FAA Rejects “Rulemaking” Process, Will Implement Strict OSA Screening

From Dr. Norman Blumenstock:

Hopefully this will make the skies safer for air travel.

The Aircraft Owners and Pilots Association (AOPA) is reporting that the FAA will move forward with implementing mandatory screening and testing for obstructive sleep apnea, despite opposition from the pilot and aviation medical communities.

During a webinar last week, the Federal Flight Surgeon said the FAA would require aviation medical examiners to calculate body mass index (BMI) for all pilots. Those with a BMI of 40 or greater would have to be screened and, if necessary, treated for obstructive sleep apnea (OSA).

“The AME may issue a medical certificate at the time of the examination; however, the FAA will follow up with a request for additional evaluations, including a sleep study and evaluation by a board-certified sleep specialist,” wrote Elizabeth A. Tennyson of the AOPA. “Pilots who don’t undertake the evaluation within 60 days would face receiving a letter of disqualification. Over time, the FAA would lower the BMI requirement, compelling more pilots to be screened by a sleep specialist. The FAA currently lists 5,000 pilots with a BMI of 40 or greater and more than 120,000 who qualify as obese with a BMI of 30 or higher.”

Much like the trucking industry, AOPA and others have objected to the new testing requirements, saying they force AMEs to venture into predictive medicine, “rather than focusing on their mandate of determining the likelihood that a pilot will be medically incapacitated at some point in the duration of the medical certificate.”

The AOPA has argued that such a significant change should go through the more stringent “rulemaking process” to allow public input and the opportunity to explore less intrusive and less costly methods for addressing concerns about sleep disorders. Instead of “rulemaking,” the FAA is using its regulatory powers to implement the new guidelines.

Source: AOPA

Originally Posted At:  http://www.sleepdt.com/faa-rejects-rulemaking-process-will-implement-strict-osa-screening/

FAA to Ground Obese Pilots Until Examined for OSA, Pilots Fight for Rulemaking

Notes from Dr. Norman Blumenstock:

This may result in improved public safety in the air. Pilots fear that they can lose their livelihood if they can't tolerated CPAP.  Oral appliances may be the best solution for those pilots that have mild or moderate obstructive sleep apnea.

Published on Tuesday, 26 November 2013 10:09

By Sree Roy

Pilots with a body mass index greater than 40 and a neck circumference of 17 inches or more will soon have to be tested for obstructive sleep apnea (OSA) before being allowed to fly, according to a bulletin issued by Federal Air Surgeon Fred Tilton, MD. "Untreated OSA is a disqualifying condition for airmen and air traffic control specialists (ATCSs), and it is a concern for the other modes of the Department of Transportation," Tildon says in the bulletin. "Dr Nick Lomangino has been working on this policy for quite a while, and I think he has developed an outstanding product....The next step will be to require AMEs [Aviation Medical Examiners] to calculate the BMI for every examinee (both airman and ATCS [Air Traffic Controller]) by using a formula that is located in the examination techniques section of the AME Guide....Airman applicants with a BMI of 40 or more will have to be evaluated by a physician who is a board certified sleep specialist, and anyone who is diagnosed with OSA will have to be treated before they can be medically certificated."

Once the FAA has handled examinees with BMIs over 40, it plans to expand the testing pool to those with lower BMIs "until we have identified and assured treatment for every airman with OSA," the bulletin says.

The Aircraft Owners and Pilots Association (AOPA) quickly denounced this decision via a letter to the FAA administrator and is garnering some support in Congress, as, on November 21, a group of House General Aviation Caucus members introduced legislation to require the FAA to go through the rulemaking process before implementing policy changes related to sleep disorders. “We believe this policy inappropriately bypasses the rulemaking process; overlooks potentially more effective and efficient solutions; provides no clear safety benefit; and imposes unjustified costs on the user community,” AOPA President Mark Baker wrote.

Baker's letter asserts there are "more affordable and less intrusive options" for addressing sleep disorders, including a provision in the AOPA/EAA Third-Class Medical Petition that would require pilots to participate in a recurring educational course that would teach them how to better self-assess their medical fitness to fly. The letter also warns that sleep apnea testing for the 124,973 airmen identified as obese by the FAA in 2011 could cost as much as $374 million. Affected pilots would also have to apply for a special issuance medical certificate at a time when the FAA already has a backlog of 55,000 cases.

The issue is reminiscent of the argument for and against mandated OSA testing in the trucking industry. In that situation, Congress passed a bill requiring the formal rule-making process be followed and forbids the issuing of any informal guidance on this subject.

Pilots Push Back on FAA Apnea Screening Policy

Notes from Dr. Norman Blumenstock:

Should airline pilots get screened for obstructive sleep apnea?

November 20, 2013 by agpubs

The Aircraft Owners and Pilots Association (AOPA) is asking the Federal Aviation Administration to indefinitely suspend a new policy that would require some pilots to be screened and, if necessary, treated for obstructive sleep apnea before receiving a medical certificate.

