Sleep Well

By Michael Breus, PhD, ABSM

Are you a lark, someone who likes being up and active in the early morning? Do you do your best work early in the day, and do you wind down in the evenings toward a relatively early bedtime? Or are you a night owl, someone who tends to wake later and perhaps gains energy and focus as the day progresses, someone who likes to work (and play) in the evening hours?

Whether you’re inclined toward one direction or another—or find yourself somewhere in the middle—these tendencies feel deeply ingrained. Scientists have been exploring for some time the notion that the circadian rhythms that regulate the sleep-wake cycle and many other of the body’s biological processes are influenced by our genes. Studies involving twins have provided evidence that our genes have a significant influence over sleep patterns and circadian rhythms. Scientists have in recent years identified a “wake up” gene that is believed to be responsible for activating the body’s biological clock in the morning.

Now a team of researchers from the United States and Canada has identified a specific genetic variant that appears to determine whether a person will be an early bird, a night owl, or somewhere in the middle. The specific type of genetic variation an individual possesses may influence the tendency to rise earlier or later by as much as 60 minutes.

Another significant finding? This gene variant—so common that it is present in most of the population—may also determine the time of day a person is likely to die.

This information could have important implications for the treatment and monitoring of illness and disease, as well as for preventative medicine.

The study that resulted in this genetic discovery began a number of years ago. Researchers studying disrupted sleep patterns among older people were looking for pre-disease markers that could be associated with the eventual onset of Parkinson’s disease and Alzheimer’s disease. This study involved 1,200 healthy men and women aged 65. Their evaluation included annual neurological exams and psychiatric exams, as well as ongoing monitoring of sleep-wake cycles and activity levels using a wrist monitor.  Participants also had agreed to donate their brains to the research project upon their death, so that scientists could gather additional information related to sleep-wake cycles.

In the course of their research project, scientists learned that the same group of volunteers had also had their DNA genotyped—a process of identifying differences in individual genetic makeup. With these data, researchers were able to compare data on patients’ sleep wake cycles with their genetic profiles, which led to their significant discovery.

They found that variations to a gene called PER1—part of a group of genes that affects circadian rhythms—are strongly linked to circadian timing, and to the tendency toward living as a night owl or a lark. Variations to this gene are so common, according to researchers, that nearly the entire population possesses one of several variants:

• 60% of the population has a variant called adenine (A)
• 40% of the population has a variant called guanine (G)

Since each individual has two sets of DNA chromosomes:

• 48% of the population will have a combination of A and G
• 36% of the population will have two As
• 16% of the population will have two Gs

According to the study results, people with the AA genotype—the early birds—tended to wake up 60 minutes earlier than those with the GG genotype. The third group—AG—tended to split the difference and wake right in the middle of this 60-minute timeframe.

How does this gene variant—and its influence on circadian timing—affect a likely time of death? Our circadian rhythms are at work in regulating a broad range of biological processes affecting our health and basic functioning. Research has shown that circadian clocks play a role in influencing the timing of major medical events such as heart attacks. Scientists describe what they call a circadian rhythm of death, which results in people generally being more likely to die in the earlier part of the day. The average time? 11 a.m.

Looking at the study population, researchers found that AA genotypes and AG genotypes tended to die around this most typical 11 a.m. time. The GG genotypes—the night owls—tended to die much later in the day, on average at around 6 p.m.

This is some fascinating and important research. There’s more to study and to learn about how our individual genotype affects our circadian timing, but this knowledge could be applied in any number of ways to manage health and the treatment of disease. This information could be used to help people create sleep-healthy schedules, particularly for shift workers and people who travel frequently and experience jet lag—that’s everyone from a national sales rep to a major league ballplayer. Also, physicians could use this knowledge to create targeted treatment and prevention programs, using this information about when an individual is most vulnerable, to time procedures, medications, and exercise.

We all can do ourselves a favor by paying attention to our natural tendencies for sleeping and waking, and using this information in making our daily schedules work for our sleep and our health.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Are you keeping an eye on your weight this holiday season, hoping to avoid adding the extra pounds that often result from the excesses and indulgences of the season? Here’s a weight-control strategy you may not have considered, but absolutely should: get a good night’s sleep.

Sleep is a powerful tool for weight management. Getting sufficient sleep—for most of us that means 7-8 hours a night—can help keep your appetite in check, curb cravings, and reduce late-night noshing. The problem is that many of us just aren’t getting that much sleep on a regular basis. And sleep deficiency can make controlling weight much more difficult.

A comprehensive new review of research related to sleep and weight gives us some perspective on what we’ve learned about the complicated relationship between the two. Researchers examined studies from the past 15 years on the possible influence of partial sleep deprivation and weight control. They emerged with a broad consensus: partial sleep deprivation appears to have a significant impact on weight—how easily it is gained, lost, and maintained. Partial sleep deprivation, in this case, is defined as sleeping fewer than six hours per night. The Centers for Disease Control estimates that nearly one-third of working adults in the U.S. are sleeping no more than 6 hours per night, an indication of just how broadly lack of sleep may be contributing to our culture’s problems with weight.

