Sleep-wake rhythms vary widely with age as well as amongst individuals of a given age

The sleep rhythms that reflect circadian systems peak later in teenagers than in adults, and vary as much as 10 hours in individuals across at any ages, according to a study published June 21, 2017 in the open-access journal PLOS ONE by Dorothee Fischer from Harvard T.H. Chan School of Public Health, USA, and colleagues.

People’s circadian systems synchronize with light and darkness in the environment, giving rise to chronotypes: individual rhythms in physiology, cognition and behavior. For example, people with early chronotypes have earlier sleep times, while those with late chronotypes have later sleep times and can sleep into the day. Currently, 30% of the U.S. workforce has unusual work schedules, such as alternating or extended shifts, and on-call duty. These unusual schedules are linked with health and safety risks. Chronotype-tailored schedules might help minimize those risks.

To investigate chronotypes variation in the US, Fischer and colleagues analyzed self-reported data from 53,689 respondents of the American Time Use Survey from 2003 to 2014. The researchers used the mid-point of sleep on weekends as a proxy for chronotype.

The researchers found that sleep chronotypes vary widely, both over an individual’s lifetime amongst age groups as well as amongst individuals. The greatest difference in chronotypes is during adolescence and early adulthood. Chronotypes become later during adolescence, peaking in lateness at about age 19. The average chronotype, or mid-point of sleep, at age 17-18 was 4:30 a.m., compared to 3:00 a.m. at age 60. Most U.S. public schools start at 8:30 a.m. or earlier, suggesting that high school students go to school during their biological night. This work supports delaying school start times to benefit the sleep and circadian alignment of high school students.

In addition, the researchers found that chronotypes vary up to 10 hours from individual to individual regardless of age. This may provide opportunities for tailoring work schedules to chronotypes, which is important because syncing workers with their optimal work times could help minimize health and safety risks.

“The timing for optimal sleep can be as different as ten hours among individuals, meaning that opposite chronotypes could share a bed without knowing that they do. What chronotype you are, is influenced by age and gender: on average, older people are earlier chronotypes than younger people and women are earlier chronotypes than men during the first half of their lives.”

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People who go to bed late have less control over OCD symptoms

A late bedtime is associated with lower perceived control of obsessive thoughts, according to new research from Binghamton University, State University of New York.

Binghamton University Professor of Psychology Meredith E. Coles and former graduate student Jessica Schubert (now at University of Michigan Medical School) monitored twenty individuals diagnosed with OCD and ten individuals endorsing subthreshold OCD symptoms during one week of sleep. Participants completed sleep diaries and daily ratings of perceived degree of control over obsessive thoughts and ritualized behaviors. The researchers found that previous night’s bedtime significantly predicted participants’ perceived ability to control their obsessive thoughts and compulsive behavior on the subsequent day.

“We’re really interested in how this kind of unusual timing of sleep might affect cognitive functioning,” said Schubert. “One possibility is impulse control. It might be that something about shifting the timing of your sleep might reduce your ability to control your thoughts and your behaviors, so it might make it more likely that you’re going to have a hard time dismissing intrusive thoughts characteristic of obsessions, and it might make it more difficult for you to refrain from compulsive behaviors that are designed to reduce the anxiety caused by obsessive thoughts.”

On average participants in the study went to bed around 12:30 at night. Patients who met criteria for delayed sleep phase disorder, about 40% of the sample, went to bed around 3 a.m.

“I always knew you were supposed to get eight hours of sleep, but I was never told it matters when you do it,” said Coles. “It’s been striking to me that this difference seems to be very specific to the circadian component of when you sleep. That we find that there are specific negative consequences of sleeping at the wrong times, that’s something to educate the public about.”

The researchers are interested in exploring this phenomenon further. Coles plans on collecting pilot data using lightboxes to shift people’s bedtimes. “It’s one of our first efforts to actually shift their bedtimes and see if it reduces their OCD symptoms, and if this improves their ability to resist those intrusive thoughts and not develop compulsions in response to them.”

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Online cognitive behavioral therapy for insomnia is effective for military

Cognitive behavioral therapy, which traditionally includes regular, and often weekly, visits to a clinician, is recommended by the American College of Physicians and other organizations for treatment of chronic insomnia.

For military personnel, internet-delivered cognitive behavioral therapy appears to be an effective alternative to meeting regularly with a therapist, although it is about half as effective as traditional methods, according to results of a study conducted by Daniel Taylor, University of North Texas professor of psychology and director of UNT’s Sleep Health Research Laboratory.

Taylor received a $1.16 million grant from the U.S. Department of Defense for the study, which was affiliated with the STRONG STAR Consortium, a federally funded network of national experts seeking the best ways to treat behavioral health problems impacting post-9/11 service members and veterans. The study was published in SLEEP, the official journal of the Sleep Research Society.

