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.

Israeli Researchers Develop Groundbreaking Approach To Evaluate Sleep Disorders.

Mon, Mar 16th, 2015

Ben-Gurion University of the Negev (BGU) researchers have developed a groundbreaking approach to determine sleep quality using their new breath sound analysis (BSA). This is less expensive and invasive than current polysomnography (PSG) technology, according to a new study published on PLOS Online.

“One of the main goals of sleep medicine today is to improve early diagnosis and treatment of the ’flood” of subjects presenting with sleep disorders,” says Prof. Yaniv Zigel Ph.D., head of the Biomedical Signal Processing Research Lab in BGU’s Department of Biomedical Engineering.

“We’ve developed a non-contact ‘breathing sound analysis’ algorithm that provides a reliable estimation of whole-night sleep evaluation for detection of sleep quality, snoring severity and Obstructive Sleep Apnea (OSA). It has the potential to reduce the cost and management of sleep disorders compared to PSG, the current standard of treatment, and could be used at home.”

PSG requires a full night sleep center stay and subjects are connected to numerous electrodes and sensors that are attached to the patient to acquire signals and data from electroencephalography (EEG), electrooculography (EOG), electromyography (EMG), and electrocardiography (ECG) tests. The data is processed and visually examined or mathematically transformed manually in order to reveal insights about sleep/wake states and many aspects of physiology. “This procedure is time-consuming, tedious and costly due to complexity and the need for technical expertise; the market is begging for a better solution,” says Eliran Dafna who conducted this study as part of his Ph.D. research.

In the study, the researchers measured whole-night breathing sounds from 150 patients using both ambient microphones and PSG simultaneously at a sleep laboratory. The system was trained on 80 subjects and a validation study was blindly performed on the additional 70 subjects. A set of acoustic features quantifying breathing patterns was developed to distinguish between sleep and wake segments. Sleep quality parameters were calculated based on the sleep/wake classifications and compared with PSG for validity.

When comparing sleep quality parameters, there were only minor average differences in the measurements between PSG and BSA. Measuring 150,000 individual time segments (epochs), the BSA epoch-by-epoch accuracy rate for the validation study was 83.3 percent with 92.2 percent sensitivity measuring sleep as sleep.

“The results showed that sleep/wake activity and sleep quality parameters can be reliably estimated solely using breathing sound analysis,” says Prof. Ariel Tarasiuk of BGU’s Department of Physiology and head of the Sleep-Wake Disorders Unit, at Soroka University Medical Center. “This study highlights the potential of this innovative approach to measure sleep in research and clinical circumstances. Clearly, the transition of this technology to at-home sleep evaluation depends on third party reimbursements for the use of home study equipment.”

The Biomedical Signal Processing Research Laboratory was established in 2007 by Prof. Yaniv Zigel. The lab’s team are experts in physiological signal processing and pattern recognition.

The for the Study and Diagnosis of Sleep Disorders was established in 1994 by Prof. Ariel Tarasiuk. The unit’s team of experts evaluate sleep disorders in children and adults and operates in conjunction with specialists in respiratory diseases, neurology, ENT, and gastrointestinal diseases.

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.

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).”

Sleep Apnea More Than Doubles Risk For Car Accidents: The Dangers Of Drowsy Driving

Mar 11, 2015 11:57 AM By Chris Weller

New evidence adds to the already compelling case that driving a car while not properly rested produces similar risks as driving drunk.

The recent study was published in the journal Sleep and found people with obstructive sleep apnea were 2.5 times more likely to be the driver in an accident than people without the sleep disorder. Fortunately, the study also found continuous positive airway pressure, or CPAP, therapy was effective at reducing the rates by up to 70 percent if the person used the technique for an average of four hours every night.

"Excessive daytime sleepiness is a common symptom of obstructive sleep apnea, which can cause you to awaken in the morning feeling tired and unrefreshed despite a full night of sleep," said Dr. Timothy Morgenthale, president of the American Academy of Sleep Medicine, in a statement.

Insufficient sleep has been officially classified as a public health epidemic by the Centers for Disease Control and Prevention, as nearly 40 percent of people report unintentionally falling asleep at least once in the past month. On their own, the dangers of sleep deprivation include a suppressed immune system and moderate cognitive impairment. But the risks increase even further when those setbacks are applied to a complex activity, like driving a car. In 2010, a study found 20 to 25 hours of sleep loss resulted in the same levels of depleted brainpower as a blood-alcohol concentration of 0.10.

