Better Sleeping
EARLY TO BED, EARLY TO RISE?
	I'd like a show of hands. How many of us go to bed at the same time each night and get up at the same time every day of the week? I know my hand isn't up, and I'm sure there aren't many. Fortunately, slightly altering your sleep schedule from day to day may not have an effect on some, but it can cause serious problems for others. Many people who suffer from insomnia fall into the bad habit of varying their sleep/wake times, which can lead to an "offset" sleep schedule. One of the more important aspects of proper sleep is regularity. A specific bedtime and rise time is very important for those who have sleep problems, in general, and more specifically, insomnia. A regular sleep schedule can often help solidify the time in bed for those of us who need a little extra help.
TYPICAL DREAMS
	Do you notice a theme, or series of themes, that work their way through your dreams on a regular basis? Researchers in Montreal have noticed there are indeed certain themes or "scenarios" that tend to turn up more often while researching the dreams of their subjects. They decided to put together a specific questionnaire that detailed the various common themes and randomly sample the general population to come up with a "top ten" list of common themes. The results may surprise you. Some common dream themes include: Falling Being chased or pursued Sexual experiences Being on the verge of falling Dreaming that a person dead is now alive Vividly sensing a presence in the room Trying again and again to do something Being frozen with fright School, teachers, studying (FYI: Flying, my favorite, came in at number 12!)
FOOD ALLERGY INSOMNIA
	Food Allergy Insomnia usually rears its ugly head in the first two weeks of life. As the name suggests, this condition is a difficulty initiating and maintaining sleep due to an allergic response to a specific food--usually cow's milk. Symptoms other than sleeplessness can include skin irritation and even respiratory irregularities. Many parents have seen this occur in newborns. In general, a change in formula resolves the problem. The problem can be a little more difficult to detect in adults, however, since our diets are usually a bit more complex than infants'. Fortunately, the "cure" is often as easy with adults as it is with children: Find the food responsible for the allergic response and remove it from your diet.
GIRLS' NIGHT OUT?
	It has taken years for research into health problems of women to come to the forefront. Fortunately for women, great strides are being made in identifying their particular health concerns. However, some of the news isn't so great. Researchers looking at the sleep patterns of women have come to the conclusion that women are two times as likely to have problems falling asleep as men. They're also twice as likely to have trouble staying asleep. There are some very obvious contributors to some of these problems--can you say, "children"--but other factors can include the menstrual cycle, pregnancy, and menopause. It's important to note that you can find help for the sleep disturbances associated with each of these factors by consulting with your doctor or with a sleep specialist. You can also make Dad get up with the kids.
OBSTRUCTIVE SLEEP APNEA SYNDROME--PART 2 OF 2: TREATMENT
	Once a diagnosis of Obstructive Sleep Apnea Syndrome (OSAS) has been made, there are a number of treatment options from which a person can choose. Since OSAS is characterized by repetitive upper airway obstructions during sleep, the most obvious form of treatment is to keep the airway open during sleep. There are a number of ways to accomplish this. Generally, the first suggested form of treatment for moderate-to-severe cases of OSAS is the use of Continuous Positive Airway Pressure (CPAP). CPAP involves a mask worn over either the nose, or the nose and mouth, and a unit to deliver the continuous pressure to the person via the mask. Sounds like fun, eh? Actually, it sounds much worse than it is. While it may take some getting used to, CPAP has proven to be one of the most effective treatments for OSAS. It acts basically like the air inside a balloon to keep the airway open once the muscle tone relaxes. Most CPAP users swear by their units and notice an almost immediate difference in the way they feel as a result of more continuous sleep. (It also eliminates the associated snoring!) Other forms of treatment for less severe cases of OSAS include weight loss and certain forms of surgery to reduce the amount of tissue in the upper airway. There's also the option of using a Tongue Retention Device (TRD) to help keep the tongue pulled forward during sleep and keep it from contributing to the airway obstruction. There's definite hope for those suffering from OSAS. Most of these forms of treatment begin to have an effect on the first night of use, leading to much more restful and restorative sleep.
