Sunday, June 24, 2007

No Games Here

This blog has been tagged with a meme. For my response, please see:

Wednesday, June 20, 2007

Sleep Myths

From MSN:
Do we really need eight hours of sleep per night?
Not necessarily, but that’s the average for healthy adults. According to the
National Institutes of Health, when healthy adults are given unlimited opportunity to sleep they are on the pillow eight to eight-and-a-half hours a night. Most sleep experts recommend between seven and nine hours to be at one’s optimum performance mentally and physically.
Do naps help?
If we really believed that life’s most valuable lessons were learned in kindergarten, we’d all be eating more cookies and taking more naps. Our grown-up culture generally frowns on the notion of daytime sleeping, but 15 or 20 minutes of shut-eye can help make up for a sleepless night and provide a freshness and clarity that seldom comes in the last few hours at work. Resting too long or too late in the day, however, can defeat the benefits by leaving the catnapper groggy in the afternoon and sleepless again at night.

Tuesday, June 19, 2007

Circadian Rhythms

USAToday has a nice article today about circadian rhythms, with the final part of the article focusing on the possible role of circadian rhythm disturbance in bipolar disorder:

In people, circadian rhythm disorders can trigger serious problems, notably depression. Seasonally affective disorder is a winter depression tied to a lack of the sunlight cues that trigger the SCN into proper rhythm.
Also, there are indications that bipolar disorder also involves circadian problems, McClung says. This disorder causes unusual shifts in mood and energy, with episodes varying between extremes and afflicting some 5.7 million people nationwide, according to the National Institute of Mental Health. "People might sleep all the time or not sleep at all," says McClung. Body temperatures and hormone levels similarly race, all pointing to a body clock with its springs missing.
At the Cold Harbor conference, McClung presented a mouse engineered to lack a specific clock gene which "looks as close to a bipolar person in a manic state as we can determine in a mouse," she says. The manic mice are hyperactive, sleep little, disregard signs of predators and voraciously consume cocaine.
For medical research, the most intriguing thing about the manic mice is that lithium, which human bipolar patients take to treat their illness, cuts their symptoms. "We don't know why lithium works, and we hope the mouse gives us an opportunity to explore its mechanism," McClung says.
Opening up the mechanism by which clock genes work, or don't work, is the task before scientists today, McClung adds. "Everyone on this planet has a 24-hour internal clock, and it is deeply ingrained in our biology," she says. "If we lived on a different planet, we'd have a different rhythm — that's how fundamental they are."

Another Sleep Blog

At the Annual Sleep Meeting in Minneapolis last week, I met the executive director of the American Sleep Apnea Association. Here is his blog.

Thursday, June 07, 2007

Sleep Apnea and Pregnancy

Sleep Review reports on the adverse effects of sleep apnea during pregnancy:

A study presented last month at the American Thoracic Society 2007 International Conference in San Francisco found that even when controlling for obesity, sleep apnea in the mother increased the risk that diabetes and/or hypertension would develop during the pregnancy.

When the women’s weight was taken into account, sleep apnea was associated with a doubling of the incidence of gestational diabetes and a fourfold increase in the risk of pregnancy-induced hypertension, which includes eclampsia and preeclampsia.

rest of sleep review quote deleted at their request

Treating sleep apnea has reduced the risk of diabetes and hypertension in non-pregnant women, so now research is needed to confirm if this is also true for pregnant women.

There are few studies examining sleep apnea during pregnancy. This study was a large database review; it is very difficult to do a clinical trial involving pregnant women. It would be interesting to perform a controlled trial to see if CPAP improves pregnancy outcomes in women with sleep apnea, but such a trial would never be approved by an IRB board.

Wednesday, June 06, 2007

Adjusting to Sleep Deprivation

A reader asks:
As a fan of your blog, I had a quick question that I was hoping I could get your advice on. I’m a 20 year old male, living in Australia where it’s currently a Wednesday night. On Saturday night I will be attending the final session of a fitness and self protection course I signed up to at college. According to friends of mine who had done the course before, the final session is akin to basic training for army recruits! (Here’s where you come in)

I’ve been told by friends that practically from Saturday night to Sunday lunch time they deprive you of sleep and run you through non stop intense fitness exercises like running, push-ups, sit-ups etc.

