Some 19 percent of soldiers returning from Iraq have migraine and migraine is suspected in another 17 percent.

While prevalence of migraine among the U.S. military is well documented, little is known about sleep quality in soldiers with chronic headaches including post-traumatic headache and migraine.

A research team from the Madigan Army Medical Center in Tacoma, WA, found that although sleep quality is poor in soldiers with post-traumatic headaches, treatment, including education, may improve the condition.

“The research sought to determine if treatment for headache and insomnia could improve sleep quality among our patients with post-traumatic headaches,” said Cong Zhi Zhao, M.D., lead author of the study.

“We found that three months after initial treatment, those with post-traumatic headache reported significantly improved sleep quality and sleep onset than baseline, although their nightmares and interrupted sleep were not significantly changed,”  Zhao said.

“Post-traumatic headache and migraine is an important cause of disability in our soldiers that affects their field performance and their lives after returning from the battlefield,” said David Dodick, M.D., president of the AHS.

“Sleep quality is an important factor which is both a result of and a contributing factor to the disability imposed by these disorders, so this work is an important step in understanding the influence of effective headache treatment on sleep quality,” he said.

cforms contact form by delicious:days

Bright light therapy has significant effects on sleep disturbances associated with combat-related post-traumatic stress disorder, according to research presented at SLEEP 2010, the 24th annual meeting of the Associated Professional Sleep Societies.

Results indicate that bright light therapy produced a significantly greater improvement than placebo in sleep disturbances specific to PTSD. Bright light therapy also produced a moderate improvement in PTSD symptoms and depression.

“Results of this ongoing study show significant effects of bright light on disruptive nocturnal behaviors associated with combat PTSD, as well as positive effects of bright light therapy on PTSD symptom severity,” said study coordinator Shannon Cornelius, Ph.D, graduate research assistant for Dr. Shawn D. Youngstedt in the department of exercise science at the University of South Carolina in Columbia, S.C.

“Because bright light therapy is a relatively simple, self-administered, inexpensive treatment with few side effects, these results are an important step to further establish the efficacy of bright light therapy as an alternative or adjunct treatment for combat-related PTSD,” Youngstedt said.

The study involved 16 soldiers who returned to the U.S. with combat-related PTSD after serving in Operation Enduring Freedom or Operation Iraqi Freedom.

Following a one-week baseline, participants were randomized to one of two four-week treatments. Eight soldiers received 10,000 lux of bright light therapy for 30 minutes each day.

The other eight participants were assigned to the placebo group and received sham treatment with an inactivated negative ion generator.

The Clinician-Administered PTSD Scale (CAPS-2) was completed at baseline and immediately following completion of the study.

At weekly intervals, depression was assessed with the Beck Depression Inventory (BDI-II), and sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) with addendum for PTSD (PSQI-PTSD).

Cornelius noted that sleep disturbance is a commonly reported problem that can play both a precipitating and perpetuating role in PTSD, making it an important target for therapy.

“Disturbed sleep is known to interact with depression and anxiety in a vicious cycle,” said Cornelius. “By reducing the severity and occurrence of sleep disturbances, it may be possible to reduce the severity of symptoms such as anxiety and depression in combat-related PTSD.”

The study was supported by a U.S. Department of Veterans Affairs Merit Award.

The American Academy of Sleep Medicine reports that 70 to 90 percent of people with PTSD describe subjective sleep disturbance.

Recurrent nightmares of the traumatic event represent one of the most problematic and enduring symptoms of PTSD. These nightmares may take the form of a realistic reliving of the traumatic event or depict only some of its elements.

Bright light therapy exposes your eyes to intense but safe amounts of light for a specific and regular length of time. Typically it involves exposure to up to 10,000 lux of light for scheduled periods of 20 minutes or more using a small light box.

In a 2007 study published in the journal BMC Psychiatry, Youngstedt reported that bright light exposure may have an anxiolytic effect. Three hours of exposure to 3,000 lux of bright light for three consecutive days reduced anxiety in a group of low-anxiety adults.

Despite recently mandated reductions in medical student workload hours, a new study reveals the widespread presence of job stress, and sleep deprivation among physicians and nurses in teaching hospitals.

When asked to keep a running account of work activity, patient load, and work stress using handheld computers, physicians reported much higher levels of work stress than nurses.

Both groups reported more stress during patient care activities compared with activities such as patient education, transit, or communication.

California researchers studied 185 physicians (attending physicians, residents, and interns), and 119 nurses working in four teaching hospitals over an 18-month period.

For one week, participants recorded their work activities and stress in handheld computers, whose content was sampled randomly over 90-minute intervals throughout each work day.

