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.”

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.

Does your dog's snoring keep you awake?

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

By Stacey Cohen

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

Photo © Tatiana Katsai - Fotolia

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

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

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

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

Extra pounds

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

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

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

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

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

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

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

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

The Drowsy Driving Epidemic [Infographic]

February 11, 2015 | Daniel R. Rosen


The Cost & Consequences of 168 Million Sleep-Deprived Drivers

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

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

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

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


Source: Law Offices of Daniel R. Rosen.

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.

Sleep deprived? Naps might help your immune system.

Published March 06, 2015 - Reuters

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

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

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

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

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

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

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

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

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

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

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

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

Grandner differentiates between two types of napping.

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

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

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

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

For Teens, Sleep Habits Can Run In The Family

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

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

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

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

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

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

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

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

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

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

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

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

How Much Sleep Is "Enough"?

By Dr. Mercola

If you’re like most people, you’re probably not sleeping enough, and the consequences go far beyond just feeling tired and sluggish the next day.

According to a 2013 Gallup poll,1 40 percent of American adults get six hours or less per night. Even children are becoming sleep deprived. According to the 2014 Sleep in America Poll,2 58 percent of teens average only seven hours of sleep or less.

Even the Centers for Disease Control and Prevention (CDC) has stated thatlack of sleep is a public health epidemic, noting that insufficient sleep has been linked to a wide variety of health problems.

For example, getting less than five hours of sleep per night may your double risk of heart disease, heart attack, and/or stroke. Research has also found a persistent link between lack of sleep and weight gain, insulin resistance, and diabetes.3,4

But while the risks of insufficient sleep are well-documented, there have been lingering questions about how much sleep is “enough,” and recommendations have shifted upward and downward over the years. On February 2, the National Sleep Foundation released updated guidelines5,6,7 to help clarify this question.

Updated Sleep Guidelines

Led by Harvard professor Charles Czeisler, the panel of experts reviewed more than 300 studies published between 2004 and 2014 to ascertain how many hours of sleep most people need in order to maintain their health. The recommendations they came up with are as follows:

Age Group	Recommended # of hours of sleep needed
Newborns (0-3 months)	14-17 hours
Infants (4-11 months)	12-15 hours
Toddlers (1-2 years)	11-14 hours
Preschoolers (3-5)	10-13 hours
School-age children (6-13)	9-11 hours
Teenagers (14-17)	8-10 hours
Young adults (18-25)	7-9 hours
Adults (26-64)	7-9 hours
Seniors (65 and older)	7-8 hours

As you can see, the general consensus is that from the time you enter your teenage years, you probably need right around eight hours of sleep on the average. According to the panel:

“Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.”

Modern Technology Can Affect Your Sleep in Several Ways

Modern technology is in large part to blame for many peoples’ sleep problems, for several reasons, including the following:

1. For starters, the exposure to excessive amounts of light from light bulbs and electronic gadgets at night hinders your brain from winding down for sleep by preventing the release of melatonin. (Melatonin levels naturally rise in response to darkness, which makes you feel sleepy.)
2. Electromagnetic radiation can also have an adverse effect on your sleep even if it doesn’t involve visible light.
According to the 2014 Sleep in America Poll,8 53 percent of respondents who keep personal electronics turned off while sleeping rate their sleep as excellent, compared to just 27 percent of those who leave their devices on.
3. Maintaining a natural rhythm of exposure to daylight during the day, and darkness at night, is an essential component of sleeping well. But not only are most people exposed to too much light after dark, they’re also getting insufficient amounts of natural daylight during the day.
Daytime exposure to bright sunlight is important because it serves as the major synchronizer of something called your master clock, which in turn influences other biological clocks throughout your body.

Even Daytime Use of Technology Can Significantly Prevent Sleep, Especially Among Teens

People now get one to two hours less sleep each night, on average, compared to 60 years ago.9 A primary reason for this is the proliferation of electronics, which also allows us to work (and play) later than ever before. 

According to recent research, teens in particular may have difficulty falling asleep if they spend too much time using electronic devices—even if their use of technology is restricted to daytime hours! As reported by the Huffington Post:10

“The cumulative amount of screen time a teen gets throughout the day -- not just before bedtime -- affects how long they sleep, according to the study11...

‘One of the surprising aspects was the very clear dose-response associations,’ said the study's lead researcher Mari Hysing... ‘The longer their screen time, the shorter their sleep duration.’"

Boys spent more time using game consoles, while girls favored smartphones and MP3 music players, but regardless of the type of device, the effect on sleep was the same. The researchers found that:

• Using an electronic device within one hour of bedtime resulted in spending more than an hour tossing and turning before falling asleep
• Using electronics for four hours during the day resulted in a 49 percent increased risk of needing more than one hour to fall asleep, compared to those who used electronics for less than four hours total
• Those who used any device for more than two hours per day were 20 percent more likely to need more than an hour to fall asleep, compared to those whose usage was less than two hours
• Those who spent  more than two hours online were more than three times as likely to sleep less than five hours compared to their peers who spent less time online

Good Sleep in Middle Age May Benefit You in Your Senior Years

Another study12,13--which looked at sleep habits and mental functioning in later years—reviewed 50 years’ worth of sleep research, concluding that sleeping well in your middle-age years is an “investment” that pays dividends later. According to Michael Scullin, director of the Sleep Neuroscience and Cognition Laboratory at Baylor University in Texas: "We came across studies that showed that sleeping well in middle age predicted better mental functioning 28 years later.”

