Insomnia & Sleep Disorders

Survey: Stress, Anxiety And Pain Disturb Americans' Sleep

Insomnia News | 06 June 2013

If you suspect you’re not getting enough sleep, you’re probably right: A new survey says 83% of Americans don’t get a good night’s sleep on a consistent basis.

Why not? Stress and anxiety were cited as the top reason by 48% of the 1,008 adults interviewed by the polling firm Harris Interactive. In addition, 47% of those surveyed said they simply weren’t able to turn off their thoughts.

Among other culprits:

* 38% of Americans said pain interfered with their ability to catch the necessary ZZZZs.

* 32% said they were too overtired to rest.

* 23% blamed background noise.

* 23% chalked up their lack of sleep to children or pets.

* 18% said they had breathing problems that kept them from sleeping soundly.

* 17% said their spouses or significant others were to blame.

Overall, women (88%) were more likely than men (78%) to report sleep deprivation or sleep disorders, the survey found.

People in households with a total income of less than $35,000 a year were also more likely than those in households that earned more than $100,000 a year to say they had sleep problems – 55% of low-income adults blamed stress and anxiety for poor sleep, and 45% of them said pain kept them up at night. (Among high-income adults, those figures were 41% and 31%, respectively.)

However, people in those income groups were equally likely to have their sleep interrupted by their children, pets or their own thoughts, the survey found.

Can You Make Up for Lost Sleep?

Insomnia News | 26 May 2013

Getting eight hours of shut-eye each night is generally recommended, but many people don't. As the week rolls from Monday to Friday, they accumulate a sleep debt. Spending a few extra hours in bed on a Saturday morning, people assume, will help them "catch up" on lost sleep. They're likely right. "Nobody knows how long the horizon is, probably a few nights, but studies show that recovery sleep in the short term does work," says Dr. Winter, a member of the American Academy of Sleep Medicine. "But the all-nighters I pulled in my residency 15 years ago? That's gone."

Sleep Banking

Recent data suggests that banking sleep in advance of a long night can actually offset upcoming sleep deprivation. "If you knew you were going to give birth on a particular day, for example, you could sleep for 10 hours a day for multiple days before the event, and be fine," he says. Just plan ahead.

'Social Jet Lag'

Experts refer to the effects of changing sleep habits from weekdays to weekends as "social jet lag." When you've revved up until midnight for five nights and then recover sleep until noon on Saturday, the body is confused. "It's like you've traveled six time zones, and you feel terrible," says Dr. Winter. While many sleep extenders complain of grogginess and dull headaches, subjectively they are better at performing tasks: "I would much rather be in the passenger seat with [a driver] who's made up the sleep than someone who's simply sleep deprived." That just-woken-up daze? It passes in a few minutes, but the benefits of extra sleep last for hours, he says.

Routine Naps

A scheduled nap is healthier than catching up on or banking sleep. "Because sleep extension can make you feel groggy, I always recommend a short nap, at the same time, every day," if a person feels they need it, says Dr. Winter. He adds that 25 minutes is ideal. He tracks his alphawaves and sleep quality with a Zeo device, and sets his Sound Oasis machine to wake him after 25 minutes. "When you schedule a short nap, your body anticipates it and slows down, without falling into a deep dream sleep," he says. That refreshing, scheduled break is better than an occasional, disruptive weekend lie-in. "The body likes routine," he says. "When it's prepared, it works more efficiently."

Sleep Types

There is some evidence to suggest that young people are more likely than older people to bounce back from long nights through recovery sleep, as the ability to shrug off deprivation wanes with age, says Dr. Winter. The effects of recovery may also have a lot to do with chronotype, which is genetic, and refers to whether you're a day person (lark) or night person (owl). (Most people fall somewhere in between.) "If you're a night owl, you may do better than a morning person with an unusual schedule, so sleep-extending can be a great tool," he says. A sleep binge is a less effective option for true morning people, who may not be able to sleep much past dawn.

Insomnia and Suicide

Insomnia News | 20 May 2013

A new study found a relationship between sleep duration and suicidal thoughts in people with insomnia.

