Sleep Problems

Copy of Your Brain Has A “Delete” Button–Here’s How To Use It

Copy of Your Brain Has A “Delete” Button–Here’s How To Use It

Have you ever wondered "How can I learn more?" This article highlights how we learn and steps you can take to facilitate learning. Hint...sleeping matters.

Winter get you down? Facts about SAD

Winter get you down? Facts about SAD

What is the first thought you have when day lights savings comes around? If it is dread of the dark and shorter evenings or winter blues, you are not alone.

What is seasonal affective disorder or SAD for short? SAD is a major depressive episode that happens in the Fall and Winter and tends to resolve in the Spring and Summer.

How to Fall Asleep in Under a Minute

4, 7, 8: Can following asleep really be this simple? A few breaths and asleep within minutes? This technique has been used for years and has proven effective for many. Laura Wiley / Bit of News

Here is how you do the exercise:

  1. Place the tip of your tongue against the tissue ridge right above your upper front teeth. Keep it there for the remainder of the exercise.
  2. Exhale completely through your mouth, making a whooshsound as you do so.
  3. Close your mouth and inhale slowly through your nose while mentally counting to four.
  4. Hold your breath for a mental count of seven.
  5. Exhale completely through your mouth for a mental count of eight. Make the same whoosh sound from Step Two.
  6. This concludes the first cycle. Repeat the same process three more times for a total of four renditions.

In a nutshell: breathe in for four, hold for seven, and breathe out for eight. You must inhale through your nose and exhale through your mouth. The four-count inhale allows chronic under-breathers to take in more oxygen. The seven-count hold gives the oxygen more time to thoroughly permeate the bloodstream, and the eight-count exhale slows the heart rate and releases a greater amount of carbon dioxide from the lungs.

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38 Health Benefits of Yoga

38 Health Benefits of Yoga

Still wondering if you should try out yoga? How is it really going to help you anyway? This article discussing 38 scientifically proven reasons why you should get up and strike a yoga pose.


If you’re a passionate yoga practitioner, you’ve probably noticed some yoga benefits—maybe you’re sleeping better or getting fewer colds or just feeling more relaxed and at ease. But if you’ve ever tried telling a newbie about the benefits of yoga, you might find that explanations like “It increases the flow of prana” or “It brings energy up your spine” fall on deaf or skeptical ears.

The 12 Worst Habits for Your Mental Health

The 12 Worst Habits for Your Mental Health

Do you practice any of these unproductive mental health habits? This article discusses the most common pitfalls that people engage in that hurt our mental health and why they are so damaging. / Carey Rossi@goodhealth  /  Nov. 3, 2014

Change these simple, everyday routines to live a happier life

Depression is usually brought on by factors beyond our control—the death of a loved one, a job loss, or financial troubles. But the small choices you make every day may also affect your mood more than you may realize. Your social media habits, exercise routine, and even the way you walk may be sucking the happiness out of your day, and you may not even know it. Luckily, these behaviors can be changed. Read on for 12 ways you’re sabotaging your good moods, and what you can do to turn it around.

How we feel can affect the way we walk, but the inverse is also true, finds a study published in the Journal of Behavior Therapy and Experimental Psychiatry. Researchers found that when subjects were asked to walk with shoulders slouched, hunched over, and with minimum arm movements, they experienced worse moods than those who had more pep in their steps. What’s more, participants who walked in the slouchy style remembered more negative things rather than positive things. Talk about depressing.

Get happy now: Lift your chin up and roll your shoulders back to keep your outlook on the positive side.

One more reason to get a good night’s sleep

The brain is magnificent. Sleep and its function is one more reason to marvel at it's efficiency. Watch this informative and entertaining Ted talk on how the brain "cleans up" during sleep.

From website: The brain uses a quarter of the body's entire energy supply, yet only accounts for about two percent of the body's mass. So how does this unique organ receive and, perhaps more importantly, rid itself of vital nutrients? New research suggests it has to do with sleep.

