Author Archives: V Tipnes

The athletes who rise to the level of professional sports in the United States are an elite bunch, some of the most physically gifted players on the planet. As difficult as it is to reach this level of sport, once they’ve been drafted into the pro leagues, their work is still just beginning. Maintaining a career in professional sports is intensely competitive and difficult, requiring serious dedication to developing and maintaining their skills.

Along with speed and agility, scoring prowess and defensive might, should an athlete’s sleep ability be a factor in determining his or her value as a player?

According to two recent studies, this may just be a pretty good strategy. Sleep researchers at Virginia’s Martha Jefferson Hospital Sleep Medicine Center have established a connection between career longevity and stability and levels of daytime sleepiness among athletes in two professional sports — football and baseball.

Both studies, which were presented at SLEEP 2012, an annual meeting of the Association of Professional Sleep Societies, investigated links between sleep and the staying power of careers for athletes in the National Football League and Major League Baseball. Researchers found that athletes in both leagues who reported experiencing high levels of daytime sleepiness were more likely to have shorter careers — and less likely to stay with the teams that originally drafted them — than players who were better rested, and reported feeling less tired during the day.

When studying NFL athletes, researchers included 55 players from around the league, all of whom went from college-level football through the draft process to professional teams. Players completed a questionnaire that enabled researchers to evaluate the athletes’ levels of daytime tiredness. They found that athletes who scored higher for excessive daytime tiredness — those who were more tired during the day — were less likely to stay with the original team that drafted them than players who scored at lower levels for excessive daytime tiredness. Among players who reported high levels of daytime sleepiness, 38 percent stayed with their drafting team, compared to 56 percent of better-rested players.

To study baseball players, researchers presented these athletes with the same questionnaire on sleep and daytime tiredness. They included 40 pro baseball players from MLB teams. Researchers discovered that those players who reported the highest levels of daytime sleepiness had significantly higher dropout rates from the league. Ballplayers who reported feeling more tired during the day had dropout rates in the range of 57-86 percent, compared to average MLB drop out rates, which are in the range of 30-35 percent.

This is important information for team organizations, players, and coaches: Protecting and encouraging sleep among these pro athletes may be one way to enhance and even prolong players’ career-long levels of performance.

This isn’t the first time we’ve seen evidence that sleep can have a powerful effect on athletes’ performance. We know from athletes’ own discussions of their training regimens that a successful training schedule often includes early bedtimes and careful attention to rest and recovery. And this 2011 study of college basketball players found that additional sleep resulted in significant improvements to speed and shooting skills, as well as diminished feelings of daytime tiredness and improvements in players’ moods and sense of well-being related to their sport.

It’s worth noting that in this college basketball study, researchers found many of the athletes suffering from chronic sleep deprivation at the study’s outset. I’d be willing to guess that with their demanding practice and game schedules, combined with near-constant traveling, many professional athletes are in a similarly sleep-deprived state. This latest study gives us reason to wonder: How much better, longer — and healthier — could our pro athletes play if that made sleep a regular part of their training regimen?

We study the health and performance of our professional athletes for many reasons. Pro sports are both big business and an important part of our culture. Leagues have a lot of incentive to push their players to play at their best — they also have a responsibility to their players’ health, and to ensure that their athletes are playing as safely as possible. In addition, what we learn from people who push their bodies to extremes can deliver lessons and insights for the broader population — those of us who don’t tackle and block against 300-pound guys for a living, or chase down 100-mph fastballs with speed and lightning-quick footwork.

Making sleep a priority — getting your seven to eight hours of sleep per night, every night, and addressing sleep problems before they become chronic or serious — can help you protect your health and your longevity on your field of play, whatever that may be. You don’t have to have a career lived out on AstroTurf or in a stadium to want to work — and live — well for a good, long time. Remember that sleep is one of your most powerful tools for helping you stay at the top of your game.

Sweet Dreams,
Michael J. Breus, PhD

Patients with moderate-to-severe obstructive sleep apnea (OSA) can be successfully managed in a primary care setting by appropriately trained primary care physicians (PCPs) and community-based nurses, according to Australian researchers.