An article posted on the AOPA Web site reports that at first, the screening would apply to pilots with a body mass index (BMI) over 40. Over time, the FAA would lower theBMI requirement, compelling more pilots to be screened by a board-certified sleep specialist. The policy is the result of NTSB recommendations, but AOPA argues that there is no evidence to support the need for such screenings among general aviation pilots.

A look at the comment section following the article shows widespread support for suspending the policy. “[The FAA] admits to no data on the effects of sleep apnea on pilot performance, and they target the entire pilot database anyway,” writes one commenter. “These are not decisions based on aviation safety. They are a nanny style directive.”

“This policy seems to be based on one incident involving an airline flight,” said Rob Hackman, AOPA vice president of Regulatory Affairs. “In that case, the crew fell asleep and missed their destination but woke up and landed safely. Analysis of a decade of fatal general aviation accidents by the General Aviation Joint Steering Committee didn’t identify obstructive sleep apnea as a contributing or causal factor in any of the accidents studied.”

AOPA is composing a formal letter to FAA Federal Flight Surgeon Dr. Fred Tilton asking him not to implement the new policy and noting that there was no public comment period before the policy was announced. The new requirements could potentially affect thousands of pilots, adding to what AOPA calls the already significant backlog for processing special issuance medicals.

In 2011, the FAA identified 124,973 airmen who are considered obese, making them potential candidates for screening. According to reporter Elizabeth Tennyson, the new policy grew out of a 2009 NTSB recommendation that the FAA change the airman medical application to include questions about any previous diagnosis of obstructive sleep apnea as well as the presence of risk factors for the disorder.

The recommendation also asked the FAA to implement a program to require pilots at high risk for obstructive sleep apnea to be evaluated and, if needed, treated before being granted medical certification.

Source: AOPA

Americans are Popping Sleeping Pills in Record Numbers

Notes from Dr. Norman Blumenstock:

The CDC report, based on data from the National Health and Nutrition Examination Survey (2005 to 2010), found that nearly nine million Americans take prescription sleeping pills in pursuit of good night’s rest.

November 21, 2013

By Dr. Mercola

The first-ever federal health study about sleeping pill usage suggests that sleep is growing ever more elusive for Americans.1 According to the latest information, between 50 and 70 million Americans suffer from sleep deprivation, with increasing numbers relying on prescription sleep aids.2

The CDC report, based on data from the National Health and Nutrition Examination Survey (2005 to 2010), found that nearly nine million Americans take prescription sleeping pills in pursuit of good night’s rest.

Usage differences were found based on age, gender, race and ethnicity. The report listed the following key findings:

• About four percent of US adults age 20 and above use prescription sleep aids
• The percentage of adults using prescription sleep aids increases with age and education; more adult women (5 percent) used prescription sleep aids than adult men (3.1 percent)
• Non-Hispanic white adults were more likely to use sleep aids (4.7 percent) than non-Hispanic black adults (2.5 percent) and Mexican-American adults (2 percent)
• Prescription sleep aid use varied by sleep duration and was highest among adults who sleep less than five hours (6.0 percent) or more than nine hours (5.3 percent)
• One in six adults with a diagnosed sleep disorder and one in eight adults with trouble sleeping reported using sleep aids

The hardest hit group is the elderly—seven percent of individuals over the age of 80 are relying on prescription sleep aids, including hypnotic drugs (such as Ambien and Lunesta) and sedating antidepressants.

Are You Sleeping Better than Your Pay Grade?

According to a recent British report, the less education you have and the lower your income, the poorer you tend to sleep.3 The report also found that the less money a couple makes, the less they sleep together.

The British report found that sleep also varies by occupation. For example, if you work in the arts, you’re more likely to lie awake at night from worry or stress. But if you’re an attorney, you’re more likely to be successfully bagging your Zzzs.

These trends are quite concerning in light of the fact that the drugs prescribed for sleep come with a number of potentially serious risks—and they don’t work that well for sleep to begin with.

Sleeping pills generally only increase the amount of time you sleep by a matter of minutes (a measly 11), and can impair your functioning the next day by making you less alert. They can also have a rebound effect—meaning, once you stop taking them, you may suffer “withdrawal” symptoms worse than the initial insomnia.

Who Benefits from Sleeping Pills?

Sleeping pills are a goldmine for the pharmaceutical industry. In 2011 alone, an estimated 40 million prescriptions for such drugs were dispensed.4 In 2011, sales of generic Ambien (zolpidem tartrate) amounted to a whopping $2.8 billion and Lunesta another $912 million.5 Prescription sleep aids are some of the most heavily marketed drugs to the public.

Lunesta’s manufacturer Sepracor spent more than $215 million and added 450 salespeople to its physician marketing staff just to pitch the drug to doctors in 2005, when it was released.

And it paid off. Lunesta generated $329 million in sales its first nine months—with one sleep specialist saying it was the only time he’d ever experienced “a line of people outside his door waiting to try a new medicine.”6

In 2005, Ambien and Ambien CR put close to $2.2 billion into Sanofi-Adventis’ pockets.7 Unfortunately, the dangers of these drugs are as impressive as the profits they generate for Big Pharma. By taking prescription sleeping pills, you may be unknowingly putting your life in danger.

