Monday, March 27, 2006

Sleep Chat

A reader posted this comment about a live web chat about sleep: Thought you all might like to know the WebMD sleep expert, Dr. Michael Breus, is going be hosting a live web chat on Saturday night (April 1) for two hours beginning at 11:30pm EST. He's going to answer sleep-related questions in a chat room on Apparently, this all part of Carpenter CO. National Sleep Better Night.

Wednesday, March 22, 2006

Update on the Relationship between Sleep and Metabolism

The Relationship between Sleep and Metabolism

Karine Spiegel, PhD, and colleagues published an article in the December 7, 2004 issue of the Annuals of Internal Medicine that suggests that sleep restriction can lead to weight gain. They found that sleep restriction (4 hrs /night) leads to decreased levels of the hormone Leptin and increased levels of Ghrelin, another hormone. The alteration of the levels of these appetite and energy regulating hormones was associated with increased hunger and appetite in the study. This study adds to the evidence linking insufficient sleep to obesity.

More recently, Dr. Henry Klar Yaggi and colleagues reported on a 15-year study that examined the association between sleep duration and the risk of developing type 2 diabetes mellitus. The prospective observational Massachusetts Male Aging Study found that men reporting short sleep duration (6 or less hours per night) and men reporting long sleep duration (more than 8 hours per night) were at significantly increased risk for developing diabetes compared to those getting 7-8 hours of sleep.

Insufficient nocturnal sleep can be caused by either a sleep disorder or voluntary sleep deprivation. Excessive sleep is usually caused by an underlying sleep disorder. Abnormal nocturnal sleep durations have been linked with obesity, impaired glucose tolerance, and diabetes mellitus.

It is important for physicians to counsel their overweight and obese patients to allow for 8 hours of sleep per night. Since obstructive sleep apnea is both a cause and consequence of obesity, practitioners should screen their obese patients for this common disorder. Useful symptoms to ask about include snoring, prolonged sleep duration, frequent nocturnal awakenings, and excessive daytime sleepiness.

Ambien and Sleepwalking

The American College of Physicians reports:
Widely prescribed sleep aid prompts complaints of sleepwalking
A widely used sleep aid has sparked concerns about sleepwalking and other unusual behaviors among people prescribed the drug.
Cases of sleepwalking related to use of zolpidem tartrate (Sanofi-Aventis’s Ambien) have been reported in medical journals and by sleep experts, said the March 14 Washington Post. Some patients also have reported evidence of nocturnal eating after taking the drug, the article said, and of having no memory of those incidents when they awake.
The drug, which accounted for more than 24 million prescriptions in 2004, has prompted more sleepwalking reports to the FDA than all other sleep medications combined, said the Washington Post. In addition, five cases were reported in a 2002 edition of the journal Sleep Medicine while researchers at the Minnesota Regional Sleep Disorders Center reported 19 cases at a medical conference last year.
The drug’s label acknowledges somnambulism as a rare but potential side effect, along with other potential central nervous system effects, that have been reported in fewer than one in 1,000 patients, said the article. Zolpidem tartrate is among a group of newer sleep aids that are considered safer and less addictive than older drugs, the Washington Post reported, adding that the FDA did not raise questions about the side effects before approving the drug in 1993.
The FDA adverse event report databases show that 207 somnambulism reports were made between 1997 and June 2005, said the Washington Post. Most physicians reporting the episodes listed the cause as unknown but 48 linked them to zolpidem tartrate. By comparison, there were 18 reports filed about benzodiazepines, an older class of sleep aids that includes six drugs.
The Washington Post is

Monday, March 20, 2006

More Psychiatrists are going into Sleep Medicine

Psychiatric News reports that psychiatrists are becoming increasingly attracted to a career in sleep medicine:
A woman hospitalized for treatment of her mood disorder snored so loudly that other patients complained. A sleep study showed she had severe obstructive sleep apnea.
After using a continuous positive airway pressure (CPAP) device that delivers air via a mask worn in sleep, she felt more focused and alert. "Her mood improved, and we were able to make greater inroads into her psychiatric problems," related William Clemons, M.D., then a resident in psychiatry at West Virginia University in Morgantown.
The contribution of a previously unrecognized sleep disorder to the woman's psychiatric illness proved a signal event for Clemons. He pursued a sleep-medicine fellowship at the University of Michigan, completing the one-year program in 2004. He now practices sleep medicine at the Baptist Sleep Institute in Knoxville, Tenn.

