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For the millions who suffer from Restless Legs Syndrome, sleep can be exceedingly difficult and disrupted. RLS is a neurological disorder and a sleep disorder, a condition that causes tingling, twitching, “creepy-crawly” feelings in the legs. These uncomfortable sensations bring about an often-urgent need to move the legs. The symptoms of RLS are most often felt when a person is lying still for a period of time, and are frequently experienced at bedtime. People with RLS commonly experience symptoms of insomnia—difficulty falling asleep and staying asleep. Medications for RLS can be successful in alleviating the twitching and tingling sensations in the lower body, but very often the insomnia symptoms remain, leaving people with RLS coping with chronic sleep problems even after the other RLS symptoms have disappeared. 

This is just one of the puzzling aspects of RLS, a condition that has proved mysterious and difficult to understand, diagnose, and treat. But new research may have delivered an important breakthrough in our understanding of how RLS works in the body, and why sleep problems can stubbornly persist even after successful treatment for tingling, twitching legs. 

Researchers at Johns Hopkins University School of Medicine investigated the relationship between brain chemistry and sleep among patients with RLS. They discovered abnormally high levels of a brain chemical involved in stimulating arousal. The brain chemical glutamate is an important neurotransmitter that arouses both the brain and the central nervous system. Researchers found elevated levels of glutamate present in the brains of patients with RLS. Abnormal levels of glutamate may help explain why RLS patients continue to have trouble sleeping, even after other medications have quieted the disruptive sensations in their legs. 

Researchers evaluated 48 adults, including 28 patients with RLS and 20 subjects without the condition. Those with RLS had experienced symptoms of the condition for at least 6 months, on 6 or 7 nights per week. Researchers first measured glutamate levels in the brain using MRI. They then spent two days measuring participants’ sleep. They found significantly higher levels of glutamate among RLS patients than in those without the condition. Among the RLS patients in the study, those with higher levels of glutamate experienced more severely disrupted sleep. 

This was a small study, and we’ll need to see follow-up research on a larger scale to confirm and further establish the role of glutamate in RLS. But these findings could represent an important step forward in our understanding of RLS. What’s more, this new information could bring about significant changes in treatment of the condition. 

Previous research and treatment for RLS has focused on another of the brain’s neurotransmitters: dopamine. Dopamine plays an important role in muscle activity and body movement, and dopamine deficiency can result in involuntary muscle movement. Several drug treatments for RLS involve raising levels of dopamine, in order to soothe the involuntary twinges and intense urges to move the legs. But these drugs have not been successful in improving RLS patients’ sleep. 

This new research may deliver an important piece of information to the RLS-sleep puzzle. High levels of glutamate in patients with RLS may be preventing these patients from sleeping well, a problem that is not currently being addressed by the array of dopamine-related medications being used to treat other symptoms of the condition. 

As many as 10% of adults in the U.S. suffer from RLS, according to the National Sleep Foundation. RLS is a condition that very often goes undiagnosed or misdiagnosed. RLS can often be misdiagnosed as another sleep disorder or another neurological disorder, a muscular disorder. Depression is another common misdiagnosis for RLS. Research shows a strong association between depression and RLS. People with RLS appear to be at a significantly elevated risk for depression. The poor sleep experienced by so many RLS patients may play a role in their increased risk for depression. In addition to chronic sleep problems and depression, patients with RLS also appear to be at elevated risk for other serious health conditions, including hypertension and coronary heart disease. The cause of RLS is not known, but the condition does run in families, and recent research has shown evidence of a genetic link. 

This latest research is an exciting breakthrough, with the potential to transform our understanding of RLS. There are many steps still to take, and questions to be explored and answered, before we know what changes are best made to the way we treat RLS. But for a condition that has often confounded experts, and caused such discomfort, disruption, and sleeplessness to so many patients, this study brings both welcome and encouraging news.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor®
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor  @sleepdrteam
Facebook: www.facebook.com/thesleepdoctor

There are several risk factors associated with obstructive sleep apnea that are long-standing and well known. They include lifestyle and health factors such as obesity or excess body weight, high-blood pressure, and alcohol and tobacco use, as well as genetic and demographic factors such as family history of the disease, being older, and being male. Now, thanks to new research, we may have a new OSA risk factor to add to this list: asthma. 