The participants also completed more than 9,500 internal surveys on work stress during the study.

Emotional stress scores among physicians were nearly 50 percent higher than those of nurses. Physicians reported feeling less alert and more worried, tense, fatigued, unhappy, tired, upset, and stressed.

Compared with physicians, nurses reported significantly higher levels of high physical demand and performance and lower levels of frustration. Direct and indirect care activities were associated with higher stress reports by both groups.

Approximately one-fifth of doctors and nurses sampled daily indicated five or fewer hours of sleep the previous night. Lower sleep quality and quantity were predictors of higher work stress scores.

Higher work stress and lower sleep quality were also associated with poorer memory performance. The study was supported in part by the Agency for Healthcare Research and Quality (HS14283).

More details are in “A real-time assessment of work stress in physicians and nurses,” by Thomas Rutledge, Ph.D., Erin Stucky, M.D., Adrian Dollarhide, M.D., and others, in Health Psychology 28(2), pp. 194-200, 2009.

cforms contact form by delicious:days

Sleep deprivation adversely affects automatic, accurate responses and can lead to potentially devastating errors, a finding of particular concern among firefighters, police officers, soldiers, and others who work in a sleep-deprived state, University of Texas at Austin researchers say.

Psychology professors Todd Maddox and David Schnyer found moderate sleep deprivation causes some people to shift from a faster and more accurate process of information categorization (information-integration) to a more controlled, explicit process (rule-based), resulting in negative effects on performance.

The researchers examined sleep deprivation effects on information-integration, a cognitive operation that relies heavily on implicit split-second, gut-feeling decisions.

"It’s important to understand this domain of procedural learning because information-integration — the fast and accurate strategy — is critical in situations when soldiers need to make split-second decisions about whether a potential target is an enemy soldier, a civilian or one of their own," Maddox said.

The study examined information-integration tasks performed by 49 cadets at the United States Military Academy at West Point over the course of two days. The participants performed the task twice, separated by a 24-hour period, with or without sleep between sessions.

Twenty-one cadets were placed in a sleep deprivation group and 28 well-rested participants were designated as controls. It revealed that moderate sleep deprivation can lead to an overall immediate short-term loss of information-integration thought processes.

Performance improved in the control group by 4.3 percent from the end of day one to the beginning of day two (accuracy increased from 74 percent to 78.3 percent); performance in the sleep-deprived group declined by 2.4 percent (accuracy decreased from 73.1 percent to 70.7 percent) from the end of day one to the beginning of day two.

This decline was much larger for those participants who shifted from an information-integration to a rule-based approach.

According to the findings, people who rely more on rule-based (over-thinking) strategies are more vulnerable to the ill-effects of sleep deprivation. This is the first study that has explored this domain of procedural learning, Schnyer said.

Maddox and Schnyer were surprised to find the adverse effects of sleep deprivation on information processing varied among individuals. Schnyer believes this finding has implications for training purposes for high-pressure, life-and-death jobs, particularly the Army.

The study, published in the November issue of the journal Sleep, was funded by the U.S. Army and through the Center for Strategic and Innovative Technologies at the University of Texas at Austin.

cforms contact form by delicious:days

Bruxism, the medical term for the grinding of teeth during sleep, is prevalent in Caucasians with sleep disorders, a study has found.

There is a high prevalence of nocturnal teeth grinding, or bruxism, in patients with obstructive sleep apnea (OSA), particularly in Caucasians.

New research presented at CHEST 2009, the 75th annual international scientific assembly of the American College of Chest Physicians (ACCP), found that nearly one in four patients with OSA suffers from nighttime teeth grinding; this seems to be especially more prevalent in men and in Caucasians compared with women or other ethnic groups.

It is estimated that eight percent of the general U.S. population suffers from bruxism, a condition frequently associated with a pre-existing dental or jaw disorders, as well as stress.

"The relationship between obstructive sleep apnea and sleep bruxism is usually related to an arousal response. The ending of an apneic event may be accompanied by a number of mouth phenomena, such as snoring, gasps, mumbles, and teeth grinding," said Shyam Subramanian, M.D., FCCP, Baylor College of Medicine, Houston, TX.

"Men typically have more severe sleep apnea, and perhaps may have more arousal responses, which may explain the higher prevalence of teeth grinding in men. Besides, men characteristically tend to report more symptoms of sleep apnea than women, such as snoring, loud grunting, and witnessed apneas," Subramanian said.

Other factors that might help explain the relationship between sleep apnea and teeth grinding include anxiety and caffeine use.