Obstructive sleep apnea, a condition in which the body’s airway gets blocked and results in difficulty breathing, may produce many of the same effects. In the latest study, Swedish researchers used data from the long-term data collection project STRADA, the Swedish Traffic Accident Registry. The team looked at 1,478 sleep apnea patients with an average age of 54 years. Comparing accident rates among a control population of more than 635,000, they found drivers in accidents were significantly more likely to suffer from sleep apnea. People who got only five hours of sleep, experienced daytime sleepiness, and regularly took sleeping pills also faced greater accident risks.

"Effective identification and treatment of sleep apnea is essential to reduce avoidable, life-threatening accidents caused by drowsy driving," Morgenthale said.

Obstructive sleep apnea is decidedly less common than general sleep deprivation. Roughlyone in five American adults has a mild case, while one in 15 has a moderate to severe case. Meanwhile, a recent Gallup poll found 40 percent of the country gets less than the recommended amount of sleep each night. Collectively, these missed hours account for 6,400 traffic-related deaths, which make up 21 percent of the U.S. total, according to a 2014 report. This is an increase from the 16.5 percent of deaths a previous 2010 study found.

For the dangers of drowsy driving, drunk driving still remains the greatest danger to motorists. The CDC reports that in 2012, alcohol-impaired drivers led to 10,322 deaths, which accounted for nearly a third of all traffic-related deaths in the U.S. Drunk driving’s annual cost is roughly $59 billion.

Drowsy driving, however, seldom receives a proportional amount of attention as drunk driving, which only adds to the risks. A deepening culture of casual sleepiness may account for Americans’ reluctance to sit passenger just because they feel a little groggy. For people with legitimate sleep disorders like obstructive sleep apnea, the latest research suggests people can dramatically cut their chances of an accident if they can identify their symptoms and take action.

For everyone else, the prescription is as simple as investing an extra hour or two of sleep each night. Given that 90 percent of the U.S. population drives a car to and from work, it’s a quick fix that can end up keeping everyone safe.

Snoring can lead to glaucoma: Experts

T Ramavarman,TNN | Mar 8, 2015, 06.15 AM IST

Snoring cuts off oxygen supply to your lungs and vital organs including the eyes. In glaucoma, already the opticval nerve cells are dying due to the increased pressure. Lack of oxygen accelerates the decay.

THRISSUR: Besides creating nuisance to those around you, snoring can aggravate glaucoma-optic nerve damage associated with the buildup of pressure in the eye-leading to loss of vision, experts said.

Studies reinforced the belief that those who snore were at the risk of developing glaucoma, ophthalmic surgeon Dr Rani Menon said.

"Snoring cuts off oxygen supply to your lungs and vital organs including the eyes. In glaucoma, already the opticval nerve cells are dying due to the increased pressure. Lack of oxygen accelerates the decay. So snoring is a very serious risk as far as glaucoma is concerned,'' she said.

When pressure builds up, the nerve cells inside the eye get strangulated and they start dying. There are about five million nerve cells in the human eye, and vision would be affected when about 30% cent of them are lost.

According to statistics, one in 200 of those aged above 40 stand the risk of getting glaucoma affected, while one in 100 aged above 65 were at risk. In India, about 11.9 million people are glaucoma-affected.

Though early detection is critical in treating glaucoma, patients seldom perceive any clear symptom, said Dr Babu Krishnakumar, secretary of the Kerala society of ophthalmic surgeons.

'Glaucoma Week' is being organized across the world from March 8.

Alternative Snoring Treatment Getting Rave Reviews

Posted: Mar 03, 2015 2:12 PM CSTUpdated: Mar 04, 2015 3:28 PM CST


http://www.waff.com/clip/11199609/newer-remedy-helps-snoring-sufferers

Norman Roby's dentist helped him find a new snoring treatment. (Source: WAFF)

DECATUR, AL (WAFF) -

Norman Roby says his snoring was pretty bad. He says he never felt rested and had a tendency to nap during the day. Finally he sought help.

