kara DioGuardi suffered from sleep eating and sleepwalking.

Sleepwalking is typically seen as a childhood problem. While it is more common in children (as many as 17 percent of children sleepwalk), up to four percent of adults sleepwalk as well.

Sleepwalking, also known as somnambulism, tends to occur during slow-wave sleep, or when you aren’t dreaming. It is difficult to wake a sleepwalker. Sometimes they wake themselves. Other times they go back to bed, not knowing they ever got up.

Most people naturally outgrow sleepwalking. Those who wake up and find themselves in dangerous or embarrassing situations, however, may need treatment.

Sometimes sleepwalking is harmless. You may wake up somewhere other than your bed and wonder how you got there. It can also be dangerous. Children can fall down stairs and adults might even try to drive!

DioGuardi’s problem, sleep related eating disorder, is unusual. But like other eating disorders, it is much more common in women than in men.

People with SRED often prepare and eat food with no recollection of doing so. They may gain weight. Eventually they can even develop type 2 diabetes.

Sleep eating tends to occur in people with histories of alcoholism, drug abuse and other sleep disorders. People with high levels of stress and anxiety may also find themselves snacking in their sleep.

DioGuardi admits that in the past she had an eating disorder and has received professional help to overcome it.

Visit an AASM-accredited sleep disorders center if you suffer from sleepwalking or have an ongoing sleep problem.

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Celtics Getting Sleep for the NBA Season

Boston Celtics head coach Doc Rivers is looking for any advantage that will help his team return to the NBA Finals this year. After winning the 2008 NBA Title, the Celtics were ousted from the 2009 playoffs by the Orlando Magic.

This season the Celtics get All-Star forward Kevin Garnett back from a knee injury. They’re also getting more sleep.

The team is being advised by Harvard sleep researcher Dr. Charles Czeisler. As a result they’re practicing at noon instead of early in the morning. And they’re no longer holding morning shootarounds on game days.

“I think they’re fresh,” Rivers told the Boston Globe. “I think we’ve had better practices.”

The goal is to help the players avoid the sleep deprivation that is rampant in the NBA. The 82-game regular season can be a brutal grind.

Play a late game; fly deep into the night to the next city on the schedule; fight off jet lag for a morning practice. Do it all over again.

As teams criss-cross the country sleep can get lost like checked luggage. That may be one reason why only seven of the 30 NBA teams had a winning record on the road last season.

“What we are trying to do is leverage the power of sleep,’’ said Czeisler. “As pro athletes, they spend so much time trying to practice and master the skills of the game - and sleep turns out to be a very critical part of the process…Teams that take advantage of this can really enhance their play.”

In January the Sleep Education Blog reported that the Portland Trail Blazers were getting help from Czeisler. They had finished the previous season with a mediocre 41-41 record.

The Blazers surged to a tie for first place in their division with a 54-28 record. The turnaround was fueled in part by a seven-game improvement in their road record.

The Celtics hope sleep will be a successful part of their gameplan this year. They’ll get their first test when they open the season against LeBron James and the Cavaliers in Cleveland on Tuesday night.

As for Czeisler, he hopes that we would all get more sleep.

“We are such a sleep-deprived society,’’ Czeisler said. “But the message is beginning to get through, that sleep is important for performance…It’s all about making sleep a priority.”

Learn more about how sleep improves sports performance.

Image by Daniel Go

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Biofeedback to Treat Insomnia

A recent article from Health magazine describes the use of “biofeedback” to treat insomnia.

What’s biofeedback? It’s a form of therapy that gives you visual or auditory feedback for certain body signals.

Cues may give you details about your heart rate, blood pressure, breathing or body temperature. Then you learn to control the body in a way that promotes sleep.

Author Leslie Goldman describes how for eight years she struggled with sleep. Then she gave biofeedback a try.

“The change has been dramatic,” she writes. “After nearly a decade of sleeping for no longer than two hours at a time, I can sleep for four hours straight and doze off again after I wake up.”

The AASM recommends biofeedback as an effective treatment for chronic insomnia.

Often biofeedback will be combined with other treatment methods. This is called cognitive behavioral therapy, or CBT.

CBT is a safe and effective treatment option for people who are struggling with ongoing insomnia. It uses a variety of methods to help you develop positive attitudes and habits that promote a healthy pattern of sleep.

Learn more about how CBT for insomnia is safe and effective. Get help for insomnia at an AASM-accredited sleep disorders center near you.

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Sleep Deprivation: A Memory-Enhancing Drug?

Researchers report that they have identified the molecular mechanism by which sleep deprivation causes memory problems. They also suggest that drug treatment may be able to prevent the cognitive effects of sleep deprivation.

Their letter was published today in the journal Nature.

“Millions of people around the world suffer from a lack of sleep,” study co-author George S. Baillie said in a University of Glasgow news release. “This research opens the door for effective treatment of the memory loss associated with this debilitating condition."

The research team studied mice that had been deprived of sleep for five hours, reports NatureNews. They detected increased levels and activity of the “PDE4” enzyme in sleepy mice.

Then they treated sleep-deprived mice with the drug rolipram. It is a PDE4 inhibitor. The treatment prevented memory deficits that normally would have appeared after sleep deprivation.

Study co-author Christopher G. Vecsey cautioned that drugs like rolipram do have side effects. He also said that the study targets only one of the negative effects that sleep deprivation can have on the brain.

Study co-author Miles D. Houslay noted that sleep deprivation has many causes.

“People suffer sleep loss not only from disease but also jet lag, looking after young babies, getting old and through types of lifestyle,” he said. “This discovery offers hope for a simple and effective treatment.”

But sleep specialist Dr. Neil Stanley expressed concerns about the potential treatment. He worries that some people may take a drug for sleep loss when lifestyle changes would be a better solution.