Chronic insomnia is defined by the Diagnostic and Statistical Manual of Mental Disorders as sleeping poorly at least three nights a week for a month or longer, despite adequate opportunity for a full night’s sleep. It is “a significant problem in the military,” said Taylor, who noted that military personnel often develop insomnia because of rapidly changing schedules and deployments that keep them constantly on alert.

Chronic insomnia is a strong risk factor for post-traumatic stress disorder, depression and substance abuse, absenteeism and occupational accidents, Taylor said. Treatment of insomnia may not only improve sleep in these soldiers, but also improve these other conditions, he said.

“About 10 percent of deployed military personnel take sleep medications, which are effective for short-term treatment of insomnia in civilian populations. For deployed military personnel, the side effects such as grogginess, slowed cognitive processing and slowed reaction time can be dangerous,” Taylor said.

One hundred soldiers at Fort Hood who had chronic insomnia were recruited for Taylor’s study. All completed one week of sleep monitoring by keeping sleep diaries and wearing activity monitors.

One third of the participants met with clinicians at Fort Hood for cognitive behavioral therapy for insomnia once a week for six weeks, while another third received the therapy via the Internet once a week for six weeks. Both the in-person and Internet therapy had the exact same content, with the Internet lessons presented as audio recordings accompanied by visual graphics and animations. A third control group of participants was contacted by the researchers every other week during the six weeks, but did not receive cognitive behavioral therapy.

Taylor discovered that the study participants who received in-person cognitive behavioral treatment for their insomnia reported significantly greater improvements in sleep quality — as determined by the sleep diaries and activity monitors — than those who received the Internet therapy. Both groups had greater improvements in sleep quality than those who did not receive cognitive behavioral therapy.

He noted that that cognitive behavioral therapy is “a multifaceted intervention that can be difficult to administer without the benefit of a therapist.” Additional training in the therapy for behavioral health providers in all branches of the military is needed, he said.

In a previous study of civilians with insomnia, Taylor and his research team discovered that cognitive behavioral therapy led to significant improvements in sleep efficiency, with the research subjects’ use of sleep medication declining from 87.5 percent before therapy to 54 percent afterward, although the subjects weren’t required to stop taking their medication.

Kristi Pruiksma, a STRONG STAR collaborating investigator and clinical psychologist, served as a clinician on Taylor’s study. She said the benefits of the online therapy include easy access to the treatment and flexibility in times for completing the sessions, which “is really helpful for those juggling work and family demands.”

“The online program can also be done from home rather than at a military behavioral health clinic, which some service members may avoid due to concerns about stigma,” said Pruiksma, an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio (UT Health San Antonio).

“Successful treatment has a real impact on patients’ daily lives. An important next step will be to figure out who is able to achieve good benefits from the online program and who is likely to need additional assistance from a therapist,” she said.

 

Burden of physical health conditions linked to increased risk of suicide

Suicide continues to be a major driver of mortality in the United States. Each year, more than 45,000 people die by suicide and in the past 15 years, the suicide mortality rate has risen by an alarming 24%. A new study in the American Journal of Preventive Medicine examines how illness plays a role in suicide risk. Researchers found that 17 physical health conditions, ailments such as back pain, diabetes, and heart disease, were associated with an increased risk of suicide. Two of the conditions — sleep disorders and HIV/AIDS — represented a greater than twofold increase, while traumatic brain injury made individuals nine times more likely to die by suicide.

While the rates of other causes of death have declined in recent years, suicide continues to trend upwards across all ages and genders. Many people who die by suicide do not have a prior mental health diagnosis, which means that patients at an increased risk for self-harm are somehow being missed by the mainstream healthcare system. In an attempt to gain some insight into the disturbing rise in suicide rates and possible novel interventions, researchers examined whether there is a link between physical illness and suicide risk.

“These data represent among the first findings from areas across the U.S. documenting an increase in suicide risk for people with a variety of major physical health conditions,” explained lead investigator Brian K. Ahmedani, PhD, LMSW, Director of Psychiatry Research, Behavioral Health Services Research Scientist, Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI. “As our nation’s healthcare systems work diligently to provide the best care for their patients, these data help support the need for suicide prevention among those with a wide variety of physical health conditions.”

This study included 2,674 individuals who died by suicide between 2000 and 2013 along with 267,400 controls matched on year and location in a case-control study across eight Mental Health Research Network healthcare systems. Seventeen of 19 medical conditions investigated were linked to an increased suicide risk: asthma, back pain, brain injury, cancer, congestive heart failure, chronic obstructive pulmonary disorder, diabetes, epilepsy, HIV/AIDS, heart disease, hypertension, migraine, Parkinson’s disease, psychogenic pain, renal disorder, sleep disorders, and stroke.

While all of these conditions were associated with greater risk, some conditions showed a stronger association than others. For example, people with a traumatic brain injury were nine times more likely to die by suicide, while those with sleep disorders and HIV/AIDS were at a greater than twofold risk. Along with varying rates among conditions, having multiple physical health conditions also substantially increased risk.

