Poor Sleep, Poor Health

September 6th, 2011 | No Comments

We all know that a night’s poor sleep can leave us feeling less than perky the next day, but now it    seems that a bad night may have more serious implications for our general health.

Research published by the American Heart Association suggests that consistently poor sleep may  cause significant increases in blood pressure. The findings imply that participants getting the least  deep sleep, particularly ‘slow wave sleep’ (SWS), have a 83% greater chance of hypertension than  the group getting the most SWS.  The smaller the period of time spent in SWS the higher blood  pressure rose, leading the researchers to conclude that deprivation of SWS may contribute to  unhealthy bloody pressure.

The research focused on men over the age of 65, an age group known to be more likely to suffer from sleep problems, but the researchers are confident that the results will also generalise to women.

Prof Espie says ‘This is yet another high quality research report that adds to the mounting evidence that sleep is associated with every aspect of our health and well-being. As this study shows, even when we are in our retirement years, deep sleep is really important … and not enough places us at risk of hypertension and maybe even heart attack’.

Posted in Sleep news, Sleep science

Reduced sleep duration linked to increased likelihood of future obesity in young children

June 3rd, 2011 | No Comments

A recent study published in the prestigious British Medical Journal reports that children who do not get enough sleep have an increased likelihood of becoming overweight and obese.

Many previous cross-sectional and prospective studies have reported that sleeping less is associated with elevations in Body Mass Index (BMI), in both children and adolescents. These reports, however, have several limitations; often not taking into account important confounding factors (like parental size, physical activity, early-life weight etc.) and failing to use objective, reliable measures of both sleep and fat distribution.

Addressing these limitations, researchers from New Zealand assessed 244 children over a four year period – from when they were 3 through to 7 yrs of age. Sleep was assessed with an accelerometer waist-band, for five days, at ages 3, 4, and 5 yrs. BMI and measures of fat distribution (biochemical impedance analysis to gauge fat mass and fat-free mass) were also collected and used as the main outcome variables, being assessed annually between 3 and 7 years of age. It was found that longer sleep duration at ages 3-5 was linked to a reduction in BMI – 0.48 for each hour of sleep – as well as a 61% reduction in the risk of being overweight at age 7. Crucially, this association between sleep duration and BMI reflected changes in fat mass (as compared to fat-free mass, like muscle tissue) and was found after controlling for several factors that are known to influence obesity, such as physical activity, diet and parental variables.

This study provides strong evidence that reduced sleep duration plays a causal role in contributing to future obesity. Although the mechanism(s) behind how sleep loss may have an ‘obesogenic effect’, the authors suggest several possibilities: including alterations to hormones that regulate appetite, which may impact snacking behaviour; and reduced energy expenditure due to sleep-loss induced fatigue. Professor Colin Espie, Clinical & Scientific Director of Sleepio comments ‘this could be an influential piece of research. We already know just how important obesity is in explaining poor health. Now we see that good sleep predicts a healthy weight whereas insufficient sleep risks being overweight. Perhaps if young people see that protecting your sleep is an investment in your body shape and your weight, then they will be more likely to value a good night’s sleep’.

Posted in Sleep news, Sleep science

Email-delivered Cognitive Behavioural Therapy for insomnia effective at improving sleep quality and depression symptoms in college students

May 18th, 2011 | No Comments

A new study, published online in the Journal of Clinical Sleep Medicine, reports findings from a trial of email-delivered cognitive behavioural therapy (CBT) for poor sleep in college students. The authors focussed on college students since they are known to have erratic sleep schedules and poor sleep quality, which could increase the likelihood of developing chronic insomnia and possibly future depression.

First year-college students from two halls of residence were assigned to either an eight-week programme called ‘Refresh’, or a programme called ‘Breathe’. The ‘Refresh’ programme involved the delivery of email PDF files to participants each week for eight weeks, covering the following main CBT components: education on sleep regulation; time in bed-restriction; relaxation training; mindfulness training; stimulus control strategies; and cognitive techniques. Each week, participants practiced the strategies described in the files. The participants in the ‘Breathe’ group received an intervention that was in equal in length but that, instead of covering sleep, targeted low mood and general stress. Baseline and post-treatment assessments of sleep quality and depression were conducted.

