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Diagnosis and management of sleep disorders in pregnancy

noreply@blogger.com (Christopher) — Sat, 27 Sep 2014 05:39:00 +0000

There are many different ways in which sleep data can be collected, the gold standard, however, is to measure sleep using polysomnography (PSG) as this provides an objective assessment of the sleep-wake cycle over the entire sleep period (Baker et al, 1999).

Much of the data regarding sleep in pregnancy is limited to self-administered questionnaires and to diaries: very few recent studies have used PSG. However, it is recognised that undertaking multiple sleep studies at different time points during pregnancy is difficult. Despite this there is evidence to suggest that sleep disorders in pregnancy can in certain individuals have adverse outcomes for the mother or baby and therefore it would be useful to develop a screening tool that could be administered quickly by health professionals during routine pregnancy consultations.

A simple and cost-effective alternative to PSG is to use actigraphy and sleep diaries. There are now many wrist-watch style actigraphs available. They are activated by movement and can differentiate when a person is awake or asleep, many also now have light monitors incorporated in them as well. They are useful in identifying night time awakenings and for determining their subsequent duration. When used in conjunction with self-recorded sleep diaries, actigraphs can help to establish a very detailed sleep pattern.

Questionnaires administered to a bed partner can also help to establish a diagnosis of sleep disordered breathing. OSA is a common but often unrecognised condition in women of childbearing age. The likelihood is increased however in women with a past or current history of polycystic ovary syndrome, depression, hypertension, diabetes, hypothyroidism, metabolic syndrome, obesity (Champagne et al, 2010). The diagnostic test of choice would be a PSG, and referral to a sleep specialist to confirm and treat primary sleep disorders may be required. Further research is also required to establish if the management thresholds for treatment of OSA in non-pregnant women are applicable to pregnant women.

Pharmacological treatment of sleep disorders in pregnancy needs to be viewed with caution, given the potential for harm to the foetus. Similar caution needs to extend to women who are breastfeeding.

Sleep disorders in pregnancy

noreply@blogger.com (Christopher) — Sat, 27 Sep 2014 05:34:00 +0000

Sleep-Disordered breathing (SDB) is the term used to describe a group of disorders which are characterized by abnormalities of respiratory pattern (pauses in breathing) or the quantity of ventilation during sleep. A recent study evaluated the frequency of sleep disordered breathing in women with gestational hypertension compared to healthy women with uncomplicated pregnancies. They observed that women with gestational hypertension may have a significantly higher frequency of sleep disordered breathing than do healthy women with uncomplicated pregnancies of similar gestational age. The frequencies of sleep disordered breathing in the more obese gestational hypertension group and the healthy group were 53% and 12% (p<0 .001="" 2011="" al="" br="" eid="" et="">

Obstructive sleep apnoea (OSA) is the most common of these sleep disorders and is characterized by the complete or partial collapse of the pharyngeal airway during sleep. To resume ventilation, feedback mechanisms arouse the individual, which leads to sleep disruption. OSA is associated with an increased CVD risk. Although, men are twice as likely to develop OSA as women, the risk is increased in women if they are overweight. Moreover, data from recent studies indicates that snoring and OSA increase during pregnancy. The prevalence of OSA is very low in normotensive women low-risk pregnancies but is increased among normotensive pregnant women with high risk pregnancies and, in those with gestational hypertension (pregnancy-induced hypertension (PIH)/pre-eclampsia) during pregnancy, the prevalence is even higher.

PIH is characterised by high blood pressure with a flat circadian rhythm and in particular does not have the normal nocturnal dip associated with sleep. Risk factors for PIH include first time pregnancy, long periods (>10years) between pregnancies, multiple pregnancies,women younger than 20 or older than 35 or women who are overweight, have a history or hypertension or kidney disease or diabetes. Recent studies indicate that OSA per se is an independent risk factor for gestational hypertension/pre-eclampsia and may contribute to other poor obstetrical outcomes. Good blood pressure control in pregnancy is important. Continuous Positive Airway Pressure (CPAP), which is used to treat OSA, may also have beneficial effects on blood pressure (Champagne et al, 2010). It may therefore be very useful in patients with PIH as this condition is associated with both increased blood pressure and a significantly narrowed upper airways and limited airflow during sleep (Izci et al, 2003). Continuation of treatment for OSA following the pregnancy may also be required.

Insomnia is a sleep disorder which is characterised by a difficulty in initiating or maintaining sleep in combination with adverse daytime consequences. The daytime effects may include excessive fatigue, impairment of performance or emotional changes. Data from self-reported questionnaires suggests that sleep complaints are more frequent in pregnancy and that sleep disturbances increases as the pregnancy progresses. In a recent study of 300 women (100 women in each trimester of pregnancy) it was observed that there was a significant increase in insomnia in the 2nd trimester, excessive daytime sleepiness (EDS) was also increased in pregnancy and the rate for specific awakenings increased by 63% in the first trimester, by 80% in the second trimester and by 84% in the third trimester (p<0 .001="" 2004="" al="" br="" et="" opes="">
Restless leg syndrome is a neurosensory sleep disorder which begins in the evening. The associated symptomatic leg movements can prevent a person from falling asleep and contribute to poor sleep quality. Pregnant women have at least two or three times higher risk of experiencing restless legs syndrome (RLS) than the general population and women affected by pre-existing RLS often complain of worsening symptoms during pregnancy. It is associated with iron deficiency anaemia.

