Apps to Track Exercise, Sleep Help Patients Participate in Clinical Trials

Smartphone data is used for crowdsourcing studies of diabetes, asthma, cardiovascular disease

http://www.wsj.com/video/apple-researchkit-links-users-to-researchers/324CA4EA-1B65-4318-A3C3-3A2E5EDE2B30.html


By RON WINSLOW / April 13, 2015 4:11 p.m. ET

Steven DeMello, like many people, uses a smartphone to keep a calendar, take notes, create artful photographs and listen to music.

Recently, he began using it for a new purpose: to participate in a clinical trial. Three times a day, the retired health-care executive, who is 60 years old and has Parkinson’s disease, performs four tests using an app on his iPhone that records his results and provides feedback to researchers—and to him—on how his Parkinson’s symptoms affect his daily life.

“If I know more about my condition, the better and smarter I will be in managing my own care,” he says.

The app, called mPower, is one of five disease-related apps for clinical trials released in March in connection with Apple Inc.’s introduction of ResearchKit, a platform where users can track personal health data and participate in health studies. Other apps include My Heart Counts for cardiovascular disease, Asthma Health, GlucoSuccess for diabetes, and Share the Journey, for a study of the after effects of treatment for breast cancer.

Together the apps—and patients like Mr. DeMello—offer a glimpse of how the ubiquitous smartphone has the potential to transform medical research. Taking advantage of smartphone features such as accelerometers, gyroscopes and GPS locators, the apps track real-time daily activity and supplement other information on a patient’s condition.

ENLARGE

Three times a day, Steven DeMello, a retired health-care executive who has Parkinson’s disease, uses an app on his iPhone to perform four tests that record results and provide feedback to researchers—and to him. PHOTO:STEVEN DEMELLO

Since the apps were launched March 9, some 60,000 patients have enrolled in five studies just by downloading the apps from the app store, answering a few questions about the disease and clicking through a consent form. None of the patients had to see a doctor to sign up.

Academic researchers doing similar trials might need several years to enroll only a few hundred patients. Pharmaceutical companies need scores of research sites and hundreds of millions of dollars to find 20,000 patients for a major drug trial.

“This is a whole new way of going forward with medical research that makes it quick, scalable and efficient,” says Eric Topol, director of the Scripps Translational Science Institute in La Jolla, Calif., who is familiar with the apps but isn’t involved with developing them.

The apps all were developed by researchers at academic medical institutions leading the studies. Apps for more diseases are planned. The scientists aren’t testing new drugs, but rather hoping to learn more about the long-term effects of chronic disease on participants, including whether the use of a smartphone might help individual patients deal more effectively with their symptoms.

“The phone can be a powerful way to engage participants and make participating in a clinical study more of a two-way information exchange,” said Stanley Shaw, co-director of the Center for Assessment Technology and Continuous Health at Massachusetts General Hospital, Boston, where the diabetes app was developed.

ENLARGE

Apple's Parkinson’s disease app includes a finger-tapping test to determine the patient’s speed of movement. Other apps include My Heart Counts for cardiovascular disease, Asthma Health, GlucoSuccess for diabetes, and Share the Journey, for a study of the aftereffects of treatment for breast cancer. PHOTO: APPLE

For now, the apps work only on the iPhone 5, 5s, 6 and 6 Plus. Although tens of millions of Americans own an iPhone, the cost puts them out of reach of many lower-income earners. That raises questions about how relevant data from iPhone-based studies would be for the broader population.

Apple plans to make the ResearchKit available soon on an open-source basis. That would enable development of apps for Android-based phones, which are often cheaper than iPhones, and potentially extend use of the apps to a broader population.

Apple said it doesn’t collect or see any of the patient information researchers gather. Study participants have full control over when and whether their data, after it is uncoupled from their identity, can be shared with other researchers. Still, some worry a privacy risk remains. A significant privacy breach from app-based studies would be a “serious hit” to their use in clinical research, said Dr. Topol, of the Scripps institute.

