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In the News, Mental Health, Research, Sleep

The importance of screening soldiers for sleep problems to combat mental-health conditions

The importance of screening soldiers for sleep problems to combat mental-health conditions

Watching over

A new report from the RAND Corporation suggests that treating military members’ sleep disturbances early on may be an important step in preventing serious mental-health conditions, including post-traumatic stress disorder, depression, and traumatic brain injury.

The two-year multi-method study examined sleep-related policies and programs across the U.S. Department of Defense and surveyed almost 2,000 veterans from various branches of the military to evaluate their sleep habits. The findings emphasized the negative effects of poor sleep on soldiers’ mental health, daytime impairment and perceived operational readiness; and it outlined interventions for helping identify and prevent sleep problems for service members.

The Huffington Post reports:

The researchers recommended that the military improve screening for sleep disturbance, and develop guidelines for doctors on how to identify and treat sleep disorders in the military. Apps on mobile phones might be one new way to identify and monitor sleep problems so they do not become chronic and debilitating, the researchers said.

Although the new report focused on activity-duty troops, studies show that sleep problems are often missed in veterans as well, [Wendy Troxel, PhD, co-author of the report] said, so there is also a need to develop guidelines for treating this population. In a previous survey of 3,000 veterans, 74 percent had symptoms of insomnia, but only 28 percent had talked with their doctor about it, Troxel said.

The researchers also recommended improving policies and programs to educate military personnel about the importance of sleep, and provide guidance on how to help military members get better sleep.

Previously: Study shows benefits of breathing meditation among veterans with PTSD, The promise of yoga-based treatments to help veterans with PTSD and Using mindfulness therapies to treat veterans’ PTSD
Photo by DVIDSHUB

In the News, Pediatrics, Sleep, Stanford News, Videos

Stanford doc gives teens a crash course on the dangers of sleep deprivation

Stanford doc gives teens a crash course on the dangers of sleep deprivation

Numerous studies, including a big one published in Pediatrics earlier this year, have shown that adolescents are getting less sleep than ever before. But most teens are unlikley unaware of the dangers of sleep deprivation – and that’s something that a group of Stanford clinicians is trying to change. Rafael Pelayo, MD, with the Stanford Center for Sleep Sciences and Medicine, and colleagues recently gave a “crash course” on sleep, and the importance of getting enough, to students at nearby Menlo-Atherton High School. ABC7 captured the story in the video above.

Previously: Talking about teens’ “great sleep recession”, With school bells ringing, parents should ensure their children are doing enough sleeping, Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”, What are the consequences of sleep deprivation? and Want teens to eat healthy? Make sure they get a good night’s sleep

Neuroscience, Research, Sleep, Stanford News

New findings on exactly why our “idle” brains burn so much fuel

New findings on exactly why our "idle" brains burn so much fuel

1959 Cadillac

“The human brain is a greedy organ,” I wrote in my release describing a new Stanford study before elaborating:

Accounting for only 2 percent of the body’s weight, it consumes 20 percent of the body’s energy. Yet the rate at which the brain gobbles glucose (the fuel our brain cells run on) barely budges when we cease performing a physical or mental activity. Even at rest, the brain seems engaged in a blizzard of electrical activity, which neuroscientists have historically viewed as useless “noise.”

The study, which appears today in in Neuron, sheds light on why the brain paradoxically appears to exhaust so much energy in what at first glance seems akin to the idling of a car’s engine. Although you wouldn’t know it from just staring at it, the human brain is a complicated orchestra of electrical circuits constantly humming along with one another over the comparatively long distances that separate one part of the organ from another.

Over the past decade, neuroscientists using brain-imaging methods have identified dozens of distributed, collaborative clusters of brain regions working in concert and dedicated to various mental activities from solving math problems to recalling what one ate for breakfast.

Now a team led by Stanford neuroscientist Josef Parvizi, MD, PhD, has tracked the electrical activity within and between these simultaneously pulsing clusters (or, in Neurospeak, “networks”) with more precision than has previously been possible, and shown that these closely coordinated firing patterns persist even during sleep. This, in turn, may go a long way to explaining why when it comes to how fast the brain guzzles energy, the most intense thoughts, emotions or actions on our part barely budge the needle.