When looking at those reporting poor sleep quality at baseline, it was found that those in the ‘Refresh’ group (n=19) experienced a significantly greater improvement in sleep quality compared with the ‘Breathe’ group (n=15). Intriguingly, it was also found that the sleep-focussed ‘Refresh’ programme produced greater reductions in depressive symptoms compared with the ‘Breathe’ programme (where there was specific emphasis on mood and stress!). It is worth pointing out, however, that those in the ‘Refresh’ group had more severe depression scores at baseline relative to the ‘Breathe’ group, perhaps indicating that regression to the mean (when scores on first measurement are extreme, they tend to be closer to the average on second measurement) could partially explain this finding.

Such work complements other published literature demonstrating that self-help CBT for insomnia can effectively ameliorate core insomnia symptoms. If the depression result can be replicated, showing positive improvement in depressive symptoms through a sleep-focussed intervention, then this study also supports preliminary research demonstrating that improving sleep in depressed patients with insomnia disorder can also help improve the anti-depressant response.

Posted in How to sleep better, Sleep news, Sleep science | Tagged: , , ,

Insomnia is the most common residual symptom after positive response to anti-depressant medication

May 18th, 2011 | No Comments

A new study has systematically investigated the frequency and nature of depressive symptoms that remain in individuals with Major Depressive Disorder, despite responding favourably to the anti-depressant, Citalopram. It has been well documented that residual depressive symptoms, even for those who go into remission, increase the likelihood of future relapse. Less is known, however, about the nature of residual symptoms in individuals who respond to anti-depressant therapy (i.e. a 50% reduction in depression severity) but don’t fully remit. Such information could be used to guide interventions targeting specific residual depressive symptoms, at an early stage, to help enhance rates of remission.

Dr. Shawn McClintock, lead author of the study, and colleagues assessed 428 responders to Citalopram treatment (i.e. those showing a 50% decrease in depression symptoms as measured by the Quick Inventory of Depressive Symptomatology questionnaire). Repeat assessments with this questionnaire at 12 weeks were conducted to determine anti-depressant response (‘responders’) and residual symptoms. It was found that the two most common residual symptom domains, rated as moderately severe in nature, were insomnia (75.5% of the sample) and appetite/weight change (20.1%). It was also found that, out of those symptoms rated as mild by responders at follow-up, insomnia (94.6%), sad mood (70.8%), decreased concentration/decision making (69.6%), and psychomotor disturbance (69.9%) were the most common residual symptom domains.

When looking at subtypes of insomnia, it was found that middle-of-the-night insomnia (problems waking up during the night) was the most common complaint of sleep disturbance, and the most common residual depressive symptom in general. The team also assessed depressive symptoms that emerged during Citalopram treatment, and which remained at follow-up. Middle-of-the-night insomnia was the most common symptom which emerged during treatment (in 51.4% of individuals that did not report it at baseline), with decreased general interest being a close second (40%).

This work, published in the May edition of the Journal of Clinical Psychopharmacology, indicates that insomnia is the most frequent, persistent residual depressive symptom, as well as the most common treatment-emergent symptom in those who respond to anti-depressant medication. Professor Colin Espie, Clinical & Scientific Director of Sleepio comments “This is important work, because it emphasises that insomnia is a distressing, persistent and perhaps crucial problem when it comes to treating depression. Insomnia needs to be taken much more seriously than has been done in the past. There is also evidence from other research that people with insomnia are at much greater risk of relapsing back into depression, and that treating insomnia alongside depression may be the most therapeutic approach”’

Posted in Insomnia, Sleep science | Tagged: , , , ,

Sleepio and The Mental Health Foundation

May 13th, 2011 | No Comments

In 2011 Sleepio proudly partnered The Mental Heath Foundation in their campaign to highlight the impact of sleep on health and mental wellbeing. Their Sleep Matters report featured findings from the Great British Sleep Survey and a wealth of information on sleep problems, their importance and how to treat them.

In order to tackle the impact of sleep problems on the health and wellbeing of the UK, the Mental Health Foundation made the following recommendations:

  • Local and national public health campaigns should be organised for schools, workplaces and other public arenas, to highlight the importance of sleep and advise on evidence-based good sleep practice and therapies (as detailed in the report).
  • GPs should be provided with up-to-date information and training about the importance of sleep and evidence-based sleep therapies.
  • The government’s new Public Health Outcomes Framework should include specific outcomes on reducing sleep problems.
  • NICE should develop guidance on the management of insomnia using evidence-based non-pharmaceutical therapies, such as Cognitive Behavioural Therapy (CBT) (the best proven therapy for persistent insomnia).
  • People with sleep problems should be recognised in the government’s Improving Access to Psychological Therapies (IAPT) programme, especially regarding access to CBT.
  • Further research into low cost CBT-based interventions for sleep problems, such as self-help books and online courses, should be carried out.

