Category: Sleep Disorders

A study in the April 1 issue of the journal Sleep demonstrates that an Internet-based intervention was effective at reducing infant and toddler sleep disturbances, as well as providing positive, indirect benefits for maternal sleep, mood and confidence. The study suggests that the Internet can give parents widespread access to individualized, behaviorally based advice for sleep problems in young children.

Results show that there were significant improvements in the sleep of infants and toddlers in the Internet-based intervention groups. The number and duration of night wakings decreased by about 50 percent or more, and the longest period of continuous sleep increased by more than two hours. Children also took less time to fall asleep and had a longer total sleep time at night. Mothers in the intervention groups also slept better and had less tension, depression, fatigue and confusion. In the control group there were only minimal improvements in sleep measures and ratings of maternal mood.

"We have always known that making simple changes can help young children sleep dramatically better at night, but we were surprised by how quickly these changes came about," said principal investigator and lead author Jodi A. Mindell, PhD, professor of psychology at Saint Joseph's University and associate director of the Sleep Center at the Children's Hospital of Philadelphia, Pa. "Within just one week, the children, and their mothers, were sleeping much better, and they continued to improve over the second week."

This three-week study involved 264 mothers and their infant or toddler (ages 6 to 36 months). Families were randomly assigned to one of two Internet-based intervention groups or a control group. After a one-week baseline period during which mothers followed their usual bedtime practices, the intervention groups followed personalized recommendations during weeks two and three. All mothers completed online versions of the Brief Infant Sleep Questionnaire, the Pittsburgh Sleep Quality Index, and the Profile of Mood States weekly.

Mothers in the intervention groups used their home computer to access the Customized Sleep Profile, an online program that collects caregivers' responses and compares their child's sleep to other children of the same age. It rates whether the child is an "excellent, good or disrupted sleeper," and uses algorithms to provide customized advice on how caregivers can help their child sleep better at night. Examples of common recommendations include implementing a bedtime routine, decreasing attention to night wakings, and decreasing or stopping nighttime feedings. Ninety percent of mothers in both intervention groups reported that they found the individualized recommendations to be "helpful," and 93 percent said that they were "likely" to continue using the recommendations after the study.

Mothers in one of the intervention groups also were instructed to institute a nightly three-step bedtime routine: a bath, a massage and a quiet activity such as cuddling or singing a lullaby. A 2009 study by Mindell found that this routine produced significant reductions in problematic sleep behaviors for infants and toddlers. In the current study, both intervention groups had similar improvements on all sleep outcomes.

According to the authors, sleep problems occur in 20 to 30 percent of young children. Although behavior-based interventions for childhood sleep problems are highly effective, their availability has been limited. The use of an Internet-based intervention gives parents widespread access to valuable recommendations that promote healthy sleep habits in children.

"Until now, there was no place online that parents could go to get customized recommendations that would help their young child sleep better," Mindell added. "This tool provides parents everywhere easily accessible help."

The Customized Sleep Profile is currently available to parents as a free resource from Johnson & Johnson as one of its "tools for better sleep" at http://www.johnsonsbaby.com/sleep. The authors do not receive financial benefit from its use.

The study was supported by Johnson & Johnson Consumer Companies Inc. Dr. Mindell and co-authors Drs. Courtney Du Mond and Avi Sadeh have consulted for Johnson and Johnson. There was no involvement from Johnson & Johnson with the data analysis or the writing of the paper.

In 2006, the American Academy of Sleep Medicine (AASM) published "Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children" in the journal Sleep. Learn more about children and sleep at http://www.sleepeducation.com and http://www.sleepeducation.blogspot.com.

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Journal Reference:

1. Jodi A. Mindell, Courtney E. Du Mond, Avi Sadeh, Lorena S. Telofski, Neema Kulkarni, Euen Gunn. Efficacy of an Internet-based intervention for infant and toddler sleep disturbances. Sleep, 2011; 34 (4): 451-458 

 If you want to increase your chances of losing weight, reduce your stress level and get adequate sleep. A new Kaiser Permanente study found that people trying to lose at least 10 pounds were more likely to reach that goal if they had lower stress levels and slept more than six hours but not more than eight hours a night.