The women who are most at risk are those with low folate, ferritin or haemoglobin prior to conception. Data from the existing epidemiological studies suggests that the rates may be as high as 27% in the third trimester(Lee et al, 2001; Manconi et al, 2004). Whilst RLS is a reversible syndrome in pregnancy and is typically limited to the third trimester it has been associated with adverse pregnancy outcomes and therefore needs to be taken seriously. The standard medications for RLS that contain dopaminergics or opioids should be avoided but preventative measures to increase the amount of folate should be encouraged at the first prenatal visit.

Complaints of heartburn increase during pregnancy and if these progress to severe nocturnal oesophageal reflux may also contribute to sleep disruption.

Sleep deprivation: Adverse sleep changes in pregnancy quantity and quality

noreply@blogger.com (Christopher) — Sat, 27 Sep 2014 05:25:00 +0000

Due to the lack of good longitudinal studies there is still little information on what constitutes normal sleep quality and quantity both during pregnancy and in the period following delivery. In a recent study however Signal et al quantified the change and variability in sleep duration and quality across pregnancy and post-partum in 8 healthy nulliparous and 11 healthy multiparous women (Signal et al, 2007).

The women wore an actigraph and completed a sleep diary for seven nights during the second trimester, one week prior to delivery, and at one and six weeks post-partum. They observed that compared to multiparous women, nulliparous women generally had less efficient sleep, spent more time in bed and had greater wake after sleep onset in the second trimester, and spent less time in bed and had fewer sleep episodes a day at one week post-partum.

The largest change in sleep however occurred during the first week after delivery with the women obtaining 1.5h less sleep than during pregnancy. In a more recent and larger study sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) in 260 women during the second and third trimester of pregnancy (Naud et al, 2010). Of the 260 women, 192 (73.6%) had a term delivery without any adverse outcome. The investigators reported that there were no differences in sleep parameters between pregnancies with adverse outcome and without adverse outcome. The PSQI scores however indicted that sleep quality deteriorated from the second (5.26 +/- 3.16) to the third trimester (6.73 +/- 4.02; P < 0.01).

This deterioration was displayed in five of seven sleep components (P < 0.01). Scores in the "poor sleeper" range were recorded by 36% of women in the second trimester and 56%, of women in the third (P < 0.01). "Poor sleep" in both trimesters was associated with low or high weight gain, low annual family income, and single motherhood (P < 0.01). A weak but not significant effect of season on sleep scores was recorded: The mean PSQI scores were 6.06 (+/-3.96) in winter, 5.21 (+/-3.21) in spring) 5.33 (+/-3.04) in summer and 5.53 (+/-2.41) in autumn); (P=0.076). In a similar study of 189 nulliparous women Facco et al demonstrated that compared with the baseline assessment (mean gestational age (13.8 (+/-3.8)) the mean sleep duration was significantly shorter at 30.0 (+/-2.2) weeks gestation (p<0 .01="" br="">

They also observed that in the third trimester the proportion of patients who reported frequent snoring (at least three nights per week) was significantly increased, and that there was an increase in those who met the diagnostic criteria for the recognised sleep disorder ‘restless leg syndrome’. Furthermore, poor sleep quality, as defined by a Pittsburgh Sleep Quality Index score greater than 5, became significantly more common as pregnancy progressed (Facco et al, 2010).

In a separate study Wilson et al also found that sleep efficiency was decreased in late pregnancy and was associated with an increase in cortical arousals when compared to women in early pregnancy and non-pregnant women. Compared to a control group, they found that women in the third trimester of pregnancy had more awakenings and had had poorer sleep efficiency. They had less stage 4 sleep and more stage 1 sleep and spent less time in rapid eye movement (REM) sleep (Wilson et al, 2010).

Sleep quality also decreases as a woman approaches labour (Evans et al, 1995) but whilst little is known of the effect of sleep disturbance on labour or delivery outcome it has been common practice to administer morphine sulphate to women in either early or non progressing latent phase labour to induce sleep. It has been observed that on awakening the contractions are more regular and active.

Sleep and pregnancy

noreply@blogger.com (Christopher) — Sat, 27 Sep 2014 05:21:00 +0000

Pregnancy is associated with many maternal physiological and psychological changes both of which may have an effect on sleep. In the first trimester, hormonal changes may disrupt sleep and in the third trimester the large baby and the anxiety regarding delivery may have associated effects on sleep. Likewise post-partum, a newborn may disrupt sleep patterns.