You can download a copy of the Sleep Matters report from www.howdidyousleep.org and visit www.Sleepio.com/about for more information about Sleepio and a free trial of our clinically proven sleep improvement course.

Posted in Great British Sleep Survey, Sleep news, Sleepio press | Tagged: , , ,

Non-depressed individuals with insomnia have double the risk of developing future depression

March 8th, 2011 | No Comments

Depression and poor sleep are known to be strongly related, and until relatively recently insomnia has tended to be viewed as secondary to depressed mood. It has been documented however, that poor sleep can also pre-date the onset of depression, hinder response to treatments for depression, and remain long after successful remission of depression. This suggests that the relationship between depression and insomnia is not a straightforward one in terms of causality, but that the two may interact, and that insomnia on its own may even predict the development of depression.

In a cutting edge article, published online in the Journal of Affective Disorders, Dr Chiara Baglioni and researchers from the University of Freiburg systematically review and quantify studies which have investigated insomnia as a predictor for the development of future depression. Studies were included in the review if they assessed the core symptoms of insomnia, namely difficulties initiating or maintaining sleep, or non-restorative sleep, and if depression was ruled out in those individuals with insomnia at time-point one. These individuals were then re-assessed for the presence of depression, at least one year later (although the average assessment point was nearly six years later).

From the 21 reviewed studies, it was found that non-depressed individuals with insomnia have double the chance of developing depression in the future, compared with those that reported no sleep difficulties. For the reviewed studies which included information on exact numbers of individuals who developed depression, it was found that 13% of those with insomnia (and no depression) at time-point one went on to report depression at the second assessment. In contrast, only 4% of those without sleep difficulties at time-point one were found to have depression at the second assessment point. One limitation of the reviewed studies is that they did not always take into account additional psychiatric and medical conditions when assessing insomnia as a predictor for developing depression.

The authors conclude that treating insomnia at the earliest opportunity may be a preventative strategy to halt the development of mood disorders. It’s yet more evidence of the importance of sleep in maintaining health and wellbeing across all areas of our lives.

Link: Journal of Affective Disorders

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Researchers shed light on poor sleep quality in patients with tinnitus

February 17th, 2011 | No Comments

A recent study may help shed light on sleep complaints in those with tinnitus. Chronic tinnitus, a disorder which may affect up to 15% of the population, is characterised by the perception of sounds (ringing, buzzing, and hissing) without the presence of external auditory stimulation. Such sounds can be distressing for sufferers and sleep is frequently reported to be disturbed and of poor quality.

Twenty two patients with tinnitus and the same number of healthy participants took part in the study. It was found that, from questionnaires, tinnitus patients reported both poorer sleep quality and sleep efficiency (the amount of time one sleeps as a percentage of the time spent in bed), as well as greater daytime impairment. A sleep diary completed every morning for seven days further supported poorer sleep quality in patients as well as reduced total amount of nightly sleep. When measuring objective sleep in the lab through recordings of electrical brain activity, researchers discovered that the two groups did not differ in key variables such as time taken to fall asleep, total sleep duration, wake time during the night, number of awakenings and sleep efficiency. However, when the team did a more fine-grained analysis of electrical brain activity – using a technique called power spectral analysis – they found that tinnitus patients had reduced power in the delta frequency band compared with healthy controls. Delta power is a marker of brain synchronization and reflects deep, restorative sleep. Having less delta power was also associated with poorer subjective sleep quality.

Such a finding is interesting given that a similar reduction in delta power has been reported in patients with primary insomnia. The work, carried out by Sylvie Hebert and colleagues, may help understand the objective underpinnings of poor sleep quality in individuals suffering from tinnitus.

Link: Journal of Sleep Research

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Brief Behavioural Treatment Improves Chronic Sleep Disturbance in Elderly Adults

February 17th, 2011 | No Comments

Researchers at the University of Pittsburgh have recently published a study detailing the benefits of a behavioural intervention in improving sleep in older adults.

