Could Chrona Be the Key to Deeper Sleep?

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Dental Clinicians’ Observations of Combination Therapy in PAP-Intolerant Patients

March 9, 2015

Based on the experiences of four highly experienced dental sleep practices, this pilot study sought to determine whether combination therapy, in which a PAP interface and mandibular advancement splint are physically connected, may provide a more acceptable therapeutic modality in obstructive sleep apnea patients who have abandoned conventional PAP therapy.

By Anne E. Sanders, MS, PhD, MS; Martin A. Denbar, DDS, DABDSM; John White, DDS, DABDSM; Ronald S. Prehn, ThM, DDS, DABDSM; Robert R. Rogers III, DMD, DABDSM; Thomas Pardue, BA; Max Schweizer, BS; and Greg K. Essick, DDS, PhD

TAP-PAPComboTherapy

In the PAP/MAS device, the PAP interface (nasal pillows) is connected to, and stabilized in position by, a rod extending from the oral appliance, a mandibular advancement splint. This obviates the need for headgear required when the PAP interface and oral appliance are not connected.

Patients with obstructive sleep apnea (OSA) attribute their poor tolerance of positive airway pressure (PAP) therapy to the presence and fit of headgear and chin straps, claustrophobia, unstable or inadequate fit of mask to facial contours, air leakage, mask-related skin ulceration and headache, aerophagia, and uncomfortably high pressure levels. As a result, only about 50% of patients continue to adhere with therapy after 1 year.

Anecdotally, sleep clinicians claim better tolerance when PAP therapy is used in conjunction with a mandibular advancement splint (MAS), but published evidence is scarce. The MAS stabilizes and advances the mandible, simulating jaw thrust and clearing the upper airway for unobstructed breathing. Improved tolerance of this combination therapy (CT) is attributed to fewer pressure-related complaints. El-Sohl et al showed in 10 patients that CT reduced both the effective continuous PAP and pressure-related complaints shortly after implementation. Consistent with lower effective pressures, Borel et al found that velopharyngeal resistance is lower with CT than with a nasal mask alone. 

In both studies, the MAS and PAP mask were not physically connected.

The PAP interface, however, can be physically connected to and supported by a MAS, eliminating the need for headgear. One early case report6 described a patient whose responses to PAP and to MAS therapy were poor, but who achieved near normal sleep respiration and a lower minimally effective PAP upon stabilization of the mandible in an upward and forward position, as corroborated elsewhere.  By analyzing existing data from four dental sleep practices, we sought to determine whether PAP delivered through an interface connected to a MAS can offer a more accepted therapeutic alternative for OSA patients who have failed conventional PAP therapy. 

Methods

The study employed a retrospective cohort design in which four dental sleep medicine experts in separate US practices retrieved existing data from records for all consecutive patients aged ≥18 years meeting inclusion criteria. The inclusion criteria were: physician diagnosis of OSA and referral to a dentist; having failed conventional PAP therapy; having attempted MAS-PAP within a specified time interval; and being on active recall for therapy evaluation. Clinicians were diplomates of the American Board of Dental Sleep Medicine with collective experience treating more than 14,000 patients with oral appliances for sleep-disordered breathing over a total of 79 years. The Biomedical IRB at the University of North Carolina at Chapel Hill approved the study.

De-identified diagnostic and CPAP titration information from patients’ sleep study reports and clinical records of CT were extracted and recorded on a standardized pretested electronic form.

Investigation was restricted to a single commercially available CT device—the TAP-PAP Chairside (manufactured by Airway Management Inc). In this device, a horizontal rod is secured to the upper component of a MAS, and a nasal pillow/hose assembly is attached using an acrylic material.

Tolerance was defined by clinician report that the patient was continuing to use PAP/MAS, based on periodic recall and ongoing evaluation by the dental sleep expert in the dental office. Acceptability was evaluated by patient report of complaints. Evidence of efficacy was determined in a subset of patients by comparison of follow-up polysomnogram or home sleep study against the diagnostic polysomnogram.

Data were imported into StataCorp LP Stata 13.1 Statistical Software for statistical analysis. Pearson chi-square tested the significance of differences between categorical variables. A paired t-test tested the null hypothesis that apnea-hypopnea index (AHI) values at OSA diagnosis did not differ from those obtained following PAP/MAS.