“With the rise in demand and growing waiting lists for sleep physician consultation and laboratory-based sleep services, there has been increasing interest in development of ambulatory strategies for the diagnosis and management of OSA involving home sleep monitoring and auto-titrating continuous positive airway pressure (CPAP),” said lead author Ching Li Chai-Coetzer, MBBS, of the Adelaide Institute for Sleep Health at Repatriation General Hospital in Australia. “While previous studies have demonstrated that ambulatory models of care for OSA in specialist settings can produce patient outcomes which are comparable to laboratory-based management, this is the first randomised controlled study to be conducted in primary care.”

The results were presented at the ATS 2012 International Conference in San Francisco.

“We randomized 155 patients to either primary care-based management or usual care in a specialist sleep center,” said Chai-Coetzer. “At 6 months, mean change in Epworth sleepiness scale (ESS) scores, the primary outcome measure of the study, was similar in the two groups (4.9 in the primary care group vs 5.1 in the specialist group).”

PCPs identified patients with symptomatic, moderate-to-severe OSA using a four-item screening tool, the ESS, and home oximetry. Primary care-based management was led by the patient’s PCP and a community-based nurse and involved use of home auto-titrating continuous positive airway pressure. Usual care in a specialist sleep center involved management by a sleep physician and laboratory-based testing.

In addition to similar changes in ESS scores at 6 months, mean change in Functional Outcomes of Sleep Questionnaire (FOSQ) score was similar in the two groups (2.3 in the primary care group vs 2.7 in the specialist group), as was compliance with CPAP. Mean daily use of CPAP was 4.8 (±2.1) hours in the primary care group and 5.4 (±1.8) hours in the specialist group.

Furthermore, within-study costs for primary care management were lower than those for specialist care, with significant savings of AUD$2,157 (95% CI: $1,293 to $3,114) per patient.

“Our results show that using a simplified, ambulatory approach for the treatment of OSA in primary care is not clinically inferior to management of these patients in a specialist sleep center,” concluded Chai-Coetzer. “This approach also offers a lower cost alternative to usual care. In addition, waiting lists for specialist sleep centers are long, and home care may be preferred by patients.”

In your opinion, can OSA be successfully managed in a primary care setting? Why or why not? How do studies like this impact the sleep profession? Join the discussion on Sleep Review’s LinkedIn page.

Despite the recommendation that adults get between seven and nine hours of sleep a night, a new study shows that about a third of us aren’t hitting those goals.

Researchers from the Centers for Disease Control and Prevention looked at data from the 2010 National Health Interview Survey on sleep habits of U.S. workers. They found that 30 percent of people in the study — which calculates to about 40.6 million workers in the U.S. — get fewer than six hours of sleep a night. Their research was published in this week’s Morbidity and Mortality Weekly Report.

The study of 15,214 people also shed light on what kinds of jobs are linked with less sleep. The researchers found that people who work in manufacturing get less sleep than other workers, with 34.1 percent of them reporting getting less than six hours of sleep a night.

In addition, people who work the night shift were more likely to report getting inadequate sleep (44 percent), compared with those working during the day (28.8 percent).

Among people who worked the night shift, certain industries had high prevalences of inadequate sleep, including 69.7 percent of warehouse and transportation workers and 52.3 percent of health-care and social assistance workers, according to the report.

The researchers also found that people between ages 30 and 64 were more likely to report not getting enough sleep, compared with workers between ages 18 and 29 and workers age 65 and older.

People who work more than one job are also more likely to not get enough sleep during the night, compared with people who just have one job — 37 percent versus 29.4 percent. People who work more than 40 hours a week are also less likely to get enough sleep per night, compared with those who work a 40-or-under week.

Sleep deprivation is dangerous because it raises the risk of a whole host of health problems. Studies have linked inadequate rest with depression, a decreased immune system and memory issues, WebMD reported. Sleep deprivation has also been linked to obesity, high blood pressure and daytime fatigue, which could present safety issues on the job, Harvard Medical School reported.

People with fibromyalgia often report problems with sleeping, but a new study in the Journal of Pain shows that troubled sleep doesn’t actually predict fibromyalgia pain.