SLEEP 101: REM SLEEP
	"To sleep, perchance to dream," the crazy Dane said in Hamlet. Well, he was only partly correct. If Mr. Shakespeare had been around today, he would have written, "To sleep, perchance to achieve my normal amount of uninterrupted stage REM." Rapid Eye Movement (REM) sleep is a stage of sleep that adults with normal sleep architecture typically spend about 20 to 25 percent of their sleep in each night. It's also referred to as Paradoxical Sleep because of its uniqueness. Brainwave activity is increased and can be as fast, if not faster, than when awake. Muscle tone is virtually gone, and the body temporarily loses its ability to control temperature (a condition called poikilothermia). Research has also indicated that we do the majority of our dreaming during REM sleep, about 70 to 80 percent of the time. REM versus non-REM dreams tend to be more involved and vivid. It's interesting to note that our ability to remember dreams is often affected by whether we wake up during the dream, or shortly thereafter. If the awakening occurs within less than five minutes of the "dream period," there's a greater likelihood of remembering its content.
SLEEP POSITION
	Are you a back, side, or stomach sleeper? Many of us have a favored position for sleeping, and we often assume that position as we're trying to go to sleep. Our sleep positions often vary during the night, however, and can actually affect the way we sleep. Most of us have been in a situation where someone in the room, be it a bed partner or your older sibling on the upper bunk, was lying flat on his or her back and snoring like a bear. Sleeping in the supine (back) position can often lead to the development of snores. This happens because the tissue in the back of the throat is being affected by gravity and vibrates as air moves through the airway passage. This can also result in a disorder called Obstructive Sleep Apnea Syndrome (OSAS), which is a disruption in breathing during sleep caused by obstruction in the upper airway. Adopting a side position can often reduce or even eliminate the snoring and even the OSAS if it's relatively mild. If the snores and the OSAS continue even when you sleep on your side, you may need to consult with your doctor about forms of treatment for both conditions.
CAT GOT YOUR TONGUE?
	Devices that "grab your tongue" can actually help you sleep. Called Tongue Retention Devices (TRDs), they've been used for a number of years in the treatment of snoring and cases of mild obstructive sleep apnea. How do they work, you ask? Basically, snoring occurs when tissue in the back of the throat vibrates during breathing. Sometimes this is associated with a serious disorder called sleep apnea, but many times it simply occurs on its own. In order to stop the vibration (and the associated elbow jab to the ribs from your spouse!), the airway needs to be opened. TRDs do this by pulling your tongue forward and opening the airway slightly. This allows the air to flow more smoothly and can decrease the snoring. Wearing a TRD is similar to wearing a retainer or a mouth guard used in sports. A TRD can take some getting used to, but if it saves a rib or two, it's well worth the trouble.
RESTLESS LEG SYNDROME
	Have you ever heard statements like, "I go to bed, and my legs just won't stop moving," or "I lay down, and it feels like something is crawling under the skin on my legs, and I have to get out of bed to make it stop"? People suffering from a disorder known as Restless Leg Syndrome (RLS) often have a difficult time explaining their symptoms because they sound so bizarre and are often dismissed as leg cramps. They are, indeed, valid symptoms and can cause quite a problem for some people. RLS has a tendency to run in families, it usually occurs in older individuals and can equally affect men and women. Causes for the disorder that aren't attributed to heredity can include alcoholism, kidney disease, and poor blood circulation. Interestingly enough, factors that can trigger an episode of RLS include smoking and caffeine consumption. Treatment for the disorder can sometimes prove difficult. Vitamin therapy, exercise, and heating pads on the legs at night have helped some, but a trip to a sleep specialist may be needed in more severe cases.