Tiny Pills, Big Risks

A startling study in 20128 revealed that people who take sleeping pills are not only at higher risk for certain cancers (35 percent higher), but they are also nearly four times as likely to die as people who don't take them. The list of health risks from sleeping pills is growing all the time, including the following:

• Higher risk of death, including from accidents
• Increased risk of cancer
• Increased insulin resistance, food cravings, weight gain and diabetes
• Complete amnesia, even from events that occurred during the day
• Depression, confusion, disorientation, and hallucinations

Studies recently submitted to the FDA revealed that blood levels of zolpidem (found in Ambien and other sleeping pills) above 50 ng/mL may impair your driving to a degree that increases the risk of an accident, especially among women. As a result, FDA recommended manufacturers cut the dosage of zolpidem from 10mg to 5mg for immediate-release products (Ambien, Edluar, and Zolpimist) and from 12.5 mg to 6.25 mg for extended-release products (Ambien CR).9

Are You Sleep-Tweeting?

Aside from increasing your risk for premature death, by taking sleeping pills, you may be in for some extremely awkwardexperiences. Sleeping pills can cause a variety of strange behavioral reactions10 that are not only bizarre but also potentially risky—and at the very least embarrassing. The following are being reported with increasing frequency:

• Sleepwalking
• Sleepdriving
• Sleep eating (including bizarre things like buttered cigarettes, salt sandwiches, or raw bacon)
• Sleep-sex or “sexsomnia” (sexual acts carried out in your sleep)
• Sleep-texting or sleep-tweeting

These behaviors, called “parasomnias,” are more common when you are stressed or sleep-deprived, but can also be triggered by certain medications, such as sedatives and hypnotics. Reports of “sleep-texting” are on the rise.11 Users are shocked to find messages they have no memory of sending—some of which are total gibberish. If this happens to you, you may want to hide your smart phone from yourself when you go to bed at night and avoid the use of sleeping pills, which may trigger a social media nightmare.

Dr. Lisa Fine, a neurologist at Swedish Medical Center in Seattle, reported that people who use digital devices just before nodding off are more likely to use them during the night. She also stated that sleeping pills are known to cause people to use digital media in their sleep. Dr. Fine told KOMO News:12 “A person may text an inappropriate message emerging out of their unconscious mind that the conscious person would not want to send.”

Insomnia Comes with Its Own Risks

It is extremely important to optimize the quality of your sleep, but drugs are not the answer. Just as sleeping pills come with serious risks, so does insomnia. Poor sleep adversely affects your immune system. Lack of sleep may directly increase your risk of developing a number of serious illnesses, such as:

• Viral and bacterial infections
• Depression
• Hypertension
• Stomach ulcers
• Cancer, heart disease, diabetes, and many more

Poor quality sleep is associated with decreased production of melatonin, insulin resistance and weight gain. These three factors all contribute to cancer development. Studies have linked poor sleep with prostate cancer in men and aggressive breast cancer (and recurrence) in women. Even if your sleep is disturbed for only one night, there may be significant health risks. Studies show that losing even one hour of sleep, such as after making the switch to Daylight Saving Time, may increase your risk for a heart attack the next day.

Lack of sleep decreases leptin (your satiety hormone), while increasing ghrelin (your hunger hormone), which explains why night shift workers are at increased risk for obesity and diabetes. Researchers have also found higher rates of breast, prostate, colorectal cancer, and non-Hodgkin's lymphoma among night shift workers. If you sleep poorly, you are more likely to crave junk foods and make poor food choices. This is because poor sleep amplifies the part of your brain responsible for cravings, while suppressing the part responsible for rational decision-making. In one study, sleepy people consumed 600 extra calories.13

Vitamin D for Sleepless Elders

A number of vitamin and mineral deficiencies may contribute to poor sleep, the three most common being potassium, magnesium and vitamin D. This is particularly important you are older. Studies indicate that vitamin D deficiency in the elderly has reached epidemic levels, because their skin produces less vitamin D and they spend less time in the sun.14 In addition to vitamin D’s wide ranging health benefits, new evidence suggests it may play a role in sleep quality. This is a significant finding, as sleep drugs are even riskier for the elderly, making natural approaches very important. Although there are not yet many studies examining the connection between vitamin D and sleep, here are a few that I found:

• A study at Louisiana State University found that vitamin D plays a role in sleep, although the mechanism remains unclear. The relationship between vitamin D and sleep appears quite complex, with skin pigmentation being an additional factor.15, 16
• In a study at East Texas Medical Center, vitamin D supplementation improved sleep in a group of patients with neurologic complaints, possibly due to decreasing their pain.17
• In a study of veterans with chronic pain, researchers concluded that vitamin D supplementation decreased their pain, and improved their sleep and overall quality of life.18
• In a sleep apnea study, as the severity of the apnea increased, the more vitamin D seemed to help.19

Vitamin D is important for regulating your mood, energy, immune function, cognitive function, and many other things that are especially challenging as you age. It makes sense there would be a sleep connection—after all, practically everything affects your sleep!