The review by Lee in 1998 demonstrated that there was a paucity of studies, which addressed the alterations of sleep in pregnant women, moreover many of these studies lacked sufficient power to allow consistent interpretation and replication of the results (Lee, 1998). Since then a number of studies have now been conducted but more research is still required to establish whether for example, a woman’s pre-pregnancy sleep pattern can affect outcome and to determine whether there is any effect of parity on sleep related maternal and foetal outcomes.

The changes in circadian rhythm of various hormones and the associated changes to sleep architecture that occur throughout pregnancy are discussed by Wolfson and Lee (2005) in ‘The Principles and Practice of Sleep Medicine’ (Kryger, Roth and Dement (Eds)).

Poor Sleep Hampers Vaccine Effectiveness: Study

noreply@blogger.com (Christopher) — Fri, 31 Aug 2012 06:52:00 +0000

Lack of sleep can reduce the effectiveness of vaccinations, according to a new study.

Researchers measured the sleep patterns of 125 adults who received the three-shot course of the vaccine to protect against hepatitis B. The immune systems of participants who slept less produced fewer antibodies in response to the vaccine and blood tests showed that they did not meet the standard of protection from the virus.

People who slept less than six hours per night were nearly 12 times more likely to be left unprotected by the vaccine than those who slept more than seven hours per night.

Only the amount of sleep, not the quality of sleep, affected the amount of antibodies produced in response to the vaccine.

"Given that more and more Americans are grappling with chronic sleep deprivation, these findings should be a wake-up call to the public health community about the clear connection between sleep and health," study author Aric Prather, a Robert Wood Johnson Foundation Health and Society Scholar at the University of California, both at Berkeley and San Francisco, said in a foundation news release.

The study, published in the Aug. 1 issue of the journal Sleep, is the first outside a sleep laboratory to confirm that the amount of sleep people get affects how they respond to vaccinations, according to Prather.

"Based on our findings and laboratory evidence, physicians and other health professionals who are administering vaccines may want to consider asking their patients about their sleep patterns first, since a lack of sleep may affect the efficacy of the vaccine," Prather said.

Adults should get seven to nine hours of sleep per night, according to the National Sleep Foundation.

While the study found an association between sleep and vaccine effectiveness, it did not prove a cause-and-effect relationship.

Adjusting Your Attitude About Chronic Pain May Help You Sleep

noreply@blogger.com (Christopher) — Wed, 29 Aug 2012 06:49:00 +0000

People with chronic pain who learn to think less about their pain may be able to sleep better, according to a new study.

They may also reduce their pain on a daily basis.

The study included 214 people with chronic jaw and face pain, often considered to be stress related. The patients were white females, whose average age was 34.

The patients filled out questionnaires about sleep quality, depression, their pain levels and emotional responses, including whether they think about their pain often or exaggerate it.

The researchers said that such negative thinking was directly linked to both poor sleep and worse pain.

"We have found that people who ruminate about their pain and have more negative thoughts about their pain don't sleep as well, and the result is they feel more pain," study leader Luis Buenaver, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, said in a university news release.

"If cognitive behavioral therapy can help people change the way they think about their pain, they might end that vicious cycle and feel better without sleeping pills or pain medicine," he added.

The study appeared online Thursday in the journal Pain.

The findings also may apply to people with other stress-related ailments such as fibromyalgia, irritable bowel syndrome, neck and back pain, and some headaches.

"It may sound simple, but you can change the way you feel by changing the way you think," Buenaver said.

Sleeping Pill Alternatives

noreply@blogger.com (Christopher) — Mon, 27 Aug 2012 06:46:00 +0000

It may sound surprising, but sleeping pills are not the best way to treat insomnia. The drugs clearly help people with short-term trouble getting to sleep. But for most insomnia sufferers, they are not the answer.

"It is pretty miserable not to be able to sleep," Collop says.

Bruno says that even when he prescribes hypnotic sleeping pills, he educates patients on proper sleep hygiene.

"This means basic education about the importance of a regular bedtime, a regular time to wake, avoiding naps, avoiding extreme physical exercise in the evening, and saving the bedroom for sleep," he says.

Kripke and all of the other experts agree that a form of short-term psychotherapy -- cognitive behavioral therapy or CBT -- is surprisingly effective for people with chronic insomnia.

Collop says it's time to see a sleep specialist if you have tried sleeping pills and they don't work any more. Looking for another brand of sleeping pill will not work.

Sleeping Pills: Right Ways and Wrong Ways to Use Them

noreply@blogger.com (Christopher) — Sat, 25 Aug 2012 06:45:00 +0000

Collop, Bruno, and Yurcheshen praise Kripke for raising the issue of sleeping pill harm.

"One part of the Kripke study I really did like is when they point out that part of the problem with hypnotics is they are really best for people with acute, short episodes of insomnia," Yurcheshen says. "Very few insomnia drugs are approved for long-term daily use. And so it is fair to say that the long-term safety of these drugs has never been explored for use in that way."

Collop says she personally is "torn whether hypnotics are good or bad." She notes that it can be harmful to be dependent on hypnotic sleeping pills for a long period of time. They can help a person who is having a hard time falling asleep for some specific reason.