CONFUSIONAL AROUSALS
	When was the last time your wife woke up and called you the wrong name, handed you the lamp from the bedside table, and then went back to sleep? Hopefully, this doesn't occur often. There's a disorder of sleep known as a confusional arousal that could manifest itself in just such a way. Generally occurring during the first third of the night, confusional arousals are often seen in children, and less so with adults. They can and do occur in the adult population, however, and can last from a few minutes up to an hour. Excessive sleepiness, certain medications, and some other sleep disorders that cause a deeper than normal sleep can all lead to confusional arousal.
CO-SLEEPING
	Most pediatric professionals recommend that children sleep alone. Most children recommend the opposite. The trend in the United States, in recent years, has been toward some degree of co-sleeping, generally with the child sleeping in the parents' bed. Co-sleeping has been reported in approximately half of families with small children, yet experts advise against it. A number of recent studies have noted that the child often ends up with disrupted sleep as a result. They also note that, unless the cycle is interrupted, parents will have a difficult time "breaking the habit," and the child can develop extremely poor sleep habits as a result. This, in turn, can lead to disrupted sleep for not only the child but for the parents as well. What's a parent to do? Begin teaching your child proper sleep habits early. Sleeping alone, regular bedtimes, as well as soothing bedtime rituals (reading a story, for example) are just a few ways to help your child build proper habits and help ensure more restful nights for everyone in the family.
SLEEP AND STAMINA
	Does how well you sleep influence your level of stamina? Researchers at San Jose State University recently asked that question and tested more than 400 university students with a variety of measures for stamina. What they found is surprising to say the least. They compared a group of 30 students who scored the lowest on the stamina scale with a group who scored the highest. They discovered that those in the low stamina group actually obtained more sleep on average than the high stamina group but were twice as likely to rate themselves as "poor sleepers." They also found that the members of the low stamina group were significantly less knowledgeable about good sleep practices and caffeine use than the high stamina group. Finally, those in the high stamina group were more likely to label themselves as "morning types" than the low stamina folk. What this suggests is that your level of perceived stamina can have more to do with your sleep habits and attitude toward sleep than with your ability to get "more" sleep.
SLEEP EATING
	It's two o'clock in the morning, you sneak into the kitchen, open the refrigerator door, and the room is suddenly filled with ringing alarms and flashing lights! It's a common theme for diet aid commercials, but for some, the problem of grabbing a snack at night can occur without their knowledge and lead to some serious problems. Nocturnal Sleep Eating/Drinking disorder is exactly as the name suggests. Patients suffering from this disorder have periodic arousals from sleep and go to the kitchen to eat or drink, often without any recollection of the activity. Attempts to interrupt the behavior on the part of an onlooker often fail since there's usually a complete lack of awareness during the episode. For sufferers of the disorder, it usually occurs during periods of high stress and is often associated with some other underlying disorders such as depression. It's a relatively rare disorder, however, and can often be treated by a qualified sleep specialist.
HOMING IN ON INSOMNIA
	Most of us have dealt with an episode of insomnia, the inability to initiate or maintain sleep. For a sleep physician, helping patients overcome their insomnia can be a difficult task. Physicians often classify insomnia into three major groups: Transient insomnia: lasting several days; Short-term insomnia: lasting up to three weeks; Chronic insomnia: lasting three weeks or more. The duration of the episode helps to provide the sleep physician with insight into the underlying cause of the disorder and how best to provide treatment. As one would suspect, there are several forms of insomnia that fall into each of the three groups mentioned. We'll discuss these forms in later tips. The first order of business with insomnia in any form is to develop and maintain good sleep habits and sleep hygiene. Generally, the problem will resolve itself (as with most forms of Transient insomnia) but if left untreated can develop into a more severe type of the disorder and may require the assistance of a sleep professional.