University of Florida researchers hypothesized that because past research has shown a link between troubled sleep and other kinds of pain, as well as a link between sleep deprivation and pain in people who don’t have fibromyalgia, there might be a link between less sleep and pain from fibromyalgia.

But in their study, they found that lack of sleep was not able to predict the pain the study participants felt. Their study was based on 74 people with fibromyalgia, whose sleep and pain information was taken for 14 days.

“This study suggests that measures of sleep duration and nightly wake time do not predict fibromyalgia pain at the group level,” the researchers wrote in the study. Rather, they said that being inactive or having fatigue may better predict pain than the amount of sleep obtained in a night.

However, this research isn’t to say there’s no link between sleep and fibromyalgia. A recent study in the journal Arthritis & Rheumatism showed that trouble sleeping can increase a woman’s risk of developing fibromyalgia by more than three times, compared to people who get better rest, Health.com reported.

But still, the researchers of that study cautioned that the research doesn’t show that sleep problems cause fibromyalgia, Health.com reported:

“Sleep problems are just one factor that may contribute to the development of fibromyalgia,” says Paul J. Mork, Ph.D., a study coauthor and a researcher at the Norwegian University of Science and Technology, in Trondheim. “Fibromyalgia is a complex pain syndrome and there are numerous other factors that may contribute to the development of this illness.”

Experiencing breathing problems during sleep may raise your risk of  depression, a new study suggests.

Women with sleep  apnea, in which breathing becomes shallow or pauses briefly during sleep,  were 5.2 times as likely to have depression compared with women without the  condition. Men with sleep apnea were 2.4 times as likely to have depression as  men without the condition, according to the study from researchers at the Centers  for Disease Control and Prevention (CDC).

Participants in the study who had other breathing  problems during sleep also  had an increased risk of depression. However, the researchers found no increased  likelihood of depression among people who snore.

“Snorting, gasping or stopping breathing while asleep was associated with  nearly all depression symptoms, including feeling hopeless and feeling like a  failure,” said study researcher Anne Wheaton, an epidemiologist with the CDC.  “We expected persons with sleep-disordered breathing to report trouble sleeping  or sleeping too much, or feeling tired and having little energy, but not the  other symptoms.”

Both depression and breathing problems during sleep  are common, and both are underdiagnosed, the researchers wrote. Screening people  who have for one disorder for the other could lead to better diagnosis and  treatments, they said.

The researchers took into account other factors that might influence the  results, such as age, sex and weight. The results are in line with those of the  other studies, the researchers said.

The study found an association, not a cause-and-effect link. However, the  researchers wrote that evidence from other research suggests that breathing  problems during sleep may contribute to the development  of depression. For example, one previous study found a link between the  severity of breathing problems during sleep and the odds of later developing  depression. And other studies have shown that people who received treatment for  sleep apnea showed improvement in their depression.

“Mental health professionals often ask about certain sleep problems, such as  unrefreshing sleep and insomnia, but likely do not realize that [breathing  problems during sleep] may have an impact on their patients’ mental health,” the  researchers wrote in their conclusion.

Although exactly how the link might work is unclear, it could partly be  explained by the fact that people with breathing problems experience sleep  that is fragmented, or may have low levels of oxygen in the blood during  sleep.

The researchers used data collected from 9,714 adults who participated in the  National Health and Nutrition Examination Survey, which is an ongoing study  conducted by the CDC.

Participants were considered to have depression based on their answers to a  questionnaire asking about how often they experienced symptoms of  depression.

Six percent of men and 3 percent of women in the study reported having  physician-diagnosed sleep apnea.

The study was limited in that participants’ depression and sleep problems  were measured at only one point in time, and in that it relied on self-reported  symptoms. People may not be aware they have breathing problems during sleep, and  there was no information about whether participants were being treated for  depression.

The study is published in the April issue of the journal Sleep.

Read more: http://www.foxnews.com/health/2012/03/30/depression-linked-with-sleep-breathing-problems-study-finds/#ixzz1rjdng6yg

Even Sleep Apnea Patients Who Don’t Feel Drowsy in Daytime Are at Risk for Heart Disease – By Caroline Wilbert, WebMD Health News

Sleep apnea — even if it is so mild that people have no daytime drowsiness — may increase the risk of cardiovascular disease, a study shows.