Results show that every one-hour increase in sleep duration was associated with a 72 percent decrease in the likelihood of moderate or high suicide risk, in comparison with low risk. Data were adjusted for age, gender, race/ethnicity, education and age of onset of sleep difficulties.

“We were surprised by the strength of the association between sleep duration and suicide risk,” said primary author Linden Oliver, MA, clinical research coordinator for the University of Pennsylvania Behavioral Sleep Medicine Research Program in Philadelphia, Pa. “A 72 percent decrease in the likelihood of moderate or high suicide risk with a one-hour increase in sleep is interesting given the small sample size.”

The research abstract was published recently in an online supplement of the journal SLEEP, and Oliver will present the findings Tuesday, June 4, in Baltimore, Md., at SLEEP 2013, the 27th annual meeting of the Associated Professional Sleep Societies LLC.

Data from two studies of insomnia were merged for the present analysis. Of the 471 total subjects, 73 indicated suicide risk using the Mini International Neuropsychiatric Interview; 55 were classified as low suicide risk and 18 were classified as moderate or high risk. Subjects without any suicide risk were excluded, as the parent studies were still enrolling subjects

According to the authors, sleep loss is associated with depression, executive dysfunction and poor decision making.  However, few studies have investigated the role of short sleep duration in suicidal ideation.

“These results further highlight the importance of obtaining adequate amounts of sleep,” said Oliver.

The American Academy of Sleep Medicine reports that about 10 to 15 percent of adults have an insomnia disorder with distress or daytime impairment.  According to the CDC, suicide is the 10th leading cause of death in the U.S., accounting for more than 38,000 deaths each year.

Prolonged Fatigue and Mood Disorders Among Teens

Insomnia News | 06 May 2013

Research suggests that poor sleep during adolescence can have “lasting consequences” on the brain. Now a new study offers additional insights into the negative health effects of sleep deprivation on teens’ health.

In the study, researchers analyzed data collected from more than 10,000 adolescents as part of the National Comorbidity Survey Adolescent Supplement.  As MedPage Today reports, their findings show that prolonged fatigue is associated with mood and anxiety disorders among teens:

In a nationally representative sample of adolescents ages 13 to 18, 3% reported having extreme fatigue lasting at least 3 months and about half of those who did also had mood or anxiety disorders, according to Kathleen Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues.

Having both prolonged fatigue and a mood or anxiety disorder was associated with poorer physical and mental health and greater use of healthcare services compared with having only one of the disorders, the researchers reported online in the American Journal of Psychiatry.

“This suggests that the presence of fatigue may be used in clinical practice as an indicator of a more severe depressive or anxiety disorder,” Merikangas and colleagues wrote.

Stanford physician Michelle Primeau, MD, recently explored the topic of how teen sleep habits affect mood in a recent Stanford Center for Sleep Sciences and Medicine blog entry on the Huffington Post. In her post, she explains why teens in particular are at risk of chronic partial sleep deprivation:

Teenagers need to sleep about nine hours, and as they get older, they tend to sleep less. This is not because they need less, but because they are busier with school, jobs, extracurricular activities, and friends. Their biology also will often shift so that they tend to fall asleep later and want to sleep in later, an occurrence that may represent delayed sleep phase syndrome. This may explains why your teenager is so hard to wake up on Saturdays. But this shift to a later bedtime, both of social and biologic causes, in combination with fixed early school times, means that many teenagers are walking around sleep deprived.

Happy People Sleep Better

Insomnia News | 30 April 2013

Want a good night’s sleep? Be positive – consistently. Although happiness is generally good for sleeping, when a person’s happiness varies a lot in reaction to daily ups and downs, sleep suffers, reports a Cornell study published online in the Annals of Behavioral Medicine.

The researchers analyzed data from 100 middle-aged participants in a longitudinal study of midlife in the United States that included telephone interviews about participants’ daily experience as well as subjective and objective measures of sleeping habits. The study looked at the overall levels of positive emotion that the participants experienced in their lives – those associated with more stable personality traits, as well as daily fluctuations in positive emotions in reaction to daily events.

The team found that, as expected, having a more positive general outlook on life was associated with improved sleep quality. However, they found that the more reactive or fragile a participant’s positive emotions were in relation to external events, the more their sleep was impaired, especially for individuals high in positivity to begin with.

