Archive for the ‘Sleep’ Category

CHRONIC ALCOHOL DEPENDENT DRINKING DISRUPTS CIRCADIAN RHYTHMS CAUSING INSOMNIA AND DEPRESSION

Thursday, August 26th, 2010

Human beings have a 24 hour biological rhythm cued by changes in daylight called a circadian rhythm. The mammalian clock that regulates our sleep-wake cycle lies in the suprachiasmatic nucleus of the hypothalamus. Temporary disruption of circadian rhythm by international flights causes a combination of insomnia and fatigue known as jet lag.

Every 24 hours we not only show changes in wakefulness, but also in body temperature, hormone production, brain waves and feeding behavior. Many tissues in our body have circadian clock genes. These genes must be expressed properly in the form of transcription and clock proteins for us to survive. Their appropriate expression is a key for people to sleep well, stay healthy and maintain a good mood. In order to operate properly these genes must have sufficient messenger RNA (ribonucleic acid) to manufacture certain proteins.

It has long been known that people who drink heavily on a chronic basis have problems with insomnia and depression. Researchers Ming-Chyi Huang and collaborators at Taipei Medical University and Taipei City Hospital wanted to know if this was related to depletion of messenger RNA in their circadian clock genes.

The researchers recruited 22 male patients diagnosed with alcohol dependency and 12 healthy control subjects. Study of their blood samples showed markedly lower baseline levels of messenger RNA in the circadian clock genes of the AD patients. The study also showed destruction of normal circadian clock gene expression in the AD patients. Reduced circadian clock expression did not normalize following early alcohol withdrawal treatment. Researcher Sy-Jye Leu said this shows that chronic AD has long term damaging effects on the expression of circadian rhythm genes. Their finds were communicated early on 8/24/10, but will be published in full in the November 2010 issue of Alcoholism: Clinical & Experimental Research.

For alcoholic lawyers in denial it’s important to realize that continuing to drink is tampering with your very genes and altering the basic circadian rhythm that sets the time for normal, healthy changes in sleep, waking, brain waves, hormone production, body temperature and hunger. Research from Dr. Joseph Takahashi of the Howard Hughes Medical Institute came out on July 13, 2010, indicating that chronic disruption of circadian rhythm can cause diabetes by impairing the ability of the pancreas to release insulin.

If you’re a lawyer with an alcohol problem who is still in denial, then it’s high time you sought treatment.

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OBSTRUCTIVE SLEEP APNEA INCREASES THE RISK OF STROKE FOR BOTH GENDERS BUT ESPECIALLY FOR MEN

Friday, August 20th, 2010

William Dement, M.D., the Stanford physician who founded the field of sleep medicine, first described obstructive sleep apnea (OSA) in 1976. OSA is a condition in which there are hundreds of episodes of apnea (complete blockage of the airway to the lungs) and/or hypoapnea (partial blockage) during sleep. OSA causes sleep interruption and reduced blood oxygen. OSA results from mechanical collapse of the airway not from a neurologic problem with the motor neurons in the brain or their connections to the muscles of the throat.   

The human airway in the throat is composed of collapsible soft tissue made of muscle and fat. People who are overweight or obese have low muscle tone and extra fat in the walls of their airway putting them at highest risk of airway collapse during sleep. Statistically the risk of OSA goes up with being overweight or obese, smoking, heavy drinking, diabetes, older age and being male.

 The spectrum of severity varies widely from patient to patient as to the number, completeness and duration of nighttime airway collapses that prevent oxygen from getting to the lungs, and from the lungs to the heart and brain. Episodes of airway collapse can last from a few seconds to a few minutes. OSA of any severity is bad for your health. The worse the OSA the worse the health consequences. OSA is associated with increased likelihood of hypertension, heart failure, irregular heartbeats, stroke, daytime sleepiness, sleep-deprived motor vehicle accidents, and diminished quality of life. Severe OSA increases the risk of fatal heart attack by 30% and has been proven to cause tissue death in the brain, especially in the hippocampus which encodes memories.

In some but not all sufferers OSA can cause loud snoring, nighttime restlessness and daytime sleepiness. The vast majority of cases of OSA go undiagnosed, because the sufferers do not see themselves as being at risk and they do not go to a sleep medicine clinic for diagnosis with oximetry (a measurement of blood oxygen) and a polysomnogram (a test which reveals the quantity, quality and continuity of sleep).