"These sleeping pills are mostly for short-term use," she says. "So the ideal patient would be someone with a very high stress level for some reason, such as the recent loss of loved one or a divorce, or for a traveler adjusting to a new time zone. This should be for a limited time period and only as needed, not on a nightly basis. In such situations these drugs are appropriate and effective."

Bruno notes that hypnotic sleeping pills affect the quality of sleep. When used too often, he says, "people don't feel as restored after sleeping with them."

He also points out that many hypnotic sleeping pills are habit forming. "For those at risk of addiction, or with other addictions, they can be dangerous," he says. "And most of these drugs increase the effects of alcohol."

Experts Weigh in on Sleeping Pill Danger

noreply@blogger.com (Christopher) — Thu, 23 Aug 2012 06:43:00 +0000

In 2010, as many as 1 in 10 Americans used one of the sleeping pills in the Kripke study. Can they really be that deadly?

Experts consulted by WebMD note that the Kripke study certainly raises a red flag. But they all note that this study -- a look-back study based on patients for whom there is incomplete information -- is not proof that sleeping pills kill.

This "very provocative and interesting study raises a lot of questions," says Nancy Collop, MD, president of the American Academy of Sleep Medicine and director of the Sleep Center at Emory University School of Medicine.

"You cannot assume, just because you find this kind of association, that hypnotics are killing people," Collop tells WebMD. "People who go on sleeping pills are a sicker population. I know they tried to control for that, but these people simply are not as healthy."

Bryan Bruno, MD, chair of psychiatry at New York's Lenox Hill Hospital, notes that the actual number of people who died in the study is small.

"This does not establish any direct cause-and-effect relationship between hypnotic use and death," Bruno tells WebMD. "But it does remind us that these drugs have risks, and even mortality, associated with them."

Michael Yurcheshen, MD, head of the sleep fellowship program and assistant professor of neurology at the University of Rochester, N.Y., notes that much can be missed in a study that looks back at medical records rather than at the patients themselves.

Sleeping Pills Called 'as Risky as Cigarettes'

noreply@blogger.com (Christopher) — Tue, 21 Aug 2012 06:41:00 +0000

The top third of sleeping-pill users had a 5.3-fold higher death risk. They also had a 35% higher risk of cancer, the study found.

"We are not certain. But it looks like sleeping pills could be as risky as smoking cigarettes. It looks much more dangerous to take these pills than to treat insomnia another way," study leader Daniel F. Kripke, MD, tells WebMD.

The sleeping pills in question are known as hypnotics. They include newer drugs such as zolpidem (the best known brand name is Ambien) as well as older drugs such as temazepam (the best known brand name is Restoril).

Hypnotic sleeping pills actually cause a person to fall asleep. This sets them apart from other sleeping aids, such as the supplement melatonin, which promote sleep through relaxation. Other sleep drugs described as hypnotics by Kripke and colleagues include eszopiclone (Lunesta), zaleplon (Sonata), triazolam (Halcion), flurazepam (Dalmane), barbiturates, and older antihistamines such as diphenhydramine.

Kripke, emeritus professor of psychiatry at the University of California, San Diego, began looking at a possible link between sleeping pills and death risk in 1975. Since then, he and others have published 18 studies that found a link.

In their latest study, Kripke's team analyzed 2002-2007 data from a large Pennsylvania health system. They obtained medical records for 10,529 people who were prescribed hypnotic sleeping pills and for 23,676 matched patients who were never prescribed sleeping pills.

Over an average of 2.5 years, the death rate for those who did not use sleeping pills was 1.2%. It was 6.1% for people with sleeping pill prescriptions. Even those prescribed 18 or fewer sleeping pills a year had a 3.6-fold higher death risk.

Based on these findings, Kripke and colleagues estimate that sleeping pills are linked to 320,000 to 507,000 U.S. deaths each year.

"We think these sleeping pills are very dangerous. We think they cause death. We think they cause cancers," Kripke says. "It is possible but not proven that reducing the use of these pills would lower the U.S. death rate."

Most of the people in the Kripke study were taking Ambien or Restoril. Sanofi-Aventis, the maker of Ambien, notes that the Kripke study has a number of shortcomings.

"Ambien has more than 17 years of real-world experience and is safe and effective when prescribed and taken according to its labeling," Sanofi says in a statement sent to WebMD. "Ambien should be prescribed in strict adherence to its labeling and patients should take their medication as prescribed. The Ambien labeling carries specific warnings against driving and against intake of alcohol together with Ambien."

Sleepiness Hampers Job Performance, Study Confirms

noreply@blogger.com (Christopher) — Sun, 19 Aug 2012 06:39:00 +0000

Regardless of how tired people think they are, not getting enough sleep can negatively affect their ability to perform certain tasks, sleep researchers have found.

A lack of sleep can make people slower than they would be if they slept for the recommended full eight hours, according to the results of a study at Brigham and Women's Hospital, in Boston.