“We really need to be thinking about ways to achieve adequate sleep in the first place - not how to deal with the consequences," Stanley told BBC News.

"We are always going to need drugs for people with serious disorders,” Stanley added. “But we don't want to end up medicalising lifestyles. We need to go back to basics and think about the way we as a society lead our lives, and the impact this has on our sleep, rather than looking for a cure."

In March the Sleep Education Blog reported on concerns that many healthy people are taking some medications as “smart drugs.” Learn more about sleep deprivation, and sleep and memory.

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Sleep Related Leg Cramps

You wake during the night with an intense feeling of pain in your leg or foot. A muscle suddenly contracted and tightened.

The pain may last for a few seconds or several minutes. Then it ends as suddenly as it began.

This describes a typical episode of a sleep related leg cramp. These leg cramps can be disruptive to your sleep. Lingering soreness from a leg cramp also can make it hard for you to go back to sleep.

Sleep related leg cramps are most common in older adults. They also occur frequently in pregnant women.

You may be more likely to have leg cramps if you have diabetes. They also may be more likely to occur if you are dehydrated.

You may be able to relieve the pain by stretching the affected muscle. Massaging the muscle also may help.

Regular exercise may help prevent sleep related leg cramps; this exercise should include stretching the leg muscles.

The drug quinine has been used to treat leg cramps. But in 2006 the FDA cautioned consumers about serious safety concerns and risks related to the drug.

“Because of the drug's risks, FDA believes it should not be used to prevent or treat leg cramps,” said a FDA news release.

Learn more about sleep related leg cramps on SleepEducation.com.

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Sleepless in Brazil

A new study shows that Americans aren’t the only people who have sleep problems. The study surveyed Brazilian adults about their sleep complaints. The results were published last week in the Journal of Clinical Sleep Medicine.

The study involved a random sample of 2,110 adults from 150 cities in Brazil. Surveys were conducted during face-to-face interviews.

Results show that 63 percent of people had at least one sleep complaint. Sleep problems significantly increased with age. Insomnia and nightmares were more common in women; snoring was more common in men.

Insomnia was the most common complaint overall; it was reported by 33 percent of people. Twenty-nine percent of people reported having a problem with snoring.

Nightmares were reported by 22 percent of people. Twelve percent reported having a problem with “kicking legs.” This could be a sign of either restless legs syndrome or periodic limb movements.

Six percent of people complained of “breathing pauses” during sleep. This is a sign of obstructive sleep apnea.

The authors estimate that more than 79 million people in Brazil have sleep disorder complaints.

Image by Kaysha

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Positional Therapy: Sleep Apnea & the Tennis Ball Technique

A new study from Australia examined long-term compliance with the tennis ball technique in people with obstructive sleep apnea. The results were published in the Journal of Clinical Sleep Medicine.

What is the tennis ball technique? It is a simple method of positional therapy that helps you avoid sleeping on your back. It was first introduced in the early 1980s.

A tennis ball is fastened to the back with a belt or strap. This makes sleeping on your back uncomfortable.

Soft tissue in the throat is less likely to collapse and block the airway when you sleep on your side. As a result positional therapy may help reduce the breathing pauses that occur when you have OSA.

The study involved 67 people with OSA, mostly men. They were overweight and had an average age of 60 years.

They had an overall apnea-hypopnea index of 29.6 breathing pauses per hour of sleep; an AHI of 15 to 30 is considered “moderate” sleep apnea. Their average AHI soared to 53 when sleeping on their back; it dropped to 14.1 when side sleeping.

They were instructed to use the tennis ball technique. Then they were followed up after an average of 2.5 years.

Results show that only four people reported that they were still using the technique. Nine people claimed that they had learned to avoid sleeping on their back.

The primary complaint was that the technique was too uncomfortable. Another common complaint was that the tennis ball moved around. Some people said the technique was ineffective. Others reported that it caused backache.

A similar study in 2006 followed up 50 people after six months. Nineteen people were still using the technique; 12 said that they had learned to avoid back sleeping.

Other variations of the technique have been used. These include a backpack with a foam ball inside, a vest that contains a piece of hard foam, a thoracic anti-supine band, a triangular pillow, and a posture alarm.

The AASM reports that positional therapy can be an effective treatment option. But some people with OSA will continue to have breathing pauses while side sleeping. Talk to your sleep specialist to see if positional therapy is a good option for you.

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

Image by Tiffany

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Use Bedtime Routines and Relaxation Techniques to Sleep Better

A new study in the Journal of Clinical Sleep Medicine examines the strategies people use to reduce daytime sleepiness.

Taking a bath was the most common sleep management practice for both men and women; 59 percent of men and 64.4 percent of women used it. Keeping a regular sleep schedule was the second most popular tactic.

People also wound down for the night by listening to music, snacking and exercising.

The results show that taking a bath and going to bed at the same time every night were the best ways to decrease daytime sleepiness. Snacking at night made people feel sleepier the next day.

One of the study’s authors said that culture influences the way people manage their sleep.

The study, conducted in Japan, includes data from 24,686 adults who completed a national health survey.

Don’t worry if you have a few sleepless nights. It is common to suffer from occasional bouts of insomnia. Stress, irregular sleep patterns and pain can cause you to lose sleep for short periods of time. This is known as adjustment insomnia. Once the problem is resolved sleep usually returns to normal.

What are some healthy ways to get better sleep?

The AASM recommends:

• Go to bed at a regular time each night.


• Wake up at the same time each night, even on weekends.


• Avoid naps if you can during the day.


• Don’t drink caffeine in the afternoon.

Find more tips about good sleep hygiene at Sleep Education.com.

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

Image by Laura Taylor

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