The paper, published March 29 in the International Journal of Obesity, was the result of a study funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine.

Nearly 500 participants from Kaiser Permanente in Oregon and Washington took part in the study, which measured whether sleep, stress, depression, television viewing, and computer screen time were correlated with weight loss. Several previous studies have found an association between these factors and obesity, but few have looked at whether these factors predict weight loss.

"This study suggests that when people are trying to lose weight, they should try to get the right amount of sleep and reduce their stress," said lead author Charles Elder, MD, MPH, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., who also leads Integrative Medicine at Kaiser Permanente Northwest. "Some people may just need to cut back on their schedules and get to bed earlier. Others may find that exercise can reduce stress and help them sleep. For some people, mind/body techniques such as meditation also might be helpful."

The study involved two phases: during the first phase, participants were asked to lose at least 10 pounds over six months. If they succeeded, they moved to the second year-long phase of the study, which tested a complementary acupressure technique against more traditional weight-maintenance strategies. Findings from phase two are not yet available.

During the study's first phase, all participants attended weekly meetings at which they were weighed and advised to reduce calorie intake by 500 calories per day, adopt a low-fat, low-sugar diet with lots of fruits and vegetables, increase physical activity to 180 minutes a week, and keep daily food records. People who kept more food records and attended more meetings were more likely to lose weight during this phase of the trial.

Participants also were asked to report levels of insomnia, stress and depression, and to record how much time they slept and spent watching television or using a computer. The research team found that sleep and stress levels were good predictors of weight loss, but depression and screen time were not.

People with the lowest stress levels who also got more than six hours, but not more than eight hours, of sleep were most likely to lose at least 10 pounds. In fact, nearly three-quarters of this group moved on to the second phase of the trial, and were twice as likely to be successful as those who reported the highest stress levels and got six or fewer hours of sleep per night.

Participants who qualified for the second phase were divided into two groups: one received monthly guided instruction in the Tapas Acupressure Technique, which involves lightly touching specific pressure points on the face and back of the head while focusing on a problem (i.e., maintaining weight loss). The other group also met monthly with a trained interventionist and a support group, but used more traditional nutrition and exercise techniques to keep weight off. Both groups met for six months and then were followed for another six months to see which group kept more weight off. Results of that phase of the trial should be available in late 2011 or early 2012.

The study authors caution that their findings may not apply to all groups trying to lose weight. The authors also noted that the participants were highly motivated, and that 90 percent had attended at least some college.

These studies are part of ongoing research at Kaiser Permanente to better understand weight loss and the key factors to maintaining optimum weight. Another Kaiser Permanente Center for Health Research study last year found that the more people logged on to an interactive weight management website, the more weight they kept off. Researchers at the Kaiser Permanente Center for Health Research also found that keeping a food diary can double a person's weight loss and that both personal contact and web-based support can help with long-term weight management.

Study authors include: Charles R. Elder, MD, MPH, Christina M. Gullion, PhD, Kristine L. Funk, MS, Lynn L. DeBar, PhD, Nangel M. Lindberg, PhD, and Victor J. Stevens, PhD, all from the Kaiser Permanente Center for Health Research in Portland, Ore.

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Journal Reference:

1. C R Elder, C M Gullion, K L Funk, L L DeBar, N M Lindberg, V J Stevens. Impact of sleep, screen time, depression and stress on weight change in the intensive weight loss phase of the LIFE study. International Journal of Obesity, 2011; DOI: 10.1038/ijo.2011.60

During a large-scale study of the socioeconomic costs of this neurodegenerative disease, Danish researchers, some from the University of Copenhagen, discovered that very early symptoms of Parkinson's disease may be revealed in dream or REM sleep.

Parkinson's disease is a brain disease best known for the trembling it causes. It is an incurable, chronic disease and gradually affects the muscles and mental capacity, seriously afflicting the lives if the patient and his or her immediate relatives.