"Our team decided to look at how sleep might affect complex visual search tasks, because they are common in safety-sensitive activities, such as air-traffic control, baggage screening and monitoring power plant operations," the study's senior author, Jeanne Duffy, an associate neuroscientist at Brigham and Women's, explained in a hospital news release.

"These types of jobs involve processes that require repeated, quick memory encoding and retrieval of visual information, in combination with decision making about the information," Duffy pointed out.

Over the course of one month, the researchers examined data on visual search tasks completed by 12 participants.

During the first week, all participants were instructed to sleep 10 to 12 hours each night to ensure they had enough rest. In the three weeks that followed, the participants got only about five and a half hours of sleep each night. They also faced effects similar to chronic jet lag because their sleep was scheduled on a 28-hour cycle.

The study participants performed visual search tests on a computer. The tests were timed so the researchers could evaluate the participants' accuracy as well as their speed in identifying important information.

Although the participants' accuracy was fairly consistent, the study revealed that the longer the participants were awake, the more slowly they completed the tasks.

The participants were also slower between the hours of midnight and 6:00 a.m. than they were during the day.

The effects of the sleep loss got worse and the participants got significantly slower as time went on, the investigators found. Despite performing their tasks much more slowly in the final weeks of the study, the participants reported feeling only slightly more sleepy. Because of this, the researchers concluded that people's perceptions of how tired they are do not always reflect their ability to perform certain tasks.

"This research provides valuable information for workers, and their employers, who perform these types of visual search tasks during the night shift, because they will do it much more slowly than when they are working during the day," Duffy said. "The longer someone is awake, the more the ability to perform a task, in this case a visual search, is hindered, and this impact of being awake is even stronger at night."

Are You Sleep Deprived?

noreply@blogger.com (Christopher) — Fri, 17 Aug 2012 06:37:00 +0000

Sleep deprivation is serious, says Mark W. Mahowald, MD. He is a neurologist and director of the Minnesota Regional Sleep Disorders Center in Rochester. "One of the biggest myths is that sleep is negotiable and something that we can get by with less and less and less of."

Pulling an all-nighter should not give you bragging rights. "Any degree of sleep deprivation impairs performance or mood," he says. "Our society has got to learn to respect sleep as biologically imperative. Getting a good night's sleep is as important as exercising regularly and eating a good diet."

How do you know if you are not getting enough ZZZs? If you need an alarm clock to get up, you are sleep-deprived, he says.

"If you hit the snooze button more than twice you are probably sleep-deprived," says sleep expert Michael J. Breus, PhD. Another clue is if you fall asleep in less than 10 minutes.

He is not surprised by the new study's finding that night shift workers and people in transportation, health care, and the warehousing business are the hardest hit.

But another group of short-sleepers is stay-at-home parents. "I would love to see moms in their first year with kids and compare their sleep to that of night shift workers. I bet new moms would be worse, and they are the ones driving 4,000-pound SUVs," he says.

Sleep Tips for Employers and Employees

noreply@blogger.com (Christopher) — Wed, 15 Aug 2012 06:36:00 +0000

Getting more sleep may be easier said the done in today's hyper-competitive, no-downtime society.

Still, employers can, and should, take steps to make sure that workers are getting the appropriate amount of sleep. This may mean tweaking night shift schedules and placing limits on how many nights a person can work in a row, Luckhaupt says.

Employee wellness initiatives should also include education about a healthy sleep routine.

This mean encouraging workers to:

Go to bed at the same time each day or night.
Create a relaxing bedroom environment that is conducive to sleep.
Avoid reading or watching TV in bed.
Avoid large meals before bed.
Turn off their mobile phone or PDA before sleep.

30% of Workers Get Far Too Little Sleep

noreply@blogger.com (Christopher) — Mon, 13 Aug 2012 06:24:00 +0000

Fully 30% of U.S. adults -- or 40.6 million workers -- sleep six or fewer hours a day, a new CDC report shows. The National Sleep Foundation recommends we get seven to nine hours of sleep each day. Most at risk, according to the report, are people who work the night shift, especially those in the transportation, warehouse, and health care industries. And sleep deprivation has consequences. "If a person doesn't get the recommended amount of sleep, they are at increased risk of injuries that could affect them or the general public if they are a commercial driver," says researcher Sara Luckhaupt, MD, MPH. She is a medical officer in the division of surveillance, hazard evaluations, and field studies at the National Institute for Occupational Safety and Health in Washington, D.C. Illuminating Luckhaupt's point: Drowsy drivers play a role in up to 20% of car crashes. Lack of sleep on a chronic basis also increases risk for other health conditions such as obesity, depression, heart disease, and diabetes. According to the new report, 44% of people who worked the night shift were short-sleepers, compared with 28.8% of those who worked during the day. People aged 30 to 44 made up the age group most likely to be sleep deprived. Others who are not getting enough sleep include people who hold down more than one job, widows, divorcees, or recently separated partners. The findings are based on data from the 2010 National Health Interview Survey. They appear in the April 27 issue of the CDC's Morbidity and Mortality Weekly Report.