“Previous research suggests that the experience of joy and happiness may slow down the effects of aging by fortifying health-enhancing behaviors such as restorative sleep,” said first author Anthony Ong, associate professor of human development in the College of Human Ecology. “Our study extends this research by showing that whereas possessing relatively stable high levels of positive emotion may be conducive to improved sleep, unstable highly positive feelings may be associated with poor sleep because such emotions are subject to the vicissitudes of daily influences.” Ong added, “These findings are novel because they point to the complex dynamics associated with fragile happiness and sleep that until now have been largely attributed to unhappy people.”

Ong co-authored the study, “Linking stable and dynamic features of positive affect to sleep,” with Deinera Exner-Cortens and Catherine Riffin, Cornell graduate students; Andrew Steptoe, University of London; Alex Zautra, Arizona State University; and David Almeida, Penn State University.

The research was funded in part by the National Institutes of Health and the Canadian Institutes of Health Research.

Reactivating Memories During Sleep

Insomnia News | 23 April 2013

Why do some memories last a lifetime while others disappear quickly? A new study suggests that memories rehearsed, during either sleep or waking, can have an impact on memory consolidation and on what is remembered later.

The new Northwestern University study shows that when the information that makes up a memory has a high value (associated with, for example, making more money), the memory is more likely to be rehearsed and consolidated during sleep and, thus, be remembered later.

Also, through the use of a direct manipulation of sleep, the research demonstrated a way to encourage the reactivation of low-value memories so they too were remembered later.

Delphine Oudiette, a postdoctoral fellow in the department of psychology at Northwestern and lead author of the study, designed the experiment to study how participants remembered locations of objects on a computer screen. A value assigned to each object informed participants how much money they could make if they remembered it later on the test.

“The pay-off was much higher for some of the objects than for others,” explained Ken Paller, professor of psychology at Northwestern and co-author of the study. “In other words, we manipulated the value of the memories -- some were valuable memories and others not so much, just as the things we experience each day vary in the extent to which we’d like to be able to remember them later.”

When each object was shown, it was accompanied by a characteristic sound. For example, a tea kettle would appear with a whistling sound. During both states of wakefulness and sleep, some of the sounds were played alone, quite softly, essentially reminding participants of the low-value items.

Participants remembered the low-value associations better when the sound presentations occurred during sleep.

“We think that what’s happening during sleep is basically the reactivation of that information,” Oudiette said. “We can provoke the reactivation by presenting those sounds, therefore energizing the low-value memories so they get stored better.”

The research poses provocative implications about the role memory reactivation during sleep could play in improving memory storage,” said Paller, director of the Cognitive Neuroscience Program at Northwestern. “Whatever makes you rehearse during sleep is going to determine what you remember later, and conversely, what you’re going to forget.”

Many memories that are stored during the day are not remembered.

“We think one of the reasons for that is that we have to rehearse memories in order to keep them. When you practice and rehearse, you increase the likelihood of later remembering,” Oudiette said. “And a lot of our rehearsal happens when we don’t even realize it -- while we’re asleep.”

Paller said selectivity of memory consolidation is not well understood. Most efforts in memory research have focused on what happens when you first form a memory and on what happens when you retrieve a memory.

“The in-between time is what we want to learn more about, because a fascinating aspect of memory storage is that it is not static,” Paller said. “Memories in our brain are changing all of the time. Sometimes you improve memory storage by rehearsing all the details, so maybe later you remember better -- or maybe worse if you’ve embellished too much. 

“The fact that this critical memory reactivation transpires during sleep has mostly been hidden from us, from humanity, because we don’t realize so much of what’s happening while we’re asleep,” he said.  

“The Role of Memory Reactivation During Wakefulness and Sleep in Determining Which Memories Endure” is published in the current issue of the Journal of Neuroscience. Additional co-authors include James W. Antony and Jessica D. Creery, both doctoral students at Northwestern.

Sleep Study Reveals How The Adolescent Brain Makes The Transition to Mature Thinking

Insomnia News | 22 March 2013

A new study conducted by monitoring the brain waves of sleeping adolescents has found that remarkable changes occur in the brain as it prunes away neuronal connections and makes the major transition from childhood to adulthood.