This seems like a reasonable conclusion when you consider the more immediate benefits of getting enough sleep. Accumulated over time, both hazards and benefits are likely to pay dividends or exact a toll... For example, recent research14,15,16 shows that lack of sleep can shrink your brain, which, of course, can have adverse long-term ramifications. Other research published in the journal Neurobiology of Aging17 suggests that people with chronic sleep problems may develop Alzheimer’s disease sooner than those who sleep well.

Researchers have also found18 that adding just one hour of sleep a night can boost your health rather drastically. Here, they set out to determine the health effects of sleeping 6.5 hours versus 7.5 hours a night. During the study, groups of volunteers slept either 6.5 hours or 7.5 hours a night for one week. They then swapped sleeping durations for another week, yielding quite significant results. For starters, the mental agility tasks became much more difficult for the participants when they got less sleep. Other studies have also linked sleep deprivation to decreased memory recall, difficulty processing information, and dampened decision-making skills.

Even a single night of poor sleep—meaning sleeping only four to six hours—can impact your ability to think clearly the next day. It's also known to decrease your problem solving ability. The researchers also noted that about 500 genes were impacted. When the participants cut their sleep from 7.5 to 6.5 hours, there were increases in activity in genes associated with inflammation, immune excitability, diabetes, cancer risk and stress. From the results of this study, it appears as though sleeping for an extra hour, if you’re regularly getting less than seven hours of sleep a night, may be a simple way to boost your health. It may even help protect and preserve brain function in the decades to come.

A Fitness Tracker Can Be a Helpful Tool to Get More Sleep

To optimize sleep, you need to make sure you’re going to bed early enough, because if you have to get up at 6:30am, you’re just not going to get enough sleep if you go to bed after midnight. Many fitness trackers can now track both daytime body movement and sleep, allowing you to get a better picture of how much sleep you’re actually getting. Chances are, you’re getting at least 30 minutes less shut-eye than you think, as most people do not fall asleep as soon as their head hits the pillow.

I recently detailed some of the benefits of fitness trackers in my article “The Year in Sleep.” Newer devices, like Jawbone’s UP3 that should be released sometime this year, can even tell you which activities led to your best sleep and what factors resulted in poor sleep. When I first started using a fitness tracker, I was striving to get eight hours of sleep, but my Jawbone UP typically recorded me at 7.5 to 7.75. I have since increased my sleep time, not just time in bed, but total sleep time to over eight hours per night. The fitness tracker helped me realize that unless I am asleep, not just in bed, but asleep by 10 pm, I simply won’t get my eight hours. Gradually I have been able to get myself to sleep by 9:30 pm.

How to Support Your Circadian Rhythm and Sleep Better for Optimal Health

Making small adjustments to your daily routine and sleeping area can go a long way to ensure uninterrupted, restful sleep and, thereby, better health. I suggest you read through my full set of 33 healthy sleep guidelines for all of the details, but to start, consider implementing the following key changes:

• Make sure you regularly get BRIGHT sun exposure during the day. Your pineal gland produces melatonin roughly in approximation to the contrast of bright sun exposure in the day and complete darkness at night. If you are in darkness all day long, it can't appreciate the difference and will not optimize your melatonin production. To help your circadian system to reset itself, make sure to get at least 10-15 minutes of morning sunlight. This will send a strong message to your internal clock that day has arrived, making it less likely to be confused by weaker light signals later on.
Also aim for 30-60 minutes of outdoor light exposure in the middle of the day, in order to “anchor” your master clock rhythm. The ideal time to go outdoors is right around solar noon but any time during daylight hours is useful. A gadget that can be helpful in instances when you, for some reason, cannot get outside during the day is a blue-light emitter. Philips makes one called goLITE BLU.19 It’s a small light therapy device you can keep on your desk. Use it twice a day for about 15 minutes to help you anchor your circadian rhythm if you cannot get outdoors.
• Avoid watching TV or using your computer in the evening, at least an hour or so before going to bed. Once sun has set, avoid light as much as possible, to promote natural melatonin secretion, which helps you feel sleepy. Devices such as smartphones, TVs, and computers emit blue light, which tricks your brain into thinking it's still daytime. Normally, your brain starts secreting melatonin between 9 and 10 pm, and these devices emit light that may stifle that process and keep you from falling asleep.
Even the American Medical Association now states:20 “…nighttime electric light can disrupt circadian rhythms in humans and documents the rapidly advancing understanding from basic science of how disruption of circadian rhythmicity affects aspects of physiology with direct links to human health, such as cell cycle regulation, DNA damage response, and metabolism.”
• Be mindful of electromagnetic fields (EMFs) in your bedroom. EMFs can disrupt your pineal gland and its melatonin production, and may have other negative biological effects as well. A gauss meter is required if you want to measure EMF levels in various areas of your home. At minimum, move all electrical devices at least three feet away from your bed. Ideally, turn all devices off while you’re sleeping. You may also want to consider turning off your wireless router at night. You don’t need the Internet on when you are asleep.
• Sleep in darkness. Even a small amount of light in your bedroom can disrupt your body’s internal clock and your pineal gland's melatonin production. Even the glow from your clock radio could be interfering with your sleep, so cover your radio up at night or get rid of it altogether. You may want to cover your windows with drapes or blackout shades. A less expensive alternative is to use a sleep mask.
• Install a low-wattage yellow, orange, or red light bulb if you need a source of light for navigation at night. Light in these bandwidths does not shut down melatonin production in the way that white and blue bandwidth light does. Salt lamps are handy for this purpose. You can also download a free application called f.lux21 that automatically dims your monitor or screens.
• Keep the temperature in your bedroom below 70° Fahrenheit. Many people keep their homes too warm (particularly their upstairs bedrooms). Studies show that the optimal room temperature for sleep is between 60 to 68° F.