In their study, Parvizi and his colleagues were able to dig deeper than brain-imaging studies can usually go, because they could directly record electrical activity in selected areas in living human subjects’ brains.

The areas in question are distinct parts of a well-studied brain network called the default mode network, which is perhaps the most energetic of the dozens that have so far been discovered. That’s because the default mode network is most active when a person is at rest — lying still with eyes closed or just staring off into space  — or is retrieving an autobiographical memory (“What did I eat for breakfast?”).

Parvizi and his associates showed that the same pattern of coordinated electrical activity observed in the default mode network regions when experimental subjects were performing an autobiographical-memory task persisted even when those individuals were sound asleep.

It adds up to this, Parvizi told me: “The vast amount of energy consumption by our brain is due to its spontaneous activity at all times when we are not consciously involved in a specific task.”

It may be that, all through the night, the brain’s circuits are talking to each other, taking each other’s measure, and staying tuned for optimal function when day breaks. An idling engine puts you just one gas-pedal pump away from a fast take-off.

Previously: In a human brain, knowing a human face and naming it are separate worries, Mind-reading in real life: Study shows it can be done (but they’ll have to catch you first), We’ve got your number: Exact spot inbrainwhere numeral recognition takes place revealed, Metamorphosis: At the push of a button, a familiar face becomes a strange one and Why memory and math don’t mix: They require opposing states of the same brain circuitry
Photo by Don O’Brien

In the News, Sleep, Sports, Stanford News

Sleep = one of the keys to Golden State Warriors’ success

Sleep = one of the keys to Golden State Warriors' success

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All-Star shooting guard Klay Thompson loves to take three pointers, and he’s good at it – he’s second in the league in made threes this season. (His teammate and fellow “Splash Brother” Stephen Curry holds the number one spot.) Thompson also loves to sleep, and perhaps the two aren’t unrelated. The Associated Press was there when Stanford sleep researcher Cheri Mah paid a visit to the Golden State Warriors’ locker room last week, sharing some tips with the team.

Much of Mah’s work focuses on sleep and athletic performance, and she says sleep is something that’s often put on the back burner, especially with elite teams who have grueling  schedules. From the piece:

“It’s one of the first things we sacrifice but one of the most important,” Mah said Thursday. “Changing time zones frequently, that can affect circadian rhythms. Really, it was addressing improving and optimizing sleep and recovery.”

Getting more sleep is something Thompson has no problems with. “I know how important recovery is,” he said in the article. “We play such a long season. And I love to sleep, so it was good hearing that if you want to be at optimal peak performance you’ve got to get your eight hours, or at least try to. You can’t be hanging out long hours at night.”

Previously: Superathletes sleep more, says Stanford researcherAsk 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
Photo by Chilli Head

Behavioral Science, In the News, Patient Care, Research, Sleep, Stanford News

Watson, the narcoleptic Chihuahua, demonstrates symptoms on-air

Watson, the narcoleptic Chihuahua, demonstrates symptoms on-air

Watson - 560

What’s black and white (with just a few splotches of brown), understands French, and falls asleep at feeding times? A narcoleptic Chihuahua named Watson.

Watson’s becoming accustomed to the spotlight — he made his debut here at Scope, then went on to star in a KQED blog post. But today, Watson made it on air for The California Report. The segment begins – endearingly — with Emmanuel Mignot, MD, PhD, cooing to Watson in French. Mignot is Watson’s human and a sleep researcher known for the discovery of the gene that causes narcolepsy in dogs. (He also directs the Stanford Center for Sleep Sciences and Medicine).

Although Watson isn’t officially a Stanford dog — he’s Mignot’s pet — Mignot is hoping to use the slightly shy pup to help some of his patients, particularly children, who suffer from narcolepsy.

One of the symptoms of narcolepsy is cataplexy, a sudden loss of muscle control and Watson often suffers these attacks when he’s excited or spots tasty food.

“He looks at you with these eye half-closed and its almost like he’s just telling you, “Oh, I love you,” but in fact its because he’s having a sleep attack,” Mignot said.