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Why Some People Respond to Stress by Falling Asleep

This is a great article about a counter intuitive phenomenon. How can you want to fall asleep when you are clearly upset. Mr. Wolfson explores the possible psychological and biological explanations in this article.
Fight or flight, or sleep

Last month, my wife and I found ourselves in a disagreement about whether or not our apartment was clean enough for guests—the type of medium-sized disagreement that likely plagues all close relationships. In the midst of it, there was a lull and, feeling exhausted all of a sudden, I got up and left the living room. In the bedroom, I immediately fell face down into the sheets. The next thing I knew it was 20 minutes later and my wife was shaking me awake. I hadn’t meant to fall asleep; I just felt so fatigued in that moment that there was nothing else I could do.

This wasn’t new for me. A few weeks earlier, I had come into conflict with an acquaintance over some money. We were exchanging tense emails while I was at my office, and I began to feel the slow oozing onset of sleep, the same tiredness that came on when, as a child, I rode in the backseat of the car on the way home from some undesired trip. A sleepiness that overtakes the body slowly but surely and feels entirely outside of your control.

Though this has happened many times before, my response to conflict still seems strange to me. After all, as everyone knows from 9th grade biology class, when faced with stress—an acute threat—our bodies enter fight-or-flight mode. It’s supposed to be automatic: the adrenal cortex releases stress hormones to put the body on alert; the heart begins to beat more rapidly; breathing increases frequency; your metabolism starts to speed up, and oxygen-rich blood gets pumped directly to the larger muscles in the body. The point is to become energized, to prepare to face the source of the conflict head on, or, at the worst, be ready to run away, at top speed.

Of course, you don’t actually want the stress response system to be too reactive. If you were constantly in fight or flight mode, constantly stressed, it could actually have long-term effects on your neurochemistry, leading to chronic anxiety, depression, and, well, more sleeplessness. Even so, it seems like a good idea to sometimes be on high alert when dealing with stressful situations.

But that’s not what my body did. My body shut down.

I asked around, and found out that many others experience the same thing. For example, Dawn, a family counselor in Columbus, Ohio, told me that her husband Brad often “starts yawning in the middle of heated discussions, and will even lie down and go right to sleep.” One time their toddler son fell down the stairs (he was fine), and Brad left the room and went to bed.  Brad has had this kind of stress response for all 24 years of their relationship; Dawn says she’s used to it by now.

Even though dozens of people told me similar stories, I began to wonder what was wrong with us—what was wrong with me. Why was my body, in the face of conflict, simply acquiescing? Where was the fight in me?

There’s a concept in psychology called “learned helplessness” used to explain certain aspects of depression and anxiety. It’s fairly old, having been firstrecognized and codified in the 1970s, but has remained largely relevant and accepted within the field. The name (mostly) explains it all: If, at a very early stage in development, a living thing comes to understand that it is helpless in the face of the world’s forces, it will continue to perceive a lack of control, and therefore actually become helpless, no matter if the context changes.

In the early studies, dogs were divided into two groups: The first half were subjected to electric shocks, but were given a way to stop the shocks (they just had to figure it out themselves). The second group of dogs received shocks but had no way to avoid, escape, or stop them. The experience, sadly, had long-term effects on the animals. When faced with stressful environments later on in life, the first group of dogs did whatever they could to try to deal with it; the second group simply gave up. They had been conditioned to respond to stress with acquiescence.

This type of learned helplessness isn’t limited to animals; many of the adults I spoke with all mentioned childhood anxiety stemming from uncontrollable situations.

“When I hit high school and stress levels became higher in my life (messy divorce between my parents and lots of moving), I began escaping into sleep,” says LeAnna, a 25-year-old from Washington state. “As an adult, I still have ‘go to sleep’ impulses whenever I feel overwhelmed.” Daniel, from Baltimore told me that “whenever there was any kind of ‘family strife’ I would just go to my room and sleep.” Daniel is now 51, and starts yawning any time he encounters a stressful situation.

My parents divorced by the time I hit high school, but before they did, they fought a lot, usually in the kitchen beneath my bedroom. What I remember feeling most was powerlessness—not anger or sadness, but a shrug-your-shoulders, close-the-door, shut-your-eyes type of response because what was I going to do? Tell them to break it up?

That coping mechanism worked for me back then. I was able to compartmentalize those stressful experiences and move on with my life. I stayed in school and kept my grades up; I had friends and was relatively well-rounded. Things went well.  But now, at 28, I still deal with interpersonal conflict by shutting the door and going to sleep. I act on feelings that are no longer relevant to the situation.

