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Research, Sleep, Stanford News

William Dement: Stanford Medicine’s “Sandman”

William Dement: Stanford Medicine's "Sandman"

dement

Sixty years before he would be referred to as the “Father of Sleep Medicine,” William Dement, MD, PhD, got kicked out of a class for dozing off.  One of the world’s foremost sleep experts, Dement is profiled in the current issue of STANFORD magazine, with writer Nicholas Weiler describing how Dement blazed a trail for the field of sleep research and medicine.

From the piece:

When he arrived at Stanford, he set aside most of his research on dreams and shifted his focus to pathologies that affect sleep quality—and to the importance of optimal sleep in our daily lives. “It wasn’t until we realized there were sleep disorders,” he says, that people started paying attention to sleep research. In 1970, he founded the Stanford Sleep Disorders Clinic, a center dedicated to the diagnosis and treatment of these maladies. The clinic was soon inundated by patients complaining of extreme daytime sleepiness due not to narcolepsy or insomnia, but to a recently discovered disorder, sleep apnea, in which the patient’s airway would collapse during sleep, causing him to wake gasping for air hundreds of times each night.

Galvanized by the unexpected prevalence of undiagnosed sleep disorders, Dement spent the next decade working feverishly to raise the profile of sleep medicine as a clinical field. Before long, similar clinics were springing up all over the country, “and they were finding the same thing,” Dement says. Still, it wasn’t until 1993 that the first long-term epidemiological study found that 24 percent of men and 9 percent of women suffer from sleep apnea. Research at the Stanford Sleep Disorders Clinic and elsewhere has found strong correlations between sleep apnea and obesity, high blood pressure and heart disease, America’s leading cause of death.

Thanks to his work and the popular sleep class that he has taught since 1971 (more than 20,000 students have taken it!), Dement is well-respected and loved among his peers and students – something captured by this 2008 video.

Previously: Stanford docs discuss all things sleepCatching some Zzzs at the Stanford Sleep Medicine CenterThanks, Jerry: Honoring pioneering Stanford sleep research and Catching up on sleep science
Related: Stalking the netherworld of sleep and Dement keeps last class wide awake
Illustration, which originally appeared in STANFORD, by Gabriel Moreno

Parenting, Pediatrics, Sleep

With school bells ringing, parents should ensure their children are doing enough sleeping

With school bells ringing, parents should ensure their children are doing enough sleeping

With so many schools starting today – or having recently started – it’s a good time for a reminder of the importance of sleep among children. In a recent blog post and the video above, Seattle Mama Doc (a.k.a. Wendy Sue Swanson, MD), offers guidance on how much sleep a child needs and offers five ways that parents can support good sleep:

    • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
    • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
    • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
    • Exercise or move 30-60 minutes a day to help kids sleep easier
    • No sleeping with cell phones (create a docking station in the kitchen)
    • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

Previously: Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”Stanford expert: Students shouldn’t sacrifice sleep, TV in a child’s bedroom? “No way,” says expert and Districts pushing back bells for the sake of teens’ sleep

In the News, Public Health, Sleep

A window of time for better sleep

A window of time for better sleep

SleepThe only time I consider myself a “morning person” is when I have jet lag. But I’ve learned that if I’m in bed by 10:30 PM, I can be relatively cordial and not hit the snooze button the next morning.

Based on my own sleep patterns, it didn’t surprise me to read in a recent Time article that the time we go to bed affects the structure and quality of our sleep. As described in the piece, there’s a shift that occurs from non-REM, deep sleep, to the lighter dream-inspired REM sleep, and it happens during the night regardless of what time we go to bed. But going to bed late will deprive us of some of the deep non-REM sleep that replenishes the brain and body. Writer spoke with several sleep experts and reports:

When it comes to bedtime, [Matt Walker, PhD, head of the Sleep and Neuroimaging Lab at the University of California, Berkeley], says there’s a window of a several hours – roughly between 8 PM and 12 AM – during which your brain and body have the opportunity to get all the non-REM and REM shuteye they need to function optimally. And, believe it or not, your genetic makeup dictates whether you’re more comfortable going to bed earlier or later within that rough 8-to-midnight window, says Dr. Allison Siebern, associate director of the Insomnia & Behavioral Sleep Medicine Program at Stanford University.

