Insomniacs should get out of bed for better sleep

Getting out of bed may be the key to helping insomnia, a new study published in the Archives of Internal Medicine suggests.

The study, done by a team of researchers at the University of Pittsburgh school of Medicine and led by Daniel Buysse, followed 79 adults with chronic insomnia who averaged 72 years of age.
Buysee wanted to find out if cognitive behavioral therapy for insomnia, which is just as effective as a pill according to previous research, could be shortened and simplified at lower costs. In the past, these pill-free therapies have been very involved and too pricey for the general population.
One conclusion from the behavioral study stated by Buysee, “When you are sleeping poorly, the most important thing you can do is spend less time in bed.”
Insomnia is defined as the difficulty in initiating, or maintaining, sleep and an estimated 30%-50% of the general population are affected by this sleep disorder. Statistically insomnia seems to affect more women than men and it’s incidence tends to increase with age.
Insomnia can affect a person’s ability to function during the day which can lead to accidents, and a wide range of various physical symptoms, including hypertension and inflammation.
The study focused on using cognitive behavioral therapy for the participants that were unable to get to sleep. The participants were given either printed educational materials about sleep, or 2 brief behavioral in-person treatment sessions followed by 2 phone call sessions.
The mental health nurse practitioner conducting the sessions focused the sleep instruction on restricting time in bed and setting regular sleep and wake-up schedules. The practitioner also gave instructions on the biological reasons for the particular sleep strategies utilized in the behavioral therapy study.
Thomas Neylan of the University of California, San Francisco, gave comment to this research stating, “A lot of insomniacs spend a lot of time lying in bed worrying about their sleep, among other things. They expect to have insomnia.”
Neylan gave further recommendations for insomniacs by suggesting, “If you’re not ready to fall asleep, don’t lie down in bed and try to force yourself to sleep. And if you wake up in the middle of the night and don’t fall back asleep easily, get out of bed. You don’t want to have any linkage between the experience of lying in bed and being awake. “

Insomnia in women with breast cancer linked to heart rate

This study is the first to analyze both hormonal and autonomic responses in metastatic breast cancer patients suffering from insomnia.
Westchester, Ill. –A study in the October 15 issue of the Journal of Clinical Sleep Medicine shows that respiratory sinus arrhythmia (RSA) is a significant predictor of insomnia in women with breast cancer and confirmed that longer nocturnal wake episodes were associated with a flatter diurnal cortisol slope.
Results of this study confirmed a relationship between frequent awakenings and abnormal cortisol (a steroid hormone that regulates blood pressure), rhythms in metastatic breast cancer, thus concluding that a disrupted cortisol rhythm may have serious medical implications in women with breast cancer.
With the addition of demographics, disease severity and psychological variables, findings suggest that Vagal regulation, assessed via RSA, an important marker of parasympathetic tone, is the most consistent and significant predictor of sleep continuity disturbance. Diminished RSA has been associated with both worse medical and psychiatric health. Previous studies suggest that RSA is associated and may even be predictive for insomnia in healthy subjects.
"It was surprising to see that the strongest association was between a parasympathetic nervous system dysregulation and sleep problems even after we considered patients' age, their disease severity, type of treatment and psychological variables such as pain and stress," said the study's lead author, Oxana Palesh, PhD, Research Assistant Professor at the University of Rochester Cancer Center.
Insomnia symptoms were associated with a lower baseline of RSA. Lower RSA is associated with decreased parasympathetic functioning in insomniacs, and weakened parasympathetic functioning is associated with increased stress and decreased emotional regulation.
The study included 99 women who had metastatic breast cancer or recurrent breast cancer and who were over the age of 45. Thirty-nine patients took antidepressant medications in this study, and 19 took medications specifically prescribed for treating disrupted sleep during study baseline. Participants collected saliva for cortisol measurement for two days, completed questionnaires, wore actigraphs to monitor their sleep-wake cycles for three days, and participated in the Trier Social Stress Task (TSST) approximately one-to-two weeks after the cortisol baseline collections. The TSST is a standardized social and cognitive stress test. Demographic and cancer diagnosis history was collected from the women through self-report.
Heart rate dysregulation (diminished or low respiratory sinus arryhthmia) during a stress task was associated with four objective measures of sleep disruption: sleep efficiency, wake after sleep onset, average number of awakenings and average length of waking episode.
Estimates from two nights of actigraphy indicate that participants spent about eight hours in bed and had wakefulness after sleep onset (WASO) of more than 71 minutes. They also had an average of 15 wake episodes each night with an average duration of 4.81 minutes.
While demographics explained some portion of the development of sleep disruption, four of the six sleep parameters examined (Sleep efficiency, wakefulness after sleep onset, mean number of waking episodes and average length of waking episodes) were best explained by low RSA.
In healthy people, cortisol levels peak early in the morning and level-out by the end of the day. However, in one-third to two-thirds of women with metastatic breast cancer, circadian rhythms are disrupted and diurnal cortisol slopes are either flattened, have multiple peaks, or are elevated at the end of the day. In the non-cancer population, evidence shows that people with insomnia have an elevated response to stress in general. Psychiatric disorders, including major depression, are linked with hypothalamic-pituitary-adrenal axis (HPA) dysregulation. Past research has linked insomnia to activation of the stress-response system, which results in an increased level of cortisol.
Sleep disruption is two to three times more common in cancer patients than in the general population; these disturbances may exacerbate concurrent cancer and/or treatment related symptoms such as fatigue, mood disturbance, and gastrointestinal distress, psychiatric illness and may lead to reduce quality of life and overall health.
According to Palesh, one of the best interventions for regulation of autonomic functioning is diaphragmatic breathing. Any number of stress management techniques would be effective, including biofeedback treatment, hypnosis, visualization exercises, meditation, progressive muscle relaxation and yoga.