Results

Among 92 OSA patients aged 25 to 85 years (mean 55 years), the mean polysomnogram-determined diagnostic AHI value was 37.6 (standard deviation (sd): 25.9). Half (n=46) met the diagnostic threshold for severe OSA (AHI ≥30), a quarter (n=23) had moderate OSA (AHI 15–29.9), and the remainder (n=23) had mild OSA (AHI 5–14.9).  

Because the proportion of PAP/MAS tolerant patients did not differ between the practices (P = 0.612), results report pooled data. Overall, 65 patients (70.7%) tolerated PAP/MAS therapy, having used it for 14.0 months on average (sd: 11.1). Although tolerance was higher in patients with severe OSA (76.1%) than mild OSA (69.8%), this difference was not statistically significant (P = 0.421).

Patients expressed substantially fewer complaints to their dentists about PAP/MAS than conventional PAP (Table 1). The most common complaints about conventional PAP related to mask discomfort and leakage, and the perceived ineffectiveness of PAP. Again, mask discomfort and leakage were the most common complaints about PAP/MAS, but these were reported by only a small minority of patients. 

A follow-up polysomnogram or home sleep test was available for 34 of the 65 PAP/MAS tolerant patients while using PAP/MAS. Patients with severe OSA were more likely to have had the follow-up polysomnogram than those with mild OSA (P = 0.023). In these patients, AHI values decreased from an untreated mean of 48.0 (sd: 28.3) events/hour to a treated mean of 3.1 events/hour (sd: 3.8) (P < 0.001), indicating that, on average, PAP/MAS eliminated OSA.

Discussion

In this study of patients who had abandoned conventional PAP, 70.7% were reported using PAP/MAS for 14.0 months, on average, after initiation of treatment. PAP/MAS tolerant patients expressed to their sleep dentists substantially fewer complaints about the CT than conventional PAP. CT reduced the AHI to less than 5, on average, achieving values not dissimilar from those achieved with conventional PAP.

Several explanations may account for better tolerance of CT. Borel et al⁵ found that joint use of PAP with MAS was at least equally effective as nasal PAP alone by increasing airway patency beyond that achieved solely with PAP. Using a phrenic nerve magnetic stimulation paradigm, the investigators showed greater decrease in velopharyngeal resistance with CT. Since resistance values determined this way are related to pressures at which the pharynx collapses, the joint therapies act synergistically to improve velopharyngeal area patency, the area primarily implicated in upper airway collapse.

El-Sohl et al found that the CPAP intolerance was associated with high pressure-related complaints. In agreement with greater pharyngeal patency demonstrated by Borel et al, El-Sohl et al also demonstrated that CT lowered the optimal pressure 29% on average and was well tolerated.

PAP therapy adherence is influenced by the mask interface. Typically, when a nasal mask results in air leakage via the mouth, an oronasal mask is tried. However, the higher pressures required for oronasal masks are associated with greater air leakage, more arousals, more residual respiratory events, dry mouth, and worse adherence than nasal masks. In addition, their manner of attachment tends to push the mandible and tongue backward, increasing the airflow resistance.

A nasal interface used with MAD overcomes the aforementioned problems. The effective pressure is typically lower than with a nasal mask. Rather than pushing the mandible backward, it is stabilized in a neutral or forward position, lowering velopharyngeal resistance and improving upper airway patency. As the mouth is kept closed, air leakage and mouth breathing are minimized.

Because nasal pillows have less facial contact, problems of claustrophobia, air leaks around the eyes, and pressure sores are minimized.  In their randomized cross-over study, Massie and Hart compared nasal pillows to nasal masks using pressures ranging from 5 to 14 cm H₂0. They reported no differences in treatment efficacy, effective CPAP pressure, Epworth sleepiness score, or quality of life measures. The nasal pillows produced fewer adverse effects, less air leakage, less difficulty sleeping and maintaining sleep, and improved sleep quality.

The nasal pillows in our study were supported via a rod extending from the maxillary component of the MAS, obviating need for a chin strap and headgear to support the air interface. This confined facial contact to the external nares and lip vermilion over which the supporting rod extended. Moreover, the rigidity of the connection with the MAS secured the nasal pillows in a stable “locked” relationship with respect to the external nares to minimize air leaks and thus disruptive arousals from sleep. Air leakage is a major deterrent to the use of PAP, hence the substantial reduction in complaints of “air leakage” and “not being able to keep in place” with PAP/MAS may, in part, underlie its success.