SLEEP RESTRICTION CAN AFFECT MOOD
	College students get to have all the fun! In a recent study to measure the effect of sleep restriction (reduced sleep) on how we respond emotionally to certain situations, researchers in Rhode Island restricted the sleep of a group of college kids for one night. The study was conducted after the students had several nights of normal sleep. After both a night of normal sleep and a night of restricted sleep, the subjects were shown a series of pictures designed to elicit certain emotional responses (anger, happiness, sadness, and so on). The students then rated their reactions to the pictures, and researchers compared the pre- and post-sleep restriction responses. As you'd expect, the post-sleep restriction responses were more negative and less positive than the pre-restriction ones, lending support to the notion that losing a bit of sleep can make us a bit more likely to be cranky the next day!
OVER THE COUNTER OR OVER THE TOP?
	An episode of the Sally Jesse Raphael show recently did a short story on a pill that claimed to correct snoring. A man tested the pill for a week, and his wife documented the results with a video camera. The pill seemed to work on the first night, but the snores returned on the second night and remained for the five days of "testing." There are quite a number of over-the-counter anti-snoring products that can vary in their effectiveness. Some are mouthpieces that are similar to those used by some sleep physicians in cases of primary snoring (snoring not associated with any respiratory disorder). Others come in pill form and even oral sprays. All claim that snores will disappear with proper use of the product. These claims may be true, but there seems to be a lack of scientifically validated evidence in support of such products. There are generally no "quick fixes" for snoring (heard that one before?).
SCREAMING CHILDREN--PART 1 OF 2: NIGHTMARES
	Every parent has at one time or another had to comfort a child after a nightmare. Nightmares, or dream anxiety attacks as some call them, occur during a stage of sleep called Rapid Eye Movement (REM) sleep and are, in fact, dreams. They tend to affect children aged three to six and usually have a gradual onset. In most cases, they go away as easily as they developed. If episodes of nightmares persist into adolescence, however, it may be necessary to seek professional help to discover the underlying cause of the nightmares. It's important to note that nightmares are often triggered by stressful events (a family move, illness, divorce, and so on) and should be dealt with in as patient a manner as possible. It may be necessary to (but should never be done too often) let the child sleep in the parents' bed for the night after a nightmare has occurred--because, as we all know, Boogymen never go there!
SCREAMING CHILDREN--PART 2 OF 2: NIGHT TERRORS
	When a child experiences a night terror, it can be an extremely frightening experience--for the parent. Night terrors are defined as sudden arousals from sleep with screams or cries and an intense manifestation of fear. Sounds pleasant, doesn't it? Night terrors differ from nightmares in that they occur during a different stage of sleep (stage 3 and 4), and the child generally has no memory of the episode. They're often confused and disoriented if awakened from the episode. Night terrors usually occur in children ages 4 to 12, and like nightmares, they generally resolve on their own. The parents' experience is quite different. The child is usually unresponsive to external stimulation and, as mentioned, displays an extreme fear reaction. Sitting up in bed, struggling, and fighting often accompany a night terror. The episodes are usually brief, and it's important to not allow the child to injure himself or herself while struggling. If the episode is allowed to run its course, the child will typically return to sleep with, as mentioned, no memory of the event. It may take the parents a bit longer to drift back to sleep, however.
SLEEP HABITS OF RAIL COMMUTERS
	Are you a member of that ever-growing portion of the population that commutes to work? Are you aware that your health may be suffering as a result? A recent study from the New York University School of Medicine took a look at nearly 5,000 people who rode the Long Island Railroad to and from work every day. Of the commuters surveyed, more than half reported sleep difficulty, but, oddly enough, only three percent sought help for their sleep problems. From the study, it was also found that, not surprisingly, the majority of those who commuted for a longer period had decreased total sleep times during the week and excessive daytime sleepiness as a result. Many of those commuters also reported napping frequently during their trips as a result of their sleepiness. This napping, in many, led to poor sleep habits that also contributed to their sleep problems. Interestingly, researchers also found those with longer commutes tended to have increasEd incidence of high blood pressure. Is there hope? Are all commuters doomed to daytime sleepiness? Of course not! By increasing awareness of proper sleep hygiene and providing resources for those commuters who have developed serious sleep disorders, anyone having to face a daily commute can learn to effectively minimize effects of lost sleep due to their trips to and from work.
