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Pediatrics, Sleep

How sleep benefits those with a rare neurological disease

How sleep benefits those with a rare neurological disease

In the latest Huffington Post blog entry from the Stanford Center for Sleep Sciences and Medicine, a pediatric neurologist highlights a rare neurological disease that’s characterized by an improvement of symptoms after sleep. Mara Cvejic, MD, shares the dramatic story of a young patient, writing:

As a sleep physician today, Jane’s face still haunts me — but in a good way. The miracles of sleep are too numerous for the scope of this article, but there is plenty of undisputed evidence to show that healthy sleep improves our mood, our heart, our ability to eat healthy, to exercise, and perform at our best during the day at work or school. It is even linked to lower cancer rates. But can it take away what appears to be Parkinson’s disease and make a little girl walk? Oddly, that answer is yes. Jane had Segawa’s disease.

Read on for the full story.

Previously: Stanford center launches Huffington Post blog on the “very mysterious process” of sleep

In the News, Research, Sleep

Sleep: More important than ever?

Sleep: More important than ever?

A headline today caught my eye: “It’s Time to Pay Attention to Sleep, the New Health Frontier.” (Since installing a sleep-tracking app on my phone, I’ve been playing with different bed times, forms of exercise and other factors to measure their effects on sleep time and quality.) Anyway, the piece, on Time.com, explains why sleep’s importance to health is more serious than many of us really acknowledge. And it offers this bit of historical perspective on why now is the time to pay attention:

According to a 2013 Gallup survey, 40% of Americans get less than the recommended seven to eight hours a night. While the typical person still logs about 6.8 hours of sleep per night, that’s a drop from the 7.9 Americans were getting in the 1940s.

Previously: Exploring the benefit of sleep appsSleep on it: The quest for rest in the modern hospital, Mobile devices at bedtime? Sleep experts weigh in and Stanford doc talks sleep (and fish) in new podcast

Aging, Genetics, Neuroscience, Research, Sleep, Stanford News

Restless legs syndrome, most common in old age, appears to be programmed in the womb

Restless legs syndrome, most common in old age, appears to be programmed in the womb

Restless legsWhile the sleep disorder called “restless legs syndrome” is more typical of older than younger people, it looks as though it’s programmed in the womb. And a group led by Stanford neurologist Juliane Winkelmann, MD, has pinpointed for the first time the anatomical region in the brain where the programming takes place.

Restless legs syndrome, or RLS, is just what it sounds like: a pattern of unpleasant sensations in the legs and the urge to move them. It has been described as a feeling similar to the urge to yawn, except that it’s situated in the legs or arms instead of the upper torso and head.

Estimates vary, but something on the order of one in ten Americans has RLS. Women are twice as likely as men, and older people more likely than young people, to have it. This urge to move around comes in the evening or nighttime, and can be relieved only by – wait for it – moving around. Needless to say, that can cause sleep disturbances. In addition, RLS can lead to depression, anxiety and increased cardiovascular risk.

Very little is known about what actually causes RLS, although it’s known to be highly heritable. Although a number of gene variants (tiny glitches in a person’s DNA sequence) associated with the condition have been discovered, each by itself appears to contribute only a smidgeon of the overall effect, and nobody knows how.

Winkelmann has been exploring the genetic underpinnings of RLS at length and in depth. In a just-published paper in Genome Research, she and her colleagues have shown that one gene variant in particular depresses the expression of a protein involved in organ development and maintenance. The DNA abnormality Winkelmann’s team zeroed in on occurs not on the gene’s coding sequence – the part of the gene that contains the recipe for the protein for which the gene is a blueprint – but rather on a regulatory sequence: a part of the gene that regulates how much of that protein (in this case, the one involved in organ development and maintenance) gets made, and when.

The kicker (pardon my pun) is that the regulatory sequence in question seems to be active only during early brain development and only in a portion of brain that is destined to become the basal ganglia, a brain region well known to be involved in movement.

“Minor alterations in the developing forebrain during early embryonic development are probably leading to a predisposition in the [basal ganglion],” Winkelmann says. “Later in life, during aging, and together with environmental factors, these may lead to the manifestation of the disease.”

(Wondering if you’ve got RLS? Check this out.)