What A Sleep Study Can Reveal About Fibromyalgia

Research engineers and sleep medicine specialists from two Michigan universities have joined technical and clinical hands to put innovative quantitative analysis, signal-processing technology and computer algorithms to work in the sleep lab. One of their recent findings is that a new approach to analyzing sleep fragmentation appears to distinguish fibromyalgia patients from healthy controls.
Joseph W. Burns, a research scientist and engineer at the Michigan Tech Research Institute (MTRI); Ronald D. Chervin, director of the University of Michigan’s Michael S. Aldrich Sleep Disorders Laboratory; and Leslie Crofford, director of the Center for the Advancement of Women’s Health at the University of Kentucky, report the results of their study in the current issue of the journal Sleep Medicine
MTRI, a freestanding research institute acquired by Michigan Tech in 2006 and based in Ann Arbor, specializes in remote sensors that collect data, and in signal processing, using algorithms or computer programs to analyze and correlate the information the sensors gather. MTRI has developed an ongoing collaboration with the University of Michigan’s sleep laboratory, one of the nation’s leading clinical and research centers specializing in sleep medicine.
This several-year collaboration provided MTRI’s first opportunities to apply quantitative analysis, remote sensing technology and computer algorithms to clinical challenges, said Burns. “In this case, our analyses of sleep stage dynamics suggest potential clinical relevance,” he noted. Newly explored measures of sleep fragmentation seem to correlate—at least in this study—with levels of pain reported by fibromyalgia patients.
Burns, who has a PhD in electrical engineering, finds that more and more of his research is taking a biomedical turn. He and his team are working with Chervin to use signal-processing technology to record and analyze the brain waves and biophysical responses of children and adults with a variety of sleep disorders. They hope it will help them better understand conventional sleep patterns, as well as diagnose and treat sleep disorders.
They presented the results of research related to assessment of sleep-disordered breathing and sleep fragmentation at Sleep 2008, an international sleep research conference, in Baltimore in June.
Patients who may have sleep disorders often undergo complicated and expensive tests in sleep laboratories, Chervin explained. These studies collect an assortment of biophysical data that reflect brain, cardiovascular and muscle activity throughout the night. Up to now, these data had to be analyzed manually by highly trained technicians.
“We are collaborating to find new ways to analyze routinely collected data in a way that will be meaningful to the patient’s health and will help us understand how sleep disorders affect brain functions,” he said.
Automated analysis of data potentially can provide improved assessments and reduce the cost of sleep studies, Burns noted. For example, MTRI and UM have developed an automated technique for assessing the severity of sleep-disordered breathing, using just two signals—brain waves and respiration—instead of the dozen or more signals typically needed for standard visual scoring of a sleep study.
“It may even become possible for people to take sleep tests—simpler and more effective than some of those currently available—at home where they can sleep in their own familiar bedrooms,” he suggested.
Both partners are reaping the benefits of the collaboration, Burns said. Not only can automated technology improve clinical research; what the MTRI scientists have learned about biomedical techniques such as brain mapping is informing their more traditional work on radar and optical sensing technology.

Women Who Sleep Less Than 8 Hours Live Longer

How much sleep is too much or too little? For women, researchers at the University of California, San Diego say that to live longer, the optimal number is less than 8 hours, and that 5.0 to 6.5 hours is ideal.

Eight hours is too much sleep for women

In the new study, a team of investigators evaluated data originally collected between 1995 and 1999 from 459 women ranging in age from 50 to 81. That study had indicated women who slept 6.5 to 7.5 hours per night had the best survival rates.
Now, 14 years later, the researchers took another look at the original group of women, of whom 444 could be identified for evaluation purposes. Eight-six women had died.
According to the study’s lead scientists, Daniel F. Kripke, MD, professor emeritus of psychiatry at UC San Diego School of Medicine, “when sleep was measured objectively, the best survival was observed among women who slept 5 to 6.5 hours. Women who slept less than five hours a night or more than 6.5 hours were less likely to be alive at the 14-year follow-up.”
The researchers also found that obstructive sleep apnea among older women did not predict an increased risk of death. Kripke noted that while sleep apnea may be associated with a greater risk of death among younger women, “it does not seem to carry a risk in the older age group, particularly for women.”
Countless studies have explored the optimal amount of sleep needed for various populations, from infants to the elderly. According to the National Sleep Foundation, there is no “magic number.” Visitors to the Foundation’s website will find that “not only do different age groups need different amounts of sleep, but sleep needs are also individual.”
That said, research shows that getting too little sleep is associated with many health concerns, including inhibited productivity, difficulty remembering and consolidating information, increased risk for motor vehicle accidents, increase in obesity, increased risk of diabetes and heart problems, and increased risk for psychiatric conditions. Some research also shows that too much sleep (generally considered more than 9 hours or more) is associated with an increased risk of illness and morbidity.
Are people losing sleep over worrying whether they are getting enough or too much sleep? According to Kripke, the results of this new study should provide some answers, at least for women who may worry about sleeping less than 8 hours. “This means that women who sleep as little as five to six-and-a-half hours have nothing to worry about since that amount of sleep is evidently consistent with excellent survival.”