Your should keep your serum vitamin D level between 50 and 70 ng/ml year-round, and the only way to determine this is with a blood test. Sun exposure or a safe tanning bed is the preferred method for increasing your vitamin D level, but a vitamin D3 supplement can be used if necessary. As a general guideline, research by GrassrootsHealth suggests most adults need about 8,000 IU's of vitamin D per day to achieve serum levels of 40 ng/ml.

It’s important to remember that if you’re taking high dose vitamin D supplements, you ALSO need to take vitamin K2. The biological role of vitamin K2 is to help move calcium into the proper areas in your body, such as your bones and teeth. It also helps remove calcium from areas where it shouldn’t be, such as in your arteries and soft tissues. Vitamin K2 deficiency is actually what produces the symptoms of vitamin D toxicity, which includes inappropriate calcification that can lead to hardening of your arteries.

The reason for this is because when you take vitamin D, your body creates more vitamin K2-dependent proteins that move calcium around in your body. Without vitamin K2, those proteins remain inactivated, so the benefits of those proteins remain unrealized. So remember, if you take supplemental vitamin D, you're creating an increased demand for K2.

Better Options for a Good Night's Rest

Numerous factors can influence your sleep, and the good news is that many are under your control. Remember that sleeping pills are not the answer and will probably create more problems than they solve. Below are four strategies for optimizing your sleep, and you will find many more in my comprehensive sleep guide.

1. Cover your windows with blackout shades or drapes to ensure complete darkness. Even the tiniest bit of light in your room, such as the glow of a bedside clock, can disrupt your sleep and therefore your melatonin production. Close your bedroom door, get rid of night-lights, and refrain from turning on any light during the night, even when getting up to go to the bathroom. If you need a light, install so-called "low blue" light bulbs in your bedroom and bathroom, which emit an amber or red light that will not suppress your natural melatonin production.
2. Keep the temperature in your bedroom at or below 70 degrees F (21 degrees Celsius). Many people keep their bedrooms too warm, which can result in restless sleep. Studies show the optimal room temperature for sleeping is fairly cool, between 60 to 68 degrees F (15.5 to 20 C).
3. Check your bedroom for electro-magnetic fields (EMFs). These can disrupt your pineal gland’s melatonin production. In order to do this, you will need a gauss meter, which can be purchased online for between $50 and $200. Some experts even recommend pulling your circuit breaker before bed to kill all power in your house. Move alarm clocks and other electrical devices away from your head. If these devices must be used, keep them as far away from your bed as possible, preferably at least 3 feet. Put away your computer, TV, iPad, and all other similar gadgets at least and hour before bedtime, as they also emit blue light.
4. Try Earthing. When walking barefoot on the earth, free electrons transfer from the ground into your body through the soles of your feet. These free electrons are some of the most potent antioxidants known to man. Experiments have shown that these electrons decrease pain and inflammation, and promote sound sleep. Spend more time with your bare feet in contact with the earth. You may want to invest in an earthing sheet for your bed.
5. Exercise to sleep better, but do it early! Exercising for at least 30 minutes per day can improve your sleep, but exercising too close to bedtime (generally within the three hours) may keep you awake.
6. Avoid foods that interfere with sleep. The worst foods for sleep include alcohol, coffee, dark chocolate, spicy foods, and certain fatty foods.
7. If you're feeling anxious or restless, try using the Emotional Freedom Techniques (EFT), which can clear emotional issues and alleviate stress and worries that keep you tossing and turning at night.

Originally Posted at: http://articles.mercola.com/sites/articles/archive/2013/11/21/sleeping-pills.aspx?e_cid=20131121Z1_DNL_art_1&utm_source=dnl&utm_medium=email&utm_content=art1&utm_campaign=20131121Z1&et_cid=DM33857&et_rid=343918557

Spotlight on Sleep Apnea

The Federal Motor Carrier Safety Administration recognizes untreated sleep apnea as a risk to the public health:

Staying awake means staying alive. Sleep apnea is a major contributor to daytime drowsiness—a condition that could prove deadly for commercial truck drivers and everyone sharing the road with them. It is a condition where, during sleep, a narrowing or closure of the upper airway causes repeated sleep disturbances leading to poor sleep quality and excessive daytime sleepiness. Since excessive sleepiness can impact a driver’s ability to safely operate the commercial vehicle, it is important that drivers with sleep apnea are aware of the warning signs.