Researchers at the University of Wisconsin investigated the influence of asthma in the development of obstructive sleep apnea. They found a significantly elevated risk for OSA among people with asthma. Those people who’d developed asthma as children were at particularly elevated risk. Researchers observed 773 adult men and women over a period of 8 years. All were participants in the Wisconsin Sleep Cohort study, and were between ages 30-60 at the time the study began. Of the 773 participants, 201 had asthma at the beginning of the study period, and 61 of them had developed asthma during childhood. None of the participants had obstructive sleep apnea. Every four years, the subjects participated in laboratory sleep evaluations, clinical health assessments, and health questionnaires. After adjusting for other risk factors for sleep apnea, including age, gender, body-mass index, smoking, and nasal congestion, researchers found that the presence of asthma significantly increased the risk for sleep apnea:

• People with asthma were 1.70 times more likely to develop sleep apnea over the 8-year study period than those without asthma.
• Among those in the study who had developed asthma during childhood, the risk was even higher. These people had 2.34 times the risk of developing obstructive sleep apnea, compared to those without asthma.
• Researchers found that the longer asthma had been present, the higher the risk for sleep apnea. Every 5-year period a person had asthma was associated with a 10% increase to their risk of developing obstructive sleep apnea.
• Among the participants, 45 developed asthma during the study observation period. Researchers found that these people were 48% more likely to develop sleep apnea than those without asthma. The size of this group was too small for researchers to demonstrate a statistical significance to these results. In their discussion of the study’s results, researchers pointed to this particular finding as an important one for follow-up investigation. 

This latest study is not the first to demonstrate a link between asthma and sleep apnea. Previous research has shown connections between the two conditions:

• In a study of more than 4,500 adults ages 20-69, asthma was found associated with symptoms common to sleep apnea, including snoring, apneas, and daytime sleepiness.
• Researchers at Israel’s Technion-Israel Institute of Technology investigated whether difficult-to-control asthma might influence the onset of sleep apnea. They found that patients with unstable, hard-to-control asthma were at significantly higher risk for obstructive sleep apnea.
• Researchers at the University of Wisconsin also looked at the risk of sleep apnea among patients with poorly controlled asthma, and found these patients were at higher risk for obstructive sleep apnea after adjusting for other sleep apnea risk factors, including obesity. 

These and other previous studies have identified an association between the two disorders, asthma and sleep apnea. The latest study comes an important step closer to establishing a causal link between the two conditions, by examining specifically the direction of the relationship between the two. The presence of asthma in people later identified as being more likely to develop sleep apnea suggests that asthma may actually contribute to the onset of sleep apnea. 

Asthma is a lung disease that causes difficulty breathing, shortness of breath, coughing, and wheezing. Some people can experience these symptoms at night, and they can interfere with sleep. Establishing asthma as a risk factor for OSA is an important public health development. More than 25 million Americans suffer from asthma, including 7 million children. If these adults and children are at higher risk for obstructive sleep apnea because of their asthma, they are also at risk for the complications that come with sleep apnea. Obstructive sleep apnea is associated with increased risk for a number of health problems, including heart disease, diabetes, and some cancers. Children can experience apnea and sleep-disordered breathing as well, and children have their own set of health risks associated with the condition, including problems with emotional, social, and cognitive development. 

Finding new ways to identify and prevent obstructive sleep apnea is critical to the sleep and overall health of millions of Americans who suffer from this serious sleep disorder. The research into the role of asthma is an important step in this direction.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor®
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor  @sleepdrteam
Facebook: www.facebook.com/thesleepdoctor

More than 238,000 men are diagnosed with prostate cancer in the United States each year, according to the American Cancer Society.  Approximately 1 in 6 men will be diagnosed with the disease at some point in their lifetime. What if the quality of sleep plays a role in a man’s risk for developing the disease? 