"In the study we saw that eight years before diagnosis, Parkinson's sufferers exhibited work and health indications that something was wrong," says Poul Jennum, professor of clinical neurophysiology at the Center for Healthy Ageing, University of Copenhagen, and the Sleep Centre at Glostrup Hospital.

Among the very early symptoms is the sleep disorder RBD, or REM sleep behaviour disorder. REM is a particular stage of sleep in which we dream, and our eyes flicker rapidly behind our eyelids, hence the term REM, or Rapid Eye Movement. To prevent us from actually acting out our dreams the body usually shuts down our muscle movement during REM sleep, but in RBD it is still active, and REM sleepers with RBD display a range of behaviours from simple arm and leg spasms to kicking, shouting, seizing or jumping out of bed.

"In some cases their behaviour may be violent and result in injuries to the patients or their partners," Professor Jennum explains.

Early symptoms of Parkinson's may be other brain disorders

"Our hypothesis is that the very earliest stages of Parkinson's disease show up as various other diseases such as RBD," Jennum says.

In recent years, great advances have been made in the treatment of Parkinson's disease, but we still do not have therapies to mitigate the later symptoms, costs and increased mortality of the disease.

"This may become possible if we are able to intervene earlier, and if we are able to find clear indications of Parkinson's disease eight years sooner than we are now, this may give us an important tool. The question is of course whether we can actually say that RBD is always a very early marker for Parkinson's disease. That is what we are now investigating at the Sleep Centre at Glostrup Hospital," says Jennum.

Parkinson's disease has considerable costs

Not surprisingly the study showed that Parkinson's sufferers are more often in contact with all sections of the health service, more often unemployed, more often on benefits, and on average cost the health service DKK 50,000 a year more than healthy control subjects.

For the study, researchers used the National Patient Register to identify all the patients diagnosed with Parkinson's disease between 1997 and 2007. 13,700 patients were compared to 53,600 healthy patients of the same sex, social class, educational background etc.

The study was carried out by researchers from the Center for Healthy Ageing, the Danish Center for Sleep Medicine, University of Copenhagen, Glostrup Hospital, Bispebjerg Hospital and the Danish Institute of Health Research, and was published in the Journal of Neurology.

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Journal Reference:

1. Poul Jennum, Marielle Zoetmulder, Lise Korbo, Jakob Kjellberg. The health-related, social, and economic consequences of parkinsonism: a controlled national study. Journal of Neurology, 2011; DOI: 10.1007/s00415-011-5969-1

Fainting, or syncope, is quite common. About 50% of people will experience fainting at some point during their lifetime. The most common type of fainting is vasovagal syncope (VVS) that is caused by a sudden drop in blood pressure resulting in reduced blood flow to the brain. VVS can occur in healthy people due to inappropriate cardiovascular responses to certain behavioral or emotional triggers such as fear, needle prick or even standing up. VVS has a daily pattern with more occurrences during the morning.

This daily pattern is possibly due to the daily distribution of behavioral and emotional stimuli or perhaps due to influences from the internal circadian system, or 'body clock'. In a new study, researchers at Brigham and Women's Hospital (BWH) provide strong evidence that the circadian system may contribute to the daily pattern of VVS via its influences on physiological responses to changes in body posture. These findings are published on March 8, 2011 in the journal Circulation.

Lead study author Kun Hu, PhD, of the Division of Sleep Medicine at BWH said that "the susceptibility to VVS is probably present in all healthy humans. Fainting can cause an individual to fall which can result in severe trauma, including skull and limb bone fractures. Recurrent VVS can also affect quality of life due to reduced activities and social adjustment. Understanding the causes of VVS is important for diagnosis, prevention and treatment of people with a history of recurrent VVS."

In this study, repeated tilt-table tests were used to determine the susceptibility to VVS across the day and night in twelve healthy participants who stayed in a controlled laboratory environment for almost 2 weeks. To measure the influence of the internal body clock on VVS while controlling for other factors including the sleep/wake cycle, meals and the environment, the researchers scheduled all behaviors of participants while they lived on a recurring 20-hour "day" (with 6.7 hours scheduled for sleep and 13.3 hours for wake).