Researchers are intrigued by the transformative potential of smartphone apps. Kathryn Schmitz, an epidemiologist at University of Pennsylvania and an investigator on the Share the Journey study, said it recently took her team three years, including the sending of 60,000 notices, to recruit just 351 patients for a separate conventional study about the impact of exercise on breast-cancer survivors.

In the first month of recruiting for Share the Journey—which she said has less stringent enrollment criteria—nearly 2,000 patients have signed up.

The apps also enable easy enrollment of patients no matter where they live in the U.S. (Apple plans international study launches.)

With Parkinson’s disease patients, mobility is a main concern. For patients who live, say, in New Jersey or on Long Island, “the idea of getting into the city to an academic center is way too overwhelming,” said Todd Sherer, head of the Michael J. Fox Foundation for Parkinson’s Research in New York, which is involved with several online research initiatives. “But if you can bring the technology to their house, they are very excited to participate.”

Smartphones also offer the capability to track people’s symptoms and activities continuously in their daily lives. In many conventional studies, patients might have just a few clinic visits a year for tests and symptom updates, and those snapshots may not provide a detailed picture.

“Patients say symptoms fluctuate over the course of a day, but we’ve never had a way of measuring that,” said Ray Dorsey, a University of Rochester researcher who heads the Parkinson’s app study. With a smartphone, patients and researchers can observe symptoms that may change hourly and see how the changes correlate with factors such as exercise, meal times and medication dose. The phone also objectively records measurements of activities—minutes of exercise, steps walked, hours of sleep—which in conventional studies are typically obtained from less-reliable patient recall.

Mr. DeMello, who lives in Oakland, Calif., says he has 20-minute visits with his neurologist about once a quarter. Yet, he lives with the disease 365 days a year.

Each day, he uses his iPhone to take a finger-tapping test to determine his speed of movement, a walking test to check his gait and balance, a voice test and a memory test. Results measure the effect of his disease.

So far, he says, he has learned his symptoms don’t move in lock step, contrary to what he used to think. “I have weeks when balance is an issue and weeks when it’s not,” he said. “Then I have weeks when I’m slower cognitively than others.”

The app, he said, “is a huge step in giving patients a chance to contribute data that is otherwise completely lost.” Now, he says, “what I mostly want to do is learn how things come together in my body and what do I have to do to make them better.”

Snoring could be an early warning sign for memory loss.

CBS NEWS     April 16, 2015, 12:43 PM

There's new evidence suggesting just how important sleep is for the brain.

A study, published Wednesday in the journal Neurology, finds that people who snore heavily and have breathing problems during sleep may develop memory loss and cognitive decline at a much younger age than average.

"This study might be keeping some people up at night," Dr. Carol Ash, director of sleep medicine at Meridian Health, told "CBS This Morning."

http://www.cbsnews.com/pictures/sleep-hacking-tips-7-ways-to-maximize-your-zzzzzs/

Snoring and sleep apnea -- a condition where breathing is repeatedly interrupted during sleep -- are common among older people, affecting about half of men and a quarter of women, according to the researchers from NYU Langone Medical Center.

They studied the medical histories of nearly 2,500 people ages 55 to 90. Participants were categorized as having either normal brain function, mild cognitive impairment (MCI), or early stages of Alzheimer's disease.

The study found that people with sleep apnea were diagnosed with mild cognitive impairment an average of nearly 10 years earlier than people without sleep apnea.

"That's significant," Ash said. Even though the study did not prove cause and effect, she said it adds to a growing body of evidence that links sleep to brain health.

• How to protect your aging brain
• New clue about what causes Alzheimer's disease

Fortunately, she said, there are things you can do to lower the risk. "When you have symptoms of snoring or symptoms that suggest you have sleep-disordered breathing, you really want to take it seriously. There's simple screening that can be done to identify somebody that has a problem. There's a home sleep test to make the diagnosis. Then there's treatment options."