Previously: National poll reveals sleep disorders, use of sleeping aids among ethnic groups, Caucasian women most likely to have restless leg syndrome
Photo by Maxwell Hamilton

In the News, Sleep, Technology

Exploring the benefit of sleep apps

Exploring the benefit of sleep apps

man sleeping in bedCan sleep-related apps be of benefit to the bleary-eyed masses? That’s the question explored today by the New York Times’ Molly Young, who sought the advice of one of our sleep experts for her story:

Browse the iTunes store or Google Play and you’ll find them by the dozen: offerings with names like SleepBot and eSleep, represented by icons of placid sheep or glowing moons. The offerings fall into two basic categories. One tracks sleep patterns through the smartphone’s accelerometer (the doodad that recognizes when your phone is upside-down), giving users a blueprint of their time in bed. The second promises to lull users to sleep with music, hypnosis or guided meditation.

If you’re the data-driven type, a sleep-tracking app surely appeals. By placing the phone next to you in bed and tapping a button, you record your movements and a sleep chart is created. But according to Dr. Clete Kushida, the medical director of the Stanford Sleep Medicine Center, these apps are hardly precise.

“Without EEG — brain wave activity — it’s very hard to tell different stages of sleep apart,” Dr. Kushida said. “People can stay still and the device will think the person’s asleep.” Still, “the advantage of these devices is that they can help individuals become more aware of a potential sleep problem,” Dr. Kushida said.

Previously: Why physicians should consider patients’ privacy before recommending health, fitness apps, A look at the “Wild West” of medical apps, Designing the next generation of sleep devices, Exploring the effect of sleep loss on health, Turning to an app to help your health and Stanford sleep expert offers evaluation of science behind one sleep device
Photo by dearoot

In the News, Parenting, Pediatrics, Sleep

Study: Baby sound machines may be too loud for little ears

Study: Baby sound machines may be too loud for little ears

DSC_0293Sound machines that help babies sleep more soundly are a staple on many new parents’  baby registries (I had a little sheep that mimicked the sounds of rainfall and ocean waves). Well, as you may have read about elsewhere today, a new study published in the journal Pediatrics finds those soothing sounds may actually do more harm than good. Researchers from the Hospital for Sick Children in Toronto have found that infant sleep machines can reach sound levels that are hazardous to infant hearing and development. Writer Michelle Healy outlines their findings in an article in USA Today:

When set to their maximum volume:

– All 14 sleep machines [studied] exceeded 50 decibels at 30 cm and 100 cm, the current recommended noise limit for infants in hospital nurseries.

– All but one machine exceeded that recommended noise limit even when placed across the room, 200 centimeters away.

–Three machines produced outputs greater than 85 decibels when placed 30 cm away. If played continuously, as recommended on several parenting websites, infants would be exposed to sound pressure levels that exceed the occupational noise limits for an 8-hour period endorsed by the National Institute for Occupational Safety and Health and the Canadian Centre for Occupational Health and Safety.

It’s important to note that the researchers only tested the maximum output levels produced by the sound machines, and not their direct effect on infants. But Nanci Yuan, MD, tells Healy that the study does raise some important concerns:

​Parents “can feel desperate and want to try anything” when a baby has difficulty sleeping, says Nanci Yuan, pulmonologist and sleep medicine specialist at Lucile Packard Children’s Hospital Stanford.

But this research highlights the potential for a previously “unknown harm that can occur,” Yuan says. “We’re getting more and more concerned about issues related to sound and noise and hearing-loss in children because it’s progressive.”

Photo by Margarita Gallardo

Sleep, SMS Unplugged

Sleep on it: The quest for rest in the modern hospital

Sleep on it: The quest for rest in the modern hospital

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

hospital bed cornerI first saw it on the face of a resident at the end of a 24-hour shift. And then again on the weary visage of a nurse after a whirlwind shift in the emergency room. Soon it was written across my own brow: The expression that said, It’s time to take a break. But as I soon realized, it wasn’t just the students, doctors and nurses who were struggling to get enough rest.

“It’s impossible to get any sleep here,” remarked one patient whom we awoke on early morning rounds. “There’s just constant disruption. I don’t feel like I’m healing.”

“Is there anything we can offer him besides sleep medications?” I asked the supervising physician after we left the room.

“Everyone says they can’t sleep,” he replied. “Unfortunately it’s just part of being in the hospital.”