In 2002 Terry Young, Ph.D., and colleagues at the Department of Population Sciences, University of Wisconsin gave the following estimates of the incidence of OSA. From 1-5% of all adults in the U.S. have severe OSA which causes  chronic daytime sleepiness. From 1-14% have moderate OSA. From 3-28% have mild OSA. In their article in the American Journal of Respiratory and Critical Care Medicine they call undiagnosed OSA in adults an epidemic and a healthcare crisis. As of 2010 the NIH National Center on Sleep Disorders Research said that more than 12 million Americans have sleep apnea but most are not diagnosed or treated.

The National Heart, Lung, and Blood Institute of NIH sponsored a study called the Sleep Heart Health Study which looked at the relationship between OSA and the risk of stroke. The results of this study were published online on March 25, 2010, and in print in the July 2010 issue of the American Journal of Respiratory and Critical Care Medicine. Dr. Susan Redline, M.D., M.P.H. of Case Western Reserve and her colleagues followed 5,422 participants aged 40 or older with no history of stroke for an average of about 9 years.

At the start of the study each participant performed a standard at-home sleep rest which determined if they had sleep apnea and its severity. During the course of the study 193 participants had a stroke. After adjusting for various cardiovascular risk factors the researchers found that men with sleep apnea had a higher stroke risk than women, that men’s risk of stroke increased with the severity of their apnea and that the only women at significantly increased risk of stroke from apnea were those with the severe form. Men with mild OSA have double the risk of stroke than men without it. Men with moderate to severe OSA have triple the risk of stroke than men without OSA or just the mild version. Dr. Redline speculated that the higher risk of stroke in men resulted from men developing OSA at an earlier age than women and having more cumulative effects.   

How do you know if you have OSA? Some people who have it don’t snore. Some people who snore don’t have it. OSA is only one of many reasons for snoring. Others include sinus congestion, drinking alcohol just before bed and use of sleep medicines. The frequency and intensity of snoring is a clue. If you snore intermittently and it’s not loud enough to send your partner out of the room, it’s much less likely that you have OSA than people who snore like buzz saws all the time. Approximately 80% of “heroic snorers” have OSA. Recently a paper was published saying that men whose eyelids were “rubbery” and tended to roll up and expose the whites of their eyes at night (leaving their eyes dry and irritated in the morning) also tended to have OSA. The only way to know for sure is to be examined by a Board Certified sleep medicine physician.

Are there any treatments for OSA? If the cause is being overweight or obese, then losing weight is crucial. These days the typical treatment during sleep is to wear a mouthpiece or to use a breathing device such as a CPAP machine which forces air down the user’s throat, keeping it open and providing good ventilation. Surgery is also used in some cases. One common technique is the uvulopalatopharyngoplasty which removes or repositions excess tissue from the soft palate and uvula.

Given the increased rate of illness and death from heart attacks and strokes, you don’t want to fool around with OSA. If you have a family history of it, if you are significantly overweight or obese, if you are a heroic snorer whose spouse or partner sleeps in another room, if you’ve been quite sleepy during the day or if you’ve been having irregular heartbeats, then run don’t walk to the nearest sleep clinic.

Lawyers spend many mentally active but physically sedentary hours engaged in reading, writing or talking. They are stuck in offices where it’s much more convenient to have food like pizza delivered. They are also highly stressed so they experience serotonin depletion, increased blood cortisol and a yen for sugary, high fat or fried comfort foods. Plenty of lawyers start their first year of law school with a normal BMI (body mass index) only to wind up overweight or obese by middle age. Some of them smoke, drink alcohol or both to control anxiety or depression. These habits and the changes in their bodies creep up on them and it’s hard for them to acknowledge they’ve put themselves at risk of OSA or that they may already have it. It’s not a pleasant scenario. Indeed it’s downright scary to think about. But, if you’re middle aged or older and you have the risk factors, then it’s time to start facing reality and take good care of yourself by making an appointment with a reputable sleep clinic.

