Silent epidemic? Head injury may be linked to lasting sleep problems

April 27, 2016

Science Daily/American Academy of Neurology

People who have had a traumatic brain injury may still have sleep problems a year and a half after being injured, according to a study. In addition, people with TBI may also be unaware of just how much their sleep is disturbed.

Every year in the United States, 1.7 million people experience a TBI and there is evidence that the rate of TBI is rising worldwide.

"This is the longest prospective and most comprehensive study about sleep quality and TBI to date," said study author Lukas Imbach, MD, of the University Hospital Zurich in Zurich, Switzerland. "We found that the majority of those with TBI, no matter how severe, had long-term sleep disturbances, yet didn't know."

For the study, researchers followed 31 people who had experienced a first TBI for 18 months. The injuries ranged from mild to severe. People with TBI were then compared to a control group of 42 healthy people.

Study participants were asked to report their own sleep behavior and daytime sleepiness. They were also monitored for two weeks with a device worn on the wrist that measures body movement. They also spent a night in a sleep video lab, which measures brain activity, eye movements, muscle activity and heart rhythm. They also took a test for excessive daytime sleepiness, which measures how quickly people fall asleep in a quiet environment during the day.

Researchers found that 67 percent of those with TBI suffered from excessive daytime sleepiness compared to just 19 percent of healthy people. In addition, when they were asked how sleepy they were during the day, those with TBI didn't report feeling any sleepier than those without TBI.

"Excessive daytime sleepiness is associated with public safety hazards such as car accidents, so people with TBI and their doctors should be monitoring for this problem," Imbach said. "The study also shows us that people with TBI may not be able to accurately assess their own sleep problems. Since this is how the sleep quality of many people with TBI is assessed, this may be a concern."

People with mild TBI were just as likely to have sleep problems as people with severe TBI, and the researchers did not find any other health problems that could have contributed to the sleep problems.

Researchers found that those with TBI slept longer, an average of eight hours a night, compared with healthy people who slept an average of seven hours a night.

"This study makes a compelling case that sleep-wake disorders after TBI may represent a silent epidemic," said Imbach. "It raises the question as to whether people with TBI should be referred for sleep studies. But further study is needed before any new recommendations are made or any guidelines are changed."

https://www.sciencedaily.com/releases/2016/04/160427221158.htm

Sleep Disturbances Improve After Retirement

November 2, 2009

Science Daily/American Academy of Sleep Medicine

A new study in the journal Sleep shows that retirement is followed by a sharp decrease in the prevalence of sleep disturbances. Findings suggest that this general improvement in sleep is likely to result from the removal of work-related demands and stress rather than from actual health benefits of retirement.

Results show that the odds of having disturbed sleep in the seven years after retirement were 26 percent lower (adjusted odds ratio of 0.74) than in the seven years before retiring. Sleep disturbance prevalence rates among 14,714 participants fell from 24.2 percent in the last year before retirement to 17.8 percent in the first year after retiring.

The greatest reduction in sleep disturbances was reported by participants with depression or mental fatigue prior to retirement. The postretirement improvement in sleep also was more pronounced in men, management-level workers, employees who reported high psychological job demands, and people who occasionally or consistently worked night shifts.

Results also show that there is a slowly increasing prevalence of sleep disturbances with increasing age, which can be observed both before and after retirement. From the first to the seventh year after retirement, the prevalence of sleep disturbances increased from 17.8 percent to 19.7 percent but remained significantly lower than at any time point prior to retirement.

"We believe these findings are largely applicable in situations where financial incentives not to retire are relatively weak," said Vahtera. "In countries and positions where there is no proper pension level to guarantee financial security beyond working age, however, retirement may be followed by severe stress disturbing sleep even more than before retirement."

http://www.sciencedaily.com/releases/2009/11/091101132537.htm

You're not yourself when you're sleepy

July 17, 2017

Science Daily/Perelman School of Medicine at the University of Pennsylvania

More than a third of Americans don’t get enough sleep, and growing evidence suggests it’s not only taking a toll on their physical health through heart disease, diabetes, stroke, and/or other conditions, but hurting their mental health as well.

According to a recent study led by Postdoctoral FellowIvan Vargas, PhD, in the journal Cognitive Therapy and Research, those who are sleep deprived lose some of their ability to be positive-minded people. That may not sound serious, but medical experts say an inability to think positively is a serious symptom of depression that could be dangerous if left unaddressed. An estimated 16.1 million adults experienced a major depressive episode in 2014.

"In general, we have a tendency to notice positive stimuli in our environment," said Vargas. "We tend to focus on positive things more than anything else, but now we're seeing that sleep deprivation may reverse that bias."

In their study, Vargas and his team took 40 healthy adults, and randomized them to either 28 consecutive hours awake, or a full eight hours of sleep. All participants participated in a computer test measuring their accuracy and response time at identifying happy, sad and neutral faces to assess how they pay attention to positive or negative information.

The team found that those who were acutely sleep deprived were less likely to focus on the happy faces. They didn't necessarily focus more on the negative, but were less likely to focus on the positive. The study may have implications for those experiencing depression and/or anxiety.

There are many symptoms of depression -- including feeling sad and no longer being able to enjoy things you typically would, but poor sleep is associated with a particularly serious sign of the condition.

"Depression is typically characterized as the tendency to think and feel more negatively or sad, but more than that, depression is associated with feeling less positive, less able to feel happy," Vargas says, "Similarly, if you don't get enough sleep, it reduces your ability to attend to positive things, which over time may confer risk for depression."

Interestingly enough, in the present study, those with a history of insomnia symptoms were less sensitive to the effects of the sleep loss. The authors believe this might be because those with a history of insomnia symptoms have more experience being in sleep-deprived conditions and have developed coping methods to modulate the effect of sleep loss.