That’s the question posed by a new study examining the link between prostate cancer and disrupted sleep. It’s just the latest in a wave of research in recent years that has discovered links between poor sleep and several types of cancer. The results of the latest study suggest that men who have trouble falling asleep and staying asleep—two common symptoms of insomnia—may be at twice the risk of developing prostate cancer. 

Researchers from the University of Iceland in Reykjavik followed 2,102 men over a period of five years. The men were all part of a large public-health study in Iceland that included more than 2,000 men between the ages 67-96. None of the men had prostate cancer at the time the study began. At the study’s outset, researchers asked all the men four questions related to their sleep:

• Did they take medication to help them sleep?
• Did they have trouble falling asleep?
• Did they wake up in the night and have difficulty returning to sleep?
• Did they wake up early in the morning and have trouble falling back asleep? 

After observing the men for five years, and adjusting for factors such as age, researchers found that poor sleep was associated with elevated risk for prostate cancer:

• 8.7% of men reported experiencing severe sleep problems
• 5.7% of men reported sleep problems classified as “very severe”
• During the five-year study period, 6.4% of men were diagnosed with prostate cancer.
• Difficulty falling asleep and staying asleep was associated with an increased risk for prostate cancer. Men with trouble falling asleep and staying asleep were between 1.7 to 2.1 times as likely to develop prostate cancer as those without these sleep problems
• Among men with advanced prostate cancer, the link with disrupted sleep was even stronger. Men with “very severe” sleep problems demonstrated as high as 3.2 times the risk of developing prostate cancer as those who did not experience sleep problems 

This study adds to the growing body of research showing evidence of a relationship between poor sleep and risk for prostate cancer and other types of cancer. No direct, causal link has been established between sleep problems and the onset of cancer. But several studies in recent years have shown strong associations between risk levels for cancer and poor, insufficient, and disrupted sleep: 

• A team of researchers at Harvard University investigated the relationship between sleep duration, snoring, and risk of colorectal cancer. Using data from the Health Professionals Follow Up Study and the Nurses’ Health Study, researchers included in their study more than 30,000 men and 70,000 women between ages 40-73. They found that longer sleep duration—sleeping 9 or more hours per night—was linked to increased risk of colorectal cancer in people who are overweight and who snore regularly. As these are symptoms of obstructive sleep apnea, these results raise the question whether the effects of sleep-disrupted breathing might be a factor in cancer risk. 

• Researchers at Case Western Reserve University also studied sleep and the risk of colorectal cancer. They found that people who averaged less than 6 hours of sleep per night had a 50% higher risk of colorectal cancer, compared to those who slept at least 7 hours nightly. Participants who developed colorectal cancer were also more likely to report having been diagnosed with sleep apnea, and were more likely to have participated in shift work. 

• Several studies have shown links between disrupted sleep and increased risk of breast cancer. A number of these studies used women participating in shift work, which frequently results in overnight work shifts and changing sleep schedules. Shift work puts people at high risk for disrupted sleep, sleep disorders, and a range of health problems. 

• Researchers in Japan examined the risk of prostate cancer among shift workers, and found an elevated risk among certain shift workers. Researchers observed more than 14,000 working men in Japan, and found that those who worked rotating shifts were 3 times as likely to develop prostate cancer as day workers. Men who worked fixed-schedule night shifts showed a very small increase to their risk of developing prostate cancer. 

We’re still at the early stages of understanding just how significant a role sleep may play as a risk factor in the development of cancer. This is an important area of study that could have a significant impact on prevention and screening, and perhaps even treatment of the disease. The prospect of a connection between sleep and cancer risk is yet another very important reason to maintain healthy sleep habits. 

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor®
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor  @sleepdrteam
Facebook: www.facebook.com/thesleepdoctor

Calories in, calories out. We’ve all heard this basic, fundamental calculation regarding weight loss and weight gain. To lose weight, we must expend more calories than we take in. Consume more than you need, and the result? The pounds go on. Turns out, lack of sleep may increase daily calorie consumption, and contribute to weight gain. 