PAP/MAS-tolerant patients had remarkably fewer complaints about the CT than conventional PAP. Our expectation that the addition of MAS would cause discomfort in masticatory muscles, TMJ, and teeth, was not met. CT may be successful with a lesser degree of jaw advancement than required for treatment with a MAS alone,¹ thereby minimizing dental side effects.

The use of CT as a first-line therapy, rather than a rescue, may decrease the number of patients who remain untreated from nonadherence to PAP therapy. Compared to conventional PAP, CT appears to offer improved comfort and interface stability, and a reduction in air leakage.

We recognize the many limitations of this pilot study. Data were limited to existing clinical records of community-based dental sleep practices. Because of this, the patients were not matched either within or across the four practices. There was no standardization of the PAP titrations, types of masks employed, or counseling that the patients received on use of conventional PAP or combination therapy. The amount of jaw advancement with PAP/MAS was not standardized within or between practices, which could have affected tolerance of the CT. There was no standardization of the follow-up PSG or home sleep study, and these data were not available for approximately half the CT-tolerant subjects. Data were not available for the nightly duration of PAP/MAS use. Nonetheless, the consistency of the experiences reported across the four unrelated, expert dental sleep practices supports the general conclusion that PAP/MAS can provide an effective treatment for OSA in many otherwise CPAP-intolerant patients and merits formal evaluation in a prospective controlled clinical trial.

Where and what is happening in your brain when you sleep?

Apr 08, Neuroscience

Sleep has profound importance in our lives, such that we spend a considerable proportion of our time engaging in it. Sleep enables the body, including the brain, to recover metabolically, but contemporary research has been moving to focus on the active rather than recuperative role that sleep has on our brain and behaviour.

Sleep is composed of several distinct stages. Two of these, slow-wave (or deep) and REM sleep, reflect very different patterns of brain activity, and have been related to different cognitive processes.

Slow-wave sleep is characterised by synchronised activity of neurons in the neo-cortex firing at a slow rate, between 0.5 and three times per second. The neo-cortex comprises the majority of the cerebral cortex in the brain which plays a role in memory, thought, language and consciousness. In contrast during REM sleep, when most of our dreaming happens, neuronal firing is rapid and synchronised at much higher frequencies, between 30 to 80 times per second.

Such patterns of brain activity during REM sleep are reminiscent of those observed during wakefulness, and for this reason REM sleep is often referred to as "paradoxical" sleep.

Cognitive functions

There is growing evidence that slow-wave sleep is related to the consolidation of memory and is involved in transferring information from the hippocampus, which encodes recent experiences, and forging long-term connections within the neo-cortex. REM sleep has been linked to processes involving abstraction and generalisation of experiences, resulting in creative discovery and improved problem solving.

Though there are substantial similarities between wakefulness and REM sleep, numerous studies have explored differences in the activity of brain regions between these states, with the cingulate cortex, hippocampus and amygdala more active during REM sleep than wakefulness. These regions are particularly interesting to cognitive neuroscientists because they are key areas involved in emotional regulation and emotional memory. 

However, which sub-regions are active within these broader cortical and limbic areas – the pathways in the brain that produce these patterns of activation – and the precise function of the activity in these regions during REM sleep is currently under-described. 

Cortical activity in rats 

A new study published in Science Advances studied the physiology and functionality of REM sleep in a group of rats and provides insight into the cortical activity and the sub-cortical pathways that result in this activity. The level of detail of this study provides a major step forward for our understanding of the effect that REM sleep has on our brain and cognitive behaviour. 

The authors studied groups of rats who were allowed to sleep, but prevented from entering REM sleep for three days. Six hours before assessment, half of the rats were allowed to sleep normally, and half continued to be deprived of REM sleep. The rats that were permitted to sleep normally then demonstrated raised levels of REM sleep within those six hours. This enabled a comparison of the effect of recent REM sleep between groups. An additional control group of rats were allowed to sleep normally throughout the study. 

Gene expression analysis involves tracking the presence of particular mRNA or proteins that can be identified as the consequences of certain genes operating. The rats who underwent substantial REM sleep before testing were found to demonstrate greater expression of several genes that are associated with syntaptic plasticity (how quickly their synapses can adapt to changes in a local environment) and which affects the efficiency of neural transmission in the hippocampus. 