“For people who are night owls, going to bed very early goes against their physiology,” Siebern explains. The same is true for “morning larks” who try to stay up late. For either type of person- as well as for the vast majority of sleepers who fall somewhere in between – the best bedtime is the hour of the evening when they feel most sleepy.

Siebern goes on to suggest trying out different bedtimes, plus making sure to wake up at roughly the same time every morning. These two factors can help maximize our natural sleep cycles and help prevent us from hitting the snooze button.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Stanford docs discuss all things sleep, “Sleep drunkenness” more prevalent than previously thought and Mindfulness training may ease depression and improve sleep for both caregivers and patients 
Photo By: FloodG

Applied Biotechnology, Parenting, Pediatrics, Research, Sleep, Stanford News, Technology

Biodesign fellows take on night terrors in children

Biodesign fellows take on night terrors in children

baby on bed

Standing in the Clark Center’s grand courtyard, gazing upward at scientists ascending an outdoor staircase and traversing the exterior corridors on the top two floors, one senses that big ideas take shape here. But how?

Prototyping, say Andy Rink, MD, and Varun Boriah, MS, who spent the last year as Biodesign fellows. Part of Stanford’s Bio-X community, the Biodesign Program trains researchers, clinicians and engineers to be medical-technology innovators during its year-long fellowship. Fellows learn the Biodesign Process, which could be likened to design thinking for health care. On teams of two or four, the fellows identify a substantial health-care need and generate ideas to solve it using medical-device innovation.

Though most Biodesign projects take root after fellows complete a “clinical immersion” shadowing health-care workers in a hospital to observe problems, Rink found his inspiration when visiting family and waking up to a 3-year-old relative’s screams from recurring night terrors. The problem was not so much that it affected the child – pediatricians may advise that children will likely outgrow the condition – but that it affected the parents, Rink saw.  The parent’s lost sleep and anxiety over their child’s well being had huge effects on their quality of life. (In some cases, these are so severe that Xanax and Valium may be prescribed to the children as a last-ditch effort.) What if a treatment could be found that involved no medication and no parental intervention, offering everyone a solid night’s sleep?

The physician and engineer are working with School of Medicine sleep researchers Christian Guilleminault, MD, professor of psychiatry and behavioral sciences, and Shannon Sullivan, MD, clinical assistant professor of psychiatry and behavioral sciences, on a clinical method to treat night terrors in children. In a first-floor room of the Clark Center, they’re protoyping an under-mattress device that senses how deeply a child is sleeping and is able to prevent the nightly episodes from occurring, creating a healthier sleep cycle for the children.  This relieves the parent’s anxiety, and helps the entire family sleep better.

Faculty and students from more than 40 departments across Stanford’s campus, including the schools of medicine, business, law, engineering and humanities and sciences, play a role in Biodesign, as do experts from outside the university. Fellows work closely with the Institute of Design at Stanford, attending – and then teaching – the school’s d.bootcamp. They also have access to the d.school’s facilities and consult regularly with their faculty. Some of the d.school’s methods – focusing on big problems, encouraging radical collaboration, prototyping early and user-testing before focusing on functionality – guide the trajectory of Biodesign projects.

Physicians who are Biodesign fellows often work outside their specialty, and engineers bring a mix of academic and industry experience to the design table. While faculty mentors may simply provide advice to fellows, Guilleminault and Sullivan have become invested in the course of the research as lead investigators on the study. For their involvement, they were both honored with the Biodesign Specialty Team Mentorship Award.

