Sleep Apnea May Reduce Antidepressant Response, Increase Dementia Risk

Published on April 7, 2015

Studies suggest sleep apnea may have a strong influence on antidepressant response and increase the risk for mild cognitive impairment in older patients with major depressive disorder, reports Medscape.

“This shows that clinicians should definitely screen for sleep apnea when patients are presenting with late-life depression,” lead author Lauren Waterman, from the University of Pittsburgh School of Medicine, Pennsylvania, told Medscape Medical News.

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

Documentary Film Explores the Enormous Price We Pay for Ignoring the Need for Sleep

January 17, 2015

By Dr. Mercola

According to the documentary, Sleepless in America, coproduced by the National Geographic Channel, 40 percent of Americans are sleep deprived. Many get less than five hours of sleep per night. Percentage-wise, adolescents are among the most sleep deprived.

The consequences are dire, not just for the individual who isn’t getting enough rest, but for those around them as well. While most people don’t give lack of sleep much thought, there are in fact life-threatening consequences.

Notably, “experts now believe that sleep deprivation may have played a role in the Exxon Valdez oil spill, the Staten Island ferry crash, and the Three-Mile Island nuclear meltdown,” the film states. Countless people have also lost their lives to tired drivers who simply dozed off behind the wheel.

It’s important to realize that getting less than six hours of sleep each night leaves you cognitively impaired. Sleep deprivation has also been linked to health effects such as obesity, diabetes, cardiovascular disease, Alzheimer’s,1and cancer. Depression and anxiety disorders are also adversely impacted by lack of sleep.

The Importance of Staying in Sync with Nature

Maintaining a natural rhythm of exposure to sunlight during the day and darkness at night is one crucial foundational component of sleeping well.

This was addressed in a previous interview with researcher Dan Pardi. In it, he explains how exposure to bright daylight serves as the major synchronizer of your master clock—a group of cells in your brain called the suprachiasmatic nuclei (SCN).

These nuclei synchronize to the light-dark cycle of your environment when light enters your eye. You also have other biological clocks throughout your body that are synchronized to your master clock.

One reason why so many people get so little sleep, and/or such poor sleep, can be traced back to a master clock disruption. In short, most people spend their days indoors, shielded from bright daylight, and then spend their evenings in too-bright artificial light.

As a result, their body clocks get out of sync with the natural rhythm of daylight and nighttime darkness, and when that happens, restorative sleep becomes elusive.

An estimated 15 million Americans also work the night shift, and the adverse health effects of working nights are well documented. As just one example, three years of periodical night shift work can increase your risk for diabetes by 20 percent, and this risk continues to rise with time.

What Happens When You’re Sleep Deprived?

What makes sleep deprivation so detrimental is that it doesn’t just impact oneaspect of your health… it impacts many. Among them are five major risks to your mental and physical well-being:

1. Reaction time slows: When you’re sleep-deprived, you’re not going to react as quickly as you normally would, making driving or other potentially dangerous activities, like using power tools, risky. One study even found that sleepiness behind the wheel was nearly as dangerous as drinking and driving.2
2. Your cognition suffers—both short- and long-term: A single night of sleeping only four to six hours can impact your ability to think clearly the next day. In one animal study,3 sleep deprived mice lost 25 percent of the neurons located in their locus coeruleus, a nucleus in the brainstem associated with cognitive processes.
Hence, if you’re sleep-deprived you will have trouble processing information and making decisions. This is why it’s so important to get a good night’s sleep prior to important events at work or home.
For example, research discussed in the film found that diagnostic mistakes shot up by 400 percent among doctors who had worked for 24 consecutive hours.