 

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USING JASMINE FRAGRANCE INSTEAD OF DRUGS TO INDUCE SLEEP

Saturday, July 10th, 2010
Difficulty falling asleep is a worldwide problem and the use of drugs to induce sleep is commonplace. In the U.S. tens of millions of people use prescription drugs to depress the central nervous system and fall asleep. The two main categories are selective GABA agonists without benzodiazepines such as Ambien, Lunesta and Sonata and benzodiazepines (anti-anxiety drugs) such as Valium, Xanax, Klonopin, Ativan, Restoril and Halcion. Benzodiazepines are also known as benzos or benzies. Both classes of drugs activate the GABA system in the posterior hypothalamus of the brain. GABA is the main inhibitory neurotransmitter in the human brain which acts to calm, relax and quiet the brain.
Not all Americans use these drugs like Ambien of Valium. Some use anti-depressants like Trazodone, anti-convulsants like Neurontin; pain medications like Darvocet; muscle relaxants like Flexeril; or over-the-counter anti-histamines like Nytol, Tylenol PM or Unisom. Many people consume alcohol to get to bed, and there are some who get hooked on cough syrup containing alcohol. Prescription drugs, alcohol and over-the-counter drugs all have their side effects. To varying degrees they pose a risk of drug tolerance (needing a higher dose to get the same effect), drug dependence and withdrawal symptoms.
The non-benzodiazepines can cause dry mouth, drowsiness, feeling drugged and dizziness. The most common side effects of benzodiazepines are related to their sedating and muscle-relaxing action. They include drowsiness, dizziness and decreased alertness and concentration. They can produce incoordination with injury-falls and traffic accidents. Decreased libido and erection problems are a common side effect. They can cause depression. Less common side effects include nausea and changes in appetite, blurred vision, confusion, euphoria, depersonalization and nightmares. Cases of liver toxicity have been described but are very rare.
In Germany 20% of adults take benzodiazepines drugs to fall asleep. These drugs are highly addictive and although they are only supposed to be taken for no more 2-4 weeks, many people take them for years. Long term use of benzodiazepines over a period of years are associated with a general deterioration in physical and mental health, including cognitive impairments, behavioral problems, anxiety and depression, loss of sex drive, agoraphobia and social phobia, an altered perception of self and environment, and an inability to experience or express feelings. The most frequent withdrawal symptoms are insomnia, gastric problems, tremors, agitation, muscle spasms, and fearfulness. Less common effects are irritability, sweating, depression, psychosis, suicidal behavior, seizures, and delirium tremors. Severe symptoms usually result as a result of abrupt or rapid withdrawal, so gradual reduction is recommended.
Recently a team of researchers in Germany (Hanns Hatt of the Ruhr University in Bochum and Olga Sergeeva and Helmut Hass of the Heinrich Heine University in Dusseldolf) tested hundreds of fragrances to find a non-harmful substitute for benzodiazepines to induce sleep. They wanted to find out which fragrances, if any, could match the potency of benzodiazepines in activating GABA receptors in the posterior hypothalamus of mice. Their published results in the online July 2010 issue of the Journal of Biological Chemistry show that the fragrance of jasmine is highly effective in sleep induction. The jasmine fragrance vertacetal-coeur and its chemical variation (PI24513) were able to increase the GABA effect in mice by more than five times and act as strongly as benzodiazepines. This was the case whether the fragrance was injected or inhaled in a plexiglass cage. The mice exposed to the fragrance became extremely tranquil and their brains showed electrophysiologic evidence of the sleep cycle. The researchers were granted a patent for their discovery.
Thus there appears to be a scientific basis for aromatherapy with regard to inducing sleep, and this holds out some promise that people who are now dependent on drugs to fall asleep may be able to use a side-effect free jasmine fragrance instead.