Fellow Boriah noted that medical-device innovation is moving from products like catheters to systems such as health IT, mobile health and software. A former CEO and co-founder of a wearable patient blood-diagnostics device, he said the Biodesign program has provided valuable “access to clinical reality.” Rink, a surgical resident at Northwestern University, said that as a fellow, he’s been “exposed to a side you don’t see in a hospital.”

The researchers are currently recruiting participants ages 2-12 for their study. Rink and Boriah are also working with the Stanford-supported StartX to see their project into the next stage of development.

Previously: Sleep, baby, sleep: Infants’ sleep difficulties could signal future problemsStudying pediatric sleep disorders an “integral part” of the future of sleep medicine and At Med School 101, teens learn that it’s “so cool to be a doctor” 
Photo by MissMayoi

In the News, Public Health, Sleep

Stanford docs discuss all things sleep

Stanford docs discuss all things sleep

“Drowsiness is red alert!” is a phrase coined by Stanford’s William Dement, MD, PhD, who is often referred to as the “Father of Sleep Medicine.” It’s also a phrase he wrote on the wall of KQED’s green room this morning as a guest on Forum. Dement, along with Stanford sleep expert Rafael Pelayo, MD, and UC  Berkeley’s Matthew Walker, PhD, discussed sleep, or lack thereof, in the United States.

KQED ForumDuring the hour-long segment, the panel weighed in on the detrimental effects that poor sleep has on people’s physical and mental health, and took numerous calls from listeners. The experts also emphasized that quality, not just quantity, of sleep is important. “You should wake up feeling refreshed,” Pelayo told listeners. “You don’t leave restaurants feeling hungry, [so] you should not wake up in the morning feeling tired.”

Previously: Stanford researcher examines link between sleep troubles and suicide in older adults, Catching some Zzzs at the Stanford Sleep Medicine Center, Exploring the effect of sleep loss on healthCatching up on sleep science and Thanks, Jerry: Honoring pioneering Stanford sleep research
Related: Sleep legend Dement keeps last class wide awake
Photo by Margarita Gallardo

Behavioral Science, In the News, Sleep, Stanford News

“Sleep drunkenness” more prevalent than previously thought

"Sleep drunkenness" more prevalent than previously thought

sleep_drunkennessA phenomenon known as “sleep drunkenness” may be more prevalent than previously thought, affecting as many as 1 in 7 adults, Stanford researchers report in a new study. That means as many as 36 million Americans experience this potentially problematic sleep condition, in which they are awakened suddenly in a confused state and may be prone to inappropriate behavior, poor decision-making, or even violence.

In interviews with nearly 16,000 adults aged 18 to 102, the researchers found that within the previous year, 15.2 percent had experienced the condition, also known as confusional arousal, with more than half saying they had at least one episode a week.

Stanford psychiatrist and sleep expert Maurice Ohayon, MD, DSc, PhD, said he was surprised at the extent of the problem and particularly the length of time that people reported feeling confused and disoriented following a sudden awakening, whether at night or from a daytime nap.

“I was thinking maybe 30 seconds, a minute or two minutes,” Ohayon told me. “When you ask people, 60 percent said it lasted more than 5 minutes. And one third said it was 15 minutes or more. A lot of things can happen in that time.

“The concern is that people in a job of security, such as engineer, may misjudge the situation because their memory is impaired. Their judgment is not taking into account the environment around them, so they will probably have a bad response. The response will not be adapted to the environment,” said Ohayon, a professor of psychiatry and behavioral sciences and the study’s first author.

He noted that the 1979 Three Mile Island nuclear disaster, the worst nuclear incident in U.S. history, was exacerbated in part by poor decision-making on the part of an engineer who had been awakened suddenly from a nap. He also cautioned that airline pilots, who may nap during a break, may not be efficient for 5 or 10 minutes after being awakened and should take their time before resuming control of an aircraft.