This review revealed consensus among multiple studies about some of the ways that sleep can influence weight. Partial sleep deprivation disrupts the normal levels of two hormones that are critical to regulating hunger and appetite: ghrelin and leptin. I’ve written before about the role that these hormones play in the sleep-weight connection. Studies show that even mild and short-term sleep deprivation can result in imbalances to these hormones that govern appetite.

Ghrelin is a fast-acting hormone, produced in cells of the stomach, which spurs appetite and drives us to eat. Ghrelin may particularly increase appetite for high-calorie foods. There’s evidence that ghrelin may also direct fat towards the midsection of the body, where it is most dangerous to health. When the body is deprived of sleep, production of ghrelin increases. Research shows that even a single night of sleep deprivation can elevate ghrelin levels—and appetite.

Leptin is a hormone that suppresses appetite by communicating to receptors in the brain that the body has the energy it needs to function, and doesn’t need to take on more. Leptin is produced in white fat cells throughout the body. The amount of fat in the body, then, influences the amount of leptin produced. When leptin levels are lower than normal, we’re less likely to feel full after eating. Food also appears more enticing to people with low leptin levels, according to research. Low sleep suppresses leptin production, making us more likely to feel ongoing pangs of hunger. Even short-term sleep deprivation has been shown to reduce leptin levels.

With these hormonal imbalances at work, it’s little surprise that sleep-deprived people are more likely to gain weight and to have difficulty maintaining a healthy weight. More than a third of adults in the US are obese, as are 17 percent of children, according to the Centers for Disease Control. Obesity, with its increased risks for many serious health problems—including diabetes, heart disease, stroke, and some types of cancer—is arguably our nation’s leading public health problem. A recent study by the CDC projects that half of all adults in the U.S. will be obese by the year 2030. Our collective weight problem endangers millions of lives and costs billions of dollars.

Researchers found that many studies conducted over the past 15 years reached similar conclusions about the influence of sleep on appetite hormones, and the consequences for weight. Their findings also suggest other areas of sleep-weight study that merit additional investigation:

The influence of sleep deprivation on energy expenditure: Does sleep deprivation diminish the effectiveness of our body to burn calories?

The effect of sleep deprivation on the quality of weight loss: Does sleep deprivation have an effect on the type of weight we lose? Does going without sufficient sleep make us more inclined to hang on to fat and shed non-fat soft tissue, like muscle?

One thing is certain: with the numbers of people currently overweight and obese—and the millions more expected to join their ranks in the coming years—we can’t afford to overlook any treatment or lifestyle adjustment that could make a difference in our battle against the bulge. Getting enough sleep on a regular basis continues to prove a challenge for millions of people. Millions, too, are struggling to lose weight or to maintain a healthy weight. In order to make a real difference in the fight against obesity, we’re going have to get a lot more serious about improving our sleep.

So when you’re strategizing to keep the pounds off through the holidays, why not make 8 hours of sleep a night part of your plan?

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Are you curious—and sometimes maybe a bit baffled—by your dreams? Do you wake up with fragments of a dream fresh in your mind and wonder: why did I dream that? Well, you’re not alone. Sleep scientists wonder the same thing. We know very little about how dreaming works in the brain, about why we dream, and what function dreaming may serve. Dreaming—the mechanics of dreaming, and its purpose–remains largely a mystery.

That’s what makes this new study so fascinating. A research team led by scientists at the ATR Computational Neuroscience Laboratory in Kyoto, Japan has used brain scans to identify the visual imagery of dreams—and garnered some new insight into the brain’s activity during dreaming. Their research used a technique called neural decoding, which uses measurements of brain activity to predict visual content. By observing brain activity during sleep, researchers hoped to be able to identify the visual content of dreams.

The study involved three adult men, who slept while researchers monitored their brain activity using MRI and EEG. In order to connect brain activity with specific imagery during dreaming, researchers woke the men in the middle of sleep and asked them to describe what they’d been seeing in their dreams just before being awakened. After giving their descriptions, the men returned to sleep. The men were awakened to report on the contents of their dreams several times per hour. For each of the three volunteers, researchers compiled more than 200 dream reports over a period of several days. These dream reports revealed that the volunteers dreamed in large part about ordinary things related to daily life—with the occasional detour into the odd or fantastical.

Researchers then divided the information from the dream reports into 20 categories representing basic visual images, including things like “car” and “computer,” “male” and “female.” After the sleep and dreaming phase of the study was complete, researchers showed the men a series of photographs that contained images representing the various categories created from their dream data. They conducted the same brain scans while the men were looking at the photographs, and compared these scans to the ones taken during sleep, paying particular attention to the areas of the brain responsible for processing visual information.

What did they find? That brain activity during dreaming is similar to the brain activity associated with processing visual information in a waking state. In simple terms, these results indicate that we “watch” our dreams in a manner similar to the way we perceive things visually while we’re awake. The patterns of neural activity were so similar that researchers were able to look at the brain activity they observed during their volunteers’ dreaming sleep and predict the visual content of their dreams with 75-80 percent accuracy.

This is some pretty cool stuff. Researchers plan to follow up this study with a similar investigation that looks specifically at dreaming during REM sleep, the stage of sleep when most of our dreaming—and many of our most emotionally resonant dreams—takes place.