Teens, Are You Getting Enough Sleep?

noreply@blogger.com (Christopher) — Sat, 11 Aug 2012 06:20:00 +0000

What's up with sleep? It may seem like a waste of time when you've got so much you want - and need - to do. But sleep can help you do better in school, stress less, and generally be more pleasant to have around. Sound good? Now consider some possible effects of not getting enough sleep:

Feeling angry or depressed
Having trouble learning, remembering, and thinking clearly
Having more accidents
Getting sick more often
Feeling less motivated
Possibly gaining weight
Having lower self-esteem

How much is enough?

Experts say most teens need a little more than nine hours of sleep each night. Only a tiny number get that much, though. Are you one of the lucky few who can manage with less? Or are you slipping up on sleep? Here are some ways to see if you're getting enough:

    Do you have trouble getting up in the morning?
    Do you have trouble focusing?
    Do you sometimes fall asleep during class?

SOURCE: girlshealth.gov. Getting enough sleep.

How much sleep do children need?

noreply@blogger.com (Christopher) — Sat, 11 Aug 2012 06:17:00 +0000

Just as with adults, the amount of sleep children need varies with both age and unique needs of the individual. Below are general guidelines for children of various ages. Should your child be happy and thriving - but need more or fewer hours of sleep than indicated - rest assured they will remain healthy.

    1 to 4 weeks old: Neonates spend approximately 65% of their daily activity in a sleep state. Waking time is of short duration and it is rare for a child of this age to have a "day-night" cycle. Their day-night "clock" is not functional until 6 to 8 weeks of age. Mothers of newborns should use their infant's sleep pattern to sleep also.

    1 to 4 months old: Infants at this early age still sleep 14 to 15 hours a day. Many begin to develop a day-night cycle during the early weeks of this period. In addition at this age, many infants have the ability to sleep evening blocks of 5 to 6 hours without interruption; however most will wake for feedings or diaper changes during the night.

    4 to 12 months old: Infants at this age continue to require 14 to 15 hours of sleep daily. Good news for parents, they do begin to sleep for longer periods at night. Also, early in this time period, many children benefit from multiple daytime naps, though there is significant variability between different infants.

    1 to 3 years old: While specialists point out that most toddlers need about 12 to 14 hours of daily sleep, many may be forced to survive on less. Daycare and erratically spaced car trips necessary for the needs of older siblings often deny or disrupt continuous sleep patterns, most often naps.

    3 to 6 years old: This age range commonly needs approximately 11 to 12 hours of sleep per day with younger individuals taking a nap after lunch. Any need for napping is generally absent by the time a child enters 1st grade.

    7 to 12 years old: Younger children in this age range commonly require 10 to 12 hours of sleep each night; pre-teens often receive 9 to 10 hours (though some may require more).

    12 to 18 years old: Middle and high school student lifestyle requirements (school, after school activities, dinner and finally homework) often reduce the sleep duration from the recommended 8 to 9 hours to 6 to 8 hours. The various social network computer websites coupled with cell phone text communication may also cut into the teenager's sleep time.

How To Reduce The Negative Impact Of Bet Wetting

noreply@blogger.com (Christopher) — Fri, 28 Jan 2011 09:08:00 +0000

While this downside is accustomed for tiny youngsters, oldsters will still booty a cardinal of accomplish and calibration aback the abrogating furnishings associated to it. oldsters will activate by advance a while in preventing the bulk from happening. As a allotment of the foremost frequently acclimated bed wetting solutions, oldsters will administration the bulk of aqueous their kid drinks aural the black and afore aiming to sleep. Diuretic drinks are bodies who abatement aural the afterward categories: caffeine containing, carbonated and acidic. Stopping your kid from arresting them in the aphotic is a admirable bed wetting resolution. It additionally helps if the ancestor trains the kid to biking to the bath appropriate afore aiming to sleep. it's all-important that a arrangement is developed during this case and additionally the kid can apprentice to defecate at a accurate hour aural the evening. This methodology, accumulated with low aqueous quantities captivated aural the evening, has a cardinal of the best able leads to abbreviation bed wetting in the dark.

Sleep Patterns In Young And Middle Aged Adults

noreply@blogger.com (Christopher) — Sun, 23 Jan 2011 05:11:00 +0000

At the age of 20 sleep efficiency is still generally around 95% but then decreased gradually.

For 35 years the period of phase 4 NREM sleep is only about 6% of total sleep time, only half of what it is 20 Insomnia at night is twice the length and duration Phase 1 of NREM sleep is slightly increased to about 5% of total sleep time. The percentage of REM sleep remained stable at around 22-25% throughout adulthood and early middle, but the density gradually decreases REM.

Avoid circadian changes in individuals over the age of about 45 from adapting as quickly and completely to changes in sleep patterns such as shift work. Other environmental factors such as reduced exposure to light due to domestic employment, reduction of sleep time and medical and psychological disorders affect sleep patterns.

Sleep Hyperhidrosis

noreply@blogger.com (Christopher) — Sun, 16 Jan 2011 12:20:00 +0000

There are two to four million sweat glands, eccrine skin that are innervated by the sympathetic nervous system with acetylcholine as a neurotransmitter.