Among those who are most prone to the condition are those with sleep disorders, such as sleep apnea or those who sleep less than 6 hours or more than 9 hours a night, as well as people with certain psychiatric disorders, such as major depression, anxiety and alcohol dependence, the researchers found. Ohayon said he was surprised to discover a strong link between the condition and the use of antidepressants, which likely modify sleep architecture and may contribute to a greater incidence of the condition. Though there is a common perception that people who take sleep medications to help them fall asleep may be confused when they wake up, that was not found to be the case, he said.

More than a third of the people in the study who experienced confusional arousal also said they had hallucinations, and 14.8 percent reported sleep-walking, sometimes accompanied by violent behavior.

“People during confusional arousal can become violent because they are awakened suddenly,” Ohayon said. “They are not happy. They are confused. They may feel aggression toward their partner or the people who have awakened them.”

He said people who experience frequent episodes of confusional arousal should consult with a physician for evaluation and possible treatment. And he urged further study of the problem, which has received little scientific attention.

The study appears in the August 26 issue of the journal Neurology.

Photo by katiecooperx

Obesity, Parenting, Pediatrics, Research, Sleep

Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”

Study shows poor sleep habits as a teenager can "stack the deck against you for obesity later in life"

11386276_c148dfd9bd_zNew research examining the effect of sleeplessness on weight gain in teenagers over time offers strong evidence that inadequate sleep may increase the risk of obesity.

In the study, researchers at Columbia University and the University of North Carolina pored over health information from the the National Longitudinal Study of Adolescent Health on more than 10,000 Americans ages 16 and 21. In addition, details about individuals’ height, weight and sleep habits were collected during home visits in 1995 and 2001.  According to a release, results showed:

Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.

“Lack of sleep in your teenage years can stack the deck against you for obesity later in life,” says [Columbia researcher Shakira Suglia, ScD]. “Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer.”

“The message for parents is to make sure their teenagers get more than eight hours a night,” adds Suglia. “A good night’s sleep does more than help them stay alert in school. It helps them grow into healthy adults.”

Previously: Want teens to eat healthy? Make sure they get a good night’s sleepProlonged fatigue and mood disorders among teensMore evidence linking sleep deprivation and obesityStudy shows link between lack of sleep and obesity in teen boys and Study shows lack of sleep during adolescence may have “lasting consequences” on the brain
Photo by Adrian Sampson

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Aging, Mental Health, Research, Sleep, Stanford News

Stanford researcher examines link between sleep troubles and suicide in older adults

Stanford researcher examines link between sleep troubles and suicide in older adults

Chassériau painting - smallAfter nights spent tossing and turning, I’m grumpy. The world becomes darker, slower and smaller.

That’s why I wasn’t terribly surprised to learn that sleep-deprived older adults are more likely to kill themselves, the results of a study published Aug. 13 in JAMA Psychiatry. Lead author Rebecca Bernert, PhD, instructor of psychiatry and behavioral science and her team examined data from a pool of 14,456 adults older than 65 between 1981 and 1991. They then probed the sleep patterns of 20 people who died by suicide with those of 400 similar individuals.

They found that participants with impaired sleep had a 1.4 percent greater chance of death by suicide than participants who slept well. “This is important because sleep disturbances are highly treatable and arguably less stigmatizing than other suicide risk factors,” Bernert commented in a press release.

Bernert and her team plan to work to develop potential interventions through two ongoing clinical trials.

What did surprise me about the findings was the prevalence of suicide deaths in older adults, particularly among older men: In fact, white men over 65 have a rate of 31 deaths by suicide per 100,000, much higher than the general population rate of 13 or so per 100,000.

Regardless, any number of suicides is too high, a belief Bernert reiterates emphatically.

“Suicide is preventable,” Bernert said. “But the interventions for suicide prevention are alarmingly scarce.”