“Our feelings are always in the past,” says John Sharp, a psychiatrist at Harvard Medical School. “This is something that’s really outlived its adaptive value.” As an adult I should have control over my current situation, but I don’t. Am I like those lab dogs, shocked into helplessness?

At first glance, sleep might seem like quintessential avoidance, like burying your head in the pillow is no better than burying your head in the sand.

But I don’t feel as though I am not helping myself. After all, going to sleep isn’t like turning the lights off; the truth is that there’s a lot still going on while your eyes are closed. While we might be able to temporarily stave the flow of conflict by falling asleep, we’re not really escaping anything. In fact, sleep in some ways forces us to not only relive the emotional experience but to process and concretize it—by going to sleep I may be making the fight with my wife more real.

If you’re like me, you probably imagine memories work pretty simply: you have an experience, it gets stored somewhere, and then you retrieve it when you need it. But that leaves out a key step, memory consolidation, and that’s where sleep comes into play.

Here’s how it really works, according to Dr. Edward Pace-Schott, professor at Harvard Medical School’s Division of Sleep Medicine: When an experience is initially encoded as a memory, it rests in the brain’s short term storage facilities, where it is fragile, easily forgotten if other experiences come along quickly. In order for the experience to last, it needs to go through a process of consolidation, where it becomes integrated into other memories that you have. That’s why when you think of, say the 1993 baseball game between the Yankees and Orioles, you also think of bright green grass, the smell of peanuts and beer, your dad, and Bobby Bonilla, and not thousands of random bits and pieces.

Of course, not every experience is worth remembering. Only the highly intense experiences—positive or negative—are prioritized for storage later on. “Emotions put a stamp on a memory to say ‘this is important,’” says Pace-Schott.  It makes sense: the color of the grocery store clerk’s shirt is significantly less essential than, say, your mother’s birthday.

If we didn’t shelve our memories appropriately, everything would be a jumble, and without consolidation, we would forget it all. Life would have no meaning, and more importantly (at least from an evolutionary standpoint) we would never learn anything—we’d be helplessly amorphous, easy prey.

Here’s the conundrum, though: the same experiences that are stamped as emotionally important can overwhelm your brain’s short term storage facilities. Dr. Rebecca Spencer, a professor at the University of Massachusetts Department of Psychology, likens it to a desk where “whatever is stressing you out is this big pile of papers, but there are also other memories piling up on you.” With more and more papers landing in front of you all day, you’ll never effectively get to them all. And emotionally rich experiences are all high priority messages, screaming to be dealt with right away. So what happens next?

“You can be driven to sleep simply by having a lot of emotional memories to process,” says Spencer. It takes sleep to provide the space needed to sift through the days’ experiences, and make permanent those that matter.

Studies show that sleep enhances your memory of experiences, and the effect is multiplied for experiences with the stamp of emotion. In fact, the memory-consolidation process that occurs during sleep is so effective that some scientists, including Pace-Schott and Spencer, have suggested that it could be used to treat PTSD.  Spencer posits that keeping someone from sleep following a traumatic event could be good in the long run. “If you force yourself to stay awake through a period of insomnia,” Spencer says, “the [traumatic] memory and emotional response will both decay.”

On the flip side, when it comes to the majority of the negative things we experience in life—the things that aren’t necessarily traumatizing like, say, a fight with your significant other—we want to go to sleep, because that protects the memory and emotional response.

And Pace-Schott points out that sleep disruption may prevent consolidation of potentially therapeutic memories, sometimes termed 'fear extinction' memories. These are memories that can dull the effect of a traumatic experience by creating more positive associations with specific triggers.] This means that improving sleep quality following traumatic events may be crucial to preventing PTSD.

Ever wonder why little kids nap so much? Researchers believe that it’s not just because they’ve been running around all day—it’s also due to the fact their short-term memory storage space is so small, and they constantly need to unload experiences and consolidate memories more often. One recent study, in fact, found that “distributed sleep” (a.k.a. napping) is critical for learning at an early age. The nap that follows a 4 year-old child getting burnt on a hot stove should help him learn from the experience.