In the neo-cortex, the gene expressions related to how well our synapses adapt also increased following REM sleep, but those related to neural transmission were reduced compared with the group that was prevented from REM sleep. So, the function of REM sleep appears to be due to changes in the way that neurons communicate. This is consistent with the view that REM sleep allows the brain's memory processing systems to re-balance, which enables effective responses to experiences the next day. 

Where in the brain? 

In a further study, the same group determined the precise location of where these changes actually occur in the brain. In the neo-cortex, there was a general increase in plasticity throughout several areas, including sensorimotor regions that bring together sensory and motor functions. In the hippocampus, it was generally confined to the dentate gyrus, which is thought to contribute to forming new episodic memories among other things. REM sleep was also associated with reduced neuro-transmission throughout many regions of the neo-cortex, indicating that REM sleep likely results in a general weakening of the connections between synapses, which may enable brain networks to better learn from multiple experiences rather than be affected only by single instances. 

The final studies the group conducted determined the source of the cortical changes in plasticity and neuro-transmission during REM sleep. By tracking signal transmission between different brain areas together with chemical lesioning (in which brain areas are temporarily inactivated), they identified two further areas called the claustrum and the supramammillary nucleus as having key roles during REM sleep. 

The claustrum: consolidating emotion and memory. Credit: Was a bee

These two areas have been identified as involved in integrating emotion and memory. The claustrum is a very thin layer of neurons that are found underneath the inner neo-cortex. It is known to link to and from very many regions of this part of the brain. As such, the claustrum has been implicated in integrating stimuli from several senses and is involved in linking areas involved in emotional processing and attention. 

The supramammillary nucleus, within the hippocampus, is also known to interconnect to multiple areas of the brain, several of which are associated with emotional processing. 

The implications of this work provide converging evidence that REM sleep modulates activation and synaptic processing in areas of the brain that contribute to the processing of emotion. This is also consistent with previously untested accounts that suggest REM sleep is important for encoding memories (but without their emotional content). While the role of dreaming during REM sleep is still yet to be linked to observed effects from neuro-chemicals in the brain, understanding what is happening in our brains when we dream could yet prove to be key to processing of emotion and memory.

Can Orange Glasses Help You Sleep Better?

By KATE GALBRAITH
APRIL 6, 2015


Most evenings, before watching late-night comedy or reading emails on his phone, Matt Nicoletti puts on a pair of orange-colored glasses that he bought for $8 off the Internet.

“My girlfriend thinks I look ridiculous in them,” he said. But Mr. Nicoletti, a 30-year-old hospitality consultant in Denver, insists that the glasses, which can block certain wavelengths of light emitted by electronic screens, make it easier to sleep.

Studies have shown that such light, especially from the blue part of the spectrum, inhibits the body’s production of melatonin, a hormone that helps people fall asleep. Options are growing for blocking blue light, though experts caution that few have been adequately tested for effectiveness and the best solution remains avoiding brightly lit electronics at night.

A Swiss study of 13 teenage boys, published in August in The Journal of Adolescent Health, showed that when the boys donned orange-tinted glasses, also known as blue blockers and shown to prevent melatonin suppression, in the evening for a week, they felt “significantly more sleepy” than when they wore clear glasses. The boys looked at their screens, as teenagers tend to do, for at least a few hours on average before going to bed, and were monitored in the lab.

Older adults may be less affected by blue light, experts say, since the yellowing of the lens and other changes in the aging eye filter out increasing amounts of blue light. But blue light remains a problem for most people, and an earlier study of 20 adults ages 18 to 68 found that those who wore amber-tinted glasses for three hours before bed improved their sleep quality considerably relative to a control group that wore yellow-tinted lenses, which blocked only ultraviolet light.

Devices such as smartphones and tablets are often illuminated by light-emitting diodes, or LEDs, that tend to emit more blue light than incandescent products. Televisions with LED backlighting are another source of blue light, though because they are typically viewed from much farther away than small screens like phones, they may have less of an effect, said Debra Skene, a professor of neuroendocrinology at the University of Surrey in England.

LEDs are also increasingly popular as room lights, but “warm white” bulbs, with less blue, tend to be a better choice than “cool white” for nighttime use. The lighting company Philips also makes a bulb, called Hue, that can change the intensity of its component colors via an app, and GE last month announced a reduced-blue LED bulb, meant to be used before bedtime.