Volume, and my city, and the sweat is controlled mainly core preoptic hypothalamus to regulate body temperature.

Night sweats may be a physiological response to increased temperature, but many normal individuals complained of excessive sweating at night without demonstrable fever.

This is probably due to increased sympathetic stimulation of sweat glands and is often linked to anxiety or stress, or is a response to sleep disorders such as obstructive sleep apnea. Menopause night

sweating related to changes in estrogen levels in the blood. Night sweats also appear in thyrotoxicosis, with infections such as tuberculosis in lymphomas, particularly Hodgkin's disease, and occasionally in hypothalamic lesions.

Sweating at night can lead to frequent awakenings from sleep. Treatment is unsatisfactory, except for sweating associated with menopause, which correspond to estrogen replacement therapy. If you are drenching night sweats and often require modification of pajamas, or tuberculosis or a lymphoma large, including Hodgkin's disease is in doubt.

Cancer To Sleep

noreply@blogger.com (Christopher) — Sun, 16 Jan 2011 11:30:00 +0000

Some of mold on appulse Beddy-bye is specific some cancers. Brain metastases; for example, can sometimes shake the circadian rhythms or account specific provision added sleep wake control. Most problems that may occur independently of the attributes of the tumor. Sleep Hygiene is usually confused, because the gradual less physical activity and the reduction of the flames with light confession naps during the day, and a more accepted in the bedroom as an active service as valid as the police headquarters sleep. Analysis of episodes of betrayal of the subject add to acoustic stimulation, sound decidedly and in light all day and usually at night.

Insomnia is usually due to all parties, and depression about grief and its results. Pain can disrupt sleep and affection, for the plague in the determination nausea and air sickness after chemotherapy, and insomnia drugs and glucocorticoids nocturia

The following analysis of the diuretic are common.Excessive daytime lethargy may be caused by sleep fragmentation due to factors arc sleepless night. sedatives such as antidepressants and anticonvulsants, can participate. excessive apathy may also be due to neurological involvement of the tumor, or brain irradiation.

Sleep disturbances due to the scourge and its analysis are understated and assistance is to analyze recent problem and to analyze its causes. Tips for reducing plenty of naps, exercise increment if possible mood improvement and maintenance of farewell beddy regular routines of sleep-wake cycle can help. Changes in analysis of drugs and can now move beddy-bye to unwillingness of the night and daytime. Supply specific analysis of drug-induced problems such as that devotion active leg because of antidepressants, noxious or beddy-bye for apnea-induced weight income after glucocorticoid treatment should be account. Analysis of cognitive-behavioral change beliefs about the burn can be useful. Negative attitudes such as the claim that the burn is recognized if the object Beddy bye non-payment must be addressed.

Sleep Restriction

noreply@blogger.com (Christopher) — Sat, 15 Jan 2011 11:04:00 +0000

Many subjects with insomnia try to compensate for this by spending more time in bed to provide enough opportunity for sleep, and particularly by staying in bed trying to sleep while this is difficult. This not only induces abnormal circadian rhythms, but also causes frustration.

Sleep restriction assumes that sleep deprivation will lead to deeper and more continuous sleep which, in turn, will reverse the negative conditioning which perpetuates insomnia. Sleep restriction techniques reduce the time in bed in order to increase sleep efficiency.

A sleep–wake diary is kept and the initial time spent in bed should represent the average time asleep or felt to be asleep, but not less than 4.5 h. This is gradually increased as long as the subjective sleep efficiency remains above 80–85% for five nights in every seven. A constant awakening time is adhered to irrespective of the time of going to bed. Fifteen to thirty-minute increments of sleep time are usual and no daytime naps are allowed.

There may be an initial worsening of daytime sleepiness but this gradually improves over a period of months.

Psychiatric disorders

noreply@blogger.com (Christopher) — Sat, 15 Jan 2011 10:56:00 +0000

Excessive daytime sleepiness is much less frequently caused by psychiatric problems than is insomnia .

It may develop as a protective psychological reaction to circumstances which are difficult to cope with. If it persists it may be difficult to distinguish from idiopathic hypersomnia but MSLTs are usually normal.

Excessive daytime sleepiness is common in younger subjects with depression, whereas later in life this more frequently causes insomnia. EDS may persist despite adequate treatment of low mood by antidepressants and may even be worsened by sedative antidepressants. EDS in depression is usually associated with weight gain whereas depression and weight loss often lead to insomnia. EDS is also a feature of the seasonal affective disorder, which is associated with weight gain.

The daytime sleepiness seen in schizophrenia is occasionally due to the disorder itself, but more commonly to sedative medication.

Insomnia and Psychiatric Disorders - The Cycle Turns Both Directions

noreply@blogger.com (Christopher) — Thu, 30 Dec 2010 15:21:00 +0000

ByChristian Goodman

Sixty-four million Americans have mental issues. These have come from sleeplessness which they suffer on a regular basis. The condition called insomnia is when one stops sleeping peacefully. This occurs when the person will not be able to find sleep and will wake up so many times in between, and also feeling a lot of tiredness on waking up.