Previously: Narcoleptic Chihuahua joins Stanford sleep researcher’s family, Stumbling upon circadian rhythms and Does influenza trigger narcolepsy?
Photo by Emmanuel Mignot

Neuroscience, Research, Sleep, Stanford News

Stumbling upon circadian rhythms

Stumbling upon circadian rhythms

PrintIn my job as a science writer, I get to hear lots of amazing stories of discovery. In some cases, researchers have worked diligently to solve one question for decades. Others I talk to describe exciting Eureka! moments where their data suddenly made sense. But some of my favorite stories are those where a scientist is studying one thing, only to make an off-the-cuff observation that leads them in a totally new direction.

In researching circadian rhythms for the latest issue of Stanford Medicine magazine, I heard lots of this last kind of story. There are many obvious ways that circadian rhythms influence biology: our sleep cycles, the way our stomachs start to grumble for lunch at the same time every day, and how many plants close their flowers each night. But scientists are also starting to reveal lots of hidden, unexpected ways that circadian rhythms – the natural cycles in living organisms – affect us. Over just the past few years, researchers in disparate fields have made chance observations that have made them think twice about the timing of their experiments; daily circadian cycles in our bodies can affect everything from how we metabolize drugs to how our immune system acts, they’ve found.

Craig Heller, PhD, who co-directs the Stanford Down Syndrome Research Center, told me about how he was testing a new drug to improve memory in mice with Down syndrome. During the course of his experiments, he noticed that mice who received the drug at night didn’t respond the same way as mice that received a dose in the morning. It led him to start investigating the link between learning, memory, and daily sleep cycles. What he discovered doesn’t just have implications for Down syndrome, but for learning and memory more broadly.

Then, sleep researcher Emmanuel Mignot, MD, PhD, of the Stanford Center for Narcolepsy, walked me through the story of how he and other scientists discovered a link between the immune system and narcolepsy. It all started, he explained, after an odd epidemiological observation: narcolepsy was more often diagnosed in the spring than in the fall.

Of course, lots of what we know about how circadian clocks tick along inside our bodies, keeping time with the world around us, comes from tireless, carefully planned out benchwork, and that can’t be discredited. But some of the most surprising new links I describe in my feature come from scientists taking leaps across fields to explain something they found curious. Check out my feature, “Hacking the Biological Clock,” to learn more about what Heller, Mignot, and other scientists have found on these journeys of discovery.

Sarah C.P. Williams is a freelance science writer based in Hawaii.

Previously: Stanford Medicine magazine reports on time’s intersection with health, Study shows altered circadian rhythms in the brains of depressed people and Narcolepsy = autoimmune disease
Illustration by Harry Campbell

Chronic Disease, Health Policy, In the News, Pediatrics, Public Health, Sleep

Talking about teens’ “great sleep recession”

Talking about teens' "great sleep recession"

Sleepy Teen Student

We all understand, at some level, that sleep is critical to our health. But there’s a cultural undercurrent that belies that understanding: We tend to glorify the go-getters who can survive on four or five hours of sleep, lauding their productivity and drive. Numerous studies have shown that Americans of all ages – kids, teens, and adults – are not getting enough sleep.

More and more, researchers are warning that lack of sleep can damage our long-term health. Just yesterday, Rafael Pelayo, MD, with the Stanford Center for Sleep Sciences and Medicine, was on KQED’s Forum radio program to discuss a new study looking at some alarming trends in teen sleep habits. The study, titled “The Great Sleep Recession” was published this week in the scientific journal Pediatrics. It showed that over the past 20 years, teens have been getting less sleep. Girls, minority teens, teens in urban areas and of low socioeconomic status were less likely to get at least seven hours of sleep than male, white teens. What’s more, minority teens and low SES teens were likely to report they thought they got enough sleep.

During the show, Pelayo spoke about our relationship with sleep and the challenges of sticking to a “sleep budget”:

When I read the title [of the study] it made me think of Bill Dement, who talks – at Stanford – about a sleep debt and not having enough total sleep. And a sleep debt has been growing and accumulating in people who have used sleep as something as optional in their lives. These students are… modeling after their parents, who are not getting enough sleep… But in the kids, it’s a particularly hard problem for them, they feel pressure to not get enough sleep.