SLEEP STARTS
	A fairly common, yet widely misunderstood, disturbance of sleep occurs generally just after falling asleep. Your body jerks or twitches, and it feels like you're "jolted" out of sleep. This sensation can be coupled with a short, dreamlike image upon awakening. These "jolts" are called sleep starts and can be broken down into two forms: hypnic jerk, the "jolt" itself, and sensory start, the "jolt" coupled with the dreamlike image. Fortunately, both of these phenomena are considered benign or harmless. However, if episodes similar to these are occurring regularly, it may be necessary to consult a physician to determine if there may be some other sleep or neurological disorder of movement occurring along with the sleep starts.
AUTOMATIC BEHAVIOR
	Sleep deprivation can have a variety of effects and elicit a number of bizarre behaviors. One of those bizarre consequences is known as automatic behavior. When an individual is extremely tired, episodes of "micro sleep" (a very short, light form of sleep) may occur. If these episodes occur while the person is engaged in simple, repetitive tasks, he or she can actually continue the behavior as if he or she were awake. Generally, there's a lack of memory associated with the episodes, but they can last from a few minutes to hours. This isn't to say that you can "sleep" through your day and still get your work done, however. The lack of awareness will cause you to make mistakes, but you can perform activities like driving, typing, assembly line work, and even marching. It's important you consult a physician if you begin to notice episodes such as this occurring, because certain forms of seizure activity can cause much the same effect.
BLINK DURATION
	There are a number of various, and in some cases, really odd ways to measure sleepiness in an individual. Researchers in Finland have been investigating ways to measure sleepiness in professional bus drivers, and they're using, of all things, blink duration. You know the feeling--you're driving late at night and your "lids" feel very heavy. Sampling a group of professional drivers with Obstructive Sleep Apnea, a breathing disorder that can result in excessive sleepiness, researchers found a definite increase in the blink duration of their subjects prior to treatment. They also found subjects were less able to remain awake when placed in a quiet, non-stimulating environment. When the subjects were placed in the driving environment, however, researchers didn't notice any significant difference in maintenance of speed or lane drifting between the "sleepy" subjects and the control, or "non-sleep," participants. What would explain this finding? They suggest that professional driving experience and "fatigue management" skills allowed sleepy bus drivers to compensate for their tiredness and, thus, perform well under the testing situations.
LUCID DREAMING--PART 1 OF 2
	We all dream. We don't all remember dreaming, but each of us has periods during sleep in which dreams occur. Also, we've each awakened from a dream and had the sudden realization that we weren't just on a date with Cindy Crawford, or Donald Trump wasn't really just shining our shoes. Some people, on the other hand, are able to have this "realization" of the dream while the dream is still in progress. Cases such as this are known as lucid dreams. Lucid dreams are dreams in which the dreamer is aware he or she is asleep and experiencing a dream. These dreams differ from typical dreams in that respect alone. Dream content, imagery, and "thought processes" are consistent between lucid and non-lucid dreams. Individuals who do gain awareness of a dream may or may not have the ability to control the dream content. Researchers are finding methods that will allow anyone to develop the ability to lucid dream.
LUCID DREAMING--PART 2 OF 2
	Studies have reported that lucid dreams occur in only about ten percent of the population. Lucid dreams are dreams in which the dreamer is aware that he or she is asleep and experiencing a dream. As you can well imagine, the ability to control dream content could come in quite handy. People suffering from certain phobias, depression, or low self-esteem could benefit greatly from being able to create scenarios that help them cope with the situation and translate that experience to their waking life--not to mention the boost you'd get by being able to fly like Superman each and every night! Briefly described below is an exercise created by Stephen LaBerge (1981) that may help non-lucid dreamers develop the ability to control their dreams: 1. Awaken early in the morning from a dream. 2. Memorize the dream, then engage in 10 to 15 minutes of an activity that requires full wakefulness. 3. When back in bed trying to return to sleep, tell yourself that the next time you dream, you'll be aware you're dreaming. 4. Visualize yourself lying in bed having rapid eye movements that would indicate you're dreaming. At the same time, imagine you're in the dream and aware it's a dream. 5. Repeat steps 3 and 4 until you feel certain your intention is clearly fixed. With practice, exercises such as these can help you develop the ability to lucid dream. Metropolis here I come!