“Although suicide risk appears to be pervasive across most physical health conditions, prevention efforts appear to be particularly important for patients with a traumatic brain injury, whose odds of suicide are increased nearly ninefold, even after adjusting for potential confounders,” reported Dr. Ahmedani. “This is the first large, multisite study conducted within the general U.S. population demonstrating a significant, large-magnitude relationship between brain injury and suicide.”

According to this study, targeted interventions in primary care and specialty care may be the key to preventing suicides. It’s reported that 80% of individuals who die by suicide make a healthcare visit in the year before their death and that 50% go to the doctor within four weeks of dying by suicide. Because most these patients do not have a diagnosed mental health problem, limiting suicide prevention efforts to standard behavioral healthcare settings may miss many of the individuals at risk.

“Several conditions, such as back pain, sleep disorders, and traumatic brain injury were all associated with suicide risk and are commonly diagnosed, making patients with these conditions primary targets for suicide prevention,” concluded Dr. Ahmedani. “Given that nearly every physical health condition was associated with suicide, widespread suicide prevention efforts in all healthcare settings seem warranted.”

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Overriding the urge to sleep

Caltech researchers have identified a neural circuit in the brain that controls wakefulness. The findings have implications for treating insomnia, oversleeping, and sleep disturbances that accompany other neuropsychiatric disorders, such as depression.

The work was done in the laboratory of Viviana Gradinaru (BS ’05), assistant professor of biology and biological engineering, Heritage Medical Research Institute Investigator, and director of the Center for Molecular and Cellular Neuroscience of the Tianqiao and Chrissy Chen Institute for Neuroscience at Caltech. It appears in the June 8 online edition of the journal Neuron.

Gradinaru and her team wanted to know: How do we overcome tiredness in the face of a looming deadline or rouse ourselves in the dead of night to feed a crying baby? In other words, in the face of so-called salient stimuli, how do we override the natural drive to sleep?

“To answer this question, we decided to examine a region of the brain, called the dorsal raphe nucleus, where there are an under-studied group of dopamine neurons called dorsal raphe nucleus neurons, or DRNDA neurons,” says Gradinaru. “People who have damage in this part of their brain have been shown to experience excessive daytime sleepiness, but there was not a good understanding of the exact role of these neurons in the sleep/wake cycle and whether they react to internal or external stimuli to influence arousal.”

The team studied DRNDA neurons in mice, which are a model organism for studying the human brain. First, the team measured DRNDA activity while the animals encountered salient stimuli, such as the arrival of a potential mating partner, or a sudden unpleasant sensation, or food. The DRNDA neurons were highly active during these events, which led the researchers to theorize that the neurons send signals of salience and arousal, which can then modulate the state of sleep or wakefulness.

“We then measured DRNDA activity throughout the sleep/wake cycle and found that these neurons are least active when the animal is sleeping and increase in activity as the animal is waking up,” says Ryan Cho, a graduate student and the first author on the paper. “We aimed to discover whether this was just a correlation or if the activity of the neurons was actually causing changes in sleep-wake states.”

The researchers used a technique called optogenetics to engineer DRNDA cells to be stimulated by light. After stimulating these neurons with light during the time that the animal would normally sleep, Gradinaru and her team found that the mouse woke up from sleep and remained awake. The reverse was true when the activity of DRNDA was chemically silenced — the animal was likely to fall asleep, even in the face of motivationally important stimuli, such as the odor of a predator or a mating partner. This implied that activity of the DRNDA neurons truly governed sleep-wake behaviors.

Finally, the researchers examined the role of these neurons in awaking due to external stimuli. The neurons’ activity was silenced with optogenetics, and a loud noise was played while the animals were asleep. Whereas control mice often woke up, the mice with blocked DRNDA often ignored the sound and remained asleep.

“These experiments showed us that DRNDA cells are necessary for full wakefulness in the face of important stimuli in mice,” Gradinaru says. “DRNDA neurons are found analogously in humans, and while they have not been studied in depth, their degeneration has been correlated with excessive daytime sleepiness in patients with neurodegenerative disorders such as multiple systems atrophy and Lewy body dementia. Further work is necessary to establish causation in humans and to test the potential of the DRNDA as a therapeutic target for insomnia or oversleeping, and for sleep disturbances that accompany other psychiatric disorders such as depression, bipolar disorder, and schizophrenia.”

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Sleep disturbances predict substance use among college athletes

Preliminary results of a new study show that sleep disturbance is strongly related to the use of alcohol, tobacco, and illicit drugs among student athletes in college.

Results show that student athletes with sleep difficulties were 151 percent more likely to use cigarettes, 36 percent more likely to drink alcohol, and 66 percent more likely to smoke marijuana. Sleep difficulties also predict an increased use of controlled, illegal, and banned substances. For example, student athletes with sleep difficulties were 317 percent more likely to use methamphetamine, 349 percent more likely to use cocaine, and 175 percent more likely to use steroids.