Pelayo went on to say that parents and teens tend to prioritize other things, like homework, over sleep – but what they should be doing is setting aside a certain amount of time for sleep. “If the homework doesn’t get done, it doesn’t get done. They can’t make homework more important than sleep,” he said.

That last statement is a pretty radical suggestion, but if we are to avoid the fall-out from our bad sleep habits, radical changes may be the only solution.

Previously: With school bells ringing, parents should ensure their children are doing enough sleeping, Stanford docs discuss all things sleep, Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life” and What are the consequences of sleep deprivation?
Photo by Alberto Vacarro

Sleep, Stanford News

Narcoleptic Chihuahua joins Stanford sleep researcher’s family

Narcoleptic Chihuahua joins Stanford sleep researcher's family

Watson the dog

Meet Watson, the narcoleptic chihuahua. He’s just like any other pampered pup, except he collapses when he’s excited, thanks to his narcolepsy. I enjoyed a demonstration of Watson’s special skills last week, when I visited Stanford sleep researcher Emmanuel Mignot, MD, PhD.

Mignot discovered the gene that triggers narcolepsy in dogs more than a decade ago, and before getting Watson he had recently lost his narcoleptic companion, Bear, a black Belgian schipperke who would swoon over broccoli. (For a lovely elegy to Bear, check out this KQED piece, including video.)

Still heartbroken, Mignot wasn’t in the market for a new dog. And certainly not for a chihuahua.

But a phone call from a breeder who had an unadoptable, sleepy dog, led to a visit to Vermont – and before long, Watson arrived. Now, Mignot is smitten, cooing to the squirmy dog in his native French. I detailed the story in the current issue of Inside Stanford Medicine.

Mignot uses Watson to demonstrate the effects of an cataplectic attack to children who are suffering from the disease. (Watson’s entertaining performance can calm frightened patients, Mignot told me.) In my piece I outlined what happened when Watson was offered a chunk of pork (one of his triggers) last week: “Watson took a big sniff and staggered backwards, struggling to ward off the attack that was paralyzing his muscles — pushing him toward sleep in just seconds. He recovered slightly, climbing to his feet and lunging for the food.”

Watson is particularly susceptible to grass-fed filet mignon, Whole Foods roast beef and new toys. He also collapses for joy when Mignot returns home from work, Mignot told me.

Interestingly, the causes of narcolepsy in humans and dogs may differ:

In humans, narcolepsy is caused when the immune system attacks certain neurons in the brain. These neurons produce a peptide called hypocretin that helps promote wakefulness and inhibits dreaming. Some dogs have that type of narcolepsy as well, although others have a genetic form that stems from a mutation in the hypocretin peptide receptor gene. Watson is a family pet and has not undergone any kind of genetic testing, so Mignot doesn’t know what type of narcolepsy he has.

Previously: Narcolepsy=autoimmune disease, Stanford center launches Huffington Post blog on the “very mysterious process” of sleep and Studying pediatric sleep disorders an “integral part” of the future of sleep medicine 
Photo by Becky Bach

Behavioral Science, Public Health, Sleep

Six simple ways to improve your sleep for the holidays

Six simple ways to improve your sleep for the holidays

IMG_5595The holiday season is usually one of the busiest – and often most stressful – times of the year. It’s also a season that often brings poor sleep. To improve your health and your mood, consider six simple ways that you can maintain healthy sleep during the hustle and bustle of the holidays and even discover the resolve to improve your sleep in 2015.

1. Go to bed when you’re sleepy.

It seems obvious, but it isn’t always easy to do: Sleep most easily comes when we are feeling sleepy. Insomnia, characterized by difficulty falling or staying asleep, can plague us throughout the year. With the added stress of the holidays, it can be even harder to fall asleep.

Many insomniacs will start to go to bed earlier, or stay in bed long after waking, to make up for lost sleep. This desperation often thins out sleep and makes it less refreshing. Imagine showing up for a holiday feast after having snacked all day. You wouldn’t have much of an appetite. If you spend too much time in bed, or take naps, you similarly will show up for the eight-hour feast of sleep without much interest.