Similarly, the nap following a fight with my wife should, ideally, teach me how to better manage interpersonal conflict. The benefits of sleep on memory don’t go away.

When we wake up from sleep, we feel different. It's not just that time has passed; we've undergone a real chemical response. When we sleep, all the stress systems in our body are damped down, letting it relax, so that tenseness you felt, the sickness in your stomach, the frayed nerves, will all be gone in the morning. “It’s almost like we are different people when we wake up,” says Pace-Schott.

One particular neurochemical, called orexin, may hold the key to the puzzle. Orexin, which was discovered only about 15 years ago, is unique in that it plays a very clearly defined dual role in the body. First and foremost, it’s a crucial element in your daily sleep/wake rhythm. You get a boost of the stuff when you wake up, and it drops before you go to sleep. Studies in rats show that if you take all of an animal’s orexin away, it can no longer effectively control sleeping and waking. Since its discovery, orexin has become one of the key diagnostic criteriafor determining narcolepsy—those with the sleep disorder essentially have none of the neurochemical.

And then there’s the second function: It’s part of the stress response system.

“The orexin system is absolutely hardwired into the sympathetic nervous system,” says Philip L. Johnson, a neuroscientist at the Indiana University School of Medicine. If everything is working normally, when you are faced with a stressful situation, your orexin system kicks in and triggers the stress responses that you expect: fight or flight.

In other words, the same exact neural pathway that handles wakefulness (we can’t even get out of bed without orexin kicking in) also handles a key aspect of our stress response.

Think about this: while narcoleptics do sometimes just nod off randomly, strong emotions are, most often, connected to onset of sleep. It’s counterintuitive, but it’s true, says Johnson. For many narcoleptics, strong emotions associated with stress can cause a complete collapse.

Of course, this should sound familiar—it’s not so different than what happens when Brad, LeAnna, Daniel, I, and so many others go head to head with stress. The science on this is still in its infancy, and it remains unclear exactly what’s going on at a chemical level here, but there does seem to be some connection.

In the meantime, sleep doesn’t seem too bad. The problem may still be there when you awake, but you’ll have a better understanding of it, and hopefully, a clear slate to handle it.

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Awakening to sleep

New research describes the immense impact sleep deprivation has on our minds and bodies. Tempted to read just one more email before you sleep? Don't. New research finds that not getting enough sleep — whether because of our insatiable desire for digital media or more traditional sleep disturbances — has far-reaching effects on physical and psychological health.

By Dr. Siri Carpenter

January 2013, Vol 44, No. 1

Print version: page 40

Awakening to sleep

Orfeu Buxton, PhD, has just pulled his first all-nighter in six years, and he is tired. Earlier in the week, he stayed up all night for the final push on a grant application to the National Institute on Aging, coordinating a small crew who worked past dawn. Two days later, he's still exhausted and says he feels "ghostlike." He may also be a little embarrassed. As a sleep researcher, he should know better. "Maybe next time the irony will be too powerful," says Buxton, a neuroscientist in the Harvard University School of Medicine and the Division of Sleep Medicine of Brigham and Women's Hospital in Boston.

Buxton has plenty of company in his sleeplessness. Technology keeps serving up ever more enticing ways to put off bedtime — whether for entertainment or work — and in this era of economic uncertainty, job and financial stress keeps millions of Americans from getting a good night's sleep. Data on just how much the nation sleeps are imprecise, but among scientists, the consensus is that it's not enough. According to the Centers for Disease Control and Prevention (CDC), a quarter of U.S. adults say they don't get enough sleep at least half of the time. Research indicates that a quarter of teens get no more than 6.5 hours, far short of the nine or so hours most need. And a 2012 study from the CDC's National Institute for Occupational Safety and Health found that 41 million workers get fewer than six hours of sleep a night — significantly less than the seven to nine hours that experts recommend.

Researchers are unlocking the unsettling and far-reaching health consequences of losing all of this sleep. Some are obvious: According to the National Highway Traffic Safety Administration, for example, driver fatigue results in 100,000 crashes annually, leading to 1,550 deaths and more than 70,000 injuries.

More subtly, a large body of research now shows that chronically getting too little sleep disrupts many aspects of physical health, including hormone regulation, glucose metabolism, insulin resistance, inflammation processes, pain perception and immune function, to name a few.