“The most surprising thing was the consistency with which sleep difficulties among student athletes predict increased use of many substances, including substances that are illegal and banned,” said senior author Michael Grander, PhD, director of the Sleep and Health Research Program at the University of Arizona in Tucson. “Across the board, students with sleep difficulties were more likely to smoke, drink, and use illegal substances.”

The study involved an analysis of survey data completed from 2011 to 2014 by 8,683 student athletes at U.S. colleges and universities as part of the National College Health Assessment conducted by the American College Health Association. Participants were asked whether, in the past 12 months, “sleep difficulties” had “been traumatic or very difficult for you to handle.” Students also were asked whether they had used a list of specific substances in the past 30 days.

Regression analyses examined whether use of any of these substances was associated with sleep difficulties, adjusted for age, sex, and survey year. Also, discrepancy between student use and perceived typical use and sleep was examined.

“Sleep difficulties are quite common among students and especially student athletes,” said lead author Chloe Warlick, research assistant in the Sleep and Health Research Program. “Substance use is also a major public health problem. These results not only underscore the important link between sleep difficulties and substance use, but they show that this relationship is quite strong, even among student athletes.”

Grandner added that the findings have important implications for both student health and athletic performance.

“Knowing this association between sleeping difficulty and substance abuse could be beneficial for coaches, physical therapists, and physicians,” he said. “These findings could provide important insight when treating sleep disturbances or attempting to improve athletic performance.”

The authors concluded that sleep-focused interventions should be evaluated to determine whether they decrease use of psychoactive substances.

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Officers on afternoon shift report being more fatigued

Police officers on the afternoon shift are twice as likely to report being tired, according to a University at Buffalo-led study.

“Officers who work the afternoon shift are more likely to be fatigued, which puts them at greater risk for accidents, errors and stress,” said John Violanti, the study’s lead author and a research professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions.

The study on shift work and fatigue among police officers was part of Violanti’s ongoing research project known as the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study, which includes occupational-related data on more than 300 members of the Buffalo Police Department.

Violanti and his co-authors, which included researchers from the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH), won first place in the poster competition at the American Association of Occupational Health Nurses (AAOHN) Annual Conference in New Orleans, where they presented their findings.

Afternoon shifts — which typically go from 4 p.m. to 2 a.m. — are the busiest because of traffic control, motor vehicle accidents, domestic disputes and assaults and homicides, explained Violanti, who served with the New York State Police for more than two decades before moving into academia.

For the study, researchers examined shiftwork and fatigue data for 308 officers, 230 of whom were men. The BCOPS study includes a 15-year work history database that contains a daily account of start times and hours worked for the participating officers. Researchers measured fatigue using a questionnaire included in the overall BCOPS study and which asked officers how often they felt tired most of the time. Of the 308 officers, 116 responded “somewhat” to “very much” to feeling tired.

The results showed that working the afternoon shift is associated with a two-fold higher prevalence of fatigue among male police officers compared to those working the day shift, Violanti reported.

“Our inquiry was based on fatigue at work only focusing on fatigue involving physical, mental and emotional tiredness. It may be possible that other factors are involved in fatigue at work due to lack of proper sleep and increased activities and responsibilities outside of work,” Violanti said, but this particular study did not explore these possibilities.

Interestingly, the researchers did not observe a significant relationship between shift work and fatigue among the 78 women officers in the study. “Female officers appear to use more effective types of coping with the stress and fatigue of shift work. Previous research shows that women are more likely than men to be supportive of each other to help protect against the stress of shift work,” Violanti said.

Examining fatigue among shift-working professionals is important because the strenuous hours they often work can have a wide range of negative health effects, including disruption of the circadian regulation system, according to Violanti.

“Our research demonstrates a need for sleep intervention into police fatigue, including educating officers and police departments on sleep hygiene, possible use of caffeine, controlled napping and light therapy,” Violanti added.

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Hospitalization risk factors for kids with autism identified

Children or teens with autism spectrum disorders often come to hospitals when behavioral episodes overwhelm the support that caregivers can provide at home — but resources at hospitals are sometimes limited, too, says clinical psychologist and researcher Giulia Righi. With that reality in mind, Righi led a new study to identify which factors put young people with autism at especially high risk of seeking inpatient psychiatric care.

“The demand is far greater than the number of clinicians, the number of programs and the number of beds we have,” said Righi, a research assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University who treats acute care patients with autism spectrum disorders at the E.P. Bradley Hospital. “One of the biggest issues is the availability of acute care services such as day hospital programs and inpatient units to support families when their children’s behaviors have escalated to the point of making a situation unsafe at home, at school or sometimes both.”