The study was performed in dim light so that the internal body clock still oscillated with an approximate 24-hour period. Core body temperature was measured throughout to indicate the times of the internal body clock. To stop the participants from actually fainting, signs of imminent VVS (presyncope) were closely monitored and tilt-table tests were immediately aborted whenever there were notable symptoms of nausea, dry mouth, dizziness, or low blood pressure or rapidly falling blood pressure.

The researchers found that the vulnerability to presyncope has a strong connection to the internal body clock, with susceptibility nine times higher at the circadian times between 10:30 PM and 10:30 AM compared to between 10:30 AM through 10:30 PM. The highest risk for presyncope occurred at the circadian time corresponding to 4:30 AM. "This vulnerable period may have relevance to individuals who remain awake or wake up frequently during the night, such as shift workers, parents feeding their infants and elderly people with increased nocturia or insomnia. These people may be at higher risk for syncope due to their postural changes during the night" said one of the investigators, Dr. Steven Shea of the Division of Sleep Medicine at BWH.

In addition, this study highlights the importance of performing tilt-table tests at similar circadian times when comparing responses of different individuals or the same person before and after treatments for syncope. The results also suggest that a higher sensitivity may be achieved by performing tilt-table testing during early morning hours or the night.

The research was funded by grants from the National Institutes of Health and the Harvard Catalyst.

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Journal Reference:

1. K. Hu, F. A. J. L. Scheer, M. Laker, C. Smales, S. A. Shea. Endogenous Circadian Rhythm in Vasovagal Response to Head-Up Tilt. Circulation, 2011; DOI: 10.1161/CIRCULATIONAHA.110.943019

A new study finds that a brain rhythm considered the hallmark of wakefulness not only persists inconspicuously during sleep but also signifies an individual's vulnerability to disturbance by the outside world. In their report in the March 3 PLoS One, the team from the Massachusetts General Hospital (MGH) Division of Sleep Medicine uses computerized EEG signal processing to detect subtle fluctuations in the alpha rhythm during sleep and shows that greater alpha intensity is associated with increased sleep fragility. The findings could lead to more precise approaches to inducing and supporting sleep.

"We found that the alpha rhythm is not just a marker of the transition between sleep and wakefulness but carries rich information about sleep stability," says Scott McKinney, informatics manager at the MGH Sleep Lab and lead author of the study. "This suggests that sleep — rather than proceeding in discrete stages — actually moves along a continuum of depth. It also opens the door to real-time tracking of sleep states and creates the potential for sleep-induction systems that interface directly with the brain."

One of numerous neuroelectrical signals produced by the brain and detected by electroencephalography (EEG), the alpha rhythm was first discovered nearly a century ago. Typically generated when the brain is relaxed but awake, the alpha rhythm fades as consciousness recedes and seems to disappear when sleep begins. However, a mathematical technique called spectral analysis, which quantifies the elemental oscillations that make up complicated signals, reveals that fluctuations in the alpha rhythm persist during sleep at levels that cannot be detected by visual inspection of an EEG.

Since alpha activity is associated with both wakefulness and receptiveness to sensory signals, the researchers hypothesized that it also could indicate a sleeper's sensitivity to environmental stimuli. To test this hypothesis, they monitored EEG rhythms in 13 healthy volunteers who spent three nights in the MGH Sleep Lab. At frequent intervals through each night the volunteers were exposed to 10 seconds of typical background noises like traffic or a ringing telephone. The sounds were repeated at successively louder levels until the EEG reflected that sleep had been disturbed.

Spectral analysis of the EEG measurements revealed that the strength of the alpha signal predicted how easily volunteers could be disturbed at the moment the measurement was taken, with a more intense alpha signal associated with more delicate sleep. The predictive power of alpha activity persisted for up to four minutes after the initial measurement, and the association was seen during both stage 2 and stage 3 non-REM sleep but not during REM sleep.

"We've found a quantitative measure that discloses sleep's momentary fragility," McKinney explains. "This technology may someday allow the development of adaptive sleep-inducing agents that can be guided by real-time feedback from neural activity — a great enhancement over conventional sleep drugs that act like sledgehammers, inducing a blanket sedation throughout the brain for an entire night."