For people with sleep apnea, a device called a CPAP mask, worn over the nose and mouth, can help keep the airways open at night. It may look uncomfortable, but Ash said, "When you have a patient who truly has this problem, it can change and save their life. You have to coax them through and get them comfortable, but once they're using it, they won't go back."

Losing a few pounds can also be effective, since excess weight often contributes to snoring and breathing problems. In other cases, dental work or surgery can make a difference.

The NYU researchers found that patients whose sleep issues were treated were able to ward off cognitive decline. "The age of onset of MCI for people whose breathing problems were treated was almost identical to that of people who did not have any breathing problems at all," study author Ricardo Osorio, MD, said in a press statement. "Given that so many older adults have sleep breathing problems, these results are exciting --we need to examine whether using CPAP could possibly help prevent or delay memory and thinking problems."

Ash stressed the importance of getting diagnosed and dealing with sleep problems, since in addition to memory decline, snoring and sleep apnea have also been linked to an increased risk of stroke, heart attack, and other life-threatening conditions.

"Sometimes you can't undo all of the damage, but I've seen significant improvements," she said. "It's worth looking into."

Could Chrona Be the Key to Deeper Sleep?

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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.

Kids Sleep Doctor: App That Improves Your Kid’s Sleep Better Than A Doctor

By Nida I Zamir on April 6, 2015

So parents are about to sigh with relief as a free app to improve children’s sleep has been launched by doctors at the Evelina Children’s Hospital in London. The app, Kids Sleep Doctor, gives parents custom advice, based on the sleeping patterns of their children, like night terrors or teens staying up all night long.

Paul Gringras, a professor of children’s sleep medicine at the hospital, said that the doctors only skim through a patient, seeing “only the tip of the iceberg” due to the “massive” waiting lists. That is why the hospital decided to develop an app which could focus on the patients more closely and give advice along the way as different problems would pop up during the life cycle of the children aged 0 – 16.

The app initially requires details about the children, like bedtimes, where the child falls asleep, how much screen time they have, and consumption of caffeinated drinks.

After five days of collecting the data on the child’s sleep habits, like night-waking and bedtimes, the actual tailored service of advice begins.

“Hopefully they are sleeping in the normal range, but if they’re outside that then it advises parents,” Prof Gringras said.

“Take a five-year-old who suddenly is waking up every night screaming, doesn’t recognize parents and pushes them away. The app would say it is like a night terror and will happen in 10% of children in this age range and they will grow out of it, but they can also try a technique called scheduled waking half an hour after they have gone to bed.”

For teenagers who are unable to sleep until really late into the night, the app would advise parents that the child needs exercise in the afternoon as it promotes healthy sleep.

“These are not annoying daily tips, it’s tailored advice,” he added.

Considering how the doctors are actually letting their waiting lists shorten for an app, it points at the hospital’s ethical responsibility which is to reduce pressure on the overburdened service, and does not focus on making a few extra dollars.

“I think there’s a lot of people it could prevent needing to see a GP. Parents can do a brilliant job,” added Prof Gringras.

However, the 200,000 children diagnosed with serious sleep disorders such as narcolepsy or obstructive sleep apnoea would still require proper doctor consultation.

Moreover, the app has a dark and orange palette to minimize the amount of blue light emission, which is the wavelength of light that disrupts sleep.

Psychologist and child therapist Professor Tanya Byron commented:

“Many children are affected by sleep problems which can have a major effect on the whole family. Getting a good night’s sleep is so important for a child’s physical and mental development, behaviour and concentration – to name but a few. We know parents know their children better than anyone, and I’m confident that the ‘Kids Sleep Dr’ app will help parents to understand and better manage their child’s sleep problems.”

Kids Sleep Doctor is currently available free on iOS. Android and Windows versions are in the pipeline.