Identifying and addressing the factors that make hospitalization more likely, she said, could reduce such instances. Notably, only two of the risk factors identified in the study of patients with an autism spectrum disorder (ASD) — their severity of autism symptoms and the degree of their “adaptive” daily life functioning — were specific consequences of the disorder. The strongest risk factors — disrupted sleep, having a mood disorder and living in a home with a single caregiver — are not necessarily associated with ASD.

“Our results underscore the importance of a multidisciplinary approach to the assessment and treatment of children and adolescents with ASD that addresses behavioral, psychological and psychiatric, adaptive, sleep and medical functioning in order to decrease behavioral crises and the utilization of inpatient psychiatric services,” Righi and co-authors wrote in the study published in Journal of Autism and Developmental Disorders.

The study made unique use of two large datasets with unusually rich information about patients, Righi said: the Autism Inpatient Collection (AIC), which includes data from children’s psychiatric hospitals in six states, and the Rhode Island Consortium for Autism Research and Treatment (RI-CART). Founded in 2013 by a coalition of local institutions including Brown, Bradley Hospital and Women & Infants Hospital, RI-CART has grown to become a community of about 1,500 patients and their families.

In the research, Righi and her co-authors looked at the AIC records of 218 patients age 4 to 20 who were hospitalized and compared them with 255 age- and gender-matched members of RI-CART who were not hospitalized. By employing statistical analysis techniques, the researchers were able to isolate risk factors that were independently and significantly associated with the risk of hospitalization.

The strongest predictor was the presence of a mood disorder, which was associated with a seven-fold increase in the odds of hospitalization. The presence of sleep problems was the second strongest risk, more than doubling the odds. A high score on a standardized scale of autism symptom severity raised the odds a little bit, though still significantly. Meanwhile, having a high score on a standardized scale of “adaptive functioning,” or basic life and coping skills, slightly but significantly lowered the odds of hospitalization. Finally, children and teens in households with married caregivers had only 0.4 times the odds of needing hospital care compared with comparable patients living with only one adult caregiver.

That last result, Righi said, is likely not about family structure or stability per se, but rather about resources available to cope with the care for a child with high needs. The hospitalization risk associated with mood and sleep disorders, meanwhile, points to the need to engage in a broad based and careful psychiatric evaluation of autism patients.

“Our findings emphasize the utility of thorough assessment and treatment of mood and sleep conditions to decrease the likelihood of requiring psychiatric hospitalization,” Righi and her co-authors wrote.

Righi noted that some factors she might have hypothesized would be independently significant were not, including the degree of intellectual disability or gastrointestinal problems.

Righi acknowledged that while research examined many factors, others that it didn’t measure might also be important. Also, the study measured associations of risk factors with hospitalization but doesn’t prove they were the cause of hospital visits.

But the study authors wrote that the risk factors they identified may be worth addressing before young autism patients reach the point where hospitalization becomes necessary.

“In spite of its limitations,” the study authors concluded, “the present findings reveal indicators that may be useful for identifying children and adolescents at greater risk of psychiatric hospitalization as well as other potential targets for individual and family intervention.”

 

Late-night tweeting by NBA players linked to worse game performance

Preliminary data from a new study suggests that NBA players had worse personal statistics in games that followed a late-night tweet between 11 p.m. and 7 a.m. Players scored on average about 1 point less in games following late-night tweets, and their shooting accuracy dropped 1.7 percentage points compared with their performance in games that did not follow late-night tweeting. After a late-night tweet, players also took fewer shots and had fewer rebounds, steals and blocks.

The research abstract was published recently in an online supplement in the journal Sleep and will be presented June 5, in Boston at SLEEP 2017, the 31st Annual Meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

“Using late-night tweeting activity as a proxy for being up late, we interpret these data to show that basketball skills are impaired after getting less sleep,” said lead investigator Jason J. Jones, PhD, Assistant Professor of Sociology at Stony Brook University. “While experimental studies have shown the impact of sleep deprivation on performance, this study uses big data to provide interpretable results on real-world performance of basketball players.”

According to the authors, most of the statistical changes following late-night tweets can be explained by fewer minutes played. Players had an average of 2 minutes less playing time following late-night tweeting.

“Our findings are relevant beyond just sports science research,” said study co-author Lauren Hale, PhD, Professor of Family, Population and Preventive Medicine in the Program in Public Health at Stony Brook University. “Our results demonstrate a broader phenomenon: to perform at your personal best, you should get a full night of sleep.”

The research team led by Jones and Hale merged two public sources of data for the study, analyzing Twitter account activity from 112 verified NBA players as well as basketball statistics from Yahoo Sports. The data, which included more than 30,000 tweets, were compiled across 7 basketball seasons from 2009 to 2016. To reduce the potential performance effects of changing time zones, the analysis included only games within the same time zone as the player’s home.

“Twitter is currently an untapped resource for late-night behavior data that can be used as a proxy for not sleeping,” said Jones. “We hope this will encourage further studies making use of time-stamped online behavior to study the effects of sleep deprivation on real-world performance.”