The study, published in the American Journal of Respiratory and Critical Care Medicine, compared patients with mild sleep apnea to a comparison group that didn’t have sleep apnea. There were 64 participants with mild sleep apnea and 15 participants without sleep apnea.

To compare the risk for heart disease, researchers tested endothelial function, which is how well the cells in the lining of the blood vessels work, and artery stiffness. Endothelial dysfunction and arterial stiffness are involved in developing atherosclerosis, or hardening of the arteries. Moderate to severe sleep apnea has already been linked to increased artery stiffness, endothelial dysfunction, and high blood pressure.

Malcolm Kohler, MD, from the Oxford Centre for Respiratory Medicine in England, and colleagues found that patients with mild sleep apnea had worse endothelial function and greater arterial stiffness than the comparison group without sleep apnea.

Researchers also tested blood pressure, another way to gauge cardiovascular disease risk. The groups tested similarly on blood pressure.

The researchers write that “although this was not associated with significantly increased blood pressure, the findings of this study suggest that patients with minimally symptomatic OSA [obstructive sleep apnea] are at increased cardiovascular risk, as has been demonstrated in more severe disease.”

“It was previously known that people with OSA (obstructive sleep apnea) severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people — some of whom may be completely unaware that they even have OSA — are at risk than previously thought,” Kohler says in a news release.

In an accompanying editorial, Geraldo Lorenzi-Filho MD, PhD, points out that just one in five patients with sleep apnea complains of drowsiness during the day. “It is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system,” he writes in the editorial.

Kohler and colleagues are now investigating the effects of continuous positive airway pressure (CPAP) therapy on arterial stiffness and endothelial function in patients with sleep apnea.

Having trouble staying asleep at night could spell trouble for your memory in old age, a new study suggests.

Research that will be presented in April at the annual meeting of the American Academy of Neurology shows that people who reported waking up more than five times in an hour also had an increased risk of having build up of amyloid plaques — which are linked with Alzheimer’s disease — in their brains.

“Further research is needed to determine why this is happening and whether sleep changes may predict cognitive decline,” study researcher Yo-El Ju, MD, of the Washington University School of Medicine in St. Louis, said in a statement.

Researchers examined the sleep patterns of 100 people ages 45 to 80 who didn’t have dementia by having them fill out sleep diaries and questionnaires, and placing a device on them as they slept for two weeks. Half of the study participants had a family history of Alzheimer’s disease.

The scientists found after the study that 25 percent of people had evidence of amyloid plaques in their brains. The average night’s sleep for the study participants was eight hours, and the average time actually spent sleeping (due to periods of wakefulness during the night) was 6.5 hours a night.

Researchers found that the more “efficient” sleepers — that is, the people who spent more than 85 percent of time in their beds actually sleeping — were less likely to have the amyloid plaques than the “inefficient” sleepers — defined as people who spent less than 85 percent of time in their beds actually sleeping.

Past studies have also shown that sleep has other beneficial impacts on the brain.

And just last year, researchers from Stanford University published a study in the journal Proceedings of the National Academy of Sciences that showed that having constantly interrupted sleep is linked with an impaired ability to learn new things, the Los Angeles Times reported. That study was conducted in mice.

By Julie Evans

Surprising reasons you’re tired all the time – Tampa

We all tend to blame fatigue on a too-busy lifestyle. And much of the time we’re right.

If you feel tired all the time, don’t blow it off. Give yourself about 2 to 3 weeks to make some lifestyle changes. Get more sleep, trim your social calendar, eat more wholesome foods, drink more fluids, take a multivitamin, and cut back on caffeine and alcohol.

“If you’re still feeling the symptoms of fatigue after those changes, then you need professional help,” says Sandra Adamson Fryhofer, MD, an internal medicine doctor in Atlanta. Excess exhaustion could be the sign of a more serious medical condition that can be treated. Here are the 6 most common problems to know about.