"We are seeing an explosion of interest in sleep medicine as a career option for psychiatrists," said Michael Sateia, M.D., a professor of psychiatry and chief of sleep medicine at Dartmouth Medical School. This interest is reflected in the American Board of Medical Specialties' (ABMS) approval last year of sleep medicine as a subspecialty for physicians practicing psychiatry, neurology, internal medicine, and pediatrics, he noted. ABMS recently added otolaryngology to the list.
Starting in 2007, the American Board of Internal Medicine will administer the sleep-medicine board exam, with certification conferred by boards overseeing the specialties listed above. The exam formerly was given by the American Board of Sleep Medicine.
"The new exam acknowledges that sleep medicine involves a sufficient body of knowledge and skill sets to qualify as an independent medical subspecialty," said Lawrence Epstein, M.D., president of the American Academy of Sleep Medicine (AASM) and regional medical director for Sleep HealthCenters in Boston.
The Accreditation Council for Graduate Medical Education (ACGME) has approved 24 sleep-medicine fellowships nationwide. ACGME recognition means that funding for fellowships is available from the Centers for Medicare and Medicaid Services. Fellowships typically provide an annual stipend of about $60,000.

Allen Richert, M.D., the psychiatry residency training director at the University of Mississippi Medical Center, thinks sleep medicine education belongs in the psychiatry residency.
"Sleep disorders and sleep deprivation contribute to depressed mood, irritability, attention deficits, and sleepiness," he said. "Psychiatrists need experience with hypnotic medications and cognitive behavioral therapy for insomnia."
Patients with sleep disorders benefit from a psychiatric perspective, he added. "Psychiatrists understand how patients' emotions drive behavior."

Psychiatrists interested in sleep medicine should contact their local sleep disorders centers, suggested Daniel Buysse, M.D., a professor of psychiatry at the University of Pittsburgh School of Medicine. "Many centers are looking for more input from psychiatrists to help them manage patients with sleep disorders and psychiatric comorbidity."

Friday, March 03, 2006

Practice Parameters for BiPAP and CPAP

The American Academy of Sleep Medicine has issued "Practice Parameters for the Use of Continuous and Bilevel Positive Airway Pressure Devices to Treat Adult Patients With Sleep-Related Breathing Disorders"; here is the abstract:
Positive airway pressure (PAP) devices are used to treat patients with sleep related breathing disorders (SRBD) including obstructive sleep apnea (OSA). Currently, PAP devices come in three forms: (1) continuous positive airway pressure (CPAP), (2) bilevel positive airway pressure (BPAP), and (3) automatic self-adjusting positive airway pressure (APAP). After a patient is diagnosed with OSA, the current standard of practice involves performing full, attended polysomnography during which positive pressure is adjusted to determine optimal pressure for maintaining airway patency. This titration is used to find a fixed single pressure for subsequent nightly usage. A task force of the Standards of Practice Committee of the American Academy of Sleep Medicine reviewed the available literature. Based on this review, the Standards of Practice Committee developed these practice parameters as a guideline for using CPAP and BPAP appropriately (an earlier review and practice parameters for APAP was published in 2002). Major conclusions and current recommendations are as follows: 1) A diagnosis of OSA must be established by an acceptable method. 2) CPAP is effective for treating OSA. 3) Full-night, attended studies performed in the laboratory are the preferred approach for titration to determine optimal pressure; however, split-night, diagnostic-titration studies are usually adequate. 4) CPAP usage should be monitored objectively to help assure utilization. 5) Initial CPAP follow-up is recommended during the first few weeks to establish utilization pattern and provide remediation if needed. 6) Longer-term follow-up is recommended yearly or as needed to address mask, machine, or usage problems. 7) Heated humidification and a systematic educational program are recommended to improve CPAP utilization.8) Some functional outcomes such as subjective sleepiness improve with positive pressure treatment in patients with OSA. 9) CPAP and BPAP therapy are safe; side effects and adverse events are mainly minor and reversible. 10) BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with hypercapnia.
Recommendation number 7 is significant. This should help patients get insurance reimbursement for having heated humidifiers added to their CPAP machines.

Thursday, March 02, 2006

Sleep Searches

One of my brothers-in-law (David) sent me the following link to the Yahoo Buzz Index:

Concerned by the results of a new poll showing Americans aren't getting the shuteye they should, we decided to get under the covers of sleep searches. We snuggled up close to our top 10 sleep queries...
Sleep Apnea
Sleep Number Bed
Sleep Disorders
Sleep Deprivation
Sleeping Pills
Sleep Paralysis
Sleeper Sofas
Sleep Aids
Sleepwalking Is eight hours of comfortable rest just a dream, or are you spending your sleepy time in a deep REM state? The thought of a nice long snooze got us daydreaming about the top 10 dream searches. Picture, if you will...
Dream Dictionary
Dream Interpretation
Meaning of Dreams
Dream Analysis
Dream Moods
Dream Symbols
Lucid Dreaming
Dream Journal
What Do Dreams Mean
Dream Poems