Drivers   Snoring - No Laughing Matter [PDF] When Snoring is More Than a Nuisance [PDF] High Blood Pressure & Heart Disease [PDF] Talking with Your Doctor [PDF] How's Your Sleep? [PDF]

Industry   Sleep Apnea & Commercial Drivers [PDF] Recognize the Dangers of Sleep Apnea Prevalence of Sleep Apnea Among Commercial Truck Drivers

Tools & Resources   Drowsy Driving Quiz [PDF] Sleep Apnea Fact Sheet [PDF] Sleep Diary Driving When You Have Sleep Apnea [PDF] Poster: Dangers of Sleep Apnea

DISCLAIMER

The materials contained on this page were developed under a contract with the National Sleep Foundation (NSF) and are being disseminated by the Federal Motor Carrier Safety Administration (FMCSA) in the interest of information exchange. The FMCSA assumes no liability of the contents or use thereof.

The materials contained on this page do not establish FMCSA policies or regulations, nor do they imply an endorsement or partiality by FMCSA of any product, the NSF, or the conclusions and/or recommendations contained in the materials. Trademarks or manufacturers’ names may appear herein only because they are considered essential to the object of the materials.

Originally Posted at:  http://www.fmcsa.dot.gov/safety-security/sleep-apnea/sleep-apnea.aspx

Sleep Therapy Seen as an Aid for Depression

Notes from Dr. Norman Blumenstock:

Insomnia can lead to depression according to a presentation by Dr Thomas Roth that I attended this past weekend at the the NJ Sleep Society.

By BENEDICT CAREY

Published: November 18, 2013

Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year.

The new report affirms the results of a smaller pilot study, giving scientists confidence that the effects of the insomnia treatment are real. If the figures continue to hold up, the advance will be the most significant in the treatment of depression since the introduction of Prozac in 1987.
Depression is the most common mental disorder, affecting some 18 million Americans in any given year, according to government figures, and more than half of them also have insomnia.
Experts familiar with the new report said that the results were plausible and that if supported by other studies, they should lead to major changes in treatment.

“It would be an absolute boon to the field,” said Dr. Nada L. Stotland, professor of psychiatry at Rush Medical College in Chicago, who was not connected with the latest research.

“It makes good common sense clinically,” she continued. “If you have a depression, you’re often awake all night, it’s extremely lonely, it’s dark, you’re aware every moment that the world around you is sleeping, every concern you have is magnified.”

The study is the first of four on sleep and depression nearing completion, all financed by the National Institute of Mental Health. They are evaluating a type of talk therapy for insomnia that is cheap, relatively brief and usually effective, but not currently a part of standard treatment.

The new report, from a team at Ryerson University in Toronto, found that 87 percent of patients who resolved their insomnia in four biweekly talk therapy sessions also saw their depression symptoms dissolve after eight weeks of treatment, either with an antidepressant drug or a placebo pill — almost twice the rate of those who could not shake their insomnia. Those numbers are in line with a previous pilot study of insomnia treatment at Stanford.

In an interview, the report’s lead author, Colleen E. Carney, said, “The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia.”
Dr. Carney acknowledged that the study was small — just 66 patients — and said a clearer picture should emerge as the other teams of scientists released their results. Those studies are being done at Stanford, Duke and the University of Pittsburgh and include about 70 subjects each. Dr. Carney will present her data on Saturday at a convention of the Association for Behavioral and Cognitive Therapies, in Nashville.

Doctors have known for years that sleep problems are intertwined with mood disorders. But only recently have they begun to investigate the effects of treating both at the same time. Antidepressant drugs like Prozac help many people, as does talk therapy, but in rigorous studies the treatments, administered individually, only slightly outperform placebo pills. Used together the treatments produce a cure rate — full recovery — for about 40 percent of patients.

Adding insomnia therapy, however, to an antidepressant would sharply lift the cure rate, Dr. Carney’s data suggests, as do the findings from the Stanford pilot study, which included 30 people.
Doctors have long considered poor sleep to be a symptom of depression that would clear up with treatments, said Rachel Manber, a professor in the psychiatry and behavioral sciences department at Stanford, whose 2008 pilot trial of insomnia therapy provided the rationale for larger studies. “But we now know that’s not the case,” she said. “The relationship is bidirectional — that insomnia can precede the depression.”

Full-blown insomnia is more serious than the sleep problems most people occasionally have. To qualify for a diagnosis, people must have endured at least a month of chronic sleep loss that has caused problems at work, at home or in important relationships. Several studies now suggest that developing insomnia doubles a person’s risk of later becoming depressed — the sleep problem preceding the mood disorder, rather than the other way around.

The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping.

The aim is to reserve time in bed for only sleeping and — at least as important — to “curb this idea that sleeping requires effort, that it’s something you have to fix,” Dr. Carney said. “That’s when people get in trouble, when they begin to think they have to do something to get to sleep.”
This kind of therapy is distinct from what is commonly known as sleep hygiene: exercising regularly, but not too close to bedtime, and avoiding coffee and too much alcohol in the evening. These healthful habits do not amount to an effective treatment for insomnia.

In her 2008 pilot study testing CBT-I in people with depression, Dr. Manber of Stanford used sleep hygiene as part of her control treatment. She found that 60 percent of patients who received seven sessions of the talk therapy and an antidepressant fully recovered from their depression, compared with 33 percent who got the same drug and the sleep hygiene therapy.