"High levels of anxiety can lead to bruxism, and untreated sleep apnea is known to cause untreated sleep apnea," said Subramanian. "Daytime sleepiness from sleep apnea may cause a person to ingest caffeine, and this has also been associated with a high risk of bruxism."

Through a retrospective chart review, Subramanian and his colleagues, from Baylor College of Medicine, assessed the prevalence of bruxism and gastro-esophageal reflux (GERD) in 150 men and 150 women with OSA. Each group consisted of 50 Caucasians, 50 African-Americans, and 50 Hispanics.

Results showed that 25.6 percent of patients suffered from teeth grinding, while 35 percent of all patients with OSA complained of nocturnal heartburn and GERD symptoms.

The researchers also examined the influence of gender and ethnicity on OSA, GERD, and bruxism. They found that bruxism was higher in men than in women — 43 percent vs. 31 percent.

Caucasians had the highest rate of bruxism compared to other ethnic groups—35 percent vs. 19 percent in Hispanics. African-Americans have the highest prevalence of GERD — 40 percent vs. 31 percent in the Hispanic population and 34 percent in Caucasians.

Overall, no correlation was observed between the presence of self-reported GERD and bruxism.

Untreated bruxism can lead to excessive tooth wear and decay, periodontal tissue damage, jaw pain, and temporo-mandibular joint or TMJ pain, headaches, and sleep disturbances for patients and their bed partners.

"Bruxism can be both a daytime syndrome as well as a nighttime syndrome, but it is bruxism during sleep, including short naps, that causes the majority of health issues," said Subramanian. "Studies do suggest that when sleep bruxism is related to OSA, certain therapies, including continuous positive airway pressure, may eliminate bruxism during sleep."

"Sleep disorders such as sleep apnea can lead to many secondary health conditions," said Kalpalatha Guntupalli, M.D., FCCP, president of the ACCP. "When treating sleep apnea, clinicians must also recognize and address secondary health conditions, such as bruxism, in order to fully manage a patient’s sleep disorder."

cforms contact form by delicious:days

Don Spence, chief executive officer of Philips Home Healthcare Solutions, has issued a written statement endorsing the Centers for Disease Control and Prevention (CDC) educational initiative to increase awareness about sleep deprivation.

In his statement, Spence wrote:

“Philips Respironics applauds the efforts of the Centers for Disease Control and Prevention (CDC) to raise awareness about an important public health issue — chronic sleep insufficiency. The CDC’s release of the first-ever government study to monitor state-by-state differences in sleeplessness is a milestone in quantifying the size and scope of the problem."

“As a long-time educator, industry leader and sleep therapy manufacturer, Philips Respironics supports government efforts to draw attention to chronic sleep insufficiency, which remains under-reported and under-treated despite being associated with numerous physical and mental health problems, injury and mortality. It is estimated that 50-to-70 million Americans chronically suffer from a disorder of sleep and wakefulness, hindering daily functioning and adversely affecting their health and longevity.

“Sleep — along with diet and exercise — is the third leg of the stool of good health. Nothing would have greater impact in reducing the health and safety toll of chronic sleep deprivation than the CDC’s recommendation that healthcare providers consider adding an assessment of chronic rest or sleep insufficiency to routine office visits.

Philips Respironics is dedicated to helping diagnose and improve the quality of life for Americans who experience sleep disorders. In 1985 we were the first company to commercialize continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA), a condition where a person’s airway collapses repeatedly during sleep, preventing proper respiration and adequate rest. Today, CPAP therapy is the first-line of treatment for millions of OSA sufferers.

“Sleep apnea is one of the world’s most common sleep disorders, linked to a host of health problems including hypertension, insulin resistance, and increased risk of heart attack, stroke, and heart failure. We look forward to working with the government to educate Americans about sleep, sleep disorders, and the consequences of sleep deprivation.”

cforms contact form by delicious:days

A research collaboration led by biologists and neuroscientists at the University of Pennsylvania has found a molecular pathway in the brain that is the cause of cognitive impairment due to sleep deprivation.

Just as important, the team believes that the cognitive deficits caused by sleep deprivation, such as an inability to focus, learn or memorize, may be reversible by reducing the concentration of a specific enzyme that builds up in the hippocampus of the brain.

It is known that sleep deprivation can have cognitive consequences, including learning and memory deficits, but the mechanisms by which sleep deprivation affects brain function remain unknown. A particular challenge has been to develop approaches to reverse the impact of sleep deprivation on cognitive function.

The findings, reported in this week’s issue of the journal Nature, could present a new approach to treating the memory and learning deficits of insomnia.