There is a tremendous amount of evidence that sleep plays an important role in weight management. Insufficient sleep is strongly linked to obesity and metabolic disorders, as well as to diabetes. But we’re still working to understand the underlying mechanisms by which sleep can influence weight. 

A new study examined the effects of insufficient sleep on weight gain, and looked specifically at energy intake (calories in) and energy expenditure (calories out). Researchers investigated the effects of sleep on these two critical factors in weight management. What did they find? During periods of insufficient sleep, people increased their calorie consumption and as a result gained weight. What’s more, people who slept too little consumed more of their calories later in the day, which may further contribute to weight gain. 

Researchers included 16 adults in a 14-15 day inpatient study. All volunteers were in good health, and at a healthy weight. Participants spent the roughly 2-week study period in a controlled environment, where researchers could manage and monitor their sleep and eating patterns. Researchers collected baseline health and weight measurements from all 16 volunteers during the study’s first 3 days. During this time participants were allowed to sleep to a maximum of 9 hours per night. Their eating was regulated during this 3-day period so they were only consuming what they needed to maintain their initial weight. 

Next, researchers split participants into 2 groups. One group continued to be allowed to sleep for as much as 9 hours nightly. The other group was limited to 5 hours of sleep per night. They slept this way for 5 consecutive nights, in a sleep pattern designed to mimic a typical workweek. During this 5-day period, both groups were allowed the same unrestricted access to food. Participants were allowed to eat larger meals, and were given free access to snacks between meals. Snack foods included both low-calorie options like fresh fruit, and high-calorie, high-fat choices such as chips and ice cream. After 5 days, the groups switched sleep schedules, for another 5-day cycle. During both 5-day phases, researchers conducted measurements and analysis of participants’ sleep and their energy expenditure. 

Their results shed light on the relationship of sleep to calorie consumption and output, and on some of the ways that sleep may contribute to weight gain. Researchers found: 

• Participants whose sleep was restricted to 5 hours a night for 5 consecutive nights burned 5% more overall calories daily than those who were allowed to sleep up to 9 hours per night. However, the daily calorie intake of restricted sleepers was 6% higher than longer sleepers. The result? An energy imbalance for restricted sleepers, with more calories consumed than used. 

• This energy imbalance led to an average weight gain of almost 2 pounds for those in the restricted sleep phase. 

• The 5-day restricted sleep pattern also resulted in alterations to participants’ circadian rhythms: the onset of nighttime melatonin release was delayed, and wake times occurred earlier. 

• Eating patterns also changed among participants in the 5-hour nightly sleep phase. People ate less early in the day, and pushed more of their eating to evening hours. In particular, people whose sleep was restricted snacked more at night. Evening snacks increased to the point where the calories consumed in these late-day snacks exceeded the calories consumed in any single meal during the day. 

• When people moved from restricted sleep to the longer sleep period, their daily calorie intake reduced. In particular, researchers saw a drop in fat and carbohydrate consumption. The transition resulted in slight weight loss among this group. 

• Researchers found that men and women responded differently to sleep restriction, with regard to weight. Overall, women were able to maintain their weight during the 9-hour nightly sleep phase, during which they had unrestricted access to food. Men, on the other hand, were more likely to gain weight in this phase. But in the restricted-sleep phase, women were more likely to gain weight than men. 

These results strongly align with other recent research on the impact of poor sleep on weight. In particular, we’ve seen other studies suggest the restricted sleep may make it more difficult for people to choose healthful foods, and that lack of sleep may contribute to a shift in calorie consumption to later in the day, to the detriment of our waistlines. 