Insomnia is of two types. They are chronic and acute. Chronic insomnia comes for 3 times a week and acute insomnia comes lesser times. The alterations in one's life will eliminate insomnia. When one avoids the things that cause insomnia then it will be very useful. The changes can be developing good sleep habits.

There are people who suffer different insomnia issues. The problems that occur may be no sleep in night or issues in sleeping and both.

Other symptoms of insomnia are: Sleeping difficulties, getting up in sleep, early waking up, no rest while sleeping, daytime tiredness, memory loss, errors and mistakes, stress headaches, problems in sleeping and gas issues, irritation and depression.

Depression is the effect of sleeplessness. If one begins to have medicines on self then it will many other mental illnesses. Getting afraid of simple things, phobias and manias are the effects of this illness.

Women suffer more health problems both mentally and physically. These mental issues are caused as an effect of insomnia and they are depression and anxiety. If there has been sleep issues for so many days then you should visit a doctor who diagnoses insomnia. The doctor will then be able to mark the issues which cause sleeplessness.

Once the insomnia is controlled then it's time to avoid all the doctors. When you visit a doctor who specializes in sleep then avoid all the everyday medications. Recommend all the natural medications as it eliminates all the chemicals from the body.

When one takes medicines and goes for sleep it does not provide the right amount of sleep. Alterations in the way of living and sleep habits can make one completely avoid insomnia. Once you want to try out the natural way of treating insomnia then it's time to check out the better sleep guides.

Blue Heron Health News is a top advertising company in the field of daily health news. Their natural health publications include a detailed notes for how to cure insomnia, health, alternative.

Article Source: http://EzineArticles.com/?expert=Christian_Goodman

What is Periodic Limb Movement Disorder (PLMD)?

noreply@blogger.com (Christopher) — Tue, 28 Dec 2010 15:20:00 +0000

ByJacob Welsh

Periodic Limb Movement Disorder (PLMD) has symptoms similar to Restless Leg Syndrome. RLS causes sufferers to feel the need to move while at rest. PLMD, RLS's ugly step-sister, causes involuntary movements of the limbs when a person is awake or asleep. While RLS causes sufferers to feel the need to move, PLMD causes actual movement.

Periodic Limb Movement Disorder is often active at night, and those who suffer may not know they have the disorder until it is pointed out by a partner. The movements caused by PLMD are rhythmic, with legs kicking once, twice, even three times per minute. These constant movements can disrupt the sleep cycle, causing you to wake tired and allowing a great night of sleep to escape you for years.

PLMD was first identified in the 1950s, and was called nocturnal myoclonus. Myoclonus is the characteristic muscle contractions, similar to those seen in people having seizures. The name was changed because the movements in PLMD are not related to those contractions typical of seizures.

Like its cousin Restless Leg Syndrome, PLMD can be a primary or secondary disorder. The causes of the primary disorder are unknown, though many doctors believe that sufferers have difficulty regulating the nerves travelling to the arms and legs from the brain. In cases where it is secondary, sufferers could have a larger problem like iron deficiency, diabetes, sleep apnea or narcolepsy. PLMD can be caused by medications, and conversely, as a symptom of drug withdrawal. If you think your PLMD could be triggered by a larger issue, make an appointment with your physician.

If you suffer from PLMD, a memory foam mattress could help you keep symptoms at bay. Memory foam mattresses sink when triggered by body heat, creating a comforting nest around the body. If you are looking to treat your restless leg syndrome or periodic limb movement disorder, a memory foam mattress topper is an affordable answer...they start at just $99!

Article Source: http://EzineArticles.com/?expert=Jacob_Welsh

What Is Childhood Sleep Apnea?

noreply@blogger.com (Christopher) — Sun, 26 Dec 2010 15:08:00 +0000

Childhood obstructive sleep apnea syndrome (OSAS) is a condition in which the air passage in the child’s throat becomes blocked during sleep. This potentially serious condition occurs in 1 to 3 percent of otherwise healthy preschool children. It is most prevalent in children ages 2 to 6, but can also strike infants and adolescents.

Patient history and physical examination alone cannot detect OSAS. However, observation while sleeping, or polysomnography, can play an important role in assessing the condition. Children with OSAS always snore and have difficulty breathing when sleeping. They sleep restlessly, may thrash about, and often sleep in unusual or contorted positions. However, these indicators alone are not absolutes. Many children who snore do so as a natural consequence of sleep and do not need treatment.

About 10% of children snore. Approximately 20-30% of snoring children have OSAS and it is very difficult to determine which of the snoring children actually have OSAS simply by examining the child's history and physical results. Any child that has daytime sleepiness may have OSAS. Sometimes, the daytime symptoms may be subtle, such as an unexplained change in behavior or decline in school performance. OSAS can also be a cause of poor growth. Any child who has poor growth or is not growing normally or has growth impairment, and has snoring, should be considered as a possible sleep apnea candidate.