Why does dream research matter? There is still so much we don’t yet know about the purpose of sleep. Despite much scientific progress, the why of sleep remains a puzzle we have yet to solve. Dreaming is an ancient and universal aspect of the sleep experience. Research into animal sleep indicates that humans are not the only species to dream, but that animals have dream states similar to ours. Understanding the mechanisms of dreaming may lead to important insights into its purpose, and to the purpose of sleep itself. Are dreams related to the learning boost that sleep appears to provide? Does dreaming play a role in the consolidation of memory that occurs during sleep? What does dreaming have to do with the processing of emotional experiences? These are just some of the questions that science is asking about dreams.

Using dreams in scientific inquiry can also reveal important insight into the workings of the brain, as in the current study, or this in this research, which used dreaming to identify—for the first time—the networks of the brain that are active in moments of self-awareness. Researchers used a phenomenon called lucid dreaming to pinpoint the neural pathways that become active during moments of self-perception, a state known as meta-consciousness. People who experience lucid dreams retain a sense of self-consciousness even in the midst of dreaming. They are aware of the fact that they are dreaming and asleep. They can manipulate their dreams and even recall memories. In a normal dream state, this sense of self-awareness is suspended, as we become immersed in the temporary “reality” of our dream state. By comparing the brain activity of lucid dreamers to the brain activity of people in a normal dream state, researchers identified the neural pathways that activate to provide us with our conscious sense of self.

Dreams are fascinating, mysterious experiences to ponder. Decoding the science behind our dreams may lead us to an ever deeper understanding of sleep, and of the mind itself.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

The search for performance enhancement leads some athletes to turn some pretty dark corners. It’s a shame, and not just because doping is dangerous, unethical, and frequently illegal. It’s also a shame because athletes at all levels of play have access to a powerful tool to improve their performance, one that won’t break any laws or put anyone’s health at risk.

What’s this wonder drug? Sleep.

There’s been a welcome uptick in the attention paid by the media and athletic professionals to the benefits of sleep for competitive athletes, and to the research that shows just how sleep can improve physical performance in sport. This season, the NY Jets brought sleep specialists into the locker room, signaling their intention to use sleep as part of their training strategy. At the other end of the spectrum, I was disappointed to read that Manchester United is addressing its players’ sleep issues by issuing sleeping pills. This strategy—and the coach’s seemingly cavalier attitude toward medicating players for sleep—is not what I recommend when I suggest that athletes and coaches pay more attention to sleep.

In recent years, Stanford University’s Center for Sleep Sciences and Medicine has been at the leading edge of examining the sleep-sport performance connection. Researchers there have conducted studies with several groups of Stanford student-athletes, examining the effects of extended sleep on athletic performance. Here’s a sampling of their results, which show improvements across a variety of sports:

Swimming: Five members of the Stanford men’s and women’s swimming teams increased their sleep goal to 10 hours per night for a period of 6-7 weeks. This led to improvements in speed, reaction time, turn times, and kick strokes. Swimmers shaved an average of .51 seconds off a 15-meter sprint, they left the blocks .15 seconds faster, shaved .10 seconds off their average turn time, and added an average of 5 kicks to their stroke frequency. Out of the water, swimmers reported reductions in their levels of daytime sleepiness, improvements to their mood, more energy, and less fatigue.

Tennis: Researchers asked five members of the women’s tennis team to increase their sleep goal to 10 hours per night for 5-6 weeks. Players improved their sprint times, dropping from an average of 19.12 to 17.56 seconds. They also increased their serve accuracy, going from an average of 12.6 valid serves to 15.61.

Football: Seven players on the Stanford football team spent 7-8 weeks attempting to sleep for 10 hours per night. Their extended sleep resulted in improvements to their 20-yard shuttle—average time decreased to 4.61 seconds from 4.71—and to their 40-yard dash, which dropped to an average of 4.89 from 4.99 seconds. (Both the shuttle and the dash are among the drills conducted at the NFL Scouting Combine.) Players also reported improvements to their daytime energy levels and mood, and reduced daytime fatigue.

Basketball: For 5-7 weeks, 11 members of the university’s basketball team extended their nightly sleep to 10 hours. As a result, shooting accuracy among the players improved significantly: Free throw shooting improved 9%, and three point shooting 9.2%.

Sensing a pattern? Extending sleep times translated into significant improvements to critical game-day skills. Worth noting: not all athletes across these studies actually slept for 10 hours per night, but attempting to sleep for 10 hours per night got them additional sleep compared to their regular routine. According to researchers, many of these athletes came to their sleep-sport studies already sleep deprived.

And that gets to the flipside of the advantages that additional sleep can give to athletes. Sleep deficiency can inhibit performance. Research shows lack of sleep can also affect the longevity of players’ careers. Two recent studies investigated the relationship between sleep and career duration and stability among NFL players and MLB players. The NFL study looked at 55 players from across the league. Those who reported higher levels of daytime sleepiness were less likely to remain with the team that drafted them than those players who reported lower levels of daytime tiredness. And MLB players who reported higher levels of daytime tiredness had attrition rates far higher than league averages.