In the four larger trials expected to be published in 2014, researchers had participants keep sleep journals to track the effect of the CBT-I therapy, writing down what time they went to bed every night, what time they tried to fall asleep, how long it took, how many awakenings they had and what time they woke up.

When the diaries show consistent, seldom-interrupted, good-quality slumber, the therapist conducts an interview to determine if there are any lingering issues. If there are none, the person has recovered. The therapy results in sharp reductions in nighttime wakefulness for most people who follow through.
In interviews, several researchers noted that the National Institute of Mental Health had sharply curtailed funding for work in sleep treatment. Aleksandra Vicentic, the acting chief of the agency’s behavioral and integrative neuroscience research branch, said that in 2009 the funding strategy changed for sleep projects.

In an effort to illuminate the biology of sleep’s impact on behavior, the agency is now focusing on how sleep affects the functioning of neural circuits. But Dr. Vicentic added that the agency continued to fund clinical work like the depression trials.

Dr. Andrew Krystal, who is running the CBT-I study at Duke, called sleep “this huge, still unexplored frontier of psychiatry.”

“The body has complex circadian cycles, and mostly in psychiatry we’ve ignored them,” he said. “Our treatments are driven by convenience. We treat during the day and make little effort to find out what’s happening at night.”

Originally Posted at:  http://www.nytimes.com/2013/11/19/health/treating-insomnia-to-heal-depression.html?pagewanted=1&_r=1&nl=todaysheadlines&emc=edit_th_20131119

Man calls police because lover 'snoring like a train'

WAUKESHA, Wis. — 

It wasn't exactly assault with a deadly weapon, but for a Wisconsin man, his lover's loud snoring was enough to warrant a call to the police.

According to a City of Waukesha police report, the man called 911 earlier this week to remove a woman from his bed because she was "snoring like a train."

Police say when the man initially called for help, he told the dispatcher that he wasn't sure how the woman got into his apartment. But he later admitted that he did let the woman in willingly. 

Once officers arrived at his home, his story changed again.

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The man, who police reported to be in an "extremely intoxicated state," told them he invited the woman over, enjoyed some drinks, "had relations" and then fell asleep.

The woman was eventually awakened by the officers and admitted to suffering from sleep apnea. 

Officers were able to settle the matter by asking the man to sleep on his couch and work the issue out on his own in the morning.

Originally posted:  http://www.ajc.com/news/news/national/man-calls-police-because-lover-snoring-train/nbq6R/

Experts Reshape Treatment Guide for Cholesterol

Notes from Dr. Norman Blumenstock:

The intermittent hypoxia created by obstructive sleep apnea appears to alter the surface of blood vessels, allowing the cholesterol to adversely affect those blood vessels. Statins drugs alone may not be enough if the obstructive sleep apnea is not treated in my opinion.

By GINA KOLATA

Published: November 12, 2013 

The nation’s leading heart organizations released new guidelines on Tuesday that will fundamentally reshape the use of cholesterol-lowering statin medicines, which are now prescribed for a quarter of Americans over 40. Patients on statins will no longer need to lower their cholesterol levels to specific numerical targets monitored by regular blood tests, as has been recommended for decades. Simply taking the right dose of a statin will be sufficient, the guidelines say.

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Dr. Neil J. Stone, chairman of a committee on cholesterol.

Related

Well: 3 Things to Know About the New Cholesterol Guidelines(November 12, 2013)

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The new approach divides people needing treatment into two broad risk categories. Those at high risk because, for example, they have diabetes or have had a heart attack should take a statin except in rare cases. People with extremely high levels of the harmful cholesterol known as LDL — 190 or higher — should also be prescribed statins. In the past, people in these categories would also have been told to get their LDL down to 70, something no longer required.

Everyone else should be considered for a statin if his or her risk of a heart attack or stroke in the next 10 years is at least 7.5 percent. Doctors are advised to use a new risk calculator that factors in blood pressure, age and total cholesterol levels, among other things.

“Now one in four Americans over 40 will be saying, ‘Should I be taking this anymore?' ” said Dr. Harlan M. Krumholz, a cardiologist and professor of medicine at Yale who was not on the guidelines committee.

The new guidelines, formulated by the American Heart Association and the American College of Cardiology and based on a four-year review of the evidence, simplify the current complex, five-step process for evaluating who needs to take statins. In a significant departure, the new method also counts strokes as well as heart attacks in its risk calculations, a step that will probably make some additional people candidates for the drugs.

It is not clear whether more or fewer people will end up taking the drugs under the new guidelines, experts said. Many women and African-Americans, who have a higher-than-average risk of stroke, may find themselves candidates for treatment, but others taking statins only to lower LDL cholesterol to target levels may no longer need them.

The previous guidelines put such a strong emphasis on lowering cholesterol levels by specific amounts that patients who did not hit their target levels just by taking statins often were prescribed additional drugs like Zetia, made by Merck. But the new guidelines say doctors should no longer prescribe those extra medicines because they have never been shown to prevent heart attacks or strokes.