Prolonged wakefulness helps to build our drive for sleep and staying up a little later until you feel sleepy can ease insomnia.Preserving 30 to 60 minutes to relax before bed can also aid this transition.

2. Ease yourself into a new time zone to prevent jet lag.

If you’re flying across the world, or even across the country, you may find that your sleep suffers. This is due to our body’s natural circadian rhythm, which regulates the timing or our desire for sleep. This rhythm is based in genetics, but it is strongly influenced by environmental cues, especially morning sunlight exposure.

If you suddenly change your experience of the timing of light and darkness by hopping on a jet plane, your body will have to play catch up. As a general rule: “West is best and east is a beast.” This points out that westward travel is more tolerated because it’s nearly always easier to stay up later than it is to wake up earlier.

Another rule of thumb is that it takes one day to adjust for each time zone changed. If you travel across three time zones, from San Francisco to New York City, it will take about three days to adjust to the new time zone. This adaptation can be expedited by adopting the new time zone’s bedtime and wake time before you depart. If you’re like most people, your best intentions might not lead to pre-trip changes.

Never fear: To catch up once you arrive, delay your bedtime until you are sleepy, fix your wake time with an alarm, and get 15 minutes of morning sunlight upon awakening.

3. Put an end to the snoring.

Whether you’re staying in grandma’s spare room or sharing a hotel suite, close quarters during the holidays may call attention to previously unnoted snoring and other sleep-disordered breathing like sleep apnea.

Remember that children should never chronically snore; if they do, they should be seen by a sleep specialist. Adults don’t have to snore either. Snoring is commonly caused by the vibration of the soft tissues of the throat. If the airway completely collapses in sleep, this is called sleep apnea. This may lead to fragmented sleep with nocturnal awakenings and daytime sleepiness. It is also commonly associated with teeth grinding and getting up to urinate at night.

When sleep apnea is moderate to severe, it may increase the risk of other health problems including hypertension, diabetes, heart attack, stroke, and dementia. It’s more than a nuisance, and if you or a loved one experience it, further evaluation and treatment is warranted.

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Research, Sleep

Holiday nightcap? Drinking before bed may be counterproductive

Holiday nightcap? Drinking before bed may be counterproductive

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If you’ve ever taken a drink of alcohol before bed to help you fall asleep, you’re not alone – approximately 20 percent of Americans do so regularly. But new research from the University of Missouri shows that while a nightcap can make you sleepy in the short term, regular alcohol consumption before bed interferes with the body’s sleep regulator and can actually cause insomnia.

A study published last month in Alcohol helps us understand alcohol’s effects in a new way. It was previously thought that alcohol shifts the circadian rhythm, the body’s “internal clock,” resulting in simply being sleepy sooner; in fact, it disrupts the mechanism by which the brain “feels” tired. Alcohol increases the production of adenosine, a naturally occurring chemical that accumulates outside cells when you’ve been awake for a long time; it signals the need for sleep by blocking “wakefulness” receptors in the basal forebrain. Adenosine levels decrease during sleep, maintaining the brain’s sleep/wake homeostasis.

Alcohol-induced adenosine wears off too quickly, which makes for less restful sleep in the short term, and can compromise the brain’s ability to maintain homeostasis in the long term (i.e., insomnia).

I asked Stanford sleep expert Brandon Peters, MD, to weigh in and he told me:

I concur that alcohol should not be used as a sleep aid. Though alcohol may induce sleepiness, as it quickly wears off it fragments sleep, leading to awakenings. Alcohol also can relax the muscles of the upper airway and contribute to obstructive sleep apnea and snoring. It is recommended that alcohol not be consumed for the several hours preceding bedtime.

What to do instead? Peters suggests:

Rather than relying on an alcohol-containing nightcap, insomnia can be improved with changes as part of a structured cognitive-behavioral therapy for insomnia (CBTI) program. Sleeping pills are also not a preferred option; you don’t need medication to feel hungry, so why would you need medication to feel sleepy? Sleep is a natural process that can be enhanced with simple interventions. If difficulty falling or staying asleep persists beyond 3 months, assistance should be sought from a board-certified sleep specialist.

Photo by Stephen Janofsky

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