I often ask patients to suggest one thing we can improve in their medical care. An overwhelming majority of them comment on the lack of peace and quiet. Perhaps the most memorable example was an elderly gentleman hospitalized for tuberculosis. Even in an individual room with airtight separation from others (“respiratory isolation”), he couldn’t go more than a few minutes without being disrupted. Doctors and medical students started their morning rounds before sunrise, vital signs were measured every four hours (including at night), and nurses constantly came in and out with meals and medications. He lamented, “The only thing I want to do is sleep. But as soon as I do, someone else comes in.”

Hospitals didn’t always used to be hectic. In fact, restful environments were long thought to have healing properties. Early in the 19th century, the French physician Laennec noticed lower rates of tuberculosis in seaside communities away from the hustle and bustle of the city. Wanting to bring a piece of that environment to his urban-dwelling patients, he began putting ocean seaweed under the beds of Parisians. More recently in the 1940s, a popular treatment for tuberculosis and other serious illnesses was the ‘sanatorium.’ Patients enjoyed the fresh air of the countryside, where it was thought they could rest and give their bodies a chance to build protective ‘walls’ around the infected nodules in their lungs.

The advent of antibiotics around the time of World War II brought a rapid end to seaweed, sanatoriums and other similar remedies. Nowadays, it’s easy to look back and chuckle at the idea of trying to cure tuberculosis by lying in a bed on the seashore. But it’s also increasingly difficult to justify the (somewhat) controlled chaos of today’s hospitals – an environment that is at best claustrophobic and at worst dangerous. After all, the benefits of a good night’s sleep have been proven beyond the shadow of a doubt. And numerous studies show that many people live longer and healthier if sent home instead of staying in the hospital with the exact same disease. Granted, much of the benefit of going home lies in avoiding exposure to others with contagious infections. But after seeing innumerable patients exhausted from being poked and prodded around the clock, it’s hard to shake the thought that the hospital environment itself may be more pathologic than we once believed.

Many of our clinical mentors came to this realization long ago, and teach us on a daily basis how mindful doctors can buffer patients from the stresses of a bustling hospital. Of course, helping someone to rest comfortably is more easily said than done. But as students, we can at least identify role models who are the kind of physicians we want to be – physicians who notice when a patient is sleeping and decide, “I’ll come back later.” Or those who notice when someone is exhausted and ask, “What can we do to help?” And if we can help patients sleep a little better, maybe – just maybe – their doctors will too.

Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school’s student journal.

Photo by oddmenout

In the News, Sleep, Technology

Mobile devices at bedtime? Sleep experts weigh in

Mobile devices at bedtime? Sleep experts weigh in

ipad in bed

Find yourself tossing and turning after checking e-mail on your smartphone or tablet before bed? Blame your body for being slow to catch up with modern times. As Stanford sleep expert John Peachey, PhD, explains today in a Real Business piece:

In the long span of human existence, we have had limited time to adapt to artificial light in the last 200 years. Humans evolved to essentially sleep with the sun. Because the brain assumes all light is sunlight, nighttime light exposure tricks the brain into believing the sun has not yet set, and therefore results in continued alertness.

Peachy and two other sleep experts, including Stanford’s Michelle Primeau, MD, go on to provide a few tips on how to “see the light and still get your Zs.”

Previously: Can adjusting your mobile device’s brightness help promote better sleep?
Photo by Johan Larrson

Pediatrics, Research, Sleep, Stanford News

Studying pediatric sleep disorders an “integral part” of the future of sleep medicine

Studying pediatric sleep disorders an "integral part" of the future of sleep medicine

kid_sleepingAs the new mom of a four-month old, I’ve become obsessed with infants and children’s sleep habits. So I was interested to read a recent entry on the Stanford Sleep Center’s blog about how studying children’s sleep disorders can further discoveries in the field for patients both big and small.

In the entry, sleep specialist Rafael Pelayo, MD, recounts Stanford’s historic role in the development of sleep medicine and notes that “infants and small children were even an early part of [research conducted by legendary Stanford sleep researcher William Dement, MD, PhD,] into rapid eye movement (REM) sleep.”  He also notes that “children were among the first patients seen” at the burgeoning clinic now known as the Stanford Center for Sleep Sciences and Medicine.