“We’ve provided the first long-term, longitudinal description of developmental changes that take place in the brains of youngsters as they sleep,” said Irwin Feinberg, professor emeritus of psychiatry and behavioral sciences and director of the UC Davis Sleep Laboratory. “Our outcome confirms that the brain goes through a remarkable amount of reorganization during puberty that is necessary for complex thinking.”

The research, published in the February 15 issue of American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, also confirms that electroencephalogram, or EEG, is a powerful tool for tracking brain changes during different phases of life, and that it could potentially be used to help diagnose age-related mental illnesses. It is the final component in a three-part series of studies carried out over 10 years and involving more than 3,500 all-night EEG recordings. The data provide an overall picture of the brain’s electrical behavior during the first two decades of life.

Feinberg explained that scientists have generally assumed that a vast number of synapses are needed early in life to recover from injury and adapt to changing environments. These multiple connections, however, impair the efficient problem solving and logical thinking required later in life. His study is the first to show how this shift can be detected by measuring the brain’s electrical activity in the same children over the course of time.

Two earlier studies by Feinberg and his colleagues showed that EEG fluctuations during the deepest (delta or slow wave) phase of sleep, when the brain is most recuperative, consistently declined for 9- to 18-year-olds. The most rapid decline occurred between the ages of 12 and 16-1/2. This led the team to conclude that the streamlining of brain activity — or “neuronal pruning" — required for adult cognition occurs together with the timing of reproductive maturity.

Questions remained, though, about electrical activity patterns in the brains of younger children.

For the current study, Feinberg and his research team monitored 28 healthy, sleeping children between the ages of 6 and 10 for two nights every six months. The new findings show that synaptic density in the cerebral cortex reaches its peak at age 8 and then begins a slow decline. The recent findings also confirm that the period of greatest and most accelerated decline occurs between the ages of 12 and 16-1/2 years, at which point the drop markedly slows.

“Discovering that such extensive neuronal remodeling occurs within this 4-1/2 year timeframe during late adolescence and the early teen years confirms our view that the sleep EEG indexes a crucial aspect of the timing of brain development,” said Feinberg.

The latest study also confirms that EEG sleep analysis is a powerful approach for evaluating adolescent brain maturation, according to Feinberg. Besides being a relatively simple, accessible technology for measuring the brain’s electrical activity, it is more accurate than more cumbersome and expensive options.

“Structural MRI, for instance, has not been able to identify the adolescent accelerations and decelerations that are easily and reliably captured by sleep EEG,” said Feinberg. “We hope our data can aid the search for the unknown genetic and hormonal biomarkers that drive those fluctuations. Our data also provide a baseline for seeking errors in brain development that signify the onset of diseases such as schizophrenia, which typically first become apparent during adolescence. Once these underlying processes have been identified, it may become possible to influence adolescent brain changes in ways that promote normal development and correct emerging abnormalities.”

Feinberg’s study, which was funded by the U.S. Public Health Service (grant R01MH062521), was co-authored by Ian Campbell, a project scientist with the UC Davis Department of Psychiatry and Behavioral Sciences.

Sleep Discovery Could Lead to Therapies That Improve Memory

Insomnia News | 18 March 2013

A team of sleep researchers led by UC Riverside psychologist Sara C. Mednick has confirmed the mechanism that enables the brain to consolidate memory and found that a commonly prescribed sleep aid enhances the process. Those discoveries could lead to new sleep therapies that will improve memory for aging adults and those with dementia, Alzheimer's and schizophrenia.

The groundbreaking research appears in a paper, "The Critical Role of Sleep Spindles in Hippocampal-Dependent Memory: A Pharmacology Study," published in theJournal of Neuroscience. 

Earlier research found a correlation between sleep spindles - bursts of brain activity that last for a second or less during a specific stage of sleep - and consolidation of memories that depend on the hippocampus. The hippocampus, part of the cerebral cortex, is important in the consolidation of information from short-term to long-term memory, and spatial navigation. The hippocampus is one of the first regions of the brain damaged by Alzheimer's disease. 