A molecular mechanism by which brief sleep deprivation alters hippocampal function is now identified in mice, involving the impairment of cyclic-AMP- and protein-kinase-A-dependent forms of synaptic plasticity, or readiness for cognitive function.

Ted Abel, Ph. D., principal investigator and professor of biology in the School of Arts and Sciences at the University of Pennsylvania, led the international team of researchers that found that sleep deprivation in mice affects an important molecular pathway in the hippocampus, a region of the brain known to be important for memory and learning.

The study showed that mice deprived of sleep had increased levels of the enzyme PDE4 and reduced levels of the molecule cAMP, the latter of which is crucial in forming new synaptic connections in the hippocampus, a physiological hallmark of learning.

Researchers then treated the mice with PDE inhibitors, which rescued the sleep deprivation-induced deficits in cAMP signaling, synaptic plasticity and hippocampus dependent memory.

This reversal also helped to rescue deficits in synaptic connections in the hippocampus and therefore counteract some of the memory consequences of sleep deprivation.

“Millions of people regularly obtain insufficient sleep,” Abel said. “Our work has identified a treatment in mice that can reverse the cognitive impact of sleep deprivation.”

Continuing, Abel said the research he and his colleages are doing “identifies specific molecular changes in neurons caused by sleep deprivation, and future work on this target protein promises to reveal novel therapeutic approaches to treat the cognitive deficits that accompany sleep disturbances seen in sleep apnea, Alzheimer’s disease, and schizophrenia.”

The study was supported by the National Institutes of Health, the Human Frontier Science Program, the Netherlands Organization for Scientific Research, a Medical Research Council (U.K.) grant, a European Union grant, the Fondation Leducq, and a U.K. Engineering and Physical Sciences Research Council training grant.

The study was conducted by Christopher G. Vecsey, Mathieu Wimmer and Ted Huang of the Neuroscience Graduate Group and Department of Biology at Penn; George S. Baillie, Kim M. Brown, and Miles D. Houslay of the department of Neuroscience and Molecular Pharmacology at the University of Glasgow; Abel, Devan Jaganath, Robbert Havekes and Andrew Daniels of Penn’s Department of Biology; and Xiang-Yao Li, Giannina Descalzi, Susan S. Kim, Tao Chen, Yu-Ze Shang, and Min Zhuo of the Department of Physiology at the University of Toronto.

cforms contact form by delicious:days

Research findings presented Wednesday, June 10, 2009, at Sleep 2009, the 23rd annual meeting of the Associated Professional Sleep Societies, caffeine use prevents increased risk-taking that occurs after several nights of total sleep deprivation.

Results indicate that despite extreme sleep deprivation, participants who had consumed caffeine did not exhibit increased risky behavior on the Balloon Analog Risk Task (BART), a computerized measure of impulsive risk-taking, according to the findings, released in abstract form, titled, “Caffeine Protects Against Increased Risk-Taking Behavior During.”

Participants who received the placebo were unchanged from baseline on the cost/benefit ratio of the BART at 51 hours of sleep deprivation, but showed a significant increase in risk-taking by 75 hours.

The caffeine group remained unchanged from baseline at either 51 or 75 hours of wakefulness and was significantly less risky than the placebo group at 75 hours.

According to the principal investigator, Major William D. ("Scott") Killgore, PhD, research psychologist at the Harvard Medical School and Walter Reed Army Institute of Research, sleep deprivation may not have a simple linear effect on risk taking.

Sleep deprivation may provide a ‘breaking point’ during which a person may show a drastic release in their ability to control or inhibit behavior. In this study, caffeine seemed to protect against that breaking point.

“People who were awake for three days straight became more impulsive and acted with less regard for consequences,” said Killgore. "However, if they had consumed caffeine each night (about the equivalent of one-to-two cups of coffee every two hours from just after midnight until dawn), they showed no increase in risky behavior."

The study involved 25 healthy volunteers – a total of 21 men and four women– between the ages of 20-and-35 years of age, each of whom had been deprived of sleep for three nights.

In a double-blind test, subjects received 200 mg of caffeine gum or identical placebo gum bi-hourly each morning from 1 a.m. to 7 a.m. during the period of sleep deprivation.

At mid-morning, subjects participated in a behavioral task of risky behavior that requires expenditure effort (BART), during which participants were asked to inflate virtual balloons on a computer and try to ‘cash in’ their value before they popped. The bigger the balloon, the more money it was worth.

According to Killgore, findings of this study look at the most extreme range of sleep deprivation, so most people will not experience such effects under normal circumstances.

Findings from a previous study, however, show people who were chronically restricted to three hours of sleep per night for a week showed a progressive increase in risk-taking behavior during the same task.