The study team, led by Dr. Dan Buysse, randomly allocated 79 elderly patients with chronic insomnia (including those with insomnia and other co-occurring medical and psychiatric illness) to receive either the brief behavioural intervention or an ‘information control’ intervention. Although some of the information overlapped in the two therapies, the crucial ingredient in the ‘active’ treatment group (those treated with behavioural therapy) was the tailoring and prescription of a strict bed- and wake-time routine for each patient.

The group receiving the brief behavioural intervention reported, at post-treatment, robust reductions in time taken to fall asleep and amount of wake-time during the night, as well as improved ratings of sleep quality, relative to the control group. Most important, however, was that by the end of the intervention, 55% of patients receiving the behavioural intervention were considered to have ‘no insomnia’, compared with just 13% of the control group. On the whole, these sleep improvements were sustained at 6 months follow-up and significant improvements were also found for ratings of depression and self-perceived health.

Access to such therapies for elderly adults is particularly important given the high prevalence of sleep disturbance in this population, often coupled with elevated prescription rates of sleeping pills – which have been frequently associated with increased risk of falls and hip fractures. Making Cognitive Behavioural Therapies (CBT) for insomnia deliverable in a brief manner, reducing cost and expertise associated with implementation, was also a major aim of the trial.

Sleepio’s Professor Colin Espie commented on the study: “This work provides further evidence that cognitive behavioural therapy is the treatment of choice for effectively alleviating chronic insomnia and, crucially, that it can be delivered in a cost-effective and brief manner.”

Link: Archives of Internal Medicine

Posted in Sleep news, Sleep science | Tagged: , , ,

Sleep helps us store memories

February 3rd, 2011 | No Comments

A recent study has shown that the hours we are asleep help us to store important information and memories.

The study published in the Journal of Neuorscience shows that during deep sleep, the brain sorts through our memories from the day and files away the ones that we need to keep.

“Our results show that memory consolidation during sleep indeed involves a basic selection process that determines which of the many pieces of the day’s information is sent to long-term storage,” lead author Jan Born, of the University of Lübeck in Germany, said in a statement. “Our findings also indicate that information relevant for future demands is selected foremost for storage.”

The brain takes in all the information we come across each day and stores it all but most of it is soon forgotten.  Study leader Born was interested to learn how the brain decided what to keep and what to discard.

The researchers performed memory experiments on almost 200 people, getting them to perform tasks like memorising pairs of words and finger taps and then testing their recall 10 hours later.  Some participants were allowed to sleep before being re-tested and some weren’t, which had a significant impact on their results.

“The more slow wave activity the sleeping participants had, the better their memory was during the recall test 10 hours later,” Born said.

The authors believe the brain’s prefrontal cortex flags the memories it decides are important while a person is awake, and the hippocampus stores them during sleep.

“These results suggest that sleep is critical to this memory enhancement,” Gilles Einstein, a memory specialist at Furman University, said in a statement.”

What an interesting study! Just another reason why sleep is so important to our overall wellbeing!

Source – Sleep Help Humans Store ‘Useful’ Information, Study Finds

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Aussie baby who forgets to breath when sleeping

February 1st, 2011 | No Comments

Breathing comes naturally to most of us, but not for little Australian boy Joshua Herron.

Every night, his parents lie awake in a constant state of fear and panic as they listen for the alarm from Joshua’s room – the alarm that indicates he has stopped breathing.

When Susie and Damien Herron watch their son nod off for the night they are constantly alert for the beeping alarm of a neo-natal respiratory monitor, which will go off if he doesn’t take a breath for 20 seconds.

Susie said: “I just haven’t been able to sleep at night. I’m afraid that if I go to sleep and Damien doesn’t hear it, what happens?”

Last year, nine-month old Joshua had to be revived 19  times by his mother after his breathing stopped while he was sleeping!

So far doctors are unable to explain Joshua’s condition, with their best guess being “immaturity between his brain and his respiratory centre”.

After he was born, Joshua spent 11 days in hospital but doctors were unable to diagnose his condition.

The first terrifying incident came two months after he arrived home. It hadn’t gotten any easier by the end of last year when Joshua suffered six incidents in just 10 days.

Joshua’s parents Susie and Damien have just one wish for the New Year -

“That he will grow out if it, that he will be healthy and strong and grow up to be a normal kid,” Damien said.

“And that he’ll let us get a bit of sleep!”

What an incredible story! Our thoughts go out to the Herron family and we hope little Joshua gets better so the whole family can get a good night’s sleep!

Source - Parents fear for baby who forgets to breath during sleep

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Posted in Sleep news