At night, Matt Nicoletti wears orange glasses to use technology. He says he thinks they make it easier to fall asleep.

BENJAMIN RASMUSSEN FOR THE NEW YORK TIMES

“Conceptually, anything that will decrease that blue light exposure at night will be helpful,” said Christopher Colwell, a neuroscientist at the University of California, Los Angeles. “I know some gamers who swear by those orange-tinted goggles.”

But orange glasses are not a panacea, Dr. Skene said. “It isn’t just get rid of the blue and everything’s fine,” she said. The intensity of light, in addition to color, can affect sleep, she said, and not all brands of orange-tinted glasses have undergone enough independent testing for their ability to aid sleep.

Screens that are not backlit, such as some e-book readers, are preferable to typical brightly lit screens, Dr. Skene said.

Mr. Nicoletti says that the orange glasses he wears, an industrial-safety brand called Uvex, do make some colors, notably blues and greens, harder to distinguish. He also uses applications designed to alter the blue light impact of his devices depending on the time of day: an app called f.lux for his computer and Twilight for his mobile phone.

Other ideas are proliferating. An Ohio company called LowBlueLights.com, for example, offers filters said to block blue light by covering the screens of electronic devices like the iPhone or iPad. Other company products include “low blue” LED lights and orange eyewear.

During the daytime, experts say, exposure to blue light is good. Best of all is sunlight, which contains many different wavelengths of light. “That’s what our brain knows,” said Kenneth P. Wright Jr., director of the sleep and chronobiology lab at the University of Colorado, Boulder.

A 2013 study he led, published in the journal Current Biology, showed just how different things can be without nighttime lights: After participants had camped in the mountains for a week, their bodies began to prepare for sleep about two hours earlier than normal.

Short of cutting out all evening electronics, experts say, it’s advisable to use a small screen rather than a large one; dim the screen and keep it as far away from the eyes as possible; and reduce the amount of time spent reading the device.

“If you can look at the iPhone for 10 minutes rather than three hours, that makes a lot of difference,” Dr. Skene said.

Does your dog's snoring keep you awake?

Dogs that snore aren't getting a good night's sleep -- and, chances are, neither are you.

By Stacey Cohen

Stacey Cohen has been a news broadcaster and talk show host for more than 25 years. She has worked with Sally Jesse Raphael, G Gordon Liddy, Martha Stewart, Jane Fonda and many more. She even did play-by-play for the O.J. Simpson trial.

Photo © Tatiana Katsai - Fotolia

For some reason we tolerate our pets' snoring more than we do our spouse's, but it can be the cover-up for an array of issues. Like any problem, if it is something new, it might be worth a trip to the vet to check out. Snoring can have some underlying serious causes.

If your dog is snoring it is some kind of obstruction that is causing the problem. Digging in the dirt, rolling in the grass, even drinking water and eating can introduce foreign objects into your dog’s nasal passage, resulting in snoring. Extra mucus from a cold will also create snoring.

For the most part, snoring caused by nasal obstructions is temporary and should stop when the passage is cleared. There are some other common reasons for snoring:

Dental problems can be a factor. If your dog has bad teeth. It can lead to an abscess. It will go right through the nasal passages. If you don't have your dog’s teeth looked at, dental problems can be a source of infection that goes through your dog’s whole body. Infections can be a host for another set of problems.

Extra pounds

Is your dog carrying a little extra weight? If so, that can be a factor that is causing the snoring. Excess tissue in the throat will cause the obstruction that blocks the airways. As your dog breathes in and out, obesity makes the trachea rings slam shut.

Or it could be a fungus that you may not even be aware of but your dog sure is, such as mold found in hay, grass clippings and similar environments. Left untreated, this fungal disease can cause discomfort, loss of appetite and serious health problems.Any type of upper respiratory problem can cause a blockage, including a temporary inflammation in the nose from a cold or seasonal allergies.

You may have just picked a breed that has this issue through genetics. Because of genetics some breeds may actually have to have a surgery to open up their nasal passages because they are almost completely shut, like a pug or Boston terrier. Brachycephalic breeds -- the breeds with very short noses, such as English/French bulldogs, Boston terriers and pugs -- have a natural tendency to snore.

Is your dog breathing secondhand smoke? Smoke can irritate the nasal passages and make it difficult to breathe. Smoke away from the dog or better yet quit. You both will be healthier.

