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Neuroscience, Research, Sleep, Stanford News, Technology

Cheating jet lag: Stanford researchers develop method to treat sleep disturbances

Cheating jet lag: Stanford researchers develop method to treat sleep disturbances

jets landing in sunset - 560

Last month, I went to a conference back East. It was a short trip, four days, and I was jet lagged the whole time. I spent my mornings gulping down hot coffee to help shake off the sleepy haze; in the evenings, when I should have been making up the lost sleep, I was wired, tossing and turning in bed. I could have tried adjusting to East Coast time in the days before I left by getting to bed a few hours earlier and getting up around 4 AM, but that would have required a level of coordination and planning that I’m unlikely to muster in the days before an out-of-town trip.

So I was curious when I learned that a team of Stanford researchers, led by neurobiologist Jamie Zeitzer, PhD, were working on a technique that helps people shift their sleep cycles by flashing light briefly at their eyes while they sleep. They recently published their findings in the Journal of Biological Rhythms.

Beyond the obvious job of vision, our eyes and brain are constantly processing information about the light around us. Light affects our moods and the daily ebb and flow of our biological clocks. It influences when we are sleepiest and most alert. Our brains do a lot of this work behind the scenes and because it happens unconsciously, we are rarely aware of these circadian rhythms – unless something disturbs them, like flying across several time zones.

Zeitzer and his team recruited volunteers and had them get on a routine sleep-wake cycle, going to bed and waking up at the same time every day for about two weeks. The researchers then had the volunteers come sleep in the lab, where the experimental group was given a series brief flashes of light about two millisconds long – about as long as a camera flash – aimed at their eyes. A control group slept in complete darkness, and the volunteers didn’t know which group they were assigned to. The team then measured whether the subjects’ sleep cycle had been affected by measuring the amount of melatonin in their blood. The brain floods the body with melatonin a couple of hours before bedtime and continues releasing the hormone until about an hour after wake time.

The researchers found that the volunteers who got the light flashes were able to shift the sleep phase of their circadian systems. What was surprising was that the intervention did not noticeably disturb the subjects’ sleep. The volunteers in the experimental group didn’t report any less restful sleep than the controls. “This kind of treatment can help people adjust even before they leave for a trip,” says Zeitzer. “Leaving for Australia, the night before you leave, you can adjust a couple of hours. On the plane, you can adjust a couple more. By the time you arrive, you’re already half-way adjusted.”

Besides jet-lagged travelers, this technique could also help teenagers who have a hard time getting up at the right time (a clinical condition for many that goes beyond adolescent laziness) and shift workers. Current treatments for sleep disturbances include sitting in front of bright lights for sometimes hours at a time, which often means it’s only used in extreme cases.

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Health and Fitness, In the News, Research, Sleep, Stanford News

Superathletes sleep more, says Stanford researcher

Superathletes sleep more, says Stanford researcher

alarm-clock-146469_640Hit snooze again – it just might boost your performance, Stanford sleep expert Cheri Mah believed. Seems intuitive, yet research findings were needed.

Mah originally tapped Stanford’s men’s basketball team to test her theory. When the team went from an average of 6.5 to 8.5 hours of sleep a night, they hit 11 percent more free throws and sprinted more quickly. Her work grabbed headlines at the time, and now it’s featured in Mark McClusky’s  forthcoming book, Faster, Higher, Stronger: How Sports Science is Creating a New Generation of Superathletes — and What We Can Learn from Them.

The Atlantic excerpted a key section from the book today; here’s McClusky (who also edits Wired.com):

For us humans, sleep is completely crucial to proper functioning. As we’ve all experienced, we’re simply not as adept at anything in our lives if we don’t sleep well…

It seems like certain kinds of athletic tasks are more affected by sleep deprivation. Although one-off efforts and high-intensity exercise see an impact, sustained efforts and aerobic work seem to suffer an even larger setback. Gross motor skills are relatively unaffected, while athletes in events requiring fast reaction times have a particularly hard time when they get less sleep.

McClusky goes on to write that Mah’s research “strongly suggests that most athletes would perform much better with more sleep – if they could get it.” But it’s tricky for top athletes to get enough sleep. Fly across the country, or the world, and your sleep schedule is skewered. And West Coast teams have it particularly hard:

In 2013, the Seattle Mariners flew more than 52,000 miles while the Chicago White Sox, with their central location and nearby division rivals, only flew about 23,000… Bouncing around the country, leaving late, arriving early, having to play the next day—it’s no surprise that travel and the management of sleep is a huge problem for athletes.

Some athletes squeeze in an afternoon nap to boost their rest times, McClusky said. And that sounds like a mighty fine idea to me.

Previously: Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance, Expert argues that for athletes, “sleep could mean the difference between winning and losing,” Why your sleeping habits may be preventing you from sticking to a fitness routine and A slam dunk for sleep: Study shows benefits of slumber on athletic performance
Image by OpenClips

Neuroscience, Research, Sleep

Memory of everyday events may be compromised by sleep apnea

Memory of everyday events may be compromised by sleep apnea

sleeping_11.3.14Previous imaging studies have shown that sleep apnea, which causes periods of disrupted breathing during the night, is associated with tissue loss in regions of the brain that process memory. Now new research published in the Journal of Neuroscience offers more evidence that the sleep disorder can cause difficulty in remembering where you left your keys and other daily events.

In a small study (subscription required), people with severe sleep apnea spent two separate nights at the NYU Sleep Disorders Center. At the lab, individuals were administered a baseline examination consisting of playing a video game requiring them to navigate three-dimensional spatial mazes. During one night of the experiment, participants’ use of their continuous positive airway pressure (CPAP) machine was reduced during REM sleep allowing sleep apnea to naturally occur. On the second night, they resumed normal use of the CPAP. Individuals played the video game before and after each sleep period.

As Medical News Today reports:

When sleep was aided by therapeutic CPAP all night, researchers observed a 30 percent overnight improvement in maze completion time from their baseline examinations. However, when REM sleep was disrupted by sleep apnea, there was not only no improvement from baseline testing, but, in fact, subjects took 4 percent longer to complete the maze tests.

Equally important, when sleep apnea occurred in REM sleep, subjects did not experience delayed reaction times on a separate test to measure attention, called a psychomotor vigilance test. [Lead researcher Andrew Varga, MD, PhD,] says that this suggests that sleepiness or lack of attention were not reasons for the decline in spatial memory, as indicated by the maze performance after experiencing sleep apnea in REM sleep.

Sleep apnea affects approximately 18 million adults in the United States. While the disorder is difficult to diagnose in children because of monitoring techniques, it’s estimated that a minimum of 2 to 3 percent of kids suffer from sleep apnea and some believe it could be as high as 10 to 20 percent, according to data from the National Sleep Foundation.

Previously: “Sleep drunkenness” more prevalent than previously thought, Study shows women with gestational diabetes at increased risk for obstructive sleep apnea, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and How effective are surgical options for sleep apnea?
Photo by Jared Polin

Neuroscience, Research, Sleep, Videos

How sleep acts as a cleaning system for the brain

How sleep acts as a cleaning system for the brain

Here’s one more reason why getting a good night’s sleep is critical to your health. As neuroscientist Jeff Iliff, PhD, explains in this just released TEDMED video, the brain has a specialized waste-disposal system that’s only active when we’re slumbering. Watch the talk above to learn how this system clears the brain of toxic metabolic byproducts that could lead to Alzheimer’s disease and other neurological disorders.

Previously: Why sleeping in on the weekends may not be beneficial to your health, The high price of interrupted sleep on your health and Examining how sleep quality and duration affect cognitive function as we age

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

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