Jeffrey Ellenbogen, MD, chief of the MGH Division of Sleep Medicine and senior author of the PLoS One report adds, "This finding paves the way toward futuristic sleep treatments in which medication or other therapies are delivered moment-to-moment, only when needed, to protect sleep when the brain is most vulnerable but otherwise let natural brain rhythms run their course. Learning more about the mechanism behind this association between the alpha rhythm and sleep fragility should lead to an even greater understanding of the factors that maintain sleep's integrity in the face of noise and other nuisances."

Ellenbogen is an assistant professor of Neurology at Harvard Medical School. Additional co-authors of the PLoS One report are Thien Thahn Dang-Vu, PhD, MGH Neurology; Orfeu Buxton, PhD, Brigham and Women's Hospital; and Jo Solet, PhD, Cambridge Health Alliance. This study was funded by grants from the Academy of Architecture for Health, the Facilities Guidelines Institute and the Center for Health Design.

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Journal Reference:

1. Scott M. McKinney, Thien Thanh Dang-Vu, Orfeu M. Buxton, Jo M. Solet, Jeffrey M. Ellenbogen. Covert Waking Brain Activity Reveals Instantaneous Sleep Depth. PLoS ONE, 2011; 6 (3): e17351 DOI: 10.1371/journal.pone.0017351

Northwestern University scientists have discovered a new mechanism in the core gears of the circadian clock. They found the loss of a certain gene, dubbed "twenty-four," messes up the rhythm of the common fruit fly's sleep-wake cycle, making it harder for the flies to awaken.

The circadian clock drives, among other things, when an organism wakes up and when it sleeps. While the Northwestern study was done using the fly Drosophila melanogaster, the findings have implications for humans.

The research will be published Feb. 17 in the journal Nature.

"The function of a clock is to tell your system to be prepared, that the sun is rising, and it's time to get up," said Ravi Allada, M.D., who led the research at Northwestern. "The flies without the twenty-four gene did not become much more active before dawn. The equivalent in humans would be someone who has trouble getting out of bed in the morning."

Allada is professor of neurobiology and physiology in the Weinberg College of Arts and Sciences and associate director for the Center for Sleep and Circadian Biology.

Period (per) is a gene in fruit flies that encodes a protein, called PER, which regulates circadian rhythm. Allada and his colleagues found that twenty-four is critically important to producing this key clock protein. When twenty-four is not present very little PER protein is found in the neurons of the brain, and the fly's sleep-wake rhythm is disturbed.

It seems it was fate that the gene Allada and his team pinpointed would be important in regulating the 24-hour sleep-wake cycle. The gene's generic name is CG4857, and the numbers add up to 24, earning it the twenty-four nickname. (The fruit fly's genome was sequenced in 2000, but until now the function of this gene was unknown.)

The known core mechanisms of the circadian clock, both in flies and humans, involve the process of transcription, where RNA is produced from DNA. A portion of the control system called a transcriptional feedback loop also is important. (The word circadian comes from the Latin phrase "circa diem," meaning "about a day.")

In trying to identify new clock components, the researchers identified a new player in the system, the gene twenty-four. Instead of operating in the process of transcription, they found twenty-four operates in the process of translation: translating proteins from RNA.

Twenty-four appears to be a protein that promotes translation of period RNA to protein. "This really defines a new mechanism by which circadian clocks are functioning," Allada said. "We found that twenty-four has a really strong and critical role in translating a key clock protein. Translation really wasn't appreciated before as having such an important role in the process."

The researchers believe it is likely that a mechanism similar to that described for the fly gene twenty-four will be evolutionarily conserved and found in humans.

Allada and his Northwestern team worked with scientists at the Korea Advanced Institute of Science and Technology (KAIST). Using a Drosophila library at KAIST, the researchers first screened the behavior of 4,000 different flies looking for flies whose sleep-wake cycles were awry. (Each fly had a different overexpressed gene and thus different behavior.) The fly with the most dramatic change was one with a longer cycle than normal, 26 hours instead of 24.