MEDICAL COST OF OSA
	In several tips, I've discussed the importance of diagnosis and treatment for a specific sleep disorder known as Obstructive Sleep Apnea (OSA). OSA causes periodic interruptions in breathing during sleep and, as a result, disrupts sleep and causes undue stress on the cardiovascular system. If left untreated, it can lead to complications such as high blood pressure, heart disease, and stroke to name a few--not to mention the effects of sleep disruption, namely daytime sleepiness, fatigue, irritability, memory loss, and sexual dysfunction. As if these weren't reasons enough to seek treatment, researchers with the Department of Medicine at the University of Washington have come up with yet another. They estimate, taking into account the numerous complications associated with OSA, that the medical cost of untreated sleep apnea in the United States alone is nearly 3.4 billion dollars per year. That dollar figure includes not only treatment for some of the conditions mentioned above, but also lost wages due to those conditions! A consultation with a sleep physician early on could not only save your insurance company money, it could also keep some of those bucks in your pocket.
READING BEFORE BED
	For a number of people, lying in bed and reading a few pages of a book or magazine has become a sort of bedtime ritual. This isn't necessarily a bad thing either. Soothing bedtime routines often help us "wind down" from our hectic lives. It's important to remember that any routine you become accustomed to should do only what it's intended to do--get you ready for sleep. If you find yourself getting too involved in your book and end up losing sleep as a result, it may be time to switch to a different behavior.
WHAT IS THAT ON HIS NOSE?
	Many of us watching a football game have noticed the little white strips taped across the players' noses. I first thought it was some form of bizarre war paint (if the fans can paint their faces, why couldn't the players?). But the strips are actually products that help keep nasal passages open so the players can breathe more easily during the game. The adhesive plastic strip is "pinched" onto the nose, and as the plastic tries to straighten out, the adhesive pulls the nose open slightly to allow easier breathing through the now enlarged passageway. The strips may also have some benefit for people who snore. Some types of snoring are the result of the nasal passage being too narrow or having excess tissue. The snores are caused by tissue vibration. The strips help to pull the nasal passage open so the air can flow more easily, and the tissue doesn't have the chance to vibrate. The strips can't help all types of snoring, but they may provide relief for some.
FATAL FAMILIAL INSOMNIA
	Insomnia can be one of the most difficult sleep disorders for an individual to deal with. It can take a number of bizarre forms and, if left untreated, can cause sleep problems for years. One of the most rare and bizarre forms of insomnia can actually have dire consequences. Fatal Familial Insomnia is a progressive form of the disorder that starts with a complete lack of sleep and actually ends with the patient lapsing into coma. Death generally follows within days of the comatose state. It's important to note that insomnia isn't the only symptom of the disorder. Abnormalities of the endocrine system and degeneration of certain structures in the brain are also present. Researchers are quick to stress that other, similar, neurologic disorders should be ruled out prior to a diagnosis of Fatal Familial Insomnia. Not to fear, however, this disorder is so rare that only a few cases have been documented, and those are limited to a very isolated portion of the population.