1. Anemia

This condition is more common in women with heavy periods or who don’t consume enough iron.

The fatigue caused by anemia is the result of a lack of red blood cells, which bring oxygen from your lungs to your tissues and cells. You may feel weak and short of breath. Anemia may be caused by an iron or vitamin deficiency, blood loss, internal bleeding, or a chronic disease such as rheumatoid arthritis, cancer, or kidney failure. Women of childbearing age are especially susceptible to iron-deficiency anemia because of blood loss during menstruation and the body’s need for extra iron during pregnancy and breastfeeding, explains Laurence Corash, MD, adjunct professor of laboratory medicine at the University of California, San Francisco.

The symptoms: Fatigue is a major one. Others include extreme weakness, difficulty sleeping, lack of concentration, rapid heartbeat, chest pains, and headache. Simple exercise, such as climbing the stairs or walking short distances, can cause fatigue.

The tests: A thorough evaluation for anemia includes a complete physical exam and blood tests, including a complete blood count (CBC), to check the levels of your red blood cells. It’s also standard to check the stool for blood loss.

2. Diabetes

More than a million people are diagnosed with type 2 diabetes every year, but many more may not even know they have it.

Sugar, also called glucose, is the fuel that keeps your body going. And that means trouble for people with type 2 diabetes who can’t use glucose properly, causing it to build up in the blood. Without enough energy to keep the body running smoothly, people with diabetes often notice fatigue as one of the first warning signs, says Christopher D. Saudek, MD, professor of medicine and program director for the General Clinical Research Center at the Johns Hopkins University School of Medicine.

The symptoms: Aside from exhaustion, other signs include excessive thirst, frequent urination, hunger, weight loss, irritability, vaginal yeast infections, and blurred vision.

The tests: There are two major tests for diabetes. The fasting plasma glucose test, which is more common, measures your blood glucose level after fasting for 8 hours, usually first thing in the morning. With the oral glucose tolerance test (OGTT), blood is drawn twice: just before drinking a glucose syrup, then 2 hours later.

3. Thyroid Disease

When your thyroid hormones are out of whack, even everyday activities will make you feel wiped out.

The thyroid gland, about the size of the knot on a man’s tie, is found in the front of the neck and produces hormones that control your metabolism. Too much thyroid hormone (hyperthyroidism), and metabolism speeds up. Too little (hypothyroidism), and metabolism slows down.

The symptoms: Hyperthyroidism causes muscle fatigue and weakness, which you may notice first in the thighs. Exercises such as riding a bike or climbing stairs become more difficult. Other symptoms include unexplained weight loss, feeling warm all the time, increased heart rate, shorter and less frequent menstrual flows, and increased thirst. Hyperthyroidism is most commonly diagnosed in women in their 20s and 30s, but it can occur in older women and men too, says Robert J. McConnell, MD, codirector of the New York Thyroid Center at Columbia University Medical Center in New York City.

Hypothyroidism causes fatigue, an inability to concentrate, and muscle soreness, even with minor activity. Other symptoms include weight gain due to water retention, feeling cold all the time (even in warmer weather), heavier and more frequent menstrual flows, and constipation. Hypothyroidism is most common in women over age 50. In fact, as many as 10% of women past 50 will have at least mild hypothyroidism, says McConnell.

The tests: Thyroid disease can be detected with a blood test. “Thyroid disorders are so treatable that a thyroid test should be done in all people who complain of fatigue and/or muscle weakness,” says McConnell.

4. Depression

More than “the blues,” depression is a major illness that affects the way we sleep, eat, and feel about ourselves and others.

Without treatment, the symptoms of depression may last for weeks, months, or even years. So it’s important to recognize the warning signs and get help.

The symptoms: We don’t all experience depression in the same way. But commonly, depression can cause decreased energy, changes in sleeping and eating patterns, problems with memory and concentration, and feelings of hopelessness, worthlessness, and negativity.