Mednick and her research team demonstrated, for the first time, the critical role that sleep spindles play in consolidating memory in the hippocampus, and they showed that pharmaceuticals could significantly improve that process, far more than sleep alone. 

"We found that a very common sleep drug can be used to increase verbal memory," said Mednick, the lead author of the paper that outlines results of two studies conducted over five years with a $651,999 research grant from the National Institutes of Health. "This is the first study to show you can manipulate sleep to improve memory. It suggests sleep drugs could be a powerful tool to tailor sleep to particular memory disorders." 

A total of 49 men and women between the ages of 18 and 39 who were normal sleepers were given varying doses of zolpidem (Ambien) or sodium oxybate (Xyrem), and a placebo, allowing several days between doses to allow the pharmaceuticals to leave their bodies. Researchers monitored their sleep, measured sleepiness and mood after napping, and used several tests to evaluate their memory. 

The researchers found that zolpidem significantly increased the density of sleep spindles and improved verbal memory consolidation. 

"(P)harmacologically enhancing sleep spindles in healthy adults produces exceptional memory performance beyond that seen with sleep alone or sleep with the comparison drug (sodium oxybate)," the sleep researchers wrote. "... The results set the stage for targeted treatment of memory impairments as well as the possibility of exceptional memory improvement above that of a normal sleep period." 

Mednick said one of the next steps in this line of research is to determine which component of the physical response to Ambien - the amnesia associated with the drug, or something related to a specific aspect of sleep - is responsible for increasing the density of sleep spindles and the resulting consolidation of memory. She also hopes to study the impact of zolpidem on older adults, who experience poor declarative memory and also decreased sleep spindles. Individuals with Alzheimer's, dementia and schizophrenia also experience decreases in sleep spindles. 

"Could we find a dose response, for example, the more Ambien, the more benefit?" she asked. 

Sleep is a very new field of research and its importance is generally not taught in medical schools, Mednick said. 

"We know very little about it," said Mednick, who began studying sleep in the early 2000s with research into how naps benefit perceptual learning. "We do know that it affects behavior, and we know that sleep is integral to a lot of disorders with memory problems. We need to integrate sleep into medical diagnoses and treatment strategies. This research opens up a lot of possibilities."

What predicts distress after episodes of sleep paralysis?

Insomnia News | 05 March 2013

Ever find yourself briefly paralyzed as you're falling asleep or just waking up? It's a phenomenon is called sleep paralysis, and it's often accompanied by vivid sensory or perceptual experiences, which can include complex and disturbing hallucinations and intense fear.

For some people, sleep paralysis is a once-in-a-lifetime experience; for others, it can be a frequent, even nightly, phenomenon.

Researchers James Allan Cheyne and Gordon Pennycook of the University of Waterloo in Canada explore the factors associated with distress after sleep paralysis episodes in a new article published in Clinical Psychological Science, a journal of the Association for Psychological Science.

The researchers used an online survey and follow-up emails to survey 293 people. They measured post-episode distress using a range of items, from post-episode rumination to interference with next-day functioning.

The level of distress following sleep paralysis episodes was associated with features of the sleep paralysis episode itself. For example, the results showed that the more fear people felt during sleep paralysis episodes, the more distress they felt afterward.

The researchers also found that sensory experiences during episodes of sleep paralysis predicted later distress. Feelings of threat and assault — such as sensing a presence in the room, feeling pressure on the chest, having difficulty breathing, or having a feeling of imminent death — were all associated with distress following sleep paralysis episodes. So, too, were vestibular-motor experiences, including feelings of floating or falling and out-of-body experiences.

Cheyne and Pennycook speculate that the sensory experiences that come with episodes of sleep paralysis could exacerbate people's fear, creating a feedback loop that enhances memories of experiences later on.

Post-episode distress was also associated with a number of individual-level factors, including cognitive style, distress sensitivity, and supernatural beliefs about sleep paralysis.

People who held supernatural beliefs about sleep paralysis experiences also experienced greater post-episode distress. Those who had more analytic cognitive styles, on the other hand, experienced comparatively less distress after sleep paralysis episodes.

Taken together, these findings show that both situational factors and individual factors contribute to these common, and often stressful, personal experiences.