• A pair of recent studies indicates that sleep deprivation causes neurological changes that may compromise judgment and trigger desire for unhealthful foods. This study found that lack of sleep is associated with diminished activity in the brain’s frontal lobe, an area that’s critical to judgment and complex decision making. Participants who were sleep deprived made different, less healthful food decisions than those who were not. And in this study, researchers found that in people who were sleep deprived, the reward center of the brain was more strongly activated by unhealthful foods than in those who had received sufficient sleep. 

• This 2011 study examined the timing of sleep and of eating, and their impact on weight. Researchers found that “night owls”—people with late bedtimes—did more of their daily eating in the evening, compared to those with earlier bedtimes. People with later bedtimes also slept less overall, and had lower quality sleep. Night owls consumed more calories at dinner and after 8 p.m. than those whose bedtimes were earlier. 

• A study of mice found that alterations to a circadian-linked gene involved in hunger regulation caused the mice to become obese. Disruptions to this “clock gene” also altered the timing of the mice’s eating, causing them to consume more calories during the period normally reserved for rest. 

The challenge of maintaining a healthy weight is a daily endeavor, made up of many small choices—What to eat? How much? When?—that over time have a powerful cumulative effect. A strongly routine of sufficient nightly sleep can aid in this endeavor, helping your body and mind work at its best, every day, for weight control and overall health.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

New research about sleepwalking has raised questions about several common beliefs regarding this frequently misunderstood sleep disorder. Researchers at the University of Montreal conducted a comprehensive review of more than 15 years of study on the topic of sleepwalking. Their analysis produced what may be a clearer picture of the sleep disorder, its possible mechanisms, and its risk factors. Their analysis also challenges some common beliefs about sleepwalking—beliefs that, if outdated, could interfere with diagnosis and treatment.  

What are these views on sleepwalking that researchers say are not supported by data? There are three primary ones, which involve the experience of activities during sleepwalking as well as the daytime effects of the disorder. Researchers say that the cumulative data challenges these three notions:

• Sleepwalkers do not remember their episodes
• The actions that sleepwalkers take during episodes have no underlying motivation
• Sleepwalking has no effect on daytime behavior 

Researchers found, in fact, that the memory recall can vary, with some sleepwalkers retaining memories of their episodes and others not. During an episode of sleepwalking, people are in a state that researchers call “dissociated arousal,” with parts of the brain in a sleeping state and other parts of the brain in a waking state. This may help to explain why some can remember their experiences while others cannot.  

Scientists also found evidence to contradict the common belief that people’s actions during sleepwalking are simply irrational, lacking any underlying motivation. The accumulated data, researchers say, suggests otherwise. It is true that episodes of sleepwalking often include strange and seemingly irrational behavior. But researchers found that sleepwalkers who were able to recall their actions during these episodes could also identify a rationale for their behavior, even in circumstances where their actions later seemed strange to them. This led researchers to conclude that sleepwalkers retain motivation for their actions during episodes.  

Contrary to the view that the effects of sleepwalking are confined to nighttime episodes, this analysis found that sleepwalkers do experience daytime effects from the disorder. A high percentage of sleepwalkers—nearly 45%--reported daytime sleepiness. Sleepwalkers perform less well on vigilance tests than those without the disorder. And sleepwalkers who were allowed to nap during the day fell asleep more quickly than those who did not sleepwalk.  

Other conclusions that came from this analysis aligned with recent research on sleepwalking. One has to do with genetics. The current review found that nearly 80% of sleepwalkers have a family history of the sleep disorder. Researchers identified stress and fatigue as possible causes of sleepwalking, but said that for people who have a genetic predisposition, any disruption to sleep might trigger the disorder.  

This conclusion is in line with previous studies, which also found family history linked strongly to the disorder. In this study, researchers at Stanford University investigated sleepwalking and found a strong family connection, with more than 30% of the study population able to identify least one other family member with the sleep disorder. The Stanford study, reported in 2012, also found sleepwalking to be significantly more common than often is thought. Stanford researchers found as many as 3.6% of U.S. adults may experience some form of nocturnal wandering during any given year. And when sleepwalking is considered over the course of a lifetime, including childhood, as many as 30% of the population may have some experience of the disorder.  