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HOW TO UNWIND BEFORE BED AND GET A GOOD NIGHT’S SLEEP

Thursday, July 1st, 2010
Lawyers are revved up all day at the office, and come home with an agitated mind which is locked into ego-protection mode or problem-solving mode and filled with quickly shifting thoughts, feelings and mini-movies that replay the day’s most stressful events. In this state of mind many lawyers reach for something to slow the churning within their minds and release the tension in their bodies. It is common for them to consume alcohol, overeat comfort food and watch “dumb” TV shows, which could be reality TV shows, late night talk shows, or both. This habitual approach to unwinding isn’t effective in promoting sleep. It not only delays the onset of badly needed sleep, but tends to cause interrupted or fitful sleep. When lawyers see a psychologist for stress one of their most common complaints is insomnia. Here are some Dos and Don’ts for getting a good night’s sleep.
Do These Things For a Good Night’s Sleep
Eat a healthful meal slowly, pausing to chew your food well and savor its flavor. If you’re having wine, drink in moderation and sip it rather than gulp it. Keep it to one or two glasses and be sure to drink water. Too much wine is dehydrating and will disturb your sleep. Keep portion size reasonable. My physician recommends three fist sized portions of a protein (like chicken, fish, beef or pork), a vegetable (like a green salad or steamed broccoli) and a starch (like baked potato, pasta or rice). When you consume gargantuan portions of food at dinner or you come back to the fridge after dinner to scarf down a pint of ice cream you are overloading and distending your stomach and making yourself physically uncomfortable as well as overloading your digestive system.
After dinner, if the weather is pleasant, go outside and talk a walk. Whether you walk the dog, walk alone or walk with a family member or friend, this is a great way to unwind and aid healthy digestion. Vigorous exercise close to bedtime is not a good idea as this increases heart rate and respiration and has the effect of waking and energizing the body, just when you want to be relaxing.
Do something pleasant to divert your mind from anxiety generating conflicts at the law office. This could be watching a funny movie, reading a novel, watching an interesting program on the History Channel or Discovery Channel with your kids or chatting on the phone with a relative or friend to see what’s going on in their lives.
If you have pain from a sore throat, headache, toothache or other condition, be sure to take enough pain medication to make you comfortable all night. If your nose or ears are stuffed up from a cold, then take enough decongestant to make it through the night.
Give a massage to or get one from your spouse or partner or, if you’re both in the mood, have sex. Massage and sex are both fun ways to release tension which are mutually nurturing, enrich your relationship and keep you affectionate (which helps when you argue later in the week!)
Take a shower or luxuriate in a warm bath, especially one with fragrant bath salts.
Nibble a piece of dark chocolate. It stimulates production of serotonin which enhances sleep.
Make sure you have a comfortable mattress and a comfortable pillow. The room should be as dark as possible. Digital alarm clocks and DVD players glow in the dark so you should cover them. You also want a comfortable temperature, no higher than 70 degrees Fahrenheit. Men like me will roast under too many blankets.
Keep a clean and tidy bedroom. A messy, cluttered bedroom makes for a messy, cluttered mind when you’re trying to fall asleep.
Keep computers and other electronic devices that buzz out of the room. If you must have them in your bedroom make sure they are at least three feet from your bed.
If you’re still having some difficulty getting to sleep after all of these sleep-promoting activities, then try listening to an audio CD or download to help you get to sleep. You can buy a CD called Deep Sleep with Medical Self-Hypnosis by Dr. Steven Gurgevich for about $13 on  from www.soundstrue.com. There are some excellent mind/body relaxation downloads at marc.ucla.edu on the left column under meditations. Some people are helped to sleep listening to a CD of the sound of waves washing ashore. Some benefit from a white noise machine or a room fan.
Don’t Do These Things Before Going to Bed
If you drink coffee, coke or another caffeinated beverage with dinner or after dinner you’re asking for trouble. Caffeine blocks sleep promoting histamines and keeps us alert and wired when we want to be drowsy and tired.
Don’t do something that will agitate or worry you near to bed time. For some people paying bills or having “that talk” with your kid about his low grades at school or his unsavory friends is quite agitating and this would be better done earlier in the day.
Don’t watch reality TV. In June 2010 BYU Professor Sara Coyne, Ph.D. published a study showing that reality TV shows have 52 acts of aggression compared to 33 per hour for non-reality shows. For the purposes of her study aggression referred to verbal, physical and relational acts of aggression including slights, insults, backbiting and dirty looks. The Apprentice topped the list at 85 acts of verbal or relational acts per hour with American Idol further down the list at 57 per hour. Dr. Coyne’s focus was on how the meanness of these shows rubs off on viewers and coarsens them. My concern for lawyers is that watching shows like these near bedtime will prompt recollection of verbal clashes at work, re-stimulate their nervous system and put them into fight-flight when they should be calming down in preparation for deep sleep.
If these things help you get that restful, refreshing, invigorating sleep you’ve longed for, then that’s wonderful. If you still have problems sleeping, and these problems have continued for more than a month I suggest you see your physician. Chronic insomnia is different from transient sleeplessness. If you have chronic insomnia, it’s possible you are having a mood disorder (anxiety or depression) or some form of sleep disorder.

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