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Connecting the dots between dreams and brain disease

Dr. John Peever at the University of Toronto has been working to answer one of humanity’s greatest questions: how do we dream? He has found a certain area of the brain is responsible for this phenomenon and that troubles with normal dreaming may be an early warning sign for ailments such as Parkinson’s Disease. His results were presented at the 2017 Canadian Neuroscience Meeting, the annual meeting of the Canadian Association for Neuroscience — Association Canadienne des Neurosciences (CAN-ACN).

Since the 1960s, the brainstem has been known to be involved in controlling the act of dreaming during Rapid Eye Movement (REM) sleep. Dr. Peever has since found the cells responsible for the dream state, called REM-active neurons. More importantly, the team has learned how to control these cells in rodents and in the process, dreaming. As Peever puts it, “When we switch on these cells, it causes a rapid transition into REM sleep.”

With this knowledge in hand, his team has examined dreaming dysfunctions such as REM sleep behaviour disorder in humans. Incredibly, the team has unveiled a link to a certain group of neurodegenerative diseases. “We observed that more than 80% of people who suffer from REM sleep disorder eventually develop synucleinopathies, such as Parkinson’s Disease, and Lewy bodies dementia. Our research suggests sleep disorders may be an early warning sign for diseases that may appear some fifteen years later in life.”

Peever hopes his research may eventually lead to a neuroprotective strategy. “Much like we see in people prone to cancer, diagnosing REM disorders may allow us to provide individuals with preventative actions to keep them healthy long before they develop these more serious neurological conditions.” This goal will take years to develop yet, but could one day help thousands of people live healthier lives long before they need serious medical attention.

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Short and long sleep, and sleep disturbances associated with increased risk of dementia and lung cancer

Difficulties in initiating or maintaining sleep at middle-age are associated with an increased risk of dementia, according to a new study from the University of Eastern Finland. The 20-year follow-up study was conducted among 2,682 men participating the Kuopio Ischaemic Heart Disease Study. The study participants were aged 42‒60 years at the baseline examinations in 1984‒1989. Shorter or longer sleep than 7-7.5 hours related independently with an increased risk of lung cancer after health behaviour, such as smoking, was taken account of. Additionally, a relationship between higher serum copper levels and short sleep duration was observed.

During sleep, the body’s energy is allocated to cellular repair, immune functions, neuronal plasticity of the brain, and memory consolidation. The need of sleep is individual and differs during the lifespan. For adults, the recommended sleep duration is 7 to 9 hours. Insufficient sleep, sleep-disordered breathing, insomnia or disruptions in the sleep-wake rhythm can lead to excessive daytime tiredness. Acute effects of poor sleep include difficulties in cognitive tasks, increased need for energy, increased cellular stress, as well as lower heart rate and body temperature. Long-term sleep disturbances both precede and co-occur with chronic diseases, such as cardiovascular diseases, cancer and dementia. Furthermore, an increased mortality risk is observed in individuals with short or long sleep duration.

The underlying factors regarding the association between sleep duration and an increased risk of lung cancer concern low-grade inflammation and disruptions in melatonin secretion. These factors contribute to the pathogenesis of cancer and acceleration of tumour growth. Low-grade inflammation is associated with sleep duration and zinc and copper levels, which contribute to pro-oxidative processes and thereby may increase the risk of cardiovascular diseases and cancer. An association between sleep disturbances and dementia may result from structural changes in the brain, low-grade inflammation, and disruptions of neurogenesis.

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Sleep disorders affect men and women differently

A new study suggests that men and women are affected differently by sleep disorders.

Results show that women are more likely than men to have more severe symptoms of depression, trouble sleeping at night, and excessive daytime sleepiness. Women also have a higher degree of difficulty concentrating and remembering things due to sleepiness or tiredness. In contrast, male snoring was more likely than female snoring to force bed partners to sleep in different rooms.

“We found that females were more likely to have sleeping disorders associated with daytime sleepiness,” said co-author Dr. John Malouf, founder of SleepGP sleep clinic in Coolangatta, Queensland, Australia. “Females were also likely to feel more affected by the burden of their symptoms.”

The main purpose of the study was to understand the differences in functional status between the sexes when they present to primary care providers with sleep problems.

“What was surprising about the results was that while men and women tended to present at a similar age, their symptoms and the effect on their lives differed markedly,” said lead author Allegra Boccabella, research associate at SleepGP clinic. “We didn’t expect there to be differences across the board in terms of the different aspects of people’s lives.”

Study results are published in the May 15 issue of the Journal of Clinical Sleep Medicine.

Boccabella and Malouf conducted a retrospective clinical audit of 744 patients who received sleep-related health care from 7 private general practices in Australia between April 2013 and January 2015. Patients completed a variety of sleep-related questionnaires, including the Epworth Sleepiness Scale (ESS), the Snoring Severity Scale (SSS), and the Functional Outcomes of Sleep Questionnaire 10.