The overexpressed gene in this fly was CG4857. The researchers next removed, or knocked out, this gene in the flies. These flies had very poor sleep-wake rhythm and would sleep and wake at all times of day. The researchers found very little of the critical PER protein in the brain neurons despite the fact that per RNA is likely produced in the neurons. Without twenty-four the RNA was not translated into the PER protein, leading to dysfunction.

In addition to Allada, other authors of the paper Chunghun Lim and Valerie L. Kilman, from Northwestern; Jongbin Lee, Changtaek Choi, Juwon Kim and Joonho Choe, from Korea Advanced Institute of Science and Technology, Korea; and Sung Mi Park and Sung Key Jang, from Pohang University of Science and Technology, Korea.

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Journal Reference:

1. Chunghun Lim, Jongbin Lee, Changtaek Choi, Valerie L. Kilman, Juwon Kim, Sung Mi Park, Sung Key Jang, Ravi Allada, Joonho Choe. The novel gene twenty-four defines a critical translational step in the Drosophila clock. Nature, 2011; 470 (7334): 399 DOI: 10.1038/nature09728

Researchers have known for decades that alcohol can initially deepen sleep during the early part of the night but then disrupt sleep during the latter part of the night; this is called a "rebound effect." A new study of the influence of gender and family history of alcoholism on sleep has found that intoxication can increase feelings of sleepiness while at the same time disrupt actual sleep measures in healthy women more than in healthy men.

Results will be published in the May 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"It's clear that a substantial portion of the population uses alcohol on a regular basis to help with sleep problems," said J. Todd Arnedt, assistant professor of psychiatry and neurology at the University of Michigan and lead author of the study. "This perception may relate to the fact that alcohol helps people fall asleep quickly and they may be less aware of the disruptive effects of alcohol on sleep later in the night."

Arnedt said that his group decided to examine gender differences in the effects of alcohol on sleep because very few alcohol administration studies have included female participants and, since women metabolize alcohol differently than men, it seemed reasonable to expect differences by gender.

"Our decision to examine family history was based on some observational studies showing different sleep characteristics among family-history positive participants compared to family-history negative participants," he explained. "Family-history positive individuals also seem to be more resistant to the acute intoxicating effects of alcohol than individuals without a family history of alcoholism."

Arnedt and his colleagues recruited 93 healthy adults (59 women, 34 men) in their twenties through advertisements in the Boston area, 29 of whom had a positive family history of alcoholism. Between 8:30 and 10:00 p.m., participants consumed either a placebo beverage or alcohol to the point of intoxication as determined by breath alcohol concentration (BrAC). Their sleep was then monitored with polysomnography between 11:00 p.m. and 7:00 a.m. Participants also completed questionnaires at bedtime and upon awakening.

"Alcohol increased self-reported sleepiness and disrupted sleep quality more in women than men," said Arnedt. "Sleep quality following alcohol did not differ between family-history positive and family-history negative subjects. Morning ratings of sleep quality were worse following alcohol than placebo. Findings also confirmed results from other studies that a high dose of alcohol solidifies sleep in the first half of the night, meaning more deep sleep, but disrupts it in the second part of the night, meaning more wakefulness."

With respect to gender differences, women objectively had fewer hours of sleep, woke more frequently and for more minutes during the night, and had more disrupted sleep than men.

"These differences may be related to differences in alcohol metabolism," explained Arnedt, "since women show a more rapid decline in BrAC following alcohol consumption than men. It is important to note that the peak BrACs were equivalent between men and women in our study so the findings are not due to higher BrACs among the female subjects. We also do not believe that the differences were due to differences in alcohol experience because the prior alcohol use was also equivalent between the men and women."

In summary, said Arnedt, this study's primary contribution was to demonstrate that the effects of alcohol on objectively measured sleep quality are different between men and women at equivalent BrACs.

"These findings may have implications for future studies examining the relationship between sleep quality and risk for the development of alcohol use disorders, as well as studies evaluating how sleep quality relates to relapse among recovering alcoholic individuals," he said.