The tests: There’s no blood test for depression, but your doctor may be able to identify it by asking you a series of questions. If you experience five or more symptoms below for more than 2 weeks, or if they interfere with your life, see your doctor or mental health professional. Your doctor may also recommend a thorough physical exam to rule out other issues.
•Fatigue or loss of energy
•Sleeping too little or too much
•A persistent sad, anxious, or “empty” mood
•Reduced appetite and weight loss, or increased appetite and weight gain
•Loss of interest or pleasure in activities once enjoyed
•Restlessness or irritability
•Persistent physical symptoms that don’t respond to treatment, such as headaches, chronic pain, or constipation and other digestive disorders
•Difficulty concentrating, remembering, or making decisions
•Feeling guilty, hopeless, or worthless
•Thoughts of death or suicide

5. Rheumatoid Arthritis

This autoimmune disease is not always easy to diagnose early, but there are some subtle clues to look for.

RA happens when your immune system turns against itself and attacks healthy joint tissue, sometimes resulting in irreversible damage to bone and cartilage.

The symptoms: Many symptoms (such as fatigue, low energy, loss of appetite, and joint pain) are shared by other health conditions, including other forms of arthritis such as fibromyalgia and lupus. Also, anemia and thyroid disorders, which also cause fatigue, are even more common in people with RA, according to John Klippel, MD, president and CEO of the Atlanta-based Arthritis Foundation.

Rheumatologists look for at least four of the following criteria in diagnosing RA: morning stiffness in and around the joints lasting at least 1 hour before maximum improvement; at least three joint areas with simultaneous soft tissue swelling or fluid; at least one joint area swollen in a wrist, knuckle, or the middle joint of a finger; simultaneous involvement of the same joint areas on both sides of the body; lumps of tissue under the skin; and bone erosion in the wrist or hand joints, detected by x-ray.

The tests: A thorough physical exam by a rheumatologist can provide some of the most valuable evidence of the disease, but there is also a test for the presence of rheumatoid factor, an antibody found in the blood. About 80% of people with RA test positive for this antibody, but the test is not conclusive.

6. Sleep Apnea

You could have this sleep-disrupting problem if you wake up feeling tired no matter how much rest you think you got.

Sleep apnea is a disorder characterized by brief interruptions of breathing during sleep. In the most common type, obstructive sleep apnea, your upper airway actually closes or collapses for a few seconds, which, in turn, alerts your brain to wake you up to begin breathing again. Someone with obstructive sleep apnea may stop breathing dozens or even hundreds of times a night, says Roseanne S. Barker, MD, former medical director of the Baptist Sleep Institute in Knoxville, TN.

The symptoms: Sleep apnea is often signaled by snoring and is generally followed by tiredness the next day. Because sleep apnea can lead to heart disease, high blood pressure, and stroke, it’s important to be tested.

People who suffer from sleep disturbances are at major risk for obesity, diabetes, and coronary artery disease, according to new research from the Perelman School of Medicine at the University of Pennsylvania.

Shown for the first time in such a large and diverse sample, analyzing the data of over 130,000 people, the new research also indicates that general sleep disturbance (difficulty falling asleep, staying asleep, and/or sleeping too much) may play a role in the development of cardiovascular and metabolic disorders. The study is published online ahead of print in the Journal of Sleep Research.

“Previous studies have demonstrated that those who get less sleep are more likely to also be obese, have diabetes or cardiovascular disease, and are more likely to die sooner, but this new analysis has revealed that other sleep problems, such as difficulty falling asleep, staying asleep, or even too much sleep, are also associated with cardiovascular and metabolic health issues,” said Michael A. Grandner, PhD, research associate at the Center for Sleep and Circadian Neurobiology at Penn and lead author of the study.

The researchers examined associations between sleep disturbances and other health conditions, focusing on perceived sleep quality, rather than just sleep duration. After adjusting for demographic, socioeconomic, and health risk factors, patients with sleep disturbances at least 3 nights per week on average were 35% more likely to be obese, 54% more likely to have diabetes, 98% more likely to have coronary artery disease, 80% more likely to have had a heart attack, and 102% more likely to have had a stroke.

The researchers say that future studies are needed to show whether sleep problems actually predict the new onset of cardiovascular and metabolic disease, and whether treatment of sleep problems improves long-term health and longevity.

Shaq Attacks Sleep Apnea – Tampa