According to the authors, understanding how the symptoms reported by women differ from those of men can help medical professionals manage sleep disorders more holistically.

“If we can identify the ways that their lives are affected, we can help produce better outcomes for the patient,” said Boccabella.

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Sleep loss affects your waistline

Sleep loss increases the risk of obesity through a combination of effects on energy metabolism. This research, presented at the European Congress of Endocrinology in Lisbon, will highlight how disrupted sleep patterns, a common feature of modern living, can predispose to weight gain, by affecting people’s appetite and responses to food and exercise.

In the 24/7 culture of the modern world, an increasing number of people report routine reduced quality of sleep and several studies have correlated sleep deprivation with weight gain. The underlying cause of increased obesity risk from sleep disruption is unclear but may relate to changes in appetite, metabolism, motivation, physical activity or a combination of factors.

Dr Christian Benedict from Uppsala University, Sweden and his group have conducted a number of human studies to investigate how sleep loss may affect energy metabolism. These human studies have measured and imaged behavioural, physiological and biochemical responses to food following acute sleep deprivation. The behavioural data reveal that metabolically healthy, sleep-deprived human subjects prefer larger food portions, seek more calories, exhibit signs of increased food-related impulsivity, experience more pleasure from food, and expend less energy.

The group’s physiological studies indicate that sleep loss shifts the hormonal balance from hormones that promote fullness (satiety), such as GLP-1, to those that promote hunger, such as ghrelin. Sleep restriction also increased levels of endocannabinoids, which is known to have appetite-promoting effects. Further work from Dr Benedict’s team shows that acute sleep loss alters the balance of gut bacteria, which has been widely implicated as key for maintaining a healthy metabolism. The same study also found reduced sensitivity to insulin after sleep loss.

Dr Christian Benedict remarks, “Since perturbed sleep is such a common feature of modern life, these studies show it is no surprise that metabolic disorders, such as obesity are also on the rise.”

Although Dr Benedict’s work has shed light on how short periods of sleep loss can affect energy metabolism, longer-term studies are needed to validate these findings. The group are now investigating longer-term effects and also whether extending sleep in habitual short sleepers can restore these alterations in appetite and energy metabolism.

Dr Christian Benedict says, “My studies suggest that sleep loss favours weight gain in humans. It may also be concluded that improving sleep could be a promising lifestyle intervention to reduce the risk of future weight gain.”

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Materials provided by European Society of Endocrinology. Note: Content may be edited for style and length.

Air pollution may disrupt sleep

High levels of air pollution over time may get in the way of a good night’s sleep, according to new research presented at the ATS 2017 International Conference.

“Prior studies have shown that air pollution impacts heart health and affects breathing and lung function, but less is known about whether air pollution affects sleep,” said lead author Martha E. Billings, MD, MSc, assistant professor of medicine at the University of Washington. “We thought an effect was likely given that air pollution causes upper airway irritation, swelling and congestion, and may also affect the central nervous system and brain areas that control breathing patterns and sleep.”

The researchers analyzed data from 1,863 participants (average age 68) in the Multi-Ethnic Study of Atherosclerosis (MESA) who also enrolled in both MESA’s Sleep and Air Pollution studies. The researchers looked at two of the most common air pollutants: NO2 (traffic-related pollutant gas) and PM2.5, or fine-particle pollution. Using air pollution measurements gathered from hundreds of MESA Air and Environmental Protection Agency monitoring sites in six U.S. cities, plus local environment features and sophisticated statistical tools, the research team was able to estimate air pollution exposures at each participant’s home at two time points: one year and five years.

Wrist actigraphy, which measures small movements, provided detailed estimates of sleep and wake patterns over seven consecutive days. This was used to calculate “sleep efficiency” — a measure of the percentage of time in bed spent asleep vs. awake. Researchers found that the sleep efficiency of the lowest 25 percent of participants was 88 percent or less. The research team studied if pollution exposures differed among those in this low sleep efficiency group.

The population was divided into “fourths” according to levels of pollution. The quarter of those who experienced the highest levels of pollution was compared to the quarter with the lowest levels.

The study found:

The group with the highest levels of NO2 over five years had an almost 60 percent increased likelihood of having low sleep efficiency compared to those with the lowest NO2 levels. The group with the highest exposures to small particulates (PM2.5) had a nearly 50 percent increased likelihood of having low sleep efficiency.

The authors adjusted for a range of factors, including age, body mass, obstructive sleep apnea, race/ethnicity, income and smoking status. They also adjusted for neighborhood socioeconomic status.

The researchers were particularly interested in chronic exposure to air pollution and what that long-term exposure might mean for sleep health. “There may be acute sleep effects to short-term exposure to high pollution levels as well, but we lacked the data to study that link,” Dr. Billings said, noting that the parent MESA study is investigating the chronic effects of air pollution on cardiovascular health.