How can you help your dog breathe more easily? Try giving your dog a pillow. It will elevate the head.

A round bed will encourage a different sleeping position. The round bed will encourage a curled position that allows air passages to expand.

A humidifier can help increase the moisture in the air and help, so the nasal passages won't be so dry.

If your dog is snoring it most likely isn't getting a restful sleep and if it isn't getting good sleep that means you probably aren't either. If the problem persists after trying to change up the sleep environment go back to the vet and see if it is an allergy or if possibly surgery is needed.

The Drowsy Driving Epidemic [Infographic]

February 11, 2015 | Daniel R. Rosen


The Cost & Consequences of 168 Million Sleep-Deprived Drivers

There are countless driving hazards every time we get behind the wheel of a vehicle. But one of the most common can also be the most deadly: driving while drowsy.

While texting and driving and drinking and driving are widespread and deadly problems, drowsy driving is even more pervasive in the U.S. More than a third of Americans fell asleep behind the wheel of a car last year, and there are 42 drowsy drivers for every one drunk driver on the road.

Drowsy driving accounts for hundreds of thousands of auto accidents, injuries and deaths, as well as billions of dollars in monetary losses every year. Driving while sleep deprived can even cause impairment that rivals driving under the influence of drugs or alcohol.

The infographic below explores the costs and consequences of drowsy driving across the U.S.


Source: Law Offices of Daniel R. Rosen.

WHAT SYDNEY LEROUX DOES TO HER NEW HUSBAND IF HE'S SNORING.

By D'Arcy Maine | Mar 16, 2015



Unless you've been living in an underground tunnel somewhere with no WiFi signal or cell service, you're aware that soccer stars Sydney Leroux and Dom Dwyer were recently married. In fact, if you follow either of them on social media, you probably already know more about their relationship than that of people you -- GASP -- actually know IRL.

And just when you thought you knew everything about their lives, Leroux documented her new husband's annoying sleep habit and maybe her attempt at killing him. So that's a new development.

After having her sleep disturbed by Dwyer's snoring, Leroux did what anyone would do and pinched his nose. It worked ... temporarily. She posted the video of her efforts on Instagram with the caption: "When you try to kill bae."

For those concerned: Dwyer is still very much alive and well. Although he might want to find a way to get his snoring in check ... before it's too late.

5 Reasons You Should Never Share Your Bed With Your Cat

• by Judy Molland
• March 14, 2015
• 11:30 am

Do you let your cat into your bedroom at night?

Sleeping with your feline friend isn’t unusual in the United States. According to a recent survey of pet owners by the American Pet Products Association, 62 percent of cats sleep with their adult owners, and another 13 percent of cats sleep with children.

It’s a great idea, right? Cats are wonderfully therapeutic; they can help calm nerves, lower blood pressure, and reduce the risk of heart attack and stroke. However, that doesn’t mean you should allow your cat into your bedroom.

Here are five really good reasons to never share your covers with your kitty.

1. Cats Disturb Your Sleep

The last time I let my cat Sargent Pepper into my bedroom, she decided at 3 am that it was time to get up and have fun. First she jumped on and off the bed a few times, then she poked at my hair, and finally she stuck her paw against my mouth.

A study released by the Mayo Clinic Sleep Disorders Center found that 41 percent of the sleep-deprived pet owners said the disturbances in their sleep come from letting their pets share the bed, while 58 percent said letting them sleep in the same room caused problems due to snoring and other interruptions.

And snoring isn’t just a people problem. The study also found that 21 percent of sleep clinic patients had snoring dogs and 7 percent had snoring cats.

2. Cats Are Nocturnal; Humans Are Not

The problem is that cats are nocturnal, mostly because they spend much of the time sleeping all day. Humans, however, are not. Enough said.

Cats just like to be active all night long: there’s the midnight stare, for example, and the endless meow. Then there’s the human mattress: cats just deciding to sleep on your chest, or on your stomach.

And the “Look what I caught” game can take a strange turn in the middle of the night. My friend Ellen was woken at 2 am last week by her kitty bringing her a paint brush, and thrusting it towards her. Huh? What was the kitty trying to tell her?

3. Cats Make Your Asthma And Allergies Worse

Over 8 percent of adults, along with 9 percent of children, suffer from asthma; if you’re one of those people, bringing a cat into the bedroom will only make you suffer more.

