Sleep Health

  • Sleep Apnea, Sleep Health, Sleep Study

    Recent studies show how a migraine can be predicted.

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    Sleep quality and energy levels are two of the biggest indicators of an impending migraine attack, the study showed. Get inspired by a weekly roundup on living well, made simple.  

    Wouldn’t it be helpful to have a sense of when a debilitating migraine may be on the way?

    You may be able to do so, a new study has shown.

    Migraine

    “The major finding from this study was that changes in sleep quality and energy on the prior day were related to incident headache in the next day,” said Dr. Kathleen Merikangas, principal investigator of the study that published Wednesday in the journal Neurology.

    Migraines are nothing to shake your head at, and they certainly aren’t just nuisance headaches. Chronic migraines are the leading cause of disability in people younger than 50, according to a February 2018 study.

    More symptoms than you think may be tied to your migraines

    The study team found that sleep quality and energy were important indicators of a migraine attack on the following day.

    Those who had bad sleep quality and low energy one day were more likely to have migraines the next morning, the data showed. An increase in energy and greater-than-average stress usually foretold a migraine would appear later the next day.

    “It’s a very exciting study because of how well done and how detailed and how large it is,” said Dr. Stewart Tepper, vice president of the New England Institute for Neurology and Headache in Stamford, Connecticut. Tepper was not involved in the research.

    The differences point to the importance of your circadian rhythm — which regulates your cycles of sleep and wakefulness — in how headaches manifest. The findings may inform the treatment and prevention of migraine attacks.

    Migraine prevention

    Knowing when a migraine is coming can make all the difference — especially with growing interest in treating one before it starts, Tepper said.

    “If we can identify things in the environment that people can change, then we’d like to be able to prevent the attack in the first place,” Merikangas said. “If we can do that with behavioral interventions … then they may be able to prevent it by either going to sleep to offset it or some other intervention that would prevent us from having to use medication to prevent the attack.”

    Tepper, however, said he is not so sure if changes in behavior can always prevent a migraine attack.

    FDA approves new nasal spray to treat migraine headaches in adults, Pfizer says

    A migraine attack isn’t just a headache. And warning signs such as fatigue, neck pain and sleep disturbance may be early symptoms of an attack — not only a trigger of one, he added.

    Instead, Tepper advises intervening with medication before the head pain starts in hopes of warding off any pain at all.

    How much is too much?

    It makes sense that people might be conservative about using medication for migraine pain, Tepper said.

    An older class of medications, called triptans, was associated with more migraines and a resulting chronic migraine condition if used more than 10 days in a month, he said.

    But a newer option, rimegepant — sold as Nurtec — doesn’t seem to carry the same risk.

    “There’s no downside because rimegepant has almost no side effects and is not associated with transformation into chronic migraine,” Tepper said.

    What you can do about migraines

    Your doctor can recommend pain medication to address your migraines, but it also helps to know the signs of an upcoming attack, Tepper said.

    As well as monitoring sleep, exercise and diet, Merikangas suggests finding a way to monitor stress to be able to track the indicators of a migraine.

    There are five typical signs of an oncoming migraine headache, Tepper said. Those are sensitivity to light, fatigue, neck pain, and sensitivity to noise and dizziness, he said.

    5 ways to reduce your stress this year

    Cognitive behavioral therapy is often useful to help manage the stress that can trigger migraine attacks. What’s more, taking vitamins and supplements, such as magnesium and riboflavin, can be effective in reducing migraine frequency, Kylie Petrarca, a nurse and education program director at the Association of Migraine Disorders, said in a previous CNN article.

    It isn’t just about avoiding the pain, Merikangas said.

    “It’s really important to think of the full context of our health,” she said. “By being able to characterize not just headaches, but also all these other systems, we might be able then to get a handle on causes of negative health events.”

  • Sleep Apnea, Sleep Health

    Why people should prioritize sleep quality over quantity.

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    By Analisa Novak – February 19, 2024 / 11:59 AM EST / CBS News

    When it comes to maintaining heart health, it’s not just how long you sleep — it’s how well you sleep that matters equally, if not more, said Dr. Shelby Harris, a behavioral sleep psychologist and clinical associate professor at Albert Einstein College of Medicine.

    “Poor quality sleep really can influence our heart health as well,” Harris told “CBS Mornings” in an interview during American Heart Month. 