In a guest editorial for Sleep Medicine Reviews, clinical psychologist Michael Grandner, PhD, of the Center for Sleep and Respiratory Neurobiology at the University of Pennsylvania, argued that along with diet and exercise, "sleep should be considered a key domain of healthy behavior." The same sort of public health resources devoted to education and interventions promoting activity and healthy eating, he and others argue, should also be directed at promoting healthy sleep.

With the mounting evidence that normal variations in sleep can lead to poorer health, both the public health community and the media now seem to be waking up to the importance of sleep in our overall health. Fixing some sleep problems may seem as simple as following a few key "sleep hygiene" guidelines, but there is still a disconnect. The temptation to check one more message, read one more article or watch one more episode is powerful and insidious.

Every hour counts

In 1938, University of Chicago physiologist Nathaniel Kleitman, PhD, and a colleague sequestered themselves for 32 days in the bowels of Kentucky's Mammoth Cave to reset their bodies to a 28-hour clock and track the physical and psychological consequences of doing so. Kleitman, whose first paper on sleep deprivation was published in 1923, is considered the founder of sleep research in the United States. His research on circadian processes and his co-discovery of the rapid-eye movement, or REM, stage of sleep in the early 1950s were foundational developments. (Kleitman's willingness to tamper with his own sleep seems, paradoxically, not to have harmed his health — he lived to the age of 104.)

Throughout Kleitman's life and since, the University of Chicago (UC) remained a center of sleep research. In 1963, Kleitman's colleague Allan Rechtschaffen, PhD, described the first sleep disorder, narcolepsy. In another influential series of studies conducted during the 1980s, Rechtschaffen showed that sleep-deprived rats eventually died from the collapse of their thermoregulatory systems.

But despite such striking demonstrations of sleep's importance to basic physiological functioning, sleep science struggled for recognition. Sure, most people understood that you might not be your sharpest after a poor night's sleep. And for sleep researchers, it seemed obvious that anything we did for a third of our lives was probably important. But for the most part, popular culture and academia alike just yawned and declared: "It's only a quarter [of your life] if you're tough." And researchers didn't have much of a comeback.

But they were on the trail. In 1991, UC sleep medicine specialist Eve Van Cauter, PhD, reported in the Journal of Clinical Investigation that subjecting healthy people to total sleep deprivation threw off their glucose tolerance and insulin resistance and that these issues resolved after recovery sleep. Since then, dozens of studies have elaborated on that finding.

For years, laboratory sleep research focused on extreme kinds of sleep loss — the kind of total deprivation that Buxton experienced when he pulled his all-nighter. But outside the nation's sleep labs, far more common than total sleep deprivation is what researchers variously call partial sleep loss, sleep restriction or short sleep. Whatever they call it, they're referring to chronically cutting one's sleep short by just an hour or two a night. The first study to look closely at the health effects of partial sleep was published in The Lancet in 1999. In that study, Van Cauter's team found that levels of leptin, a hormone that regulates hunger and appetite, dropped 19 percent during a period of partial sleep deprivation.

The cardiometabolic trap

Subsequent studies have confirmed the effects of partial sleep loss on hormone regulation and have led to a burgeoning of research on the role of sleep in obesity, diabetes and cardiovascular disease — a tangled triumvirate of sickness and mortality that are key elements of what researchers sometimes refer to as cardiometabolic disease. In a 2012 article published in the American Journal of Human Biology, UC biomedical anthropologist Kristen Knutson, PhD, reviewed research on sleep and cardiometabolic health and concluded that sleep restriction leads to "substantial and clinically significant changes in appetite regulation, hunger, food intake, glucose metabolism and blood pressure control." Knutson also found a significant association between short sleep duration (less than six hours per night, in most studies) and either more obesity or a higher body mass index. Adolescents and children showed a stronger association, suggesting they may be especially vulnerable to the effects of lost sleep.

One way in which lack of sleep may thwart cardiometabolic health is by skewing people's dietary choices. In a 2011 study published in the American Journal of Clinical Nutrition by a large multicenter team, healthy men and women who were restricted to just four hours of sleep per night over six nights took in significantly more calories, particularly from fat, than their well-rested counterparts — and they didn't make up for it by burning more energy.