Looking toward the future, he writes:

In 2009, the historic clinic previously situated on Quarry Road near Stanford’s main campus was relocated to a state-of-the-art 14 bedroom facility at the Stanford outpatient campus in Redwood City. Thousands of patients are seen every year for diagnosis and management of sleep disorders, of which approximately 25 percent are children. This speaks to the future of sleep medicine: recognizing these conditions in childhood so that interventions can change development, affecting everything from growth to behavior. It is a significant need and one that deserves wider attention on a national and international basis.

Decades ago the synergy of neuroscience and psychiatry was essential in establishing this new field. The study of normal sleep and sleep disorders in children is an especially integral part of the development of the future of modern sleep medicine.

Previously: Stanford study sheds light on narcolepsy, “will shape the next decade of research” into the disease, Expert argues that for athletes, “sleep could mean the difference between winning and losing”, BBC study: Oh, what a difference an hour of sleep makes and Ask Stanford Med: Rafael Pelayo answers questions on sleep research and offers tips for ‘springing forward’
Photo by tamakisono

In the News, Sleep

A look at dreams in art

A look at dreams in art

catdreamHere’s something you may have missed over the holidays: A fun piece on NewScientist.com that uses artists’ renderings to demonstrate how certain cultures have depicted dreams over time and what nighttime imaginings could tell us about ourselves in the waking world. From Homer to Lewis Carroll, Alfred Hitchcock and Salvador Dalí, writers, filmmakers, painters and more have attempted to share what’s otherwise known only to the one who sleeps and dreams it. Now, science has opened windows into some of the neurological processes at work.

From the piece:

Normally, we don’t think our dreams are bizarre while we’re dreaming them – a quirk that researchers ascribe to reduced activity in the frontal and parietal cortices of the brain. Director Michel Gondry exploits this oddity in The Science of Sleep (2006), as dreams and real life begin to merge for Stéphane Miroux (played by Gael García Bernal).

Oversized features such as Miroux’s gigantic hands should be one of the surest signs we are dreaming. These exaggerated proportions may be a result of reduced working memory, which makes it difficult for the brain to keep all the elements in perspective as the scene changes.

Previously: Exploring the possibility of decoding our dreamsEye movement in REM sleep: Rapid, but perhaps not random and What we know about the meaning of dreams
Photo by RCB

Autoimmune Disease, Research, Sleep, Stanford News

Stanford study sheds light on narcolepsy, “will shape the next decade of research” into the disease

Stanford study sheds light on narcolepsy, "will shape the next decade of research" into the disease

Back in 2009, I wrote about Stanford research indicating that narcolepsy is an autoimmune disease, caused when patients’ immune systems kill the neurons that produce the protein hypocretin. A just-published study confirms that finding while also showing that the condition can sometimes be triggered by a similarity between a region of hypocretin and a portion of a protein from the pandemic H1N1 virus. My colleague Krista Conger explains the detailed science behind the work and summarizes its significance in a release:

The study provides some of the most compelling cellular and molecular evidence to date for a scientific concept known as “molecular mimicry.” Mimicry is the idea that the normal immune response to a pathogen, in this case the pandemic 2009 H1N1 influenza virus, can trigger autoimmunity — when the immune system mistakenly attacks healthy components of the body — because of similarity between a pathogen protein and a human protein.

“The relationship between H1N1 infection, vaccination and narcolepsy gave us some very interesting insight into possible causes of the condition,” said Emmanuel Mignot, MD, PhD, professor of psychiatry and behavioral sciences [and director of the Stanford Center for Sleep Sciences and Medicine. “In particular, it strongly suggested to us that T cells of the immune system primed to attack H1N1 can occasionally also cross-react with hypocretin and somehow cause the destruction of hypocretin-producing neurons.”

The new study suggests new ways to try to intervene before complete destruction of the specialized brain cells. Their loss is the hallmark of the disease and leads to its dramatic symptoms. The study also could pave the way to a new blood test to diagnose narcolepsy. And it sheds light on a previously observed association between a pandemic H1N1 vaccine used in Europe in 2009 and an increase in narcolepsy cases in Scandinavia the subsequent year.

Mignot shares senior authorship of the research with immunology researcher Elizabeth Mellins, MD, who told Conger that the findings “will shape the next decade of research into narcolepsy.” The study appears today in Science Translational Medicine.

Previously: Does influenza trigger narcolepsy?, More clues about narcolepsy and Narcolepsy = autoimmune disease

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