"I did a sleep study over at Decatur General, at the time, and they determined that I was suffering from Sleep apnea, so I used a C-pap for a long time."

C-pap, or continuous positive airway pressure machines, have long been the standard treatment for slumberers who snore. But those machines come with some caveats.

Roby says he was miserable. "I didn't like being put in a bridle. I couldn't roll and turn and (it) had a noise going, and if I had any kind of a head cold I couldn't use the Cpap. I had to take it off. I slept worse with it than I did without it."

His friend Dr. Randall Sandlin, a Decatur dentist, helped him. "But, unfortunately it's not all that comfortable and there is a pretty high percentage, maybe half or more, of patients who just can't tolerate c-pap, because you're tethered to a machine and you're limited in your sleep position," Sandlin explained.

Sandlin says the oral appliance he recommended works differently. "It all fits within the mouth. It fits like a kid's retainer after braces." 

SomnoDent is a two-piece oral appliance that works to hold the lower jaw slightly forward. 

"The tongue is actually attached to the lower jaw, and when you bring the lower jaw slightly forward, you are bringing the tongue just a few millimeters slightly forward - which helps it open up the airway and keep it from collapsing," the dentist said.

Sandlin says you can speak, yawn, drink water with the device, so small, it can fit in your pocket. He says this device is a medical-grade acrylic appliance which will not "hold odor".

Roby says he can finally catch some "Z's.

"I was sleeping better than I had in years... sleeping like a fat baby," he laughed

And he says he's not the only one. "My wife is sleeping a lot better too ."

Snoring Could Be Hurting Your Relationship

February 23, 2015 4:00 AM

(credit: American Academy of Dental Sleep Medicine)

FORT WORTH (CBSDFW.COM) - If you’re having trouble in the bedroom, you might not need to look any further than your nose for the solution. A recent survey from the American Academy of Dental Sleep Medicine found that more than a quarter of Americans are annoyed — even angered — by a snoring bed partner.

The study looked at more than 1,000 randomly selected adults.

One out of five people surveyed added that the noise drives them out of bed. But the problems do not end there. Nearly one out 10 people admitted that snoring has hurt at least one past romantic relationship. And, guys, some 40 percent of women cited snoring as a turn off.

“It can be embarrassing,” stated AADSM president Kathleen Bennett in a news release on the study’s findings. “Snoring can often be the elephant in the room when it comes to addressing relationship frustrations and health concerns.”

People in the Generation X age range (35-44) reported the highest number of snoring struggles, with 43 percent saying that their partner’s snoring forces them to lose sleep, and 24 percent adding that they do — or would like to — sleep in a different room.

But many snorers are not even aware that they are making the noise. “It’s important that your significant other is made aware of their snoring,” Bennett added, “and the effects it has on you, your relationship and their personal health — so they can begin taking steps to remedy it.”

Frequent snoring could be a sign of sleep apnea, which causes sufferers to stop breathing during their sleep, sometimes for more than a minute. This can increase the risk of other serious health problems — from heart disease to depression, just to name a few.

Click here to find a dentist that can help you — or your loved one — with regular snoring or possible sleep apnea.

The Annoying Thing You're Doing In Bed That Might Be A Total Turn-Off

The Huffington Post  |  By Sarah Klein

Posted: 02/14/2015 8:46 am EST Updated: 02/15/2015 9:59 pm EST

If there's one thing we think it's safe to say is almost always a bummer in the bedroom, it's snoring.

According to a new survey from the American Academy of Dental Sleep Medicine (AADSM), 39 percent of American adults agree: When the opposite sex snores, it's a turn-off.

Luckily for the snorers among us, it's not a total deal-breaker -- 83 percent of the 1,009 people surveyed by telephone said they had had a snoring bed partner, but only 26 percent said all that log sawing made them angry or annoyed and just 9 percent said snoring has had a negative impact on a romantic relationship.

"Because it can be embarrassing, snoring can often be the elephant in the room when it comes to addressing relationship frustrations and health concerns," Kathleen Bennett, DDS, president of the AADSM, said in a statement. "But it's important that your significant other is made aware of their snoring -- and the effects it has on you, your relationship and their personal health -- so they can begin taking steps to remedy it."