Another study, conducted by Arlet Nedeltcheva, MD, and colleagues at UC and published in the American Journal of Clinical Nutrition in 2009, found that adults who were allowed to sleep only 5.5 hours per night for two weeks indulged in more snacks than their counterparts who enjoyed 8.5 hours of sleep each night. Likewise, in a 2012 yet-to-be-published study that drew on data from the CDC's 2007–08 National Health and Nutrition Examination Survey, Knutson, Grandner and colleagues mapped dietary patterns to sleep complaints including difficulty falling asleep, difficulty staying asleep, non-restorative sleep and daytime sleepiness. Every complaint, they found, was significantly associated with greater total caloric intake.

In a 2012 study published in the Annals of Internal Medicine, a team of UC researchers uncovered a molecular clue to how lack of sleep might promote diabetes: Fat cells in people who don't get enough sleep have a 30 percent reduced ability to respond to insulin. Fortunately, the biochemical processes that sleep loss sets in motion may reversible, at least if skipping sleep doesn't become a lifelong habit. In September, psychologist Karen Matthews, PhD, of the University of Pittsburgh, reported in SLEEP that if teens who normally got six hours of sleep per night were allowed just one extra hour of sleep, their insulin resistance improved by 9 percent.

Now, Till Roenneberg, PhD, of the University of Munich's Institute of Medical Psychology, has introduced a new wrinkle to the sleep literature: The physiological chaos that ensues when the body's internal clock, which is set by our exposure to sunlight and night-time darkness, is out of sync with our "social clocks," which are set by the demands and temptations of modern life, from early-morning alarms to the late lure of "The Daily Show." Roenneberg calls this familiar brand of circadian disruption "social jet lag," noting that staying up later and sleeping later on weekends, then wrenching one's schedule back in time at the beginning of each workweek, is akin to traveling from New York to Denver every Friday night, then returning every Monday morning.

In a study in Current Biology in 2012, Roenneberg and colleagues in Germany and the Netherlands surveyed 65,000 European adults to understand their sleep habits, health behavior and physical health. They found that 69 percent of respondents suffered from at least an hour of social jet lag each week, and a third of participants regularly suffered at least two hours of social jet lag. Like short sleep, social jet lag appears to be a significant health hazard. Even after the researchers accounted for sleep duration and other characteristics that affect health, people who suffered social jet lag were more likely to be overweight than those whose social and biological clocks were more in sync. And among people who were overweight, more extreme social jet lag was associated with much greater risk of obesity.

The importance of considering both the duration and the timing of sleep is further bolstered by a study by Buxton and colleagues, which showed that disrupting people's internal clocks as well as partially restricting their sleep could increase risk of both diabetes and obesity. In the research, reported in Science Translational Medicine in 2012, Buxton's group controlled the sleep and diet of 21 participants for six weeks, cutting their sleep by about two hours per night and subjecting them to an artificial 28-hour circadian day for three weeks. The participants' pancreatic function went "haywire," Buxton says, causing hyperglycemia after a breakfast meal, which over time leads to increased risk of diabetes. The circadian and sleep disruption also caused a metabolic slowdown that, if not counteracted, would cause a weight gain of about 10 pounds a year.

Far-reaching effects

The ill effects of too little sleep go well beyond metabolism and cardiovascular risk. For example, research indicates that sleep loss also messes with people's moods and leads to exaggerated pain perception. In a 2005 study published in Pain, Harvard University neurologists Monika Haack, PhD, and Janet Mullington, PhD, brought research participants into the laboratory and randomly assigned them to sleep for either four or eight hours per night for 12 consecutive nights. Even when participants did not report fatigue, the shorter sleepers reported lower levels of optimism and sociability, an effect that grew stronger the longer the experiment continued.

Haack and Mullington also found that sleep-deprived research participants reported increasing "bodily discomfort" — known to most of us as pain — starting after the second sleep-deprived night and lasting until after their recovery sleep. In a follow-up study published in SLEEP in 2007, they found that sleep deprivation caused increases in blood plasma levels of interleukin-6 (IL-6), a signaling molecule that contributes to pain sensitivity. The more bodily discomfort that participants reported in Haack and Mullington's study, the more their IL-6 levels were elevated. Even though the increases in IL-6 were typically small, the researchers argued that they may play an important role in exacerbating pain.