“These new findings indicate the possibility that commonly experienced levels of air pollution not only affect heart and lung disease, but also sleep quality. Improving air quality may be one way to enhance sleep health and perhaps reduce health disparities,” Dr. Billings said.

Future studies, she added, need to explore the association between other air pollutants and sleep, the mechanisms by which these pollutants may disrupt sleep patterns and whether traffic noise is the driving factor contributing to poor sleep quality.

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To improve chronic pain, get more sleep (coffee helps too)

New research from Boston Children’s Hospital and Beth Israel Deaconess Medical Center (BIDMC) shows that chronic sleep loss increases pain sensitivity. It suggests that chronic pain sufferers can get relief by getting more sleep, or, short of that, taking medications to promote wakefulness such as caffeine. Both approaches performed better than standard analgesics in a rigorous study in mice, described in the May 8, 2017 issue of Nature Medicine.

Pain physiologist Alban Latremoliere, PhD, of Boston Children’s and sleep physiologist Chloe Alexandre, PhD, of BIDMC precisely measured the effects of acute or chronic sleep loss on sleepiness and sensitivity to both painful and non-painful stimuli. They then tested standard pain medications, like ibuprofen and morphine, as well as wakefulness-promoting agents like caffeine and modafinil. Their findings reveal an unexpected role for alertness in setting pain sensitivity.

Keeping mice awake, through custom entertainment

The team started by measuring normal sleep cycles, using tiny headsets that took electroencephalography (EEG) and electromyography (EMG) readings. “For each mouse, we have exact baseline data on how much they sleep and what their sensory sensitivity is,” says Latremoliere, who works in the lab of Clifford Woolf, PhD, in the F.M. Kirby Neurobiology Center at Boston Children’s.

Next, unlike other sleep studies that force mice to stay awake walking treadmills or falling from platforms, Alexandre, Latremoliere and colleagues deprived mice of sleep in a way that mimics what happens with people: They entertained them.

“We developed a protocol to chronically sleep-deprive mice in a non-stressful manner, by providing them with toys and activities at the time they were supposed to go to sleep, thereby extending the wake period,” says Alexandre, who works in the lab of Thomas Scammell, MD, at BIDMC. “This is similar to what most of us do when we stay awake a little bit too much watching late-night TV each weekday.”

To keep the mice awake, researchers kept vigil, providing the mice with custom-made toys as interest flagged while being careful not to overstimulate them. “Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball,” says Latremoliere. “Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball.”

In this way, they kept groups of six to 12 mice awake for as long as 12 hours in one session, or six hours for five consecutive days, monitoring sleepiness and stress hormones (to make sure they weren’t stressed) and testing for pain along the way.

Pain sensitivity was measured in a blinded fashion by exposing mice to controlled amounts of heat, cold, pressure or capsaicin (the agent in hot chili peppers) and then measuring how long it took the animal to move away (or lick away the discomfort caused by capsaicin). The researchers also tested responses to non-painful stimuli, such as jumping when startled by a sudden loud sound.

“We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice,” says Alexandre. “The response was specific to pain, and was not due to a state of general hyperexcitability to any stimuli.”

Analgesics vs. wake-promoting agents

Surprisingly, common analgesics like ibuprofen did not block sleep-loss-induced pain hypersensitivity. Even morphine lost most of its efficacy in sleep-deprived mice. These observations suggest that patients using these drugs for pain relief might have to increase their dose to compensate for lost efficacy due to sleep loss, thereby increasing their risk for side effects.

In contrast, both caffeine and modafinil, drugs used to promote wakefulness, successfully blocked the pain hypersensitivity caused by both acute and chronic sleep loss. Interestingly, in non-sleep-deprived mice, these compounds had no analgesic properties.

“This represents a new kind of analgesic that hadn’t been considered before, one that depends on the biological state of the animal,” says Woolf, director of the Kirby Center at Boston Children’s. “Such drugs could help disrupt the chronic pain cycle, in which pain disrupts sleep, which then promotes pain, which further disrupts sleep.”

A new approach to chronic pain?

The researchers conclude that rather than just taking painkillers, patients with chronic pain might benefit from better sleep habits or sleep-promoting medications at night, coupled with daytime alertness-promoting agents to try to break the pain cycle. Some painkillers already include caffeine as an ingredient, although its mechanism of action isn’t yet known. Both caffeine and modafinil boost dopamine circuits in the brain, so that may provide a clue.

“This work was supported by a novel NIH program that required a pain scientist to join a non-pain scientist to tackle a completely new area of research,” notes Scammel, professor of neurology at BIDMC. “This cross-disciplinary collaboration enabled our labs to discover unsuspected links between sleep and pain with actionable clinical implications for improving pain management.”

“Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities,” notes Kiran Maski, MD, a specialist in sleep disorders at Boston Children’s. “This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care. Clinical research is needed to understand what sleep duration is required and to test the efficacy of wake-promoting medications in chronic pain patients.”