Zetia has been viewed with increasing skepticism in recent years since studies showed it lowered LDL cholesterol but did not reduce the risk of cardiovascular disease or death. Still, it is among Merck’s top-selling drugs, earning $2.6 billion last year. Another drug, Vytorin, which combines Zetia with a statin, brought in $1.8 billion in 2012, according to company filings. And in May, Merck won approval for another drug, Liptruzet, which also contains the active ingredient in Zetia and a statin, a development that surprised many cardiologists because of questions about its effectiveness.

The new guidelines are part of a package of recommendations to reduce the risk of heart attack and stroke that includes moderate exercise and a healthy diet. But its advice on cholesterol is the flash point, arousing the ire of critics who say the authors ignored evidence that did not come from gold-standard clinical trials and should also have counted less rigorous, but compelling, data.

For example, Dr. Daniel J. Rader, the director of the preventive cardiovascular medicine and lipid clinic at the University of Pennsylvania, points to studies of people with genes giving them low LDL levels over a lifetime. Their heart attack rate is greatly reduced, he said, suggesting the benefits of long-term cholesterol reduction.

Committee members counter his view, saying that cholesterol lowered by drugs may not have the same effect.

Critics also question the use of a 10-year risk of heart attack or stroke as the measure for determining who should be treated. Many people will have a lower risk simply because they are younger, yet could benefit from taking statins for decades to keep their cholesterol levels low, they say.

Dr. Rader and other experts also worry that without the goad of target numbers, patients and their doctors will lose motivation to control cholesterol levels.

Experts say it is still unclear how much the new guidelines will change clinical practice. Dr. Rader suspects many cardiologists will still strive for the old LDL targets, at least for patients with heart disease who are at high risk. “They are used to it and believe in it,” he said.

Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, said he thought it would take years for doctors to change their practices.

The process of developing the guidelines was rocky, taking at least twice as long as in the past. The National Heart, Lung and Blood Institute dropped out, saying that drafting guidelines was no longer part of its mission. Several committee members, including Dr. Rader, also dropped out, unhappy with the direction the committee was going.

The architects of the guidelines say their recommendations are based on the best available evidence. Large clinical trials have consistently shown that statins reduce the risk of heart attacks and strokes, but the committee concluded that there is no evidence that hitting specific cholesterol targets makes a difference. No one has ever asked in a rigorous study if a person’s risk is lower with an LDL of 70 than 90 or 100, for example.

Dr. Neil J. Stone, the chairman of the committee and a professor of preventive cardiology at Northwestern University’s Feinberg School of Medicine, said he was surprised by what the group discovered as it delved into the evidence. “We deliberated for several years,” he said, “and could not come up with solid evidence for targets.”

Dr. Nissen, who was not a member of the committee, agreed. “The science was never there” for the LDL targets, he said. Past committees “made them up out of thin air,” he added.

The Department of Veterans Affairs conducted its own independent review and came to the same conclusion. About a year ago, the department, the nation’s largest integrated health care system, dropped its LDL targets, said Dr. John Rumsfeld, the V.A.'s national director of cardiology.

“It is a shift,” he acknowledged, “but I would argue that it is not a radical change but is a course correction.”

Dr. Paul M. Ridker, the director of the center for cardiovascular disease prevention at Brigham and Women’s Hospital, in Boston, said he worried the new guidelines could easily lead to overtreatment. An older man with a low LDL level who smokes and has moderately elevated blood pressure would qualify for a statin under the new guidelines. But what he really needs is to stop smoking and get his blood pressure under control.

Dr. Stone said he hoped doctors would not reflexively prescribe a statin to such a patient. Doctors are supposed to talk to their patients and realize that, with a man like the one Dr. Ridker described, the real problem was not cholesterol.

“We are taking people out of their comfort zone,” Dr. Stone said. “Instead of being reassured that reaching this number means they will be fine, we are asking, ‘What is the best therapy to do the job?' ”

Originally Posted:  http://www.nytimes.com/2013/11/13/health/new-guidelines-redefine-use-of-statins.html?pagewanted=1&_r=1&nl=todaysheadlines&emc=edit_th_20131113

Snoring warning for mothers-to-be

Thursday, October 31, 2013 - 07:03 PM

Mothers-to-be who snore are more likely to give birth to smaller babies, a study has found.

Snoring during pregnancy was also linked to higher rates of Caesarean delivery.

Experts said snoring may be a sign of breathing problems that could deprive an unborn baby of oxygen.

Previous research has already shown that women who start to snore during pregnancy are at risk from high blood pressure and the potentially dangerous pregnancy condition pre-eclampsia.

More than a third of the 1,673 pregnant women recruited for the new US study reported habitual snoring.

Scientists found that women who snored in their sleep three or more nights per week had a higher risk of poor delivery outcomes, including smaller babies and Caesarean births.

Chronic snorers, who snored both before and during pregnancy, were two thirds more likely to have a baby whose weight was in the bottom 10%.