Sleep's importance is now felt across more areas of medicine. In a 2012 study in the American Journal of Geriatric Psychiatry, psychologist Kathi Heffner, PhD, of the University of Rochester Medical Center, and colleagues reported that when healthy men and women age 50 and older were given stressful cognitive tasks, those who were poor sleepers showed a larger IL-6 response — a marker of inflammation — than did good sleepers.

Other research shows that sleep apnea and other sleep-disordered breathing (SDB) conditions are associated with higher cancer incidence as well as more deaths from cancer. In a study published in the American Journal of Respiratory and Critical Care Medicine in 2012, the University of Wisconsin's F. Javier Nieto, MPH, MD, PhD, and colleagues found that the incidence of cancer deaths in patients with severe SDB was five times higher than in those without the disorder.

Even the body's immune response to vaccines is weaker if the recipient is short on sleep, according to a recent study in SLEEP led by University of California, San Francisco, health psychologist Aric Prather, PhD. The researchers gave 125 healthy adults a three-dose series of hepatitis B shots, monitoring their sleep duration and quality for a week before and after each shot. Results showed that people who slept less during the study had lower antibody response to the vaccine, potentially increasing their susceptibility to hepatitis infection.

Who lacks sleep?

Just as important as understanding the effects of insufficient sleep is understanding who is most at risk, so that efforts to fix the problem can be concentrated most effectively. In recent years, sleep researchers have found that insufficient sleep is related to a constellation of social factors, including socioeconomic status, race and ethnicity, and workplace and neighborhood conditions.

In a 2010 survey of 9,714 randomly selected Pennsylvania adults, published in BMC Public Health, Grandner and colleagues found a significant "sleep disparity" within the sample. Overall, minority respondents had poorer sleep quality than white respondents. However, among those who were impoverished, whites unexpectedly fared worse.

In the most refined look at sleep and race to date, Northwestern University's Mercedes Carnethon, PhD, used wrist monitors to study sleep patterns in a random sample of 500 healthy U.S. adults. Results showed that after accounting for potentially confounding cardiovascular disease risk factors and education levels, black adults slept an average of only 6.8 hours per night, compared with 7.4 hours, on average, for whites. Asians and Hispanics didn't fare much better — they slept an average of 6.9 hours per night.

Workplace conditions also appear to exert power over one's sleep — or lack thereof. In a 2010 study in the Journal of Occupational Health Psychology that looked at sleep duration and cardiovascular disease risk in 393 health-care workers, Buxton and colleagues found that workers with less-supportive managers — as defined by their "openness and creativity in dealing with employee work-family needs" — got 29 minutes less sleep daily and were twice as likely as those with more supportive bosses to have two or more risk factors for cardiovascular disease. "That's a powerful effect of a supervisor on their low-wage employees," Buxton says.

Where one lays one's head is another important risk factor, says Lauren Hale, PhD, of Stony Brook University School of Medicine. She suspects that people in low-income neighborhoods can't sleep as well due to a constellation of physical and psychological hazards — from high-traffic streets and inadequate heating and cooling to food insecurity and landlord hassles. In a study published in Social Science & Medicine in 2012, Hale and colleagues examined the associations among neighborhood conditions, sleep quality and health in using data from the Survey of the Health of Wisconsin. People who reported they lived in neighborhoods with more physical and social disorder tended also to report poorer sleep quality, perceive their health as poorer and experience more symptoms of depression.

By statistically controlling for numerous demographic and health factors, Hale's team found that people's sleep quality accounted for about 20 percent of the association between neighborhood quality and both self-rated health and depression. "The determinants of poor sleep fall along lines of social disadvantage," Hale concludes. "My hunch is that it's bigger than just A/C and noise. It's more about autonomy. If people have choices and control over their lives, they have more ability to shut down at night and sleep when they need to sleep and wake up when they need to wake up."