There’s also evidence that sleep can increase the risk of injury among athletes. In this study of teenage student-athletes, those who slept at least eight hours per night were 68 percent less likely to injure themselves playing sports than those who slept less than eight hours nightly. Researchers examined the sleep patterns and sports-related injuries of 112 male and female athletes from grades 7-12. They discovered that sleep and age were the most significant factors in assessing injury risk. (In addition to being more injury-prone when short on sleep, students were also more likely to injure themselves as they moved to higher grade levels.)

So what’s behind the performance boost from sleep?

The cognitive benefits of sleep translate onto the field. Memory, learning, reaction time and focus: sleep is critical to the brain’s ability to perform these mental tasks efficiently and well. The brain uses sleep to consolidate memory into longer-term knowledge, clearing the area of the brain used for short-term memory in preparation to absorb new information. During sleep, the brain also works to prioritize the information it thinks will be important in the future. Sleep deprivation has well-studied negative effects on reaction times—and even a single night of sleep deprivation can slow quick response times.

Sleep promotes muscle recovery. Sleep is a critical time for cell regeneration and repair in the body. During non-REM stages of sleep, cell division and regeneration actually becomes more active than during waking hours. Insufficient sleep, on the other hand, hinders muscle recovery.

Sleep is a stress reducer. Sleep and stress have a tangled relationship—and both are dangerous to healthy immune function when we don’t get enough (sleep), or have too much (stress). Stress can interfere with sleep—this study ranked worry as the most common cause of sleeplessness among adults 34-79. But lack of sleep can also affect mood, and make us more susceptible to stress and anxiety.

Is sleep the next big thing in sports? I’d say it’s more than earned its shot in the big show.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Here’s a recent column from The Wall Street Journal on an often puzzling and frustrating issue for parents: teens’ sleep habits. Anyone who lives in close proximity to a teenager knows what I’m talking about. We know that  adolescent tendency toward night owl behavior isn’t a matter of preference. There are biological changes at play during puberty that drive teens toward sleeping in and staying up later.

Studies have shown that during adolescence, circadian rhythms change. These include a shift in the timing of the release of the sleep-hormone melatonin and changes in sensitivity to light at certain times of day and night. These biological adjustments to teens’ circadian clocks result in significant transformation of adolescents’ sleep patterns:

• Teens become more prone to daytime sleepiness, and more alert at night
• Teens experience a delayed onset of sleep

These biological shifts are not confined to humans. Studies show that other mammals also experience similar changes in sleep patterns during adolescence. Research also indicates that these biological changes—and their impact on sleep— begin often before physical changes of puberty are apparent. As early as age 11, children’s bedtimes are delayed, and total sleep amounts are reduced.

Biological changes are an important part of the teen-sleep picture, but they don’t tell the whole story. Combined with these biological shifts are environmental and lifestyle factors that also can interfere with teens’ sleep:

Early morning school schedules. The typical early-morning start to the school day functions in direct opposition to the circadian changes teens undergo. There have been efforts among scientists and policy makers to adjust school schedules to shift school start times to later in the morning, to bring them at least somewhat more in sync with adolescent sleep patterns. But for now, most teens (and parents) cope with school days that start at or before 8 a.m., making it difficult for many to get the recommended 9 hours of sleep a night.

Academic and extracurricular workload. With adolescence comes the academic rigor of high school and the looming prospect of college for many students. Teenagers often face academic pressure and heavy homework loads during these years. Many teens keep a rigorous schedule of sports and other extracurricular activities on top of school, which often means homework doesn’t get started until evening. Research shows that skimping on sleep in favor of studying doesn’t pay off—but it’s a common practice nonetheless.

Technology—and the light that comes with it. Teens today are digitally connected in ways that most of us could never have imagined when we were growing up. Smart phones, tablets, laptops—teenagers are constantly engaged with personal technology and social media. These new technologies pose real hazards for sleep for teens. The teen-sleep technology problem is twofold: the mental stimulation of many of these activities can be a deterrent to sleep, and the light emitted from these devices can disrupt teens’ already fluctuating circadian rhythms, making it even more difficult for them to wind down in the evening.

Given this constellation of challenges, it’s little surprise that most adolescents aren’t sleeping enough. This large-scale study conducted by the CDC found that nearly 70% of teenagers in the U.S. aren’t getting sufficient nightly sleep during the week.

The consequences of sleep deprivation in adolescents are serious and wide ranging: low sleep in teens is associated with academic difficulties, behavioral problems, and a downright scary list of risky behaviors that reads like any parent’s nightmare. Insufficient sleep in teenagers also puts them at elevated risk for very adult health problems, including obesity and cardiovascular disease.

So, we know why teens sleep differently and what risks and hazards exist for them if they don’t get enough sleep. How do we get them the sleep they need?

Set a schedule for the week. Good sleep habits don’t develop by accident. Having a set routine for sleep can help teens create strong sleep habits. A good sleep routine includes a regular bedtime that’s based on a realistic wake time. If your teen needs to be up at 7 a.m. during the week, then a 10 p.m. bedtime will allow them the roughly 9 hours they need per night.

Be flexible, especially on the weekends. Letting your teen sleep in on the weekends is fine and a good way for them to relax and get some extra rest. Just don’t overdo: sleeping two hours beyond their weekday bedtime is okay, but sleeping until noon or later can wreak havoc with their body clock and actually make them feel more tired.