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.

In Resistant Hypertension, Sleep Apnea Results in Greater Blood Pressure and Treatment Lowers It.

Published on April 6, 2015

A new meta-analysis published in the Journal of Hypertension suggests that untreated sleep apnea may be a major factor in why medications appear to be less effective in reducing high blood pressure in some people. Further, the study shows that CPAP therapy may be the key to helping those with difficult to treat hypertension get their blood pressure under control.

As many as 10 million people in the United States have “resistant hypertension” which either doesn’t respond to or requires multi-drug therapy. Most people with resistant hypertension also have obstructive sleep apnea (OSA). It’s a deadly combination that exponentially increases the risk of death or disability from a stroke or heart attack, but one that researchers say may have a relatively simple solution.

“Our study indicated that the patients with resistant hypertension and the very highest blood pressure experienced the greatest reduction in blood pressure after using CPAP therapy,” says Ulysses Magalang, MD, the study’s principal investigator and director of the Sleep Disorders Center at The Ohio State University Wexner Medical Center, in a release. “This response suggests that untreated sleep apnea may be why these people haven’t seen improvement in their blood pressure despite the concurrent use of three or four medications.”

Previous studies have shown that CPAP therapy offers patients with hypertension a significant, yet modest two to three point reduction in blood pressure. Magalang and the research team found that when they honed in on the specific results for those with resistant hypertension, the benefits of CPAP use looked quite different.
In their study, patients experienced an average reduction of 7.21 millimeters of mercury (mmHg) in ambulatory systolic blood pressure (SBP), and 4.99mmHg in ambulatory diastolic blood pressure (DBP) from baseline after using CPAP therapy. Ambulatory blood pressure (measured over a 24 hour period) is considered a good predictor of future organ damage and cardiovascular problems.

“We know that small changes in blood pressure translate into big benefits in terms of protecting the heart and reducing stroke risk,” says co-author Christopher Valentine, MD, a nephrologist at Ohio State’s Wexner Medical Center. “These findings suggest that physicians may need to be more aggressive with screening for sleep apnea and ensuring CPAP therapy compliance in patients with resistant hypertension.”

Systematic Analysis of Resistant Hypertension and CPAP Use

Despite the fact that millions of people suffer from resistant hypertension, and that its cardiac comorbidities carry a significant public health burden, studies looking at CPAP use and hypertension historically haven’t focused on this difficult to treat population.

“We have a lot of evidence about the benefits of CPAP in people with hypertension and OSA, but ours is the first analysis to systematically review CPAP use in people with difficult to treat hypertension and apnea,” Valentine says. “The results are clinically relevant because the effects that we found are significantly higher than what’s been previously observed in a more general hypertensive population. CPAP use could offer this subset of patients a new chance to reach a healthier blood pressure goal, or even to reduce their medication burden.”

From an initial scan of 157 articles, the researchers narrowed the data from 6 different studies, looking at pre- and post-CPAP blood pressure measurements from more than 300 patients with resistant hypertension. The duration of CPAP use ranged from 3 weeks to 6 months. In addition to measuring ambulatory blood pressure, investigators also looked at CPAP therapy and its impact on nighttime blood pressure—another predictor of future cardiac events.

While the researchers found significant improvement in ambulatory and nocturnal blood pressure measurements after CPAP use in some of the studies, other cuts of the data showed that CPAP therapy delivered about the same nocturnal blood pressure benefit as observed in previous studies.

“More studies are needed to further define CPAP influence on blood pressure, but overall, we think that the longer the CPAP is used during the night, the greater the impact,” Magalan says.

The authors also acknowledge other limitations of their analysis, including small sample size, and potentially confounding factors such as the concomitant use of the antihypertensive medications, obesity, and other life-style factors such as the use of alcohol and smoking.

Sleep Apnea, High Blood Pressure: Shared Genetic Origins?