Long thought to be simply an annoyance to a bed partner and not much more, snoring is now understood to carry some pretty substantial health risks. "When you are snoring, you're spending too much energy to breathe," Dr. M. Safwan Badr, past president of the American Academy of Sleep Medicine, previously told HuffPost. "Snoring is like fever for a general internist -- it tells you somethig is going on, but it doesn't tell you what."

Snoring could be a sign of sleep apnea or other sleep-disordered breathing, which has been linked to increased risk of hearing loss, osteoporosis, depression and more. Understandably, 43 percent of the AADSM survey respondents said they worried about the health of their snoring bed partners.

Sleep apnea is typically treated with continuous positive airway pressure, or CPAP, which is delivered by a bedside machine that can be, let's just say, a little cumbersome. The AADSM advocates for another option called oral appliance therapy, or OAT, a mouthguard-like device that, while not exactly sexy, may at least be a little sexier.

For snorers who don't have sleep apnea, experts recommend sleeping on your side, avoiding alcohol too close to bedtime and shedding excess weight. Your bed partner will thank you for the Valentine's Day gift of a quieter night's rest.

http://www.huffingtonpost.com/2015/02/14/snoring-turn-off_n_6679120.html#slide=start

Is the Apnea/Hypopnea Index the Best Measure of Obstructive Sleep Apnea?

December 9, 2014


Obstructive sleep apnea (OSA) continues to challenge otolaryngologists and patients alike, with estimates of the condition affecting between 2% and 4% of the adult population in the United States. Gold standard OSA diagnosis is made through a polysomnogram (PSG) test, which uses the apnea/hypopnea index (AHI) as its main defining measure.

The AHI, which quantifies the number of times each hour a patient has a total (apnea) or partial (hypopnea) blockage of breathing during sleep, has been the most-used measure, not only of how OSA is diagnosed, but also of how well treatment modalities, including continuous positive airway pressure (CPAP) and surgery, improve breathing patterns.

Recently, however, some otolaryngologists have been questioning whether the AHI should be the main—and sometimes only—determining factor of treatment effectiveness, or whether other measures such as sleepiness scales, quality of life (QOL) measurements, and physiological measurements such as blood pressure should play a more prominent role.

The Challenges of AHI

Much of the focus around this questioning has arisen not only because of AHI’s value as a measurement index, but also because of its changing definition.

“As an index, the AHI can vary a lot between sleep centers and even within the same sleep center. You’ll get a different number depending on which definition and sensors you use,” said

Ofer Jacobowitz, MD, PhD, assistant clinical professor of otolaryngology at Mount Sinai Hospital in New York City. “Hypopnea can be defined based on either a 30% or 50% decrease in inflow and associated with either a 3% or 4% oxygen desaturation.or even an arousal. The recommended definition of hypopnea has changed multiple times over the years.”

The effects of this shifting definition have been noted in research. In a 2012 study published in The Laryngoscope that examined the effects of different PSG scoring systems on outcome measurement following OSA surgery, the researchers noted that interpretation of OSA surgical treatment literature remains problematic, because the study authors continue to use different AHI criteria for investigation and different AHI thresholds for defining surgical success (Laryngoscope. 2012;122:1878-1881). They found that the success rate for OSA surgical treatment ranged from 38.9% to 91.7%, depending on the criteria and metric used to define a successful outcome.

Another issue is that, even with a stable definition, the AHI number may not represent an accurate picture of an individual patient’s experience with the disease. “The AHI tells you about the sum of apneas and hypopneas, but two patients with the same AHI number may have completely different scenarios—one with mostly apneas and longer or more severe desaturations and one with mostly hypopneas with minimal desaturations,” said Dr. Jacobowitz.

“It used to be thought that the more severe a patient’s sleep apnea, the more sleepy he or she would be, but that turns out not to be the case,” said Eric Kezirian, MD, MPH, professor of clinical medicine in the department of otolaryngology-head and neck surgery at the Keck School of Medicine of the University of Southern California in Los Angeles. “Sleep apnea can reduce the sleep quality for patients, resulting in sleepiness, fatigue, and decreased quality of life. It turns out the AHI doesn’t capture that.”