Findings that link sleep deficiencies to social factors signal a need for a more sophisticated public health approach to promoting healthy sleep, sleep researchers believe. "We have to understand the social and environmental context of health behaviors before we can intervene on them," Grandner says. For some people, simple changes to "sleep hygiene" can go a long way toward ensuring a good night's sleep. But it would be naïve to believe that across the board, simply educating people about the importance of healthy sleep habits — avoiding caffeine late at night, having a consistent bedtime routine, eschewing the seductive blue light of the laptop late at night — will be sufficient to correct endemic problems that lead to insufficient sleep.

Strength in sleep

"I'll sleep when I'm dead."

You've no doubt heard it said, and possibly even said it yourself. You were joking, and projecting a certain brio, the notion that sleep is a luxury.

Buxton doesn't see the humor, and he has a quick retort. "If you want [death] to come sooner," he responds. Sleep, he argues, can be an incredibly strong indication "of things going well or things going wrong."

Even as the causes and consequences of insufficient sleep become better understood, developing and implementing behavioral interventions to improve sleep are likely to be major challenges. Grandner speculates that doing so will require a community-based behavioral strategy, similar to campaigns used to improve diets and promote regular exercise.

Can we change health at a societal level by changing sleep patterns?

"I think it's possible," Hale says. "Do I think it's easy? No." But she does think it's important to try to tackle the deteriorating length and quality of sleep wrought by new devices, new media and new societal pressures. Recently, she came across a disturbing video in which a motivational speaker tells teens, "If you're going to be successful, you've got to be willing to give up sleep. … You've got to be willing to work off of three hours of sleep, two hours … because if you go to sleep, you might miss the opportunity to be successful."

"I hate the ethos that sleep is for the weak," she says. "That's very shortsighted, and the wrong message to be sending adolescents. In the long run, everybody is better off if they go to bed at a reasonable hour."

Siri Carpenter, PhD, is a writer in Madison, Wis.

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Sleep Problems Cost Billions

What is your insomnia costing you?

Nov. 1, 2012— Insomnia and sleep apnea are turning us into major health service consumers, causing us to be less productive at work, and may even lead to serious accidents.

If you can't sleep at night, you're not alone. Around ten per cent of the population suffer from insomnia, where you have trouble falling asleep, wake up frequently at night, and still feel tired when the morning comes.

"When you feel tired and indisposed, your performance at work suffers," says Børge Sivertsen, professor at UiB's Department of Clinical Psychology and senior researcher at the Norwegian Institute of Public Health.

Sleep apnea is a more severe problem, affecting four to five per cent of the population. Sufferers can stop breathing for up to 40 seconds several times during the night, putting a huge strain on the heart. As a result, they have many micro-awakenings that stop them from reaching deep sleep.

Bad night, bad day

According to the sleep scientist, a recently-published study from the United States puts the annual losses from insomnia alone at 63.2 billion US dollars annually. Only a third of this was due to actual absence from work; two thirds was due to a loss in productivity while at work.

"An Australian study found that about two per cent of Australia's GDP is lost due to sick leave caused by insomnia and sleep apnea disorder. This shows how common these diseases are and how much they affect work," Sivertsen says.

Danger on the roads

In their own ways, each sleep disorder also has a strong impact on accident statistics. For example, lorry drivers have sedentary jobs, and this increases the risk of developing obesity and sleep apnea.

"The disease is a major cause of the many traffic accidents on American roads," Sivertsen says.

As for insomnia, drug use can cause problems. Sivertsen's studies show that sedatives can cause users to feel less rested during the daytime.

"Sleep medication may work in the short term, but after six weeks of use we noticed a decrease in deep sleep. Sleep may be uninterrupted, but you may not necessarily get quality sleep," he says.

Testing every treatment there is

Sleep disorder sufferers are often major health care users, which leads to an increase in social costs.

"When you feel bad, you will try every treatment there is. There is an overconsumption of alternative methods amongst insomnia sufferers. They often consume too much alcohol and visit their GPs, psychologists, physiotherapists, and chiropractors more often."

Sivertsen wants insomnia treatment to become more accessible, and to include cognitive behavioural therapy.

"Several recent studies show that the Internet can be used to offer good and cost-effective methods of treatment. This is particularly true in areas where sleep centres are few and far between," he suggests.

The University of Bergen (2012, November 1). Sleep problems cost billions. ScienceDaily. Retrieved December 10, 2012, from­ /releases/2012/11/121101110514.htm

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