COMPLICATIONS OF CPAP THERAPY--PART 1 OF 2
	Many people who suffer from Obstructive Sleep Apnea, a breathing disorder that causes periodic interruptions in breathing during the night, have chosen a form of therapy called Continuous Positive Airway Pressure (CPAP). CPAP consists of a mask worn over the patient's nose that connects to a unit next to the bed. This unit provides a continuous flow of air pressure through the patient's mask while he or she is sleeping to keep the airway open. The effect is similar to the air pressure inside a balloon. As you can imagine, this may take some getting used to, and there are a number of problems that CPAP patients face when they first begin their therapy. Initially, for some, the main obstacle is simply becoming used to breathing against the positive pressure. Often, these patients need to work up gradually to wearing the mask full-time. Many find it's helpful to sit with the CPAP unit while watching television and hold the mask to their face. This allows them to become accustomed to breathing against the pressure so when they go to bed, they're better able to fall asleep wearing the mask.
COMPLICATIONS OF CPAP THERAPY--PART 2 OF 2
	As mentioned in a previous tip, becoming accustomed to the use of a Continuous Positive Airway Pressure (CPAP) device can pose certain problems for a patient. Once the patient has become used to the actual pressure being delivered from the unit, he or she may develop problems with the type of mask he or she has chosen or with the way the mask has been adjusted to fit. Fortunately, there are several types of masks a patient can choose from. Most masks simply fit around the patient's nose, spanning across the lip to the bridge of the nose and back down again. Alternatives include "nasal pillows," which press on the end of the patient's nose or even a full face mask that covers both the patient's nose and mouth. Patients having difficulty becoming accustomed to their masks can contact the durable medical equipment company and/or the sleep disorder center that prescribed the CPAP unit to get help finding a mask that works best for them.
BEDWETTING
	Approximately seven million children in the United States suffer from poor bladder control at night. More commonly referred to as Enuresis, or bedwetting, this condition can be very frustrating and very distressing if left untreated. Detection of the disorder is usually not very difficult. Treatment, however, can be a bit more involved. rug therapy tends to be used more frequently by physicians than any other treatment, with the drug of choice typically being an antidepressant called Imipramine. There are a number of alternate forms of treatment that mostly include the development of certain continence skills. These techniques include retention control, which helps to expand bladder capacity, and alarm training, which awakens the child during urination so he or she can get to the restroom or hold it until a more appropriate time. It's important for parents to be aware that taking care of the problem usually takes some time, but the child will benefit most if the parent is patient and willing to help him or her learn the continence skills needed to overcome the problem.
EFFECTS OF HEAT AND HUMIDITY ON SLEEP
	You've heard the phrase, "It's not so much the heat as it is the humidity." Well, where sleeping is involved, it's actually both! It's well known that increased temperature can adversely affect sleep, but there hasn't been a great deal of study into the affect of humidity on sleep. Researchers in Japan decided to try and answer that question. Testing the sleep patterns of volunteers at different combinations of heat and humidity, they discovered that sleep was worse at higher temperatures coupled with high humidity than at the same temperature with a lower humidity. There was more wake time during the night and, interestingly enough, reduced amounts of Delta sleep (stage 3 and 4 sleep) and REM (Rapid Eye Movement) sleep. What does this mean to the layperson? Cool air humidification for those who require more moisture and an ambient room temperature of around 70 degrees Fahrenheit.
MYTHS ABOUT SLEEP: "BLIND PEOPLE DON'T DREAM"
	The lack of sight, either from birth or occurring after a number of years of sightedness, doesn't play a role in whether an individual dreams. It can affect the form a dream may take, however. Individuals born blind do have dreams, but their dreams take form from their other senses, usually auditory. Dream content, storyline, and characters are unaffected by their lack of sight. Those who were born sighted, but have lost their sight for some reason, report that initially their dreams remained as they were before: visually based. After a period of time, however, their vision in dreams is eventually replaced by their other senses.
NOISE AND SLEEP
	A dog barks, a car door slams, an airplane flies overhead, and your husband's watching Letterman. Through all of this, you sleep soundly. However, the first time your husband flips the light switch in the bathroom, the sound wakes you. For many of us, certain types of noise have no effect on our sleep because we've become accustomed to them. They may cause brief arousals from sleep, depending on the depth of sleep at the time of the noise, but these arousals generally don't disrupt the sleep to cause daytime sleepiness. It's often the case that certain low levels of ambient noise, such as a fan or an air conditioner running, can actually help us sleep more soundly by drowning out those noises that do disrupt our sleep. There are also devices specifically made to provide "white noise" at night, allowing us to get better, less-interrupted sleep.