    Harris said the body’s balance of ghrelin and leptin, hormones that regulate hunger, is also disrupted by poor sleep, leading to increased consumption of high-sugar and high-fat foods. 

    Sleep disorders like sleep apnea and insomnia are closely linked to heart health. Sleep apnea, characterized by snoring and breathing pauses, affects both men and women, though women are evaluated less frequently for it. 

    Strategies for improving sleep quality include limiting alcohol and caffeine intake, reducing screen time before bed and managing how much liquid you drink before bed. 

    “Once you have better quality then we try to work on the quantity of sleep possible,” Harris said.

    For those struggling to achieve a longer sleep duration, getting a good quality amount of sleep but shorter is ideal when you first are trying to tackle this goal. 

    “For some people, I might have them go to bed later and then I might slowly have them go to bed earlier over time as opposed to that shifting back and forth. Because that can create a lot of problems for people as well,” she said. 

    Harris said that sleeping pills and aids are not ideal for most people, but said cognitive-behavioral therapy for insomnia may offer an alternative solution to medication. 

    She said most people try four to eight sessions of the therapy and if that doesn’t work, then she would recommend sleeping aids. 

    “You work on not just the hygiene but you work on the timing of sleep. … We work on thoughts about sleep, a lot of people put pressure on themselves to sleep and they worry about what’s going to happen if they don’t sleep and so we work on that aspect,” she said. 

    Harris said dietary choices also play a role in a good night’s sleep. She said people should avoid consuming large or heavy meals, such as a big dinner, before going to bed.

    Instead, opting for a small, light snack that includes a mix of protein and carbohydrates can be beneficial. “That’s a really good mix to help you throughout the night so you don’t wake up hungry, which a lot of people do as well,” said Harris.

  • Sleep Health

    Energy Drinks Linked to Poor Sleep Quality, Insomnia Among College Students

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    January 23, 2024 | Chelsie Derman | Original Article

    Male college students were found to consume more energy drinks than female college students, and they had a greater risk for a short sleep duration due to energy drink consumption.

    College students may consume energy drinks to stay alert, but the beverage may make people sleepier—a new study found energy drinks are linked to poor sleep quality and insomnia among college students.1,2

    “Even small amounts of [energy drinks] had an impact on sleep where daily [energy drinks] consumption increased the risk of sleep problems across all parameters for both sexes,” wrote the investigators.

    A study, led by Siri Kaldenbach, from the Innlandet Hospital Trust, in Lillehammer, Norway and the department of clinical medicine at the University of Oslo in Oslo, Norway, sought to investigate the frequency of energy drink consumption and the association between energy drink consumption and sleep characteristics in Norwegian college and university students. They also evaluated whether males or females consumed more energy drinks and how energy drinks affected their quality of sleep.

    The investigators conducted a cross-sectional study and obtained data from the Students’ Health and Wellbeing Study 2022 (SHOT2022), a national survey. The survey, comprised of mental health and lifestyle questions, was distributed electronically between February 8 – April 19, 2022, to full-time Norwegian students. The study included 53,266 students enrolled in higher education in Norway, aged 18 – 35 years (mean age: 24 years) with 66.4% women.

    The survey evaluated energy drink consumption, with the option of daily, 4-6 times a week, 2-3 times a week, 1 time per week, 1-3 times per month, and seldom/never. The survey also assessed sleep-related questions, and students reported usual bedtime and bed-rise time. The investigators evaluated sleep onset latency and wake after sleep onset.

    Of the participants, 4.7% of men and 3.3% of women reported consuming energy drinks daily. Moreover, men were associated with consuming more energy drinks than women. Women (49.6%) were more likely than men (39.6%) to never or seldom consumed energy drinks.

    Additionally, 5.5% of women reported consuming energy drinks 4 -6 times a week and 3.3% consumed them daily. In contrast, 7.8% of men consumed energy drinks 4-6 times a week with 4.7% consuming the drinks daily.

    Kaldenbach and colleagues observed a larger frequency of energy drink consumption was linked to sleep pattern issues such as sleep onset latency and wake-after-sleep onset. The strongest association was observed between daily energy drink consumption and short sleep duration, with men (risk ratio [RR], 2.07; 95% CI 1.77 – 2.42) exhibiting a greater risk of short sleep duration than women (RR, 1.87; 95% CI 1.64 – 2.14).

    Investigators called attention to an association between energy drink consumption and insomnia. Among women, insomnia was present among 51% reporting energy drink consumption compared to 33% among those who never or seldom consumed energy drinks. Among men, insomnia was present among 37% reporting energy drink consumption compared to 22% among those who never or seldom consumed energy drinks.

    “Most of the associations between [energy drinks] and sleep were similar for male and female students but with a few notable exceptions,” investigators wrote. “For bedtime and risetime, we observed a significantly stronger effect for men compared with women.”

    Because of the observational design, the investigators stated they could not infer causality. Moreover, the team said did not know what time the energy drink was consumed or the specific amount of the beverage—they only had access to the frequency of energy drink consumption—so that could have affected results. Another limitation, as pointed out by the team, was the “modest response rate” of 35.1% and limited information about the participants who did not complete the survey other than their age and sex.

    “The results from the current study show that there is a robust association between the frequency of [energy drinks] consumption and the different sleep parameters,” investigators wrote. “Identifying modifiable risk factors for sleep problems among college and university students is vital and our results suggest that the frequency of [energy drinks] consumption could be a possible target for interventions.”

    References

    1. Kaldenbach S, Hysing M, Strand TA, et al. Energy drink consumption and sleep parameters in college and university students: a national cross-sectional study. BMJ Open 2024;14:e072951. doi:10.1136/ bmjopen-2023-072951
    2. Energy Drinks Linked to Poor Sleep Quality And Insomnia Among College Students. EurekAlert! 2024. https://www.eurekalert.org/news-releases/1031709?. Accessed January 22, 2024.
  • Sleep Health, Sleep Study

    Too Little Sleep Might Raise a Woman’s Odds for Diabetes

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    Original Article | Dennis Thompson, Published in HealthDay Magazine

    Key Takeaways

    • Women who get poor sleep might have an increased risk of diabetes
    • Getting just 90 minutes less sleep increased insulin resistance in women
    • Researchers will look at whether better sleep helps control diabetes

    TUESDAY, Nov. 14, 2023 (HealthDay News) — Women who don’t get enough sleep might have an increased risk of diabetes, an effect even more pronounced in postmenopausal females, a new study finds.

    Shortening sleep by just 90 minutes increased insulin resistance in women used to getting adequate sleep, researchers at Columbia University.

    The findings are the first to show that even a mild sleep deficit maintained for six weeks can raise the risk of diabetes, researchers said.

    “Throughout their lifespan, women face many changes in their sleep habits due to childbearing, child-rearing and menopause,” said lead researcher Marie-Pierre St-Onge, director of the Center of Excellence for Sleep and Circadian Research at Columbia University in New York City. “And more women than men have the perception they aren’t getting enough sleep.”

    For this study, St-Onge and her colleagues enrolled 38 healthy women, 11 of whom had gone through menopause.

    All of the women routinely slept at least seven hours each night. The recommended amount of sleep for optimal health is between seven and nine hours, researchers said, but about a third of Americans get less sleep than that.

    Each of the women were asked to participate in two different phases of the study, in random order.

    Women were asked to maintain their regular adequate sleep in one phase, but in the other phase they were asked to delay their bedtime by an hour and a half, shortening their total sleep to around six hours. Each phase lasted six weeks.

    Curtailing sleep by 90 minutes for six weeks increased fasting insulin levels by more than 12% overall, and by 15% among premenopausal women.

    Insulin resistance increased by nearly 15% overall, and by more than 20% among postmenopausal women.

    Average blood sugar levels remained stable for all participants throughout the study, but researchers said the changes in insulin resistance could cause them to start rising in the long-term.

    Although increased belly fat is a key driver of insulin resistance, the researchers found that the effects of sleep loss on insulin resistance were not linked to any increases in fat.  

    “The fact that we saw these results independent of any changes in body fat, which is a known risk factor for type 2 diabetes, speaks to the impact of mild sleep reduction on insulin-producing cells and metabolism,” St-Onge said.  

    Researchers will next investigate whether better sleep can improve blood sugar control and glucose metabolism.

    The study was published Nov. 13 in the journal Diabetes Care.

    More information

    The U.S. Centers for Disease Control and Prevention has more about sleep and diabetes.

    SOURCE: Columbia University, news release, Nov. 13, 2023

  • Sleep Apnea, Sleep Apnea Dentist, Sleep Health

    Five Weird Signs of Sleep Apnea

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    Original Article | By Sandee Lamotte CNN

    Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.CNN — 

    If you snore the house down, you may be suffering from obstructive sleep apnea, or OSA — a potentially dangerous condition in which people stop breathing for 10 seconds or more at a time.

    The condition has been linked to smaller brain volume, damage to the white matter communication pathway in the brain and even a three times higher risk of dying from any cause. If left untreated, obstructive sleep apnea puts you at higher risk for hypertension, heart disease, type 2 diabetes, depression and even an early death, according to the American Academy of Sleep Medicine.

    Yet even if you’re a rock star at snoring, you may not know you have obstructive sleep apnea unless someone tells you about your nocturnal roars. That’s why it’s important for partners and friends to speak up and encourage snorers to get professional help.

    But what if you have an odd or quirky symptom besides snoring? You and your loved ones may have no idea that you are in danger, and the condition could go undiagnosed for years.

    “Greater than 30 million people have sleep apnea in the United States, yet it’s often underdiagnosed or misdiagnosed,” said sleep specialist and pulmonologist Dr. Raj Dasgupta, an associate professor of clinical medicine at the University of Southern California’s Keck School of Medicine.

    “It’s really misdiagnosed in women versus men because women may not present with the classic, heroic snoring that men often show,” he said.

    Here are five weird signs of obstructive sleep apnea to watch for, according to Dasgupta.

    Headache as a result of sleep apnea

    Night sweats

    There are many reasons people may sweat at night. It could be too hot, especially with the persistent heat waves in the past few years due to the climate crisis. Certain medications can cause night sweats, as can cancer, thyroid issues, the flu and bacterial infections, and the onset of menopausal symptoms, according to the Mayo Clinic.

    But research has shown that about 30% of people with obstructive sleep apnea have reported night sweats, Dasgupta said.

    “It’s because your body isn’t getting enough oxygen you fall into this sympathetic fight-or-flight mode, which triggers night sweats,” he said. “The research showed people with OSA that had night sweats were also more likely to have really low oxygen levels on top of having obstructive sleep apnea.”

    Sleep apnea can cause you to wake up tired, have difficulty regulating emotions and suffer from brain fog, experts say.

    Frequent awakenings

    Many people get up at night to empty their bladders — it can be caused by alcohol overindulgence, diabetes, edema, high blood pressure, certain medications, pregnancy, prostate issues and even drinking too many fluids before bed, according to the Cleveland Clinic.

    But getting up at least two times a night to urinate — which is called nocturia — can also be a sign of obstructive sleep apnea, Dasgupta said.

    “One study found about 50% of patients with OSA had nocturia, and they noted that treatment for the sleep disorder did cut back on awakenings,” he said.

    Nevertheless, frequent nighttime urination is not commonly asked about in screening questionnaires on sleep apnea in primary provider offices, Dasgupta said.

    Teeth grinding

    Grinding or clenching teeth while sleeping is called bruxism, and it too may be a sign of obstructive sleep apnea, Dasgupta said.

    “Certainly, anxiety and other factors can cause bruxism, but a common cause is obstructive sleep apnea,” he said. “There’s a theory on why — the airway becomes obstructed, so the muscles in the mouth and jaw move to try to free the blocked airway. That’s not been proven, but it is an interesting hypothesis.”

    Most people who grind or clench their teeth use a mouthguard suggested by their dentist for protection, but it won’t protect the jaw, Dasgupta said.

    “So, a person might also develop TMJ (dysfunction), which is pain in the temporomandibular joint, and that may also lead to other issues, such as headaches,” he said.

    Morning headaches

    Studies have found a link between having obstructive sleep apnea and waking up with a headache, Dasgupta said.

    “They typically occur daily or most days of the week and may last for several hours after awakening in the morning,” he said. “The cause of the headaches is not well-established and may be multifactorial.”

    Headaches caused by obstructive sleep apnea don’t appear to lead to nausea or increased sensitivity to light and sound. Instead, they seem to be a pressing sensation on both sides of the forehead that lasts about 30 minutes, according to a June 2015 study.

    Depression, fatigue and insomnia

    Some symptoms of obstructive sleep apnea can disguise themselves as issues of mental health, brain fog or other sleep problems, Dasgupta said.

    “Sleep affects our ability to think, react, remember and solve problems,” he said. “Women especially have a tendency to underreport atypical symptoms such as insomnia, fatigue and depression.”

    If obstructive sleep apnea awakens you, it may be hard to go back to sleep. A person may suspect insomnia, not realizing that a different issue may be triggering the awakenings.

    Symptoms of daytime fatigue include a lack of motivation to accomplish everyday tasks, a lack of productivity at work, memory problems and a low interest in being social, Dasgupta said. Those are also signs of depression, so if the sleep issues aren’t brought up at a health visit, the underlying cause may be missed.

  • Sleep Health

    Regular napping linked to larger brain volume

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    Original Article | UCL News

    Daytime napping may help to preserve brain health by slowing the rate at which our brains shrink as we age, suggests a new study led by researchers at UCL and the University of the Republic in Uruguay.

    woman napping

    The study, published in the journal Sleep Health, analysed data from people aged 40 to 69 and found a causal link between habitual napping and larger total brain volume – a marker of good brain health linked to a lower risk of dementia and other diseases.

    Senior author Dr Victoria Garfield (MRC Unit for Lifelong Health & Ageing at UCL) said: “Our findings suggest that, for some people, short daytime naps may be a part of the puzzle that could help preserve the health of the brain as we get older.”

    Previous research has shown that napping has cognitive benefits, with people who have had a short nap performing better in cognitive tests in the hours afterwards than counterparts who did not nap.

    The new study aimed to establish if there was a causal relationship between daytime napping and brain health.

    Using a technique called Mendelian randomisation, they looked at 97 snippets of DNA thought to determine people’s likelihood of habitual napping. They compared measures of brain health and cognition of people who are more genetically “programmed” to nap with counterparts who did not have these genetic variants, using data from 378,932 people from the UK Biobank study, and found that, overall, people predetermined to nap had a larger total brain volume.

    The research team estimated that the average difference in brain volume between people programmed to be habitual nappers and those who were not was equivalent to 2.6 to 6.5 years of ageing.

    But the researchers did not find a difference in how well those programmed to be habitual nappers performed on three other measures of brain health and cognitive function – hippocampal volume, reaction time and visual processing.

    Lead author and PhD candidate Valentina Paz (University of the Republic (Uruguay) and MRC Unit for Lifelong Health & Ageing at UCL) said: “This is the first study to attempt to untangle the causal relationship between habitual daytime napping and cognitive and structural brain outcomes. By looking at genes set at birth, Mendelian randomisation avoids confounding factors occurring throughout life that may influence associations between napping and health outcomes. Our study points to a causal link between habitual napping and larger total brain volume.”

    Dr Garfield added: “I hope studies such as this one showing the health benefits of short naps can help to reduce any stigma that still exists around daytime napping.”

    The genetic variants influencing our likelihood to nap were identified in an earlier study looking at data from 452,633 UK Biobank participants. The study, led by Dr Hassan Dashti (Harvard University and Massachusetts General Hospital), also an author on the new study, identified the variants on the basis of self-reported napping, and this was supported by objective measurements of physical activity recorded by a wrist-worn accelerometer.

    In the new study, researchers analysed health and cognition outcomes for people with these genetic variants as well as several different subsets of these variants, adjusted to avoid potential bias, for instance avoiding variants linked to excessive daytime sleepiness.

    Genetic data and magnetic resonance imaging (MRI) scans of the brain were available for 35,080 individuals drawn from the larger UK Biobank sample.

    In terms of study limitations, the authors noted that all of the participants were of white European ancestry, so the findings might not be immediately generalisable to other ethnicities.

    While the researchers did not have information on nap duration, earlier studies suggest that naps of 30 minutes or less provide the best short-term cognitive benefits, and napping earlier in the day is less likely to disrupt night-time sleep.

    Previous research looking at the UK and the Netherlands found that nearly a third of adults aged 65 or over had a regular nap.

    The study was supported by Diabetes UK, the British Heart Foundation and the Diabetes Research and Wellness Foundation. In Uruguay it was supported by Programa de Desarrollo de las Ciencias Básicas (PEDECIBA, MEC-UdelaR), Agencia Nacional de Investigación e Innovación (ANII), Comisión Sectorial de Investigación Científica (CSIC, UdelaR), and Comisión Académica de Posgrados (CAP, UdelaR). In the United States it was supported by the National Heart, Lung, and Blood Institute.

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    Mark Greaves

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    E: m.greaves [at] ucl.ac.uk