Magalang and Valentine say their findings also support the idea that resistant hypertension and OSA represent an “extreme phenotype” of those who have OSA, but never develop hypertension. A phenotype describes how an individual’s characteristics are influenced by the interaction of their genes with their environment. The researchers further suggest that resistant hypertension in those with sleep apnea may be caused by a less common gene variant that nonetheless has significant impact.

It’s a hypothesis that will likely be put to the test over the next decade. The researchers who collaborated on the paper all belong to the Sleep Apnea Genetics International Consortium (SAGIC), a partnership of scientists from five continents who are building the first-ever international biomedical database to uncover the genetic causes of sleep apnea. By collecting biological material from thousands of patients with sleep disorders, the group hopes to amass enough data to start identifying underlying genetic causes of different conditions.

“We’re only just now beginning to appreciate the link between sleep apnea and disease,” says Magalang. “We hope that one day we will find common genes shared between people who have uncontrollable blood pressure and sleep apnea, and that will open up a whole new world of interventions and treatment strategies.”

The research was supported by the National Heart, Lung and Blood Institute. Ohio State’s Center for Clinical and Translational Science (CCTS) also provided biomedical informatics support for the study and provides ongoing informatics support for SAGIC.

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.

6 Things That Are Keeping You Fat.

K. Aleisha Fetters, U.S. News & World Report
MARCH 30, 2015  11:23 AM

You're filling up on healthy foods, exercising daily and still, the scale isn't budging. It's mind-numbingly frustrating. Luckily, it's also fixable. Here are six common things that could be standing between you and your weight-loss goals – plus easy ways to bust through each.


1. You Aren't Tracking What You Eat

"Most of the time, when someone comes into my office saying they aren't losing weight, the problem is that they are eating a lot more than they think they are," says Holly Herrington, a registered dietitian and clinical nutritionist with the Center for Lifestyle Medicine at Northwestern Medical Faculty Foundation. "Almost every single person underestimates how much they are eating." You can blame oversized restaurant portions, mindless munching and "health halos" for that, she says.

After all, French fries and ice cream aren't the only things that are calorie-packed. So are healthy foods, including olive oil, avocado and nuts. For instance, 1 cup of almonds contains about 750 calories. If you're snacking on them (a great idea), but without measuring and tracking those calories (a bad idea), you could easily end up gaining weight, Herrington says.

She recommends tracking everything you eat, at least for a couple months, with apps like My FitnessPal, which will help you learn proper portion sizes and how your favorite health foods measure up calorie-wise. In one American Journal of Preventive Medicine study, people who kept daily food records lost double the weight of those who didn't track their food intake.

2. You're Not Sleeping Enough

A bad night's sleep can wreck your weight-loss efforts through a two-pronged approach. For one, it makes you hungry and likely to overeat. "When you don't get enough sleep, your levels of cortisol and also ghrelin, a hormone that increases the sensation of hunger, rise," explains board-certified internist Dr. Patricia Salber.

For example, in one University of Chicago study, healthy young men who got just four hours of sleep two nights in a row (compared to their usual seven to nine hours) reported a 24 percent increase in appetite, along with cravings for candy, cookies, chips, bread and pasta. They also experienced an 18 percent decrease in leptin, which promotes fullness, and a 28 percent increase in the hunger-hormone ghrelin.

Second of all, not getting enough sleep could make your body store what you do eat as fat. For instance, a 2011 study in the American Journal of Clinical Nutrition found that just one night's bad sleep caused healthy men's resting energy expenditure – the number of calories they burned by simply being alive – to drop by 5 percent. The number of calories they burned after each meal also dropped by 20 percent.

"Sleep deprivation and sleep apnea may affect blood sugar levels and increase insulin resistance," says endocrinologist Dr. Michael Bergman, clinical professor of medicine at the NYU Langone Medical Center. "Sleep disorders, namely obstructive sleep apnea, [have] been associated with the development of Type 2 diabetes."