These findings are important, the researchers say, because they provide insight into a common experience of distress that is not well understood. Some participants lamented that their experiences of terror following episodes of sleep paralysis were often dismissed by clinicians.

Given that a large percentage of people report some carryover effects on their functioning the next day, sleep paralysis could "make a significant contribution to the billions of dollars, worldwide, in costs associated with accidents, illnesses, and lost productivity associated with sleep disturbances," the researchers note.

Sleeping less than six hours a night skews activity of hundreds of genes

Insomnia News | 26 February 2013

Genes affected by lack of sleep include those governing the immune system, metabolism and the body's response to stress. Getting too little sleep for several nights in a row disrupts hundreds of genes that are essential for good health, including those linked to stress and fighting disease.

Tests on people who slept less than six hours a night for a week revealed substantial changes in the activity of genes that govern the immune system, metabolism, sleep and wake cycles, and the body's response to stress, suggesting that poor sleep could have a broad impact on long-term wellbeing.

The changes, which affected more than 700 genes, may shed light on the biological mechanisms that raise the risk of a host of ailments, including heart disease, diabetes, obesity, stress and depression, in people who get too little sleep.

"The surprise for us was that a relatively modest difference in sleep duration leads to these kinds of changes," said Professor Derk-Jan Dijk, director of the Surrey Sleep Research Centre at Surrey University, who led the study. "It's an indication that sleep disruption or sleep restriction is doing more than just making you tired."

Previous studies have suggested that people who sleep less than five hours a night have a 15% greater risk of death from all causes than people of the same age who get a good night's sleep. In one survey of workers in Britain more than 5% claimed to sleep no more than five hours a night. Another survey published in the US in 2010 found that nearly 30% of people claimed to sleep no more than six hours a night.

Professor Dijk's team asked 14 men and 12 women, all healthy and aged between 23 and 31 years, to live under laboratory conditions at the sleep centre for 12 days. Each volunteer visited the centre on two separate occasions. During one visit, they spent 10 hours a night in bed for a week. In the other, they were allowed only six hours in bed a night. At the end of each week, they were kept awake for a day and night, or around 39 to 41 hours.

Using EEG (electroencephalography) sensors, the scientists found that those on the 10 hours-per-night week slept around 8.5 hours a night, while those limited to six hours in bed each night got on average 5 hours and 42 minutes of sleep.

The time spent asleep had a huge effect on the activity of genes, picked up from blood tests on the volunteers, according to a report in the US journal Proceedings of the National Academy of Sciences. Among the sleep-deprived, the activity of 444 genes was suppressed, while 267 genes were more active than in those who slept for longer.

Changes to genes that control metabolism might trigger or exacerbate conditions such as diabetes or obesity, while disruption to other genes, such as those that govern the body's inflammatory response, might have an impact on heart disease. Further genes that were affected have been linked to stress and ageing.

Sleep loss also had a dramatic effect on genes that govern the body's biological clock, suggesting that poor sleep might trigger a vicious cycle of worsening sleep disruption. The tests showed that people who slept for 8.5 hours a night had around 1,855 genes whose activity rose and fell over a 24-hour cycle. But in the sleep deprived, nearly 400 of these stopped cycling completely. The remainder rose and fell in keeping with the biological clock, but over a much smaller range.

"There is a feedback between what you do to your sleep and how that affects your circadian clock, and that is going to be very important in future investigations," said Dijk.

The researchers did not check how long it took for genes to return to their normal levels of activity in the sleep-deprived volunteers, but they hope to in further studies. Though scores of genes were disrupted in the sleep-deprived, the scientists cannot say whether those changes are a harmless short-term response to poor sleep, a sign of the body adapting to sleep-deprivation, or are potentially harmful to health.

Jim Horne, professor of psychophysiology at Loughborough University's Sleep Research Centre, said: "The potential perils of 'sleep debt' in today's society and the need for 'eight hours of sleep a night' are often overplayed and can cause undue worry. Although this important study seems to support this concern, the participants had their sleep suddenly restricted to an unusually low level, which must have been somewhat stressful.

"We must be careful not to generalise such findings to, say, habitual six-hour sleepers who are happy with their sleep. Besides, sleep can adapt to some change, and should also be judged on its quality, not simply on its total amount."