Part of the issue is that people can be fatigued for a number of reasons, Dr. Kezirian added. They may not be sleeping enough, they may have insomnia, or there may be other sleep issues. “You want to have some objective way to measure how well you’re treating OSA,” he said. “The AHI is certainly part of that; it’s a single number that allows you to get a sense of what a patient’s breathing patterns are like. But we don’t treat numbers, we treat patients, and so we care about the broader implications of the treatment.”

These researchers looked at 21 studies on outcome measures in addition to the AHI that were published between 1997 and 2012. The authors found that patients with OSA scored differently in measurement tools in all categories when compared with control populations or after treatment and that, in general, there was a poor correlation with AHI.

“The issue with AHI is that it’s only part of the definition of OSA—it is a marker of sleep apnea, a surrogate variable of the disease,” said Dr. Jacobowitz. “AHI will remain important because there is reasonable evidence that when a patient’s AHI is over 30, it is associated with increased mortality. But it’s an indirect measure of only the respiratory component of sleep apnea and does not measure sleepiness. For example, if the AHI is less than 15, you can’t make an OSA diagnosis unless the patient has associated symptoms, and that’s exactly what we’re talking about: sleepiness, quality of life, and more.”

Other Measures of OSA

While researchers commonly use AHI, other metrics have been used alongside it to give a broader sense of treatment, according to Dr. Kezirian, including the Epworth Sleepiness Scale and QOL measurement questionnaires. Additional measures also include blood pressure, oxygen desaturation index, psychomotor vigilance tasks, and, over the long term, serious cardiovascular events and mortality.

In clinical application, these other measurements can give a clearer picture of the patient’s reason for seeking treatment, particularly where OSA surgery is concerned. “A sleep study comes from a single night, either in a sleep laboratory where patients are hooked up to many different monitors, or at home where, although there are fewer monitors, it can still be disruptive,” said Dr. Kezirian. “The study may not capture the general pattern of a patient’s sleep over longer periods of time. This single snapshot of one night may not represent what’s typically happening for a particular patient for a number of reasons: Many patients tend to sleep more on their backs during studies and may give an artificially worse picture of their sleep apnea, and there is some disruption of sleep by the monitors, to name just a couple of those reasons. For patients and sleep surgeons considering surgery, there are many gradations of sleep apnea and a number of reasons why the AHI might not capture the effects of treatment, good and bad. That’s why other measures are helpful.”

They are not, however, without their problems, including the fact that the questionnaire measurements are highly subjective and can have a placebo effect. “If a patient undergoes surgery and wants to feel better, they sometimes will,” said Dr. Kezirian. “A better assessment would include a combination of metrics. An otolaryngologist could look at the sleep study result, but also at how that patient is doing overall.”

Looking Forward

“The goals of surgical OSA treatment are the reduction of cardiovascular risk, increased survival, reduced sleepiness, improved quality of life, and, of course, reduced snoring,” said Dr. Jacobowitz. “These can only be captured by using the AHI in conjunction with other quality of life, physiological, and clinical measurements.

So why haven’t alternate metrics been used more often in the clinical assessment of OSA treatment? Dr. Jacobowitz believes it’s a matter of familiarity and ease with using a single quantifiable parameter—the AHI. “The traditional gold-standard treatment of OSA is CPAP [continuous positive airway pressure], and CPAP was designed to improve AHI,” he added.

There is some evidence validating the use of a variety of metrics in outcome measurements. In the 2012 Laryngoscope study, outcomes not only showed a reduction in AHI (in all indices) but also a reduction in patient-reported symptoms. “OSA is not defined solely by a metric; the diagnosis and management of this condition takes into account patient symptomatology as well as disease severity…. Polysomnographic parameters as outcome measures are important surrogates of some clinical outcomes, such as cardiovascular risk, but they should not be mistaken for clinical outcomes themselves,” said the authors. “Similarly, the definition of surgical success should be by more than just the AHI reduction alone, and other outcomes should be included in assessment of postoperative consideration.”

“For CPAP, although you can normalize the AHI in the sleep lab, often there is residual elevated AHI at home and many patients do not use CPAP for the entire night at home,” added Dr. Jacobowitz. “When you look at this AHI variable with regard to sleep surgery outcome, typically the AHI is reduced significantly but doesn’t normalize completely. At the same time, with respect to meaningful primary clinical outcomes, CPAP and surgery can reduce cardiovascular morbidity and decrease the rate of car accidents despite that imperfect AHI reduction.”