If clean-sleep habits – such as keeping your bedtimes consistent and not playing on electric devices in the hour before bed – don't help you get eight solid hours a night, talk to your doctor about how you can sleep better and longer, he says.

3. You're Eating the Same Number of Calories You Did on Day One of Your Diet

Oh, the weight-loss plateau: At the beginning of your diet, you were losing weight and feeling great. But now, you're doing the exact same thing, but with zero results. That might be the problem. "As you lose weight, your caloric needs will change," Herrington says. "The smaller you get, the fewer calories your body needs, so the fewer calories you'll need to eat to continue losing weight."

If your weight-loss results have plateaued for one to two months, she recommends gradually cutting back on calories. Start by eating 100 fewer calories a day and see how the scale shifts in a couple weeks' time. Don't cut back too much, though. Most women shouldn't eat any fewer than 1,200 calories a day and men shouldn't eat any fewer that 1,700 a day. Meanwhile, you should never feel famished or low on energy, she says.

4. You're Constantly Stressed

Acute stress – say from a looming work deadline or relationship drama – can cause your appetite to go MIA. But if the stress keeps up and becomes chronic, too-high levels of the stress hormone cortisol can increase your appetite, particularly for high-carbohydrate foods, according to Salber.

"When stressed, people seek to comfort themselves and relieve the tension," she says. "All too often, that means turning to sugar or starchy foods." High-carb foods can cause a quick spike in blood sugar and feel-good serotonin levels. But both crash quickly, and put you in a vicious cycle of stress and overeating.

Meanwhile, by stimulating the production of insulin, cortisol also increases your body's tendency to store calories as visceral fat. A type of fat that hangs out in the abdominal cavity and likes to hug your vital organs, visceral fat is associated with the development of insulin resistance and, in some cases, diabetes, Salber says.

If you can't remember the last time you weren't stressed, consider visiting your doctor or a therapist to help you manage your stress levels and get healthy. Mental health issues, including stress, are no different than physical health issues, she says. They deserve professional help.

5. You're Using Artificial Sweeteners

Artificial sweeteners, whether you stir them into your coffee, get them from diet sodas or spoon them from your yogurt container, are an easy way to cut calories and sugar in the short term, but they could harm your long-term weight-loss efforts. Case in point: Research from the University of Texas found that over the course of 9.5 years, the average two-a-day diet-soda drinker puts on five times more belly fat than do people who abstain.

That could be because your brain responds to artificial sweeteners by telling you to eat more sweet stuff, according to the Harvard School of Public Health. Meanwhile, they may also throw off the balance of healthy bacteria in the gut, Salber says.

A 2014 study from the Israel-based Weizmann Institute of Science's immunology department found a significant correlation between the consumption of artificial sweeteners, gut bacterial configuration and a tendency to develop glucose intolerance, which contributes to the development of obesity and Type 2 diabetes.

Eliminate any artificial sweeteners in your diet and replace them with sweeteners that also contain vitamins and minerals, such as honey and maple syrup. Just make sure to count their calories.

6. You Have a Medical Condition

While rare, underlying health conditions can make weight-loss difficult to achieve on your own. For instance, Cushing's disease, marked by excess cortisol levels, and polycystic ovary syndrome, a common endocrine disorder in women, can both contribute to glucose disorders, Bergman says.

Meanwhile, hypothyroidism, a condition in which the thyroid gland doesn't produce enough hormones, can also contribute to weight-management issues. About half of thyroid disorder cases in America are undiagnosed, according to the American Association of Clinical Endocrinologists.

If you aren't losing weight, but feel like you are following your body's caloric needs and are exercising between two and five hours a week, Herrington recommends talking to your doctor about your weight-loss concerns. He or she may be able to run some simple tests to make sure a health condition isn't behind your frustrations. If something is amiss, treating it will do more than help you lose weight.