Sleep deprived medical residents also reported a 73 percent increase in self-inflicted needle sticks and scalpel stabs, and when driving home from work, they had a 170 percent increased risk of having a serious motor vehicle accident.
Research4 also suggests that people with chronic sleep problems may develop Alzheimer’s disease sooner than those who sleep well. One of the reasons for this is because sleep is critical for brain detoxification—a process during which harmful proteins linked to Alzheimer's are cleared out.
3. Memory and learning declines: The process of brain growth, orneuroplasticity, is believed to underlie your brain's capacity to control behavior, including learning and memory. However, sleep and sleep loss modify the expression of several genes and gene products that may be important for synaptic plasticity.
Furthermore, certain forms of long-term potentiation, a neural process associated with the laying down of learning and memory can be elicited in sleep, suggesting synaptic connections are strengthened while you slumber.
4. Emotions are heightened: As your reaction time and cognition slows, your emotions will be kicked into high gear. This means that arguments with co-workers or your spouse are likely, and you’re probably going to be at fault for blowing things out of proportion.
The amygdala controls basic emotions like fear and anger. As discussed in the film, another area of your brain called your frontal cortex, plays a key role in the regulation of emotions, and sleep is vital for its function.
When you’re well rested, your frontal cortex is nicely connected to your amygdala—that deep emotional center—and works almost like “a break to your emotional gas pedal.”
Sleep deprivation causes a disconnect between these two brain centers, allowing your emotions to run amok. Sleep deprivation also plays an important role in mental illness, and tends to result in more adverse psychiatric outcomes.
5. Immune function and health deteriorates: Sleep deprivation has the same effect on your immune system as physical stress or illness,5 which may help explain why lack of sleep is tied to an increased risk of numerous chronic diseases.
For example, research shows that sleeping less than six hours per night more than triples your risk of high blood pressure, and women who get less than four hours of shut-eye per night double their chances of dying from heart disease.6

You Need Around Eight Hours of Sleep Every Night

The studies are quite clear and most experts agree, you are seriously fooling yourself if you think you can do fine on less than eight hours of sleep. But eight hours of sleep is not eight hours in bed. If you go to bed at 10 pm and get out of bed at 6 am, you might say you’ve slept for eight hours. In reality, you probably spent at least 15-30 minutes falling asleep and may have woken during the night one or more times.

With the advent of fitness-tracking devices such as Jawbone’s UP, however, we now have access to actual sleep data (and more) from wristband users. The data is quite useful on a personal level and they helped me understand that I need to start getting to sleep around 9.30 PM if I hope to get a full eight hours of sleep, which I now typically do.

Newer devices, like Jawbone’s UP3 that should be released in early 2015, can even tell you what activities led to your best sleep and what factors resulted in poor sleep. It’s also fascinating on a larger scale, as the data reveal insights into sleep patterns from around the world.

The Glorification of Sleep Deprivation

According to the 2013 International Bedroom Poll by the National Sleep Foundation,7 25 percent of Americans report having to cut down on sleep due to long workdays. On average, Americans get only 6.5 hours of sleep on weeknights, but report needing 7.25 hours in order to function optimally. As noted in a previous article in The Atlantic:8

“For some, sleep loss is a badge of honor, a sign that they don’t require the eight-hour biological reset that the rest of us softies do. Others feel that keeping up with peers requires sacrifice at the personal level—and at least in the short-term, sleep is an invisible sacrifice.”

Modern man’s penchant for equating sleep with unproductiveness (if not outright laziness) can be traced back to the heyday of Thomas Edison, who was known for working around the clock. According to the featured article:9

“Edison spent considerable amounts of his own and his staff’s energy on in publicizing the idea that success depended in no small part in staying awake to stay ahead of the technological and economic competition.”  No one... did more to frame the issue as a simple choice between productive work and unproductive rest ...

Over time, children’s books and magazines began to promote this type of Edisonian asceticism... Edison encouraged all Americans to follow his lead, claiming that sleeping eight hours a night was a waste and even harmful. “There is really no reason why men should go to bed at all,” he said in 1914.”

This culture of sleep deprivation started with the invention of the light bulb, and has only gotten worse with the proliferation of light-emitting electronics, which disrupt your natural waking-sleeping cycle. The following infographic, created by BigBrandBeds.co.uk, illustrates how your electronic gadgets wreak havoc on your sleep when used before bedtime.10

Notes from Dr. Norman Blumenstock
Dr Oz  understands the importance of of optimal sleep.

Please check out the video.

http://www.doctoroz.com/episode/dr-oz-nationwide-sleep-clinic-sleep-breakthroughs-uncovered

Sleep Therapy Seen as an Aid for Depression

Notes from Dr. Norman Blumenstock:

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

By BENEDICT CAREY

Published: November 18, 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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