For the future, Dr. Kezirian sees more otolaryngologists adopting broader assessments of patients. “These questionnaires have been around for a while, but they are now being used more often in routine clinical practice. They go beyond just asking, ‘How are you doing?’” he said. “Using the questionnaires helps us determine the benefits of treatment if outcomes are not perfect, so we can tell if someone is making progress. The AHI alone is too simplistic. Patients may have no or little change in their AHI but still feel better, but they can also show major improvement in the AHI but still feel awful, which isn’t good enough either.”

Dr. Jacobowitz believes that widespread adoption will come with greater emphasis on alternative measurements in any clinical trial for OSA. “This isn’t difficult for quality-of-life measures, but it will present a challenge for some other variables such as cardiovascular incidents because they must be measured over a very long time,” he said. “But we have to remember what’s important to the patient and for our health system: how the patient is functioning, and the overall status of their health.”

Amy Hamaker is a freelance medical writer based in California.

The Three Different Definitions of AHI

AHIChicago More than 50% decrease in a valid measure of air flow, or a lesser airflow reduction in association with an oxygen desaturation of more than 3%, or an arousal.

AHIRec Abnormal respiratory event lasting 10 seconds or more, with 30% or higher reduction in thoracoabdominal movement or airflow, and with 4% or higher oxygen desaturation.

AHIAlt 50% or higher reduction in nasal pressure signal excursions and 3% or higher desaturation or arousal.

Non-AHI Measurements of OSA

• Biological Measurements (including assessment of hypertension, C-reactive protein, myeloperoxidase, oxygen desaturation, cardiovascular events)
• Measurements of Sleepiness (including the Epworth Sleepiness Scale)
• Performance Measurements (including assessment of motor vehicle collisions and psychomotor vigilance tasks)
• QOL Measurements (including Short Form-36, Nottingham Health Profile, Sickness Impact Profile)

Abstracts from The Laryngoscope

What Is ‘‘Success’’ Following Surgery for Obstructive Sleep Apnea? The Effect of Different Polysomnographic Scoring Systems

ABSTRACT

Objectives/hypothesis: To illustrate that the diagnosis of obstructive sleep apnea (OSA) is dependent on the polysomnographic scoring criteria used, and the success rates of treatments for OSA are dependent on the defined outcome measures.

Study design: Retrospective case series with prospective reanalysis of polysomnographic data.

Methods: Consecutively treated adult patients (N 1/4 40) with moderate to severe OSA having multilevel pharyngeal surgery in 2007 were studied. All patients underwent submucosal lingualplasty and concurrent or previous uvulopalatopharyngoplasty six palatal advancement. Full polysomnography (PSG) was performed preoperatively and at a mean of 145 days postoperatively. Pre- and postoperative PSG data were analyzed by two different but widely used scoring systems for the apnea-hypopnea index (AHI): The American Academy of Sleep Medicine (AASM) 1999 Chicago criteria and the AASM 2007 recommended criteria.

Results: Follow-up PSG data were available in 31 of 40 patients. Successful surgery was defined as a reduction in AHIRec <20 with a 50% reduction from the patient’s baseline, and in this group the surgical intervention was associated with a 72.2% success rate. If, however, differing AHI metrics are used or the absolute or percent reduction used to define a successful outcome is changed, then the rate of surgical success is shown to range from 39% to 92%.

Conclusions: Different criteria for measuring AHI and defining success following OSA surgery can produce widely conflicting outcome data. Reported results following OSA surgery should be interpreted with this in mind. Using acceptable criteria, multilevel sleep surgery can be demonstrated to be of benefit to the majority of carefully selected patients. (Laryngoscope. 2012;122:1878-1881).

Outcome Measurements in Obstructive Sleep Apnea: Beyond the Apnea-Hypopnea Index

ABSTRACT

Objectives/hypothesis: The apnea-hypopnea index (AHI) is overwhelmingly used as the main therapeutic metric in the assessment of obstructive sleep apnea (OSA) in surgical studies. However, using AHI as the sole measure is problematic. This study investigates the utility of other outcome measures for patients with OSA undergoing surgery.

Study design: Systematic review of cohort and review studies.