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Journal Reference:

1. J. Todd Arnedt, Damaris J. Rohsenow, Alissa B. Almeida, Sarah K. Hunt, Manjusha Gokhale, Daniel J. Gottlieb, Jonathan Howland. Sleep Following Alcohol Intoxication in Healthy, Young Adults: Effects of Sex and Family History of Alcoholism. Alcoholism: Clinical and Experimental Research, 2011; DOI: 10.1111/j.1530-0277.2010.01417.x

An inadequate amount of sleep has been associated with higher risks of obesity, heart disease, diabetes, and death. Now colon cancer can be added to the list.

In a ground-breaking new study published in the Feb. 15, 2011 issue of the journal Cancer, researchers from University Hospitals (UH) Case Medical Center and Case Western Reserve University School of Medicine, found that individuals who averaged less than six hours of sleep at night had an almost 50 percent increase in the risk of colorectal adenomas compared with individuals sleeping at least seven hours per night. Adenomas are a precursor to cancer tumors, and left untreated, they can turn malignant.

"To our knowledge, this is the first study to report a significant association of sleep duration and colorectal adenomas," said Li Li, MD, PhD, the study's principal investigator, family medicine physician in the Department of Family Medicine at UH Case Medical Center and Associate Professor of Family Medicine, Epidemiology and Biostatistics at Case Western Reserve University School of Medicine. "A short amount of sleep can now be viewed as a new risk factor for the development of the development of colon cancer."

In the study, patients were surveyed by phone prior to coming into the hospital for scheduled colonoscopies at UH Case Medical Center. They were asked demographic information as well as questions from the Pittsburg Sleep Quality Index (PSQI), which obtains information about the patient's overall sleep quality during the past month. The PSQI asks for such information as how frequently one has trouble sleeping and how much sleep one has had per night. The study was funded by the National Cancer Institute through Case Western Reserve University School of Medicine.

Of the 1,240 patients, 338 were diagnosed with colorectal adenomas at their colonoscopy. The patients with adenomas were found in general to have reported sleeping less than six hours compared to compared to those patients without adenomas (control) patients, and the association between amount of sleep and adenomas remained even when adjusted for family history, smoking, and waist-to-hip ratio (a measurement of obesity).

The researchers also found a slightly stronger association of sleep duration with adenomas with women compared to men, but the difference was not statistically significant.

Dr Li said the magnitude of the increase in risk due to less hours of sleep is comparable to the risk associated with having a first-degree relative (parent or sibling) with colon cancer, as well as with high, red meat intake. "Short sleep duration is a public health hazard leading not only to obesity, diabetes and coronary heart disease, but also, as we now have shown in this study, colon adenomas," he said. "Effective intervention to increase duration of sleep and improve quality of sleep could be an under-appreciated avenue for prevention of colorectal cancer."

Although why fewer hours of sleep may lead to colon cancer is unknown, Dr. Li said some of theories include that less sleep may mean less production of melatonin, a natural hormone that in animals has been linked to DNA repair, or that insulin resistance may underlie the link between sleep disturbance and cancer development.

Dr. Li and other researchers on the study are also associated with the UH Seidman Cancer Center, the Case Comprehensive Cancer Center, the Department of Epidemiology and Biostatistics at Case Western Reserve University, the Center for Clinical Investigation at Case Western Reserve, and the Department of Medicine at UH and Case Western Reserve University School of Medicine.

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Journal Reference:

1. Cheryl L. Thompson, Emma K. Larkin, Sanjay Patel, Nathan A. Berger, Susan Redline, Li Li. Short duration of sleep increases risk of colorectal adenoma. Cancer, 2011; 117 (4): 841 DOI: 10.1002/cncr.25507

New research from Warwick Medical School published in the European Heart Journal shows that prolonged sleep deprivation and disrupted sleep patterns can have long-term, serious health implications. Leading academics from the University have linked lack of sleep to strokes, heart attacks and cardiovascular disorders which often result in early death.

Professor Francesco Cappuccio from the University of Warwick Medical School, explained: "If you sleep less than six hours per night and have disturbed sleep you stand a 48 per cent greater chance of developing or dying from heart disease and a 15 per cent greater chance of developing or dying of a stroke.