That’s why for Bernert, the suicide net recently approved for the Golden Gate Bridge is a no-brainer. She recently joined the board of directors of the Bridge Rail Foundation, the nonprofit formed to advocate for the net. “This is a very effective way to prevent suicides,” she said.

More than 1,600 people have died by suicide at the bridge; a similar number of deaths due to any other reason would have necessitated public intervention decades ago, she said.  She attributed the delay, in part, to the powerful stigma that surrounds suicide.

Bernert urged others to learn about suicide by visiting the American Foundation for Suicide Prevention, or, if in crisis, to call 1-800-273-TALK to reach a 24-hour help line.

Becky Bach is a former park ranger who now spends her time writing, exploring, or practicing yoga. She’s currently a science writing intern in the medical school’s Office of Communication & Public Affairs.

Previously: Stanford’s Keith Humphreys on Golden Gate Bridge suicide prevention: Get the nets, CDC report highlights the dangers of sleep deprivation and Sleep deprivation may increase young adults’ risk of mental distress, obesity
Painting by Théodore Chassériau via Wikipedia Commons

From August 11-25, Scope will be on a limited publishing schedule. During that time, you may also notice a delay in comment moderation. We’ll return to our regular schedule on August 25.

Medical Apps, Sleep, Technology

Can sleep trackers help you get a better night’s rest?

Can sleep trackers help you get a better night's rest?

As the number of self-tracking gadgets grows, many people are beginning to experiment with monitoring lifestyle habits in an effort to improve their health. In fact, seven in ten American adults say they track at least one health indicator, according to data from the Pew Research Center’s Internet & American Life Project. But there has been some concern about the accuracy of such technology.

A recent CBS News segment took a closer look at the effectiveness of sleep trackers and outlined the differences in information collected by the devices and data collected by sleep specialists in a clinical setting. Stanford sleep expert Michelle Primeau, MD, also commented, “The reason why these devices are so good is [using them] puts greater emphasis on sleep.”

Previously: Why sleeping in on the weekends may not be beneficial to your health, The high price of interrupted sleep on your health, Exploring the benefit of sleep apps and Designing the next generation of sleep devices

Public Health, Research, Sleep

Why sleeping in on the weekends may not be beneficial to your health

Why sleeping in on the weekends may not be beneficial to your health

tired_072214Many of us, myself included, use the weekends to pay off the sleep debt we accrued during the work week. However, excessive sleeping can often leave us feeling more fatigued. A piece published today on Wired Science examines this phenomenon and discusses why clocking extra hours of shut-eye doesn’t necessarily benefit our health. Nick Stockton writes:

Oversleeping feels so much like a hangover that scientists call it sleep drunkenness. But, unlike the brute force neurological damage caused by alcohol, your misguided attempt to stock up on rest makes you feel sluggish by confusing the part of your brain that controls your body’s daily cycle.

Your internal rhythms are set by your circadian pacemaker, a group of cells clustered in the hypothalamus, a primitive little part of the brain that also controls hunger, thirst, and sweat. Primarily triggered by light signals from your eye, the pacemaker figures out when it’s morning and sends out chemical messages keeping the rest of the cells in your body on the same clock.

Scientists believe that the pacemaker evolved to tell the cells in our bodies how to regulate their energy on a daily basis. When you sleep too much, you’re throwing off that biological clock, and it starts telling the cells a different story than what they’re actually experiencing, inducing a sense of fatigue. You might be crawling out of bed at 11am, but your cells started using their energy cycle at seven. This is similar to how jet lag works.

The article goes on to explain that past research has shown that, “If you’re oversleeping on the regular, you could be putting yourself at risk for diabetes, heart disease, and obesity.”

Previously: The high price of interrupted sleep on your health, Examining how sleep quality and duration affect cognitive function as we age, What are the consequences of sleep deprivation? and BBC study: Oh, what a difference an hour of sleep makes
Photo by Stephen Poff

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