Set limits on technology. We all know how easily our electronic and digital devices can infiltrate every aspect of our lives. One place that ought to remain free of digital technology? The bedroom. This goes for all of us, but especially for teens, who are less able to self-regulate their tech habits. Set an electronic curfew for your teenager, one that allows them to wind down for an hour or so before bedtime.

Get outside and get moving. Exposure to sunlight—especially in the morning—will help strengthen teens’ circadian rhythms, helping them to feel less tired early in the day and more ready for bed at night. Exercise, too, will help to keep their body clocks in line with their bedtimes and wake times.

Talk to your teenager. When you’re setting bedtime schedules and limits, talk to your teens about why these things are important. The more they understand about their bodies’ changing needs for sleep, the more they can actively participate in learning to manage their own sleep habits.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Ever feel a creepy, crawly feeling in your legs when you’re stretched out in bed at night? The kind of odd, tingling sensation that makes you need to shake your limbs, or jump out of bed to move your legs? If so, you may be one of the estimated 10% of Americans who suffer from restless leg syndrome.

Restless leg syndrome (RLS) is a sleep disorder that causes tingling, twitching, and crawling sensation in the legs. These sensations usually occur around the time of sleep:  in the evening or when a person is lying down for extended periods of time. These unpleasant sensations make it very difficult to lay still—people with RLS feel a powerful urge to move in order to alleviate those creepy, crawly feelings. RLS can be extremely disruptive to sleep, making it difficult to fall asleep and to stay asleep.

Science has made real progress in recent years in its basic understanding of restless leg syndrome. It wasn’t long ago that there was debate about whether RLS was even a “real” disorder. Restless leg syndrome is now recognized as both a sleep disorder and a neurological disorder. Despite this progress, RLS still remains something of a mystery condition. We don’t know what causes RLS, though studies have shown there may be a strong genetic component. Restless leg syndrome has been associated with a number of other health conditions—including cardiovascular diseases and depression.

A trio of new studies, each conducted by groups of researchers at Boston’s Brigham and Women’s Hospital and Harvard Medical School has explored the relationship between RLS and three other health conditions: hypertension, coronary heart disease, and depression. All three studies relied on data from the Nurses’ Health Study, a decades-long project that collects and analyzes information about women’s health, using female nurses as subjects.

In a study of RLS and hypertension, researchers investigated a possible relationship between restless leg syndrome and high blood pressure in middle-aged women. Using subjects from the Nurses’ Health Study, researchers included 64,544 women between the ages of 41-58. All the women included had been given a probable diagnosis of RLS, and were experiencing symptoms at least five times per month. Women with certain conditions, including arthritis and diabetes, were excluded, since aspects of both of these conditions can appear similar to restless leg syndrome.

Using information collected via questionnaire and adjusting for other medical and lifestyle factors that could affect hypertension, including age, weight, physical activity, tobacco, and alcohol use, they found:

• Women with restless leg syndrome were more likely to have hypertension than those without RLS
• The more severe the RLS, the more the chances a woman also had high blood pressure: women who reported having RLS symptoms 15 or more times in a month were significantly more likely to have hypertension
• RLS was associated with increases in both systolic and diastolic pressures

Researchers cautioned that this study does not demonstrate a direct, causal link between restless leg syndrome and hypertension. Rather, it shows an association between the two, which warrants additional investigation.

In another study, researchers examined a possible link between RLS and coronary heart disease. In particular, researchers considered how the duration of RLS symptoms over time might relate to incidence of heart disease. Researchers evaluated information from 70,977 women over a period of 5.6 years. The average age of the women was 67. None of the women included in the study had evidence of coronary heart disease at the study’s outset. They found:

• Women who had restless leg syndrome when the study began had a greater risk of developing coronary heart disease during the observation period than those who did not begin the study with RLS
• The risk of developing heart disease appeared to be influenced by the duration of restless leg syndrome. Researchers found that women who had experienced RLS symptoms for three years or more had a higher risk of developing coronary heart disease than women without symptoms, or those who had experienced RLS symptoms for a shorter period of time

As with hypertension, previous studies have shown an association between restless leg syndrome and coronary heart disease. This study bolsters evidence of that relationship. But as researchers themselves noted in discussing these results, the details of the relationship between RLS and heart disease isn’t clear. We don’t yet know the path by which RLS may influence the development of coronary problems, or vice versa. Is it the lack of sleep that accompanies RLS? Does it have to do with the hypertension that is also associated with restless leg?

In a third study of health problems associated with RLS, researchers looked at a possible link between restless leg syndrome and depression. Again using participants from the Nurses Health Study, researchers followed 56,399 women for approximately six years. The women’s average age was 68, and none had symptoms of depression at the start of the study. During the six-year observation period, 1268 women developed clinical depression. Researchers found:

• Women who had RLS at the study’s outset were more likely to develop depression than those who did not have RLS
• Women with RLS scored higher on two standard depression tests than women without RLS

Other studies have indicated an elevated risk of depression for people with restless leg syndrome—as much as 2 to 4 times the level of risk than for those without the sleep disorder. Complicating this picture, it is believed that some anti-depressant medications may exacerbate RLS symptoms.