OSAS AND AUTO CRASHES
	Did you know that up to 40 percent of automobile accidents can be attributed to human error? Inattention, poor judgment, and perceptual errors are among the contributing factors. What could cause such problems in an otherwise healthy adult (excluding alcohol)? Uncontrolled sleep apnea, for one. A group of researchers at the university of Western Ontario recently attempted to answer the question of sleep apnea as it related to automobile accidents in the general population. As we've known for quite some time, sleep apnea, a breathing disorder that causes periodic disruptions of sleep, can have a great impact on an individual's ability to concentrate, as well as on that individual's perceptual and motor skills. This is a result of the excessive sleepiness caused by the disorder. The Ontario researchers looked at a number of people with varying degrees of sleep apnea (mild, moderate, and severe) to assess whether there was an increase in automobile accidents for each of those groups. They found there was indeed an increase, but it was limited to cases of more severe sleep apnea. This doesn't suggest that mild to moderate cases of sleep apnea are in less need of treatment. On the contrary, finding treatment for the problem early can help you avoid the long-term effects of sleep apnea and hopefully make the roads a little safer for all of us.
PREGNANCY AND SLEEP
	Sleeping during pregnancy can be a chore, as any mother can attest to! Generally, during the early stages of pregnancy, women report feeling fatigued and find they're sleeping longer hours at night. This change may be linked to increased levels of progesterone in their systems. Fortunately, or unfortunately, depending on your perspective, this situation reverses as the pregnancy progresses toward the third trimester. Sleep patterns become more fragmented as a result of leg cramps, a more frequent need for urination, movement of the child, and the general discomfort associated with pregnancy. It's vital throughout the pregnancy, though, to try to keep a regular sleep/wake schedule to minimize the resulting sleep disruption. I'm happy to report there's a definite cure for pregnancy-related sleep disorders, but it usually takes about nine months to achieve.
ALTITUDE INSOMNIA
	Believe it or not, there are individuals who claim they have never had a night of insomnia in their lives. To those people I say, "Go climb a rock--a big one!" If you do, chances are very good you'll develop a form of insomnia known as Altitude Insomnia. Altitude Insomnia is caused by a respiratory disorder that develops when we're exposed to lower levels of oxygen than we're used to. Mountain climbers that ascend above 4,000 feet tend to develop symptoms of the disorder usually within 72 hours: headaches, loss of appetite, fatigue, and sleeplessness. Generally, the symptoms will fade as you become accustomed to the lower oxygen, and they'll disappear once you return to your "typical" altitude. Have a good climb!!!
HEADBANGING
	No, I'm not talking about listening to heavy metal music. Headbanging is a rhythmic movement disorder that involves a very consistent, stereotypical "rocking" movement involving the head and sometimes the shoulders. It's usually seen in children under the age of two years. It occurs just as the child is falling asleep and can continue into the lighter stages of sleep. Concerned parents should consult their pediatrician if the movements become too severe or are disruptive to the sleep of others in the household. Precautions should also be taken so children don't cause any injury to themselves. Padded headboards and bed rails may be needed, and in some cases, protective headgear may be in order. Benzodiazapines have proven effective in treatment of the disorder. However, the child will generally grow out of it by age two.
LONG SLEEPERS
	As you probably know (especially if you've been following these tips for awhile), most of us require between seven and a half to eight hours of sleep per night in order to function normally during the day. But, as with most things, there are exceptions to this rule. I reported a while back about Short Sleepers, individuals who require much less sleep than normal and have no resulting impairment as a result. As you might assume, they have counterparts on the opposite end of the "sleep continuum"--Long Sleepers. Long Sