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  • “Insomnia-Like” Sleep Patterns Can Predict Future Stress

    As part of our outreach efforts to our clients, we will often share informative articles related to sleep and sleep apnea. The following is an insightful piece written for Sleep Review by Sree Roy.


    Inverse: New research suggests fragmented sleep patterns contain a critical message.

    Dipesh Chaudhury is the study’s lead author and an assistant professor of biology at New York University Abu Dhabi. He tells Inverse that this study deepens our understanding of how stress and sleep are related. Typically, we assume that stress leads to poor sleep. But things could also work the other way around, with poor sleep dampening resilience to stress at the same time.

    “Our findings also indicate that those mice that exhibit abnormal sleep prior to stress are more sensitive to future stress exposure. In other words, sleep abnormalities can also be a cause of stress-related disorders,” Chaudhury says.

    A BAD NIGHT’S SLEEP COMES WITH A HOST OF CONSEQUENCES, some of which aren’t obvious right away. This is especially true when stressful situations — like a year defined by a pandemic — hit. Research suggests specific abnormal sleep patterns may decrease one skill that’s crucial to weathering the storm.

    In a mouse study published Tuesday in Frontiers in Neuroscience, scientists found fragmented sleep patterns – a pattern of sleep marked by more awakenings and shorter bouts of non-rapid eye movement sleep –could predict how mice responded to future stress. Mice with regular sleep patterns were resilient to bullying, while those with fragmented sleep patterns weren’t equipped to deal with the abuse.

    WHAT DOES A “DISRUPTED SLEEP PATTERN LOOK LIKE?

    “Our findings also indicate that those mice that exhibit abnormal sleep prior to stress are more sensitive to future stress exposure. In other words, sleep abnormalities can also be a cause of stress-related disorders,” Chaudhury says.

    Chaudhury’s study was based on the sleep and stress patterns of 22 mice who had electrodes implanted into their brains. Those electrodes could measure the amount of time each mouse spent in each stage of sleep.

    Like humans, mice move through sleep stages including rapid eye movement sleep (REM) — when most dreaming happens in humans — and lighter, non-REM stages.

    Every mouse was exposed to chronic social defeat — 15 consecutive days of being attacked by aggressive mice identified at the outset of the study. The researchers found that they could break the mice up into two groups: mice who were resilient, bouncing back from bullying ready to socialize, and ones that succumbed, and retreated from others.

    WHAT WAS DISCOVERED

    The scientists found there were significant differences in the sleep patterns of each group of mice beforethey were exposed to the bullying.

    The mice in the non-resilient group showed signs of fragmented non-REM sleep. They woke up more during sleep periods (mice sleep during the day) and had were shorter NREM bouts, on average, than those seen in the resilient mice.

    “In essence, the susceptible mice exhibit insomnia-like traits even before exposure to stress,” Chaudry says.

    Ultimately, these patterns could predict which group the mice ended up in with about 80 percent accuracy, suggesting that it could have been one reason they were less resilient when stress took hold.

    WHAT DOES THIS MEAN FOR HUMANS?

    This study taps into a robust area of research on human mood disorders. Depression and sleep are intertwined in a way that makes it hard to distinguish cause and effect. Disturbed sleep is often seen in depressive patients, but those who experience insomnia are also more likely to develop depression in the first place.

    Though this study focuses on stress, it suggests that sleep may pose an even more central role in mood disorders – or in this case, resilience to stress. Before the stressful situation occurs, sleep patterns may contain early warning signs.

    These results are early-stage, Chaudhury cautions. A mouse brain (and a mouse’s stress) is quite different from a human’s. But he is optimistic that the idea that sleep signatures could be a prediction of stress — specifically the way the brain transitions in and out of non-REM sleep — will hold true in humans.

    He imagines monitoring the sleep patterns of people who have particularly high-stress jobs, like first responders or frontline workers. Even if signs of stress have yet to show themselves, a disrupted sleep pattern could be the sign of a vicious cycle (stress leading to worse sleep, leading to less resilience to stress) about to go awry.

    “By having simple non-invasive markers of stress susceptibility, such as EEG sleep patterns, it may be possible to develop strategies to protect the more vulnerable people,” Chaudhury says.

    Abstract: There is a tight association between mood and sleep as disrupted sleep is a core feature of many mood disorders. The paucity in available animal models for investigating the role of sleep in the etiopathogenesis of depression-like behaviors led us to investigate whether prior sleep disturbances can predict susceptibility to future stress. Hence, we assessed sleep before and after chronic social defeat (CSD) stress. The social behavior of the mice post stress was classified in two main phenotypes: mice susceptible to stress that displayed social avoidance and mice resilient to stress. Pre-CSD, mice susceptible to stress displayed increased fragmentation of Non-Rapid Eye Movement (NREM) sleep, due to increased switching between NREM and wake and shorter average duration of NREM bouts, relative to mice resilient to stress. Logistic regression analysis showed that the pre-CSD sleep features from both phenotypes were separable enough to allow prediction of susceptibility to stress with >80% accuracy. Post-CSD, susceptible mice maintained high NREM fragmentation while resilient mice exhibited high NREM fragmentation, only in the dark. Our findings emphasize the putative role of fragmented NREM sleep in signaling vulnerability to stress.

  • 6 Diseases Your Lack Of Sleep Could Be Causing

    by DailyHealthPost EditorialDecember 16, 2020

    Sleep isn’t just blissful, it’s necessary. While you sleep, your body is conducting countless activities, including growth and cell repair. It also works on restoring energy and nutrients to worn out muscles and tissues (1).

    Sleep also balances out hormones and supports your immune system while working to supporting memory function. That’s why poor sleep can leave you feeling not only groggy and cranky, but also less focused and more forgetful.

    Sleep Deprivation And Disease

    Here are 6 conditions directly caused by too little sleep.

    1. Alzheimer’s

    Since sleep is necessary to remove waste from tired brain cells as well as repair worn or damaged structures. If this isn’t done properly, cognitive decline, dementia, and other brain conditions may occur (2).

    In fact, in 2013, researchers at Johns Hopkins University found that skipping out on sleep is one of the possible causes of Alzheimer’s disease.

    The study followed 70 adults between the ages of 53 and 91. Participants who experienced poor sleep frequently were found to have higher quantities of beta-amyloid deposition in their brains on PET scans.

    Since the compound is a marker for Alzheimer’s disease, researchers hypothesized that poor sleep prevented the brain from clearing up beta-amyloid “waste”, leading to a higher incidence of cerebral disease (3).

    2. Obesity And Diabetes

    Researchers at the University or Chicago have proved that poor sleep is linked to obesity, and ultimately, diabetes (4).

    They found that too little sleep led to fatty acid buildup, which impacted both metabolism and insulin sensitivity. By analyzing the sleeping pattern of 19 men over 3 nights, researchers found that men who only got 4 hours of sleep had fatty acid blood levels 15 to 30 percent higher than participants who slept 8.5 hours a night (5).

    Short sleepers also showed signs of prediabetes and obesity while people who had more sleep did not.

    3. Cardiovascular Disease

    Cardiovascular disease is highly influenced by diet and lifestyle, so it’s no wonder that sleep comes into play (6).

    In an annual meeting, the European Society of Cardiology presented evidence that sleep directly affects your risk of heart disease (7).

    The study, which followed 657 Russian men aged 24-64 for a total of 14 years found that two-thirds of those who experienced a heart attack also suffered from a sleeping disorder.

    Poor sleepers were also found to have a 2.6 times greater risk of myocardial infarction, a heart attack caused by the heart muscle dying. They even had a one-and-a-half to four times greater risk of stroke.

    4. Suicide

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    Poor sleep is known to cause serious mental health problems.

    In fact, a 2014 study found a link between incidences of suicide in adults and poor sleep, regardless of past bouts of depression (8).

    The 10-year Stanford University of Medicine study examined 420 young and middle-aged adults. Unfortunately, out of the group, 20 participants who suffered from poor sleep committed suicide (9).

    Chronic lack of sleep was also linked to a 1.4 times higher risk of committing suicide.

    Researchers compared their results to other studies that have concluded that poor sleep also increased the incidence of age-associated health problems, especially in men 85 years old and over.

    5. Ulcerative Colitis

    Ulcerative colitis is an inflammatory bowel disease characterized by ulcers along the digestive tract. Studies have found that colitis, along with Crohn’s disease, are heavy correlated to sleep deprivation (10).

    In 2014, Researchers from Massachusetts General published a study that studied women enrolled within the Nurses’ Health Study (NHS) I since 1976 and NHS II since 1989 and found that women who slept 6 hours of sleep or less (despite other risk factors like age, weight, smoking, and drinking) were more likely to suffer from one of the conditions (11).

    Oddly enough, getting more than 9 hours of sleep also put the women at risk, meaning that getting the right amount of sleep every night is key to controlling inflammation in the digestive tract.

    6. Prostate Cancer

    In a study published in the journal Cancer Epidemology, Biomarkers and Prevention, researchers found that sleep can actually protect your prostate (12).

    For 3-7 years,the study followed 2,425 Icelandic 67 to 96 years old and examined their sleeping patterns. Men who had trouble sleeping were 60% more likely to develop prostate cancer while men who had trouble staying asleep were nearly 120% more likely to be affected by the disease. Plus, these men experienced, on average, a more aggressive form of the disease (13).

    The Icelandic researchers concluded that prostate cancer was affected by melatonin, a sleep hormone. They noted that other studies proved that higher levels of melatonin actually suppressed tumor growth.

    If you’re not getting enough sleep, check out these little tricks that help you fall sleep and stay asleep.

  • Better Sleep Health May Help People Quit Smoking

    Original Post by Sree Roy | Dec 2, 2020 | InsomniaParameters

    Smoking is the leading cause of preventable disease, according to the US Centers for Disease Control and Prevention (CDC), and quitting is not easy. New research from the University of Arizona Health Sciences shows getting a good night’s sleep could be another tool to help people successfully quit smoking.

    “Quitting smoking is hard and causes insomnia,” says Michael A. Grandner, PhD, MTR, an associate professor in the UArizona College of Medicine-Tucson’s Department of Psychiatry and director of the Sleep and Health Research Program, in a release. “The more insomnia and stress from not sleeping, the more people are going to smoke, and many of the smoking cessation treatments can make insomnia worse because medications people are using—patches or pills—are actually stimulating.”

    While smoking rates are down generally, still one in seven, or 14%, of US adults smoke, according to the CDC. Smoking accounts for 480,000, or one in five, US deaths a year. Although most people associate lung disease with smoking, smokers are more likely to die of heart disease. That’s because nicotine stresses the heart and cardiovascular system, making it a leading cause of preventable cardiovascular disease.

    The pilot study, which looked at the correlation between sleep health and successful smoking cessation, was published in June in the Journal of Smoking Cessation. The team, led by Freda Patterson, PhD, a smoking cessation expert at the University of Delaware, found that improving sleep health prior to stopping smoking was associated with greater success in quitting.

    [RELATED: Smoking Disrupts Circadian Clock Function]

    A Closer Look at an HIV-Positive Population

    Building off those promising results, Grandner and Elizabeth Connick, MD, chief of the Division of Infectious Diseases in the College of Medicine-Tucson and a member of the UArizona BIO5 Institute, are leading a research team including Patterson, that will focus on smokers who are HIV positive. The new study, “Sleep Training Approach to Reducing Smoking (STARS),” is funded by a $3.85 million grant from the National Institute on Drug Abuse.

    The CDC reports smoking increases health risks for people who are HIV positive, particularly for heart disease, cancer, serious lung diseases such as pneumonia, and infections. Yet more than 50% of people who are HIV positive smoke.

    “Heart disease is a major cause of morbidity and mortality in people living with HIV, who have higher rates than the general population. Cigarette smoking is the greatest reversible risk factor for heart disease in this population,” Connick says in a release. “Improving smoking cessation rates in people living with HIV could substantially reduce heart disease and improve overall health.”

    The STARS study—which will be conducted via telehealth appointments to ensure participant safety during the pandemic—is currently recruiting participants in Phoenix and Tucson, Arizona. Individuals with HIV who are interested in participating can contact clinical research coordinator Ryan Weltzer at 520-848-4043 or [email protected].

    This research is supported by the National Institute on Drug Abuse, a unit of the National Institutes of Health, under Award No. R01DA051321.

    Photo 84646914 © Puhhha – Dreamstime.com

  • How Micriobiome Manipulation Impacts Sleep: A Study on Mice Adds to a Growing Body of Research

    Original Article | Posted by Sree Roy | Dec 3, 2020 | Sleep & the Body

    Researchers in mice led by Masashi Yanagisawa, MD, PhD, a professor at the University of Tsukuba in Japan, revealed the extent to which bacteria can change the environment and contents of the intestines, which ultimately impacts behaviors like sleep. The research is published in Scientific Reports.

    microbiome

    The experiment itself was fairly simple. The researchers gave a group of mice a powerful cocktail of antibiotics for four weeks, which depleted them of intestinal microorganisms. Then, they compared intestinal contents between these mice and control mice who had the same diet. Digestion breaks food down into bits and pieces called metabolites. The research team found significant differences between metabolites in the microbiota-depleted mice and the control mice. “We found more than 200 metabolite differences between mouse groups,” Yanagisawa says in a release. “About 60 normal metabolites were missing in the microbiota-depleted mice, and the others differed in the amount, some more and some less than in the control mice.”

    The team next set out to determine what these metabolites normally do. Using metabolome set enrichment analysis, they found that the biological pathways most affected by the antibiotic treatment were those involved in making neurotransmitters, the molecules that cells in the brain use to communicate with each other. For example, the tryptophan-serotonin pathway was almost totally shut down; the microbiota-depleted mice had more tryptophan than controls, but almost zero serotonin. This shows that without important gut microbes, the mice could not make any serotonin from the tryptophan they were eating. The team also found that the mice were deficient in vitamin B6 metabolites, which accelerate production of the neurotransmitters serotonin and dopamine.

    [RELATED: A Fecal Transplant Gave Healthy Mice Sleep Disturbances. Could Gut Microbiome Manipulation Treat Sleep Apnea?]

    The team also analyzed how the mice slept by looking at brain activity in EEGs. They found that compared with the control mice, the microbiota-depleted mice had more REM and non-REM sleep at night—when mice are supposed to be active—and less non-REM sleep during the day—when mice should be mostly sleeping. The number of REM sleep episodes was higher both during the day and at night, whereas the number of non-REM episodes was higher during the day. In other words, the microbiota-depleted mice switched between sleep/wake stages more frequently than the controls.

    Yanagisawa speculates that the lack of serotonin was responsible for the sleep abnormalities; however, the exact mechanism still needs to be worked out. “We found that microbe depletion eliminated serotonin in the gut, and we know that serotonin levels in the brain can affect sleep/wake cycles,” he says. “Thus, changing which microbes are in the gut by altering diet has the potential to help those who have trouble sleeping.”

    Illustration 99464470 © Xsviatx – Dreamstime.com

  • Benefits of Oral Appliance Therapy for Treatment of Sleep Apnea

    Oral Appliance Therapy – Benefits & Side Effects

    For mild to moderate sleep apnea, oral appliance therapy can be quite useful. The health and mental benefits from the treatment of sleep apnea are undeniable. Several of our patients have reported some of the following benefits and side effects from the use of an oral appliance.

    Benefits reported include:

    Ease of use – Many of our patients prefer oral appliances because they are easier to wear than a CPAP machine. CPAP users have reported several difficulties with the CPAP, (getting twisted in the tubes, the loud noise, ill-fitting mask, and more).

    Small and easy to transport – Traveling with your sleep apnea device is a lot simpler with an oral appliance. Unlike CPAP, oral appliances are small enough to fit in your purse or carry-on bag.

    Since oral appliances are designed to fit inside your mouth, they do not disrupt your movement while you sleep. You can lie in any position without the fear of getting entangled in your CPAP tubes.

    Improved relationships with loved ones who are enjoying a good night’s sleep sans tossing and snoring.

    Possible side effects

    Oral appliance therapy may cause some of the following side effects:

    • Excessive salivation
    • Dry mouth
    • Tooth and jaw discomfort
    • Temporary bite changes

    Some patients experience potential complications such as:

    • Jaw or tooth pain
    • Permanent changes to your bite
    • TMJ symptoms

    When weighing in on the benefits versus the side effects of oral appliance therapy, consider seeing a dental sleep medicine specialist. A dentist trained in dental sleep medicine can provide oral appliance therapy that is right for you. Call 617.964.4028 today and one of our knowledgeable staff members will be available to assist.

  • Are You A CPAP Dropout?

    Many of our clients come to us because of their intolerance to the CPAP machine. There is a multitude of reasons that people are unable to tolerate CPAP therapy. We stumbled upon this article and thought it was worth the share. It nicely articulates many of the reasons CPAP is not always the solution for the treatment of sleep apnea.

    Original Post | By Victoria Knight, Kaiser Health News

    When doctors told Frances Faulkenburg she had sleep apnea, she was more than ready for relief from her tired-all-the-time existence. She used to fall asleep at red lights while behind the wheel. At night, she’d wake up gasping for air, heart pounding. Her husband told her she snored.

    But Faulkenburg, 47, couldn’t tolerate the CPAP machine her doctor prescribed.

    “I just could not get used to the face mask covering both my nose and mouth,” said Faulkenburg, who lives in Oviedo, Fla.

    It was claustrophobic. I felt more like I was suffocating than getting breathing relief.

    Frances Faulkenburg

    CPAP, or continuous positive airway pressure, is often one of the first solutions doctors suggest for sleep apnea. With this disorder, a person’s breathing stops and starts so frequently during the night that it can lead to or exacerbate health problems. The National Sleep Foundation estimates that more than 18 million American adults have sleep apnea.

    A CPAP machine blows a stream of air into the back of the throat to let people breathe easier. It prevents muscles in the back of the throat from narrowing, which can constrict the airway, causing snoring or disturbed sleep.

    Yet Faulkenburg quit using her CPAP and went back to feeling sleepy and tired all the time.

    Many people have a negative reaction to the machines and are tempted to do the same. The big whoosh of air in your throat. The restrictive mask on your face. It can be a lot to adjust to. Studies suggest that from one-third to more than 50% of patients either stop using their CPAP machine or never bother to fill their prescription. They quit for a variety of reasons, but mostly because the device can be cumbersome and uncomfortable. Sometimes, they quit because of confusing or stringent health insurance restrictions.

    But the health effects of untreated sleep apnea can be serious. People struggle with anxiety, tiredness, and low productivity. There’s even an increased risk of high blood pressure, heart attack, and stroke.

    Mary Mertens, a respiratory therapist at the Cleveland Clinic, helps patients work through problems with their CPAP machine. Patients often complain that the volume of air the machine puts out feels too intense.

    “Think about it as sticking your head out of a car window with your mouth open at 60 mph versus 25 mph,” said Mertens. “The high pressure can be very overwhelming.”

    So Mertens’ team goes to people’s homes to help troubleshoot problems. That includes explaining sleep apnea and how a CPAP can help.

    “Picture the air passage at the back of their throat like a garden hose with no water in it. The hose collapses down,” said Mertens. That’s what happens when a person with sleep apnea is sleeping.

    “When we put a CPAP on somebody, it’s like turning the water on for the garden hose,” she said. “The hose then pops open and stays open.”

    At the Cleveland Clinic, about 70% of patients in the Respiratory Home Care program keep using their CPAP, Mertens said.

    Follow-up is key. Mertens’ team checks in with patients during the first three to five days, again between 30 and 45 days and again between 60 and 90 days.

    Faulkenburg, the patient in Florida, first tried a CPAP 15 years ago but never checked back with her pulmonologist when she was struggling. And, she said, the physician never contacted her. Then several people in her social circle died in their sleep—all of them right around her age. Those stories shook Faulkenburg, and she decided to try her CPAP again.

    “I got a mask that covered just my nose, which let my mouth stay closed. That ended up being the whole issue,” she said. “I sleep so well, I can’t sleep without my CPAP now.”

    Dr. Indira Gurubhagavatula, a sleep medicine physician at the University of Pennsylvania Health System, said the look of the device alone can be alarming.

    “One of the first things that I hear is that the thing itself is intimidating—they see the tubing and mask and it’s blowing air in their face—they have real concerns: ‘Am I actually going to sleep better with that thing?’

    It is a big ask to go to bed with this thing strapped to their faces.

    Gurubhagavatula said people who feel claustrophobic should wear their CPAP mask during the day while reading or watching TV. That can help the nerve endings in the face get used to the mask.

    “It’s just like breaking in new shoes or new jeans,” said Gurubhagavatula. “Once it’s broken in, it’s less of an issue.”

    Pulmonologist James Rowley, a sleep medicine physician at Detroit Medical Center, said the air pressure from the CPAP can cause a runny nose, nasal congestion or dry mouth. He said he can help by adjusting humidity settings on the machine or prescribing an antihistamine.

    Medicare and private insurance companies require patients to use their CPAP very consistently—often at least four hours every night and for 70% of nights each month. Sometimes the usage is monitored.

    Patients who don’t comply may end up paying out-of-pocket. That’s the topic of this week’s episode of the podcast “An Arm and a Leg.” Kaiser Health News co-produces the podcast.

    Prices vary, but a fully equipped machine typically costs from $500 to $3,000, with the national average around $850. After that initial investment, masks, hoses and filters need to be replaced two or three times a year. And users have the ongoing cost of maintenance supplies—wipes and brushes to keep the machine parts clean.

    Patients whose machines have been taken away because they couldn’t follow the insurance company rules.

    “They may have child care or elder responsibilities that make their sleep disrupted. Or they sleep in chunks of time because they work certain shifts,” she said. “The rule is arbitrary because using the machine, even if part-time, is beneficial.”

    Nate Wymer, 44, said his machine is lying around his home somewhere in Holly Springs, N.C., but he hasn’t seen it in years.

    “When I had the mask on I had to think about breathing out of my nose,” said Wymer. “That’s not something I normally do. After a couple of nights, I just couldn’t do it.”

    “My doctor never really followed up from what I can remember, so I back-burnered it,” said Wymer. “But, if you get in front of somebody, actually talk to them and make sure everything is going OK, that would have been nice.”

    Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.