All three of these recent RLS studies were conducted with women subjects only. Additional research on these subjects will need to continue to explore these RLS-linked health problems with both men and women.

Restless leg syndrome is thought to be dramatically under-diagnosed. Once identified, however, there are a number of effective treatment options, including:

Physical therapies: bath, massage, and exercise

Lifestyle changes: reducing or eliminating the consumption of alcohol, caffeine, and tobacco

Prescription medications: in cases of more serious RLS, or RLS that doesn’t respond to other therapies, there are several medications that can treat the symptoms of this disorder

These studies provide a potent reminder that sleep disorders such as RLS have complicated and consequential links across the spectrum of mental and physical heath. While we’re working to learn more about the causes of RLS, and relationship between restless leg syndrome to other health problems, we also need to be working harder to make sure those who suffer from this disorder don’t go un-diagnosed and un-treated.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Do you have difficulty falling asleep, tossing and turning for a long while before finally drifting off? Are you someone who wakes up in the middle of the night, thoughts racing in a way that makes it hard to fall back asleep? Maybe you’re someone who sleeps for a few hours but wakes early, unable to complete a full night of sleep?

These are all signs of insomnia, the most common sleep disorder among adults. As much as 40% of the U.S. population suffers from insomnia at some point, and 15% or more of U.S. adults grapple with chronic insomnia, where symptoms persist for a month or more at a time. It’s all too common for people to shrug off their episodes of insomnia, to do their best to function and cope with daytime tiredness, fatigue, and mental distraction that result from sleeping poorly. This kind of “power through” strategy is rampant in our busy world, but there’s no real escape from the consequences that insomnia can bring. At an individual level, insomnia raises risks to health, compromises quality of life, and impairs ability to function at one’s best at work and in personal relationships.

There are also broader, collective consequences to society that come from insomnia. This new study attempted to quantify the economic costs of the sleep disorder and found that insomnia is associated with an estimated $31 billion in workplace costs resulting from accidents and errors that happen on the job.

Researchers analyzed data from 4,991 adults, all of whom were employed and had health insurance. Using a diagnostic questionnaire, researchers evaluated participants for insomnia, as well as collecting information on 18 other chronic health conditions that might affect workplace performance. They examined the incidence of insomnia and these other health problems to determine a possible link between the insomnia and workplace errors and accidents. To narrow in on the financial cost of insomnia-related problems in the workplace, researchers inquired specifically about accidents or mistakes on the job that resulted in “damage or work disruption with a value of $500 or more.” They found that a link between insomnia and workplace accidents or errors was both common and costly. Among the study results:

• An estimated 20% of adults had experienced some form of insomnia for at least a year
• Insomnia was associated with 7% of costly workplace accidents and errors, and with 23.7% of the total costs of these problems
• Based on their results, researchers estimated that a total of 274,000 accidents and errors transpire in the workplace every year, as a result of insomnia, at a total estimated cost of $31 billion

This is not the first study to assess the increased risk of insomnia-related accidents, or their costs:

• This study examined the link between insomnia and the risk of injury both in the workplace and outside it. Researchers looked at rates of injury among nearly 5,000 adults who had suffered from insomnia for at least a year. They found that people with insomnia were significantly more likely to experience injury both at work and outside of work than those who did not have the sleep disorder.
• This large-scale study investigated the link between insomnia and work productivity, activity impairment, and health-related quality of life. Researchers analyzed data from nearly 20,000 adults—some with insomnia and others without. They found that people with insomnia had significantly greater rates of absenteeism from work and significantly greater losses of productivity at work. Those with insomnia also had lower quality of life scores with regard to both physical and mental health.
• This study examined the effects of insomnia on work performance and the resulting costs to the economy. Researchers analyzed data from 7,428 employed adults in the US. Based on information gathered in a questionnaire, they estimated that nearly a quarter of participants—23.2%–were suffering from insomnia. Researchers found a per-person loss of 7.8 days of productivity per year linked to insomnia, whether through days missed from work or impaired performance on the job. Applying these results across the US workforce, researchers estimated a cost of $63 billion in reduced productivity and performance related to insomnia.

Rates of insomnia are high across both the developed and the developing world. Here in the United States, nearly one-third of workers are getting by on no more than 6 hours of sleep per night. We’re living in an age where sleep is challenged by the very technological advancements that are supposed to make life easier and more streamlined. Clearly, it’s time to stop shrugging off the consequences of insomnia and other sleep disorders, consequences that include an incredibly high price tag, both in dollars and in health.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

It was great to see this news of the New York Jets’ recent decision to make sleep specialists part of their in-season training program. According to the news reports, sleep experts have worked directly with players, teaching them strategies for getting more and better sleep amid a physically and mentally demanding schedule of practice and games. In addition, the coaching staff has adjusted players’ schedules to be more sleep friendly, including starting their work day 90 minutes later and shortening the duration of some meetings and practices. Players who spoke to reporters seemed enthusiastic about the team’s newfound attention to sleep. “It was awesome,” one player told Fox Sports. “You still get the same amount of work in, but you get to sleep in a bit more and get off your feet a bit more.”