What I was thinking of doing was perhaps changing my sleeping pattern so my body will effectively not be missing out on sleep. Let’s say I stayed up tomorrow night (Thursday night), slept all of Friday, stayed up all Friday night, and slept all Saturday - come Saturday night my body will expect to be awake and it won’t be as gruelling – right? Would this be effective? Is this enough time for my body to adjust or would I just be making things worse?

It's too short of a time for you to adjust your biological clock- the body is only capable of adjusting 1 hr each day. You are essentially facing 2 problems- 1) sleep deprivation and 2) circadian rhythm dysfunction (you will be expected to be active during a time when your body expects you to be asleep).
I recommend that you keep your normal sleep schedule and then try to take a 2-3 hour nap right before your final course begins. If allowed during your course, caffeine and Provigil would be helpful. Bright light exposure during your course, if possible, would also be helpful.
Hope this helps
Michael Rack, MD

Tuesday, June 05, 2007

Saturday, June 02, 2007

Treatment of Alcohol-related sleep disorders

The following is from an article I wrote for Medlink Neurology on "Sleep disorders associated with alcohol use and abuse." It is copyrighted by Medlink Neurology:

For the sleep disorders occurring during alcohol intake, cessation of alcohol use is often the only necessary treatment. Treatment of the sleep apnea exacerbated by alcohol requires avoidance of alcohol intake at least for 4 hours to 6 hours before going to bed. If the apnea does not resolve with alcohol cessation, then standard treatments for obstructive sleep apnea, such as nasal continuous positive airway pressure, are required. The hypersomnia that can occur with alcohol use is usually eliminated after 1 day or 2 days without alcohol, but insomnia may actually worsen for the first 2 weeks to 7 weeks off alcohol. It is important not to restart the alcohol even at a low dose to ameliorate this problem; similarly, use of hypnotics is contraindicated because of the cross-tolerance with alcohol and the potential for both abuse and dependence. Sedating antihistamines or low doses of sedating antidepressants can be used for temporary relief when insomnia episodes are particularly severe. Patients should be reassured that in most cases the insomnia gradually gets better.
Behavioral treatments for insomnia with good sleep hygiene, relaxation training, desensitization, or sleep restriction should be used during the withdrawal period. If evidence develops for depression then a sedating antidepressant (eg, amitriptyline or mirtazapine) may be helpful for both sleep and depression.
As mentioned above, sleep abnormalities in alcoholics can persist for several years after alcohol cessation; this sleep disturbance may contribute to relapse of alcoholism. Various medications and psychotherapy techniques have been used to treat this sleep disturbance. Gabapentin, at doses of 300 mg to 1800 mg at bedtime, is useful in treating insomnia in abstinent alcohol-dependent outpatients and appears to be more effective than trazodone (Karam-Hage and Brower 2003). Although quetiapine is of potential benefit for this condition (Monnelly et al 2004; Sattar et al 2004), the risk of tardive dyskinesia and metabolic abnormalities associated with the use of atypical antipsychotics suggests that they should be used cautiously, if at all, for insomnia. Cognitive-behavioral treatments, including stimulus control, sleep restriction, and cognitive restructuring, have been shown to improve subjective sleep quality in recovering alcoholics (Currie et al 2004).
The melatonin receptor agonist Ramelteon (Rozerem-Takeda) is an option for treating insomnia in recovering alcoholics, though controlled trials are lacking. Ramelteon is not a controlled substance, and has essentially no abuse liability (Anonymous 2005; Griffiths and Johnson 2005). It is approved for the treatment of insomnia characterized by difficulty with sleep onset (Laustsen and Andersen 2006). The standard dose is 8 mg, taken within 30 minutes of going to bed. It is metabolized by cytochrome p450 enzyme 1A2 but does not appear to inhibit or induce this enzyme (Laustsen and Andersen 2006). It should not be used in combination with fluvoxamine, a strong 1A2 inhibitor (Takeda Pharmaceuticals 2005).
Acamprosate (Campral- Forest Pharmaceuticals) is a glutamate modulator that is FDA-approved for the maintenance of abstinence from alcohol in patients with alcohol dependence who are abstinent at treatment initiation (Forest Pharmaceuticals 2005). A recent parallel double-blind placebo-controlled study found that acamprosate improved sleep quality during early abstinence (Staner et al 2006).

disclaimer: this is not the final edited version that will appear in Medlink Neurology. I encourage you to check out the website for Medlink Neurology for the full version of this article as well as numerous other articles about sleep (a few written by me).