If you have asthma or allergies, you’re better off with no cat presence, but maybe you already have a feline friend, or  your kids have fallen in love with an adorable kitten? If the cat has to stay, limit your exposure to the kitty and restrict her to certain sections of your home. Above all, keep the cat out of your bedroom at all times. Instead, install a high-efficiency particulate arrestance (HEPA) filter in your sleeping area to clear the air and give your nose a few hours a day to recover.

4. Cats May Pass On Infectious Diseases

Emerging Infectious Diseases, in conjunction with the CDC, released an article called “Zoonoses in the Bedroom.” These are diseases that animals can spread to people. In this article they give a few scary examples, including a young boy who got plague after having his flea-infested cat sleep with him.

Approximately 60 percent of all human pathogens could have been transmitted by an animal: rabies, ringworm, hookworms, toxoplasmosis, roundworm, giardia, even bubonic plague.

Ugh! Who wants to risk getting any of those?

5. What About Sex?

Can having a cat in your bedroom interfere with your sex life? I don’t know about you, but for me the idea of sexual intimacy while my cat is on the bed, or even in the bedroom, creeps me out.

However, not all cat lovers agree with me. Elizabeth and Charles Schmitz, love and marriage experts who wrote “Golden Anniversaries: The Seven Secrets of Successful Marriage,” report that many of their successful couples have pets and many sleep in the same room as those pets. But when it comes to being intimate, “Some put them outside the bedroom because they don’t want them to watch,” Elizabeth Schmitz says. “Some give them a treat to distract them. Some don’t mind if the pet stays on the bed.” So it all works out as long as you both agree on how you feel about your cat being in your bedroom.

Of course, just because you don’t allow your cat into your bedroom doesn’t mean she won’t object. Almost every morning, around 5:30 am, I am woken by a loud thumping and scratching on the bedroom door, Sargent Pepper’s way of informing us that she is wide awake and ready for breakfast.

What do you think? Do you let your kitty friend into your bedroom?

SDB Treatment May Reduce Hospital Admission Rates in Chronic Heart Failure Patients

Published on March 12, 2015

ResMed today announced data from two studies about sleep-disordered breathing (SDB) in chronic heart failure will be presented at the 64th Annual Scientific Sessions of the American College of Cardiology, from March 14 through 16.

“The data we are presenting are important because they point toward a connection between breathing disorders in sleep, like sleep apnea, and chronic heart failure,” says ResMed chief medical officer, Glenn Richards, MD, in a release. “We look forward to learning the results of our landmark clinical study called SERVE-HF, that examines whether addressing sleep-disordered breathing in people with chronic heart failure improves survival.”

Final data from nearly 7,000 patients in a German registry of more than 10,000 patients with stable chronic heart failure showed that SDB was present in nearly one out of two people (46%). Prevalence of SDB increased rapidly with age. Other risk factors include male gender, more severe heart failure, atrial fibrillation, and increased weight.

This data will be presented in a poster session by Olaf Oldenburg, senior cardiologist in the Department of Cardiology at the Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany, on March 16 from 9:45 AM to 10:30 AM. (Session 1252, Poster 212; Prevalence and Predictors of Sleep-Disordered Breathing in Patients with Stable Chronic Heart Failure: Final data of the SchlaHF Registry; Poster Hall B1)

Data from an American study suggests that treatment of SDB may reduce hospital admission rates in patients with chronic heart failure. Patients compliant with PAP therapy had significantly reduced hospital visits in the 6 months after starting therapy compared to the 6 months before therapy. A comparable group who were not compliant with PAP therapy had no change in frequency of hospital visits.

This data will be presented in a poster session by Dr Sunil Sharma, associate professor in the Department of Medicine at Thomas Jefferson University on March 14 from 3:45 PM to 4:30 PM. (Session 1145, Poster 192; Treatment of Sleep Disordered Breathing in Patients Admitted for Decompensated Heart Failure Reduces 6 Months Hospital Visits, Poster Hall B1)

Sleep deprived? Naps might help your immune system.

Published March 06, 2015 - Reuters

Getting too little sleep is linked to poor health, but short naps might partly offset that effect, a small study suggests.

Sleep deprivation can have a negative impact on brain function, metabolism, hormones and the immune system. While research has shown that a 30-minute afternoon nap can restore alertness, the current study is the first to examine whether napping has any impact on stress or immune system function, said Brice Faraut, a sleep researcher at Université Paris Descartes-Sorbonne Paris Cité in France.