Sleepwalking is more common during childhood, a conclusion confirmed by this latest research review. Data indicates that sleepwalking is most common in children ages 6-12. Researchers link childhood prevalence of sleepwalking to brain development, and the readiness of a young brain to successfully complete the complicated neurological task of transitioning from wake to sleep. Very often, episodes of sleepwalking will diminish and disappear altogether during adolescence. But as many as 25% of adolescent sleepwalkers will continue to have episodes during adulthood, researchers say.  

Sleepwalking in adulthood will also decrease with age. This is related to a diminished amount of time spent in the phases of deep sleep, also known as slow-wave sleep. Sleepwalking occurs during periods of slow-wave sleep. As we age, we naturally spend less time in slow-wave sleep, and sleepwalking tends to occur with less frequency. Researchers conducting the review point to evidence of abnormalities in the slow-wave sleep of sleepwalkers, including repeated episodes of “micro-arousals.” Further study into the slow-wave sleep of people who experience sleepwalking may shed important light on the underlying causes and triggers for the disorder. 

What about the dangers of sleepwalking? The current research review indicates that sleepwalking overall is not particularly dangerous, that its episodes are brief and usually harmless to sleepwalkers and their bedmates. However, other recent research paints a very different picture, one that suggests sleepwalking poses significant risks for physical harm. Among sleepwalkers in this study, 58% experienced some kind of violent sleep-related behavior, and 17% had at least one episode that required medical treatment for either the sleepwalker or a bed partner. 

We’ve got a long way to go in our understanding of the causes and behaviors of sleepwalking. I hope this latest review will spur more interest in the questions that remain unanswered by this often-overlooked sleep disorder.

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

When most people think of married couples sleeping in separate bedrooms, they picture either a troubled relationship or one with Victorian-era ideas about the role of sex in a partnership.  However, it’s now estimated that 25% of American couples sleep apart.   In fact, many new homes are being designed with two master bedrooms.  But is this rising trend of solo slumber actually beneficial to those that try it?  Experts seem to be split.

Couples who choose to sleep separately have different reasons for doing so.  Some are on wildly different schedules and don’t want to disturb one another.  Others are trying to get away from a partner that snores or moves around too much during the night.   It’s also common among new parents whose sleep schedules are already in shambles.

Proponents of separate bedrooms claim that it’s beneficial for both partners, because they deeper, more restorative sleep.  Some studies claim that sleeping alone allows for up to 50% less disrupted sleep.  Waking up more refreshed is just the beginning; good sleep also helps with weight loss, mental clarity, recovery from illness, and a litany of other benefits that are just now being understood.  Sleep experts also claim that when couples are well-rested, it improves their communication and overall satisfaction with each other.

On the other hand, many sleep specialists believe sleeping apart is the wrong solution to sleep problems.  They recommend making sure your bedroom is a sleep-friendly zone, with a high quality mattress and appropriate temperature and lighting.  Just about everyone agrees making your bedroom an electronics-free zone without televisions or computers is a great step for a less disruptive nighttime.  It’s also suggested you work with your partner when possible to compromise on sleep habits – such as a lights out bedtime.   If these things aren’t working, the next step may be to contact a medical professional who specializes in sleep disorders.

There are several reasons couples might consider going through all the steps listed above instead of simply sleeping in separate rooms.   Most people reported feeling a better sense of togetherness when sleeping in the same bed.  Many people said they felt the few minutes before bedtime were some of the only, and therefore most precious, moments they got to spend with their partner.  Additionally, having a partner in close proximity leads to more sex and intimacy, which is vital to most people for a healthy relationship.  Finally, several cases were cited where one partner had a health crisis in the night, such as a stroke, heart attack or seizure, that was addressed much faster due to having their partner right next to them.

While there is no one right answer for the best way for you and your partner to live your life and get the best night’s sleep possible, it seems fair to say that before you and your partner move into different bedrooms, you should assess other aspects of your sleep habits and hygiene that may be contributing to disruptive sleep.