It probably won’t surprise you to hear that I think this is a pretty smart and forward-thinking strategy for a team to take. Sleep can play a big role in the competitive world of pro sports. Among these elite athletes, big rewards often comes from gains measured in small increments: shaving a couple of seconds off running speed, improving agility and reaction time by fractions of a second, drawing on ever-so-slightly deeper reserve of energy and power for a block or tackle. Here are some examples of research that has shown how sleep can improve athletic performance:

• These studies of pro players in the National Football League and Major League Baseball found a link between career longevity and levels of daytime sleepiness in players. In the NFL, athletes who reported lower levels of daytime tiredness were more likely to be retained by the teams that drafted them than those who reported feeling more tired during the day. Baseball players who reported higher levels of daytime tiredness were more likely to drop out of the league than their better-rested counterparts.
• A study of college basketball players found that increasing nightly sleep amounts resulted in improvements to on-court performance. The college ball players in the study—many of whom were found to be sleep deprived at the study’s outset—were put on an expanded sleep schedule that included a goal of 10 hours of sleep per night. (Players’ actual average nightly sleep during the study period was 8.5 hours, right in the zone of the recommended daily sleep amounts.) After 5-7 weeks on this new sleep schedule, researchers found that players had improved their running speeds, shooting accuracy, and reaction times. They also demonstrated less daytime fatigue and improved moods during practices and games.

And what about the rest of us? We may not be taking to the football field or basketball court every day, but the underlying relationship between better sleep and higher functioning applies in different ways to all of us. We’re learning more all the time about how sleep can improve not only physical but cognitive performance, and also about the negative consequences of disrupted sleep on performance:

• This study used word-pair memorization exercises to demonstrate a link between sleep and memory retention. People who slept shortly after learning new information were more likely to retain that information than those who delayed sleep after learning.
• Sleep deprivation has frequently been shown to have a negative effect on reaction time. Results from this study indicate that a single night of sleep deprivation can significantly impair reaction time. And according to this research, sleep deprivation was associated with increased levels of confusion, hostility, anger, and depression, as well as slowed reaction times. These changes to reaction time, as well as mood and personality, can have truly wide-ranging effects on how we function in daily life, affecting our judgment and decision making, putting strain on relationships at work and at home, and putting us at greater risk for accident or injury.
• Forgoing sleep for the sake of being “productive”—something most of us have probably done at some point—appears to wind up interfering with performance, not enhancing it. I wrote not long ago about this study, which showed high school students who stayed up late to study were more likely to have academic problems in school the following day.

It won’t surprise me to see more sports teams adopting a sleep-better-to-perform better strategy similar to the one the Jets have put into play this season. But using sleep to improve performance isn’t just the purview of athletes—we can all benefit from making sleep a fundamental part of everyone’s game plan.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Here’s some sobering and serious news for women: sleeping poorly may double your risk of a form of high blood pressure that is not easily treated.

In a study presented at the American Heart Association High Blood Pressure Research 2012 Scientific Sessions, researchers from Italy’s University of Pisa said they’d found a strong association between poor sleep quality and resistant hypertension in women. Resistant hypertension is a form of high blood pressure that does not respond to treatment, including use of blood-pressure-lowering medications. Researchers in this study also examined a possible relationship between depression and resistant hypertension.

The study included 234 adults who were already being treated for high blood pressure in an outpatient hypertension program, a group that was evenly split between men and women.  Researchers analyzed data on sleep quantity and sleep quality, depression and anxiety, and risk factors for cardiovascular problems.

When it came to sleep duration, researchers found:

• The average amount of daily sleep among participants was 6.4 hours. This measurement was roughly the same for men and women
• 49% of those studied slept fewer than 6 hours daily

But it was sleep quality, not sleep quantity, that researchers determined had link to the risk of resistant hypertension. When examining sleep quality, researchers found that women were significantly more likely to experience poor sleep quality than men:

• 46% of women studied had poor sleep quality
• 30% of men experienced poor sleep quality

Researchers also found that women had higher rates of depression, more than double that of men:

• 20% of women had depressive symptoms
• 7% of men had symptoms of depression

Overall, 15% of the study population was found to be suffering from resistant hypertension. When looking at the relationship between resistant hypertension and sleep quality, researchers found that, among women, those who had resistant hypertension were five times as likely to also have poor sleep quality. They found no similar association between poor sleep quality and resistant hypertension among men.

Investigating a possible association between depression and resistant hypertension, researchers found similar results. Women who had resistant hypertension were more likely to show signs of depression than those without. And again, the study results produced no similar association between depression and resistant hypertension among men.

There’s a lot to take note of here. First the researchers found that it was sleep quality—not quantity—that was a significant factor in the link between resistant hypertension and sleep. Second, the differences between men and women are striking, and potentially significant. It’s too early to know, on the basis of an individual study, whether women are more at-risk than men to resistant hypertension, on the basis of their sleep. But we do know that men and women experience the effects of sleep differently and have different vulnerabilities when it comes to the health consequences of sleep problems. We need more research in this area to better understand not only the effects of disrupted sleep on high blood pressure, but also how the risks for men and women may differ.