Vargas and colleagues recently presented a related study at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC, on the association of insomnia and suicide, finding that people who suffer from insomnia are three times more likely to report thoughts of suicide and death during the past 30 days than those without the condition.

The study comes amid a growing body of knowledge associating sleep disorders and depression. For example, ongoing research presented this year at SLEEP 2017 from a multi-center NIH-sponsored "Treatment of Insomnia and Depression" study (abstract 0335 here) suggests that cognitive-behavioral therapy for insomnia (CBT-I) may help achieve depression remission in those suffering from both depression and insomnia who sleep at least 7 hours each night. (A clinical practice guideline published in 2016 in Annals of Internal Medicine recommends CBT-I (not sleep medications) as the initial treatment for chronic insomnia.

Additionally, a new study in the journal Child Development furthers our understanding of the connection between late night cell phone use, mental health, and disrupted sleep, finding that using a cell phone at night can increase depression in teenagers and lower their self-esteem.

https://www.sciencedaily.com/releases/2017/07/170717120048.htm

Purpose in life by day linked to better sleep at night

Older adults whose lives have meaning enjoy better sleep quality, less sleep apnea, restless leg syndrome

July 10, 2017

Science Daily/Northwestern University

Having a purpose in life means you are more likely to sleep better at night with less sleep apnea and restless leg syndrome, reports a new study. Cultivating a purpose in life could be drug-free strategy to improve sleep, scientists said. The study participants were older adults -- who tend to have more insomnia and sleep disturbances -- but researchers said the findings are likely applicable to the broader public.

Having a good reason to get out of bed in the morning means you are more likely to sleep better at night with less sleep apnea and restless leg syndrome, reports a new Northwestern Medicine and Rush University Medical Center study based on older adults.

This is the first study to show having a purpose in life specifically results in fewer sleep disturbances and improved sleep quality and over a long period of time. Previous research showed having a purpose in life generally improves overall sleep when measured at a single point in time.

Although the participants in the study were older, researchers said the findings are likely applicable to the broader public.

"Helping people cultivate a purpose in life could be an effective drug-free strategy to improve sleep quality, particularly for a population that is facing more insomnia," said senior author Jason Ong, an associate professor of neurology at Northwestern University Feinberg School of Medicine. "Purpose in life is something that can be cultivated and enhanced through mindfulness therapies."

The paper will be published in the journal Sleep Science and Practice.

Individuals have more sleep disturbances and insomnia as they get older. Clinicians prefer to use non-drug interventions to improve patients' sleep, a practice now recommended by the American College of Physicians as a first line treatment for insomnia, Ong said.

The next step in the research should be to study the use of mindfulness-based therapies to target purpose in life and resulting sleep quality, said Arlener Turner, the study's first author and a former postdoctoral fellow in neurology at Feinberg.

The 823 participants -- non-demented individuals 60 to 100 years old with an average age of 79 -- were from two cohorts at Rush University Medical Center. More than half were African American and 77 percent were female.

People who felt their lives had meaning were 63 percent less likely to have sleep apnea and 52 percent less likely to have restless leg syndrome. They also had moderately better sleep quality, a global measure of sleep disturbance.

For the study, participants answered a 10-question survey on purpose in life and a 32-question survey on sleep. For the purpose in life survey, they were asked to rate their response to such statements as, "I feel good when I think of what I've done in the past and what I hope to do in the future."

The next step in the research should be to study the use of mindfulness-based therapies to target purpose in life and resulting sleep quality, Turner said.

Poor sleep quality is related to having trouble falling asleep, staying asleep and feeling sleepy during the day. Sleep apnea is a common disorder that increases with age in which a person has shallow breathing or pauses in breathing during sleep several times per hour. This disruption often makes a person feel unrefreshed upon waking up and excessively sleepy during the day.

Restless leg syndrome causes uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or evening hours and are often most severe at night when a person is resting, such as sitting or lying in bed.

https://www.sciencedaily.com/releases/2017/07/170710091734.htm

Poor Sleep in Adolescents May Increase Risk of Heart Disease

October 1, 2012

Science Daily/Canadian Medical Association Journal

Adolescents who sleep poorly may be at risk of cardiovascular disease in later life, according to a study in CMAJ (Canadian Medical Association Journal).

"We found an association between sleep disturbance and cardiovascular risk in adolescents, as determined by high cholesterol levels, increased BMI [body mass index] and hypertension," writes lead author Dr. Indra Narang, respirologist and director of sleep medicine at The Hospital for Sick Children (SickKids), Toronto, Ontario, with coauthors. "These findings are important, given that sleep disturbance is highly prevalent in adolescence and that cardiovascular disease risk factors track from childhood into adulthood."

Approximately 20% of adolescents have significant sleep problems, such as sleep disturbances or sleep deprivation. Sleep disturbances include frequent waking up during the night, early wakening, inability to fall asleep within 30 minutes, restlessness and bad dreams.

Students who consumed more fried foods, soft drinks, sweets and caffeinated drinks exercised less and had more screen time had higher sleep disturbance scores. A higher sleep disturbance score was associated with a higher cholesterol level, higher BMI, larger waist size, higher blood pressure and increased risk of hypertension. Shorter sleep duration was also associated with higher BMI and waist size but not increased cholesterol levels or blood pressure.

"In addition to these health risks, previous studies have shown that poor sleep also negatively impacts school performance. Parents should monitor caffeine intake, bedtimes and bedrooms overloaded with media," says Dr. Brian McCrindle, senior author and cardiologist at SickKids.

http://www.sciencedaily.com/releases/2012/10/121001124753.htm