It is possible that a similar ‘breaking point’ occurs with longer periods of chronic sleep deprivation, though further research is still necessary.

cforms contact form by delicious:days

Individuals who get less than seven hours of sleep per night appear about three times as likely to develop respiratory illness following exposure to a cold virus as those who sleep eight hours or more, according to a report in the January 12, 2009 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Studies have demonstrated that sleep deprivation impairs some immune function, according to background information in the article. Research indicates that those who sleep approximately seven to eight hours per night have the lowest rates of heart disease, illness, and death. However, there has previously been little direct evidence that poor sleep increases susceptibility to the common cold.

Sheldon Cohen, Ph.D., of Carnegie Mellon University, Pittsburgh, and colleagues studied 153 healthy men and women (average age 37) between 2000 and 2004. Participants were interviewed daily over a two-week period, reporting how many hours they slept per night, what percentage of their time in bed was spent asleep (sleep efficiency) and whether they felt rested.

Participants were then quarantined and administered nasal drops containing the common-cold–causing rhinovirus. For five days afterward, the study participants reported any signs and symptoms of illness and had mucus samples collected from their nasal passages for virus cultures. About 28 days later, the participants had a blood sample taken, which was tested for antibody responses to the virus.

The less an individual slept, the more likely he or she was to develop a cold. Lower sleep efficiency was also associated with developing a cold — participants who spent less than 92 percent of their time in bed asleep were five and a half times more likely to become ill than those whose efficiency was 98 percent or more. Feeling rested was not associated with colds.

“What mechanisms might link sleep to cold susceptibility? When the components of clinical illness (infection and signs or symptoms) were examined separately, sleep efficiency but not sleep duration was associated with signs and symptoms of illness. However, neither was associated with infection,” the authors write.

“A possible explanation for this finding is that sleep disturbance influences the regulation of pro-inflammatory cytokines, histamines and other symptom mediators that are released in response to infection,” the authors added. The results, they say, suggest seven to eight hours of sleep is the appropriate amount of sleep people should get each night.

cforms contact form by delicious:days

The number of patients assigned to medical residents and the complexity of care patients require has just as much impact on residents’ training as the number of hours they work, according to a study published by researchers at the University of Chicago Medical Center in the September 10, 2008 issue of JAMA.

This study is believed to be the first of its kind using information gathered objectively from medical residents who work long shifts as part of their training.

"A lot of people have been talking about this, but no one had any hard data until now," said study author Vineet Arora, M.D., assistant professor of medicine at the University of Chicago Pritzker School of Medicine. "In the past, we have focused on the hours that residents work, but now we also need to focus on the intensity of the work."

The study is timely. The Institute of Medicine is expected to release new recommendations in winter 2008 about how residents’ schedules should be changed to improve patient safety. The last major guidelines for resident work schedules came in 2003 after the Accreditation Council for Graduate Medical Education set a maximum shift duration of 30 hours, with a maximum work week of 80 hours.

The IOM report is expected to address more than just time spent at work, including how work experiences can be redesigned so residents can reach their educational goals, instead of winding up tired and overwhelmed. In contrast to U.S. medical residents, European physicians in training only work a maximum of 56 hours per week.

The University of Chicago Medical Center study is unique because it used objective methods to track work routines and the effect of work demands on residents. Previous studies relied on residents reporting their own information and data.

Residents in the study wore wrist activity monitors that measured their sleep so they didn’t have to report it themselves; on-call hours were gathered through pager data that indicated exactly when residents clocked in and out; and residents carried Pocket PCs that asked them to report what they were doing when they got beeped.

The study included 56 internal medicine first-year residents in typical ward rotations at the University of Chicago Medical Center. From July 1, 2003, to June 24, 2005, those who participated in the study were monitored for a total of 1,100 on-call nights.

The study found that for each patient admitted, the resident lost sleep, worked a longer shift, and had less time for educational activities. The most sleep loss and longest shifts occurred early in the academic year–when most residents are "learning the ropes" in their new hospital setting.

Study co-author Emily Georgitis, M.D., a first-year resident, said it’s difficult to get enough sleep and attend educational conferences when her workload increases. "If I admit five patients, I know I am going to get less sleep and not have as much time to pursue other activities that enhance my education–things that will ultimately make me a better doctor," she said.

Arora says that reducing the number of work hours without considering the work load could make conditions worse for residents by requiring them to "do the same amount of work in a shorter time."

"These findings raise concerns about the possibility of future duty-hour restrictions in the absence of corresponding limits on workload," the study adds.

cforms contact form by delicious:days