There’s much we don’t yet know about the relationship between sleep and high blood pressure, but we have seen other research that shows a link between the two, in men and women:

• This study found men who were deprived of deep sleep were more likely to develop hypertension during their older years. Researchers examined the sleep patterns 784 men ages 65 and older. None of the men had high blood pressure at the outset of the study. Over a period of 3.4 years, approximately 30% of these men developed hypertension. The men who developed hypertension were significantly more likely to spend less time in the stage of deep sleep, or slow wave sleep, than men who remained free of high blood pressure.
• This study of nearly 6,000 men and women ages 40-100 looked at the relationship between sleep quantity and hypertension. They found that sleeping fewer than 7 hours a night was associated with an increased risk of high blood pressure. Sleeping fewer than 6 hours per night was associated with a particularly high risk. This study also found that sleeping more than 8 hours was associated with an elevated risk for hypertension.

Nearly one third of men and women in the United States suffer from high blood pressure which, without treatment, can cause serious health complications, including heart attack and stroke. We don’t know everything we need to, yet, about the relationship between sleep and hypertension, or the ways it may affect men and women differently. But here’s what we do know: Sleep, more specifically high-quality sleep, can play an important role in protecting your cardiovascular health. Getting enough sleep—and the right kind of restorative sleep—may help to reduce your risk of high blood pressure.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

By Michael Breus, PhD, ABSM

Looking for a low-impact exercise routine with high returns for health and sleep? Try yoga.

The pleasures and benefits of yoga are widely understood: yoga can improve physical strength, flexibility, and breathing; reduce stress; and enhance mental focus. What may be less well known are the positive effects that yoga can have on sleep.

A new study indicates that yoga can help to improve sleep among people suffering from chronic insomnia. Researchers at Harvard Medical School investigated how a daily yoga practice might affect sleep for people with insomnia and found broad improvements to measurements of sleep quality and quantity.

In this study, researchers included people with different types of insomnia, evaluating people with both primary and secondary insomnia. Primary insomnia is sleeplessness that develops on its own, independent of any other health problem or sleep disorder. Secondary insomnia develops as a symptom or consequence of another medical condition. Many illnesses and health problems are associated with insomnia, including cancer, chronic pain conditions such as arthritis and fibromyalgia, and depression. Medications taken for chronic or acute health conditions can also trigger insomnia, as can the use (and abuse) of substances such as alcohol.

Researchers in this study provided their subjects with basic yoga training, then asked them to maintain a daily yoga practice for 8 weeks. The study participants kept sleep diaries for 2 weeks before the yoga regimen began, and for the duration of the 8-week study period. In the sleep diaries, they kept a record the amount of time spent asleep, number of times they awakened during the night, and the duration of time spent sleeping between periods of waking, in addition to other details about nightly sleep amounts and sleep quality. Twenty people completed the 8-week evaluation, and researchers analyzed the information in their sleep diaries to evaluate the influence of yoga on the disrupted sleep of chronic insomnia. They found improvements to several aspects of sleep, including:

• Sleep efficiency

• Total sleep time
• Total wake time
• Sleep onset latency (the amount of time it takes to fall asleep)
• Wake time after sleep onset

There isn’t a great deal of research into the effects of yoga on sleep and its potential value as a treatment for sleep problems and disorders. But we have seen other scientific evidence in recent years of yoga’s effectiveness in improving sleep:

• This study of 410 cancer survivors found that yoga was linked to improved sleep quality, reduced feelings of fatigue, reduced frequency of use of sleep medication, and an improved sense of quality of life among patients who practiced yoga twice a week for 75-minute sessions.
• This research looked at the effects of yoga among post-menopausal women with insomnia, and found that yoga was linked to a reduction in symptoms and the severity of the sleep disorder. This study also found yoga linked to lower stress levels and an enhanced sense of quality of life.
• In this study of women with osteo-arthritis and sleep problems, an evening yoga practice was linked to significant improvements in sleep efficiency and a decrease in the frequency of individual nights of insomnia.

Insomnia is the most common sleep disorder among American adults, with 10-15% of the population suffering from chronic insomnia. As many as 40% of adults in the U.S. experience some type of insomnia every year. Older people, women, and those with other health problems are at higher risk for insomnia. Despite its prevalence, insomnia, like many other sleep disorders, remains significantly under-diagnosed, according to recent research. This study showed that while 1% of the population surveyed had a clinical diagnosis of insomnia, 37% of those surveyed showed symptoms of insomnia.

Insomnia may be common, but if left untreated its health consequences can be anything but benign. Chronic insomnia is associated with a number of serious medical conditions, including high blood pressure and other cardiovascular symptoms, obesity and its associated diseases, and inflammation in the body.

Research indicates that lack of sleep can have negative effects on cognition, and the brain. Pme study linked insomnia with destruction of gray matter in the brain, and a group of four studies, conducted independently of one another, found evidence that poor and fragmented sleep may contribute to impaired cognition as we age.

Insomnia has been found linked to both anxiety and depression. The relationship between sleeplessness and these mental health disorders is still being understood, including whether one condition precipitates the other. But insomnia, depression, and anxiety share a deep and difficult connection.

With so much at stake, finding effective treatment for insomnia is an important endeavor. Sometimes medication can be an appropriate choice, but any treatment is best to begin with basic lifestyle changes. Yoga and other regular forms of exercise can help to form the basis of a long-term, sustainable lifestyle that helps you sleep more, and better.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com