Methods: A review was performed using the PubMed database. English articles focusing on outcome measures in adults with OSA were included. Studies in pediatric populations, those combining obstructing and central sleep apnea, and those without the use of outcome measures were excluded. Articles were categorized according to level of evidence. The Downs and Black scale and AMSTAR scale were used to assess quality.

Results: Of a total of 10,454 retrieved articles, 21 studies met inclusion and exclusion criteria. Most articles related to continuous positive airway pressure outcomes. Many categories of outcome measures were found: general quality of life, OSA-specific quality of life, measurements of sleepiness, performance, and physiological. Subjects with OSA scored differently in measurement tools in all categories compared to control populations or after treatment, and generally a poor correlation with AHI was seen.

Conclusions: The literature shows a range of tools based on symptoms and physiology of OSA that can assess effects of treatment. Assessment of surgical treatment for OSA should neither be limited to AHI as an outcome, nor should this be the only outcome stressed (Laryngoscope. 2014;124:337-343).

Changes in Obstructive Sleep Apnea Severity, Biomarkers, and Quality of Life After Multilevel Surgery

ABSTRACT

Objectives/hypothesis: To evaluate the impact of multilevel obstructive sleep apnea surgical treatment on sleep-disordered breathing severity, health-related measures, and quality of life, and to examine the association between changes in sleep-disordered breathing severity and these other outcomes.

Study design: Prospective cohort study.

Methods: Subjects with obstructive sleep apnea unable to tolerate positive airway pressure therapy and with evidence of multilevel (palate and hypopharynx) obstruction underwent uvulopalatopharyngoplasty, tonsillectomy, and genioglossus advancement, with or without hyoid suspension. All subjects had preoperative and postoperative study assessments, including blood draw for C-reactive protein, interleukin-6, homocysteine, homeostasis model of insulin resistance, and leptin, and evaluation with the Functional Outcomes of Sleep Questionnaire.

Is the Apnea/Hypopnea Index the Best Measure of Obstructive Sleep Apnea?

Results: Thirty subjects underwent multilevel surgical treatment. The mean apnea-hypopnea index decreased from 44.9 ± 28.1 to 27.8 ± 26.4 events/hour (P = .008). Thirteen (43%) subjects in this heterogeneous sample achieved a response to surgery (defined as an apnea-hypopnea index reduction of ≥50% to an absolute level less than 15 events / hour and body mass index ≤32 kg/m2 was associated with a higher likelihood (55%, 12/22) of response (P = .04). There was no overall change in C-reactive protein levels, but responders demonstrated a decrease (−1.02 ± 0.98 mg/L, P = .003) that was independent of changes in body weight. There were no significant changes in other health-related measures. Responders and nonresponders both demonstrated improvements in sleep-related quality of life.

Depression, Sleepiness, and Disease Severity in Patients with Obstructive Sleep Apnea

ABSTRACT

Objectives/hypothesis: To determine if a relationship exists between depression, disease severity, and sleepiness in patients with obstructive sleep apnea (OSA).

Study design: Case control study.

Methods: Fifty-three consecutive patients with suspected OSA were evaluated before treatment and compared with controls by using the Beck Depression Inventory (BDI), Epworth Sleepiness Scale (ESS), and polysomnography.

Results: OSA was associated with an increased risk of depression in the study group compared to the control group (odds ratio = 6.3, 95% confidence interval: 1.9-20.6, P = .002); depression was seen in 35% of OSA patients and 8% of controls (P < .001). There was a significant correlation between BDI and ESS scores (r = 0.342, P = .012). In addition, ESS was significantly associated (P = .039) with depression in a linear regression model that controlled for race, sex, age, and respiratory disturbance index (RDI). RDI and depression were weakly associated (P = .056) in this model, and there was no correlation found between BDI scores and OSA disease severity (RDI)(r = 0.446).

Conclusions: Patients with OSA and daytime sleepiness are more likely to have depressive symptoms as compared with controls. OSA disease severity, as measured with the RDI score, is a weak predictor of BDI score, and no correlation was seen between the severity of OSA and BDI scores after controlling for other factors. However, there was a strong correlation between sleepiness (ESS) and disease severity (BDI). These data suggest that OSA patients with symptoms of excessive sleepiness have the highest risk of associated depressive symptoms and may benefit most from depression screening (Laryngoscope. 2010:120:2331-2335).