"The trend for late nights and early mornings is actually a ticking time bomb for our health so you need to act now to reduce your risk of developing these life-threatening conditions."

Professor Cappuccio and co-author Dr Michelle Miller, from the University of Warwick, conducted the research programme which followed up evidence from seven to 25 years from more than 470,000 participants from eight countries including Japan, USA, Sweden and UK.

Professor Cappuccio explained: "There is an expectation in today's society to fit more into our lives. The whole work/life balance struggle is causing too many of us to trade in precious sleeping time to ensure we complete all the jobs we believe are expected of us."

He added: "But in doing so, we are significantly increasing the risk of suffering a stroke or developing cardiovascular disease resulting in, for example, heart attacks."

Dr Miller explained further: "Chronic short sleep produces hormones and chemicals in the body which increase the risk of developing heart disease and strokes, and other conditions like high blood pressure and cholesterol, diabetes and obesity."

But Professor Cappuccio did warn of the implications of going too far the other way, as sleeping overly long — more than nine hours at a stretch — may be an indicator of illness, including cardiovascular disease.

"By ensuring you have about seven hours sleep a night, you are protecting your future health, and reducing the risk of developing chronic illnesses. The link is clear from our research: get the sleep you need to stay healthy and live longer."

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Journal Reference:

1. F. P. Cappuccio, D. Cooper, L. D'Elia, P. Strazzullo, M. A. Miller. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal, 2011; DOI: 10.1093/eurheartj/ehr007

 After a good night's sleep, people remember information better when they know it will be useful in the future, according to a new study in the Feb. 2 issue of The Journal of Neuroscience. The findings suggest that the brain evaluates memories during sleep and preferentially retains the ones that are most relevant.

Humans take in large amounts of information every day. Most is encoded into memories by the brain and initially stored, but the majority of information is quickly forgotten. In this study, a team of researchers led by Jan Born, PhD, of the University of Lübeck in Germany set out to determine how the brain decides what to keep and what to forget.

"Our results show that memory consolidation during sleep indeed involves a basic selection process that determines which of the many pieces of the day's information is sent to long-term storage," Born said. "Our findings also indicate that information relevant for future demands is selected foremost for storage."

The researchers set up two experiments to test memory retrieval in a total of 191 volunteers. In the first experiment, people were asked to learn 40 pairs of words. Participants in the second experiment played a card game where they matched pictures of animals and objects — similar to the game Concentration — and also practiced sequences of finger taps.

In both groups, half the volunteers were told immediately following the tasks that they would be tested in 10 hours. In fact, all participants were later tested on how well they recalled their tasks.

Some, but not all, of the volunteers were allowed to sleep between the time they learned the tasks and the tests. As the authors expected, the people who slept performed better than those who didn't. But more importantly, only the people who slept and knew a test was coming had substantially improved memory recall.

The researchers also recorded electroencephalograms (EEG) from the individuals who were allowed to sleep. They found an increase in brain activity during deep or "slow wave" sleep when the volunteers knew they would be tested for memory recall.

"The more slow wave activity the sleeping participants had, the better their memory was during the recall test 10 hours later," Born said. Scientists have long thought that sleep is important in memory consolidation. The authors suggest that the brain's prefrontal cortex "tags" memories deemed relevant while awake and the hippocampus consolidates these memories during sleep.

Gilles Einstein, PhD, an expert in memory at Furman University, said the new findings help explain why you are more likely to remember a conversation about impending road construction than chitchat about yesterday's weather. "These results suggest that sleep is critical to this memory enhancement," said Einstein, who was unaffiliated with the study. "This benefit extends to both declarative memories (memory for a road detour) and procedural memories (memory for a new dance step)."

The research was supported by the German Research Foundation.

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Journal Reference:

1. I. Wilhelm, S. Diekelmann, I. Molzow, A. Ayoub, M. Molle, J. Born. Sleep Selectively Enhances Memory Expected to Be of Future Relevance. Journal of Neuroscience, 2011; 31 (5): 1563 DOI: 10.1523/JNEUROSCI.3575-10.2011