Faraut and colleagues studied 11 healthy young men who typically slept seven to nine hours each night, didn’t smoke and didn't normally take naps.

Two separate times, each man participated in a three-day session of sleep tests in a laboratory where food intake and lighting were strictly controlled and no alcohol, caffeine or medications were allowed.

During one session, they slept normally for one night but then were only allowed to sleep for two hours the next night. The men could sleep as much as they liked on the third night.

The other session was the same - except the men were allowed to take two 30-minute naps the day after their sleep was restricted.

The study team collected urine and saliva samples each day to measure levels of norepinephrine, a substance that's typically released when the body is under stress. It increases heart rate, constricts blood vessels and raises blood pressure and blood sugar.

The men’s norepinephrine levels were more than doubled in the afternoon after the night of sleep restriction, compared to the day after they had slept normally. But there was no change in norepinephrine when participants were allowed to nap.

Lack of sleep also affected an immune-regulating molecule called interleukin-6, which dropped when the men were sleep-deprived but stayed normal when they were allowed to nap.

This relatively short nap duration can be a "powerful countermeasure to sleep debt," Faraut said in an email, adding that the findings need to be tested in real-life situations.

Michael Grandner, a sleep researcher at the University of Pennsylvania who was not involved in the study, said the immune findings were somewhat contradictory to the existing literature.

“But these are complicated processes, and studies like these, that examine what happens during partial recovery, (help) us understand all of the ways that sleep is important for health and functioning,” Grandner told Reuters Health by email.

Grandner differentiates between two types of napping.

“First are naps that you take because you are so exhausted that you cannot stay awake,” Grandner said. “A nap in this case may help a little, but being that exhausted is a sign of insufficient sleep or a sleep disorder and it's unlikely that the nap can completely fix the problem.”

“You might have a sleep disorder like sleep apnea (which is a very common cause of sleepiness) or you may be sleep deprived," he said, "which has been shown to be an important risk factor for weight gain and obesity, heart disease, poor performance, and many other outcomes.”

Grandner said the second type of nap is one you take to refresh yourself.

“Rather than a nap by necessity, this is a nap by choice,” he said. “These naps, since they are not in the context of exhaustion, have the opportunity of boosting your performance (rather than simply making up for lost sleep).”

For Teens, Sleep Habits Can Run In The Family

(FROM THE WALL STREET JOURNAL 2/17/15) 
By Ann Lukits

To understand teenagers’ sleep habits, look at their parents, a study suggests. When parents go to bed, how long they sleep, and when they wake up may help to shape their children’s sleep patterns during adolescence, according to the study, in the February issue of the Journal of Adolescent Health.

Lack of sleep has been linked to obesity, accidents, substance abuse and other health problems during high school, researchers said. Efforts to improve teen sleep should consider the sleep routines of parents and possibly other family members, they said.

The study, at the University of California in Los Angeles, involved 336 pairs of teens and parents, ages 15 and 42 years old, on average, respectively. Most of the teens, 87%, were born in the U.S. while 81% of parents, mostly mothers, emigrated from Mexico.

The researchers said family togetherness is emphasized in Mexican-American families but it wasn’t known if that was a factor in the sleep patterns of parents and teens.

Over a two-year period, teens and parents documented their sleep habits and daily activities nightly for two weeks in each of the years. Parent-teen relationships also were assessed.

On average, teens slept 8.6 hours on nonschool nights and about 30 minutes less on school nights. Parents went to bed and woke up earlier than teens and slept about 17 minutes less on school nights.

Although parents and teens didn’t always go to bed at the same time, the similarity in their sleep habits was significant: If parents stayed up later or went to bed earlier, teens also stayed up later or went to bed earlier.

The variability in parental bedtimes was more closely related to variability in girls’ bedtimes.

The association between the sleep habits of parents and teens remained significant after adjusting for other factors such as studying, suggesting family sleep routines may shape adolescent sleep over and above other events in their life, researchers said.

The relationship between parent-teen sleep was strongest in larger families and those with greater parental support.

Caveat: The size of the home, type of neighborhood, lighting, noise and family members’ morning and evening preferences weren’t known. It isn’t known if similar sleep patterns would be seen among other ethnic groups, researchers said.