They were also more than twice as likely to need an elective Caesarean delivery, or C-section, compared with non-snorers.

Dr Louise O’Brien, from the University of Michigan’s Sleep Disorders Centre, said: “There has been great interest in the implications of snoring during pregnancy and how it affects maternal health but there is little data on how it may impact the health of the baby.

“We’ve found that chronic snoring is associated with both smaller babies and C-sections, even after we accounted for other risk factors. This suggests that we have a window of opportunity to screen pregnant women for breathing problems during sleep that may put them at risk of poor delivery outcomes.”

Women who snored both before and during pregnancy were more likely to have smaller babies and elective C-sections, the researches found. Those who started snoring only during pregnancy had a higher risk of both elective and emergency Caesareans, but not of smaller babies.

Snoring is a key sign of obstructive sleep apnoea, which results in the airway becoming partially blocked, said the researchers, whose findings appear in the journal Sleep.

This can reduce blood oxygen levels during the night and is associated with serious health problems, including high blood pressure and heart attacks.

Sleep apnoea can be treated with CPAP (continuous positive airway pressure), which involves wearing a machine during sleep to keep the airways open.

Dr O’Brien added: “If we can identify risks during pregnancy that can be treated, such as obstructive sleep apnoea, we can reduce the incidence of small babies, C-sections and possibly NICU (neo-natal intensive care unit) admission that not only improve long-term health benefits for newborns but also help keep costs down.”

Alzheimer's Link to Sleep Apnea Being Studied, With Dr. Ricardo S. Osorio, NYU School of Medicine

American Academy of Dental Sleep Medicine - Dr. Norman Blumenstock Receives Distinguished Service Award

AADSM Annual Awards

Distinguished Service Awards

The Distinguished Service Award is presented at the Annual Meeting to individuals who have exhibited exceptional initiative, leadership and service in the field of dental sleep medicine. At the discretion of the board, this award may not be presented every year.

2013 Winner - Norman Blumenstock, DDS

Past Recipients

2012 - Jeffrey Pancer, DDS 2011 - Jeffrey Prinsell, DMD, MD, Diplomate, ABDSM 2010 - Kent E. Moore, DDS, MD 2009 - Bruce Templeton, DMD 2008 - Keith Thornton, DDS 2007 - B. Gail Demko, DMD 2006 - Harold A. Smith, DDS

2005 - Don A. Pantino, DDS 2004 - R. Michael Alvarez, DDS   2003 - Jonathan A. Parker, DDS 2002 - Arthur M. Strauss, DDS 2001 - Laurence I. Barsh, DMD 2000 - Mary Beth Rogers 1999 - Robert R. Rogers, DMD

Pierre Robin Academic Award

The Pierre Robin Academic Award is presented at the Annual Meeting to individuals who have exhibited exceptional initiative and progress in the areas of education and academic research with original contributions to the field of dental sleep medicine. Final selection of the recipient is based on the nomination form, the submission of a current Curriculum Vitae and an assessment of submitted recent publications in the field. At the discretion of the Board, this award may not be presented every year.

The AADSM Board of Directors is currently accepting nominations from AADSM members who are in good standing. Applications will be accepted until March 3, 2014. Download AADSM Pierre Robin Academic Award Nomination form

2013 Winner - Aarnoud Hoekema, DMD

Past Recipients

2012 - Olivier Vanderveken, MD, PhD 2011 - Fernanda Almeida, DDS, MSc, PhD 2010 - Stuart J. Menn, MD 2009 - Sergio Tufik, MD, PhD 2008 - Marie Marklund, DDS, PhD 2007 - Christian Guilleminault, MD 2006 - Peter Cistulli, MD, PhD

2005 - Gilles Lavigne, DDS, PhD 2004 - Kathleen Ferguson, MD 2003 - Rosalind D. Cartwright, PhD 2002 - Wolfgang Schmidt-Nowara, MD 2001 - Glenn T. Clark, DDS   2000 - Daniel I. Loube, MD 1999 - Alan A. Lowe, DMD, PhD

Honorary Member Award

The Honorary Member Award is presented at the Annual Meeting to individuals for continued advances in the field of dental sleep medicine. The award is based on an individual’s significant, original and sustained contributions of a basic, clinical or theoretical nature evidenced by publications, patents, academic appointments and other efforts. Candidates may or may not be current members of the AADSM. The award recipient will be invited to present a lecture at the AADSM Annual Meeting.

2013 Winner - David F. Dinges, PhD

Past Recipients

2012 - Bernard Fleury, MD 2011 - Colin E. Sullivan, MD, PhD, FRACP 2010 - Allan I. Pack, PhD, MBChB 2009 - Siroh Isono, MD 2008 - Peter Cistulli, MD, PhD

2007 - Kathleen Ferguson, MD   2006 - John Remmers, MD 2005 - Victor Hoffstein, MD, PhD 2004 - Wolfgang Schmidt-Nowara, MD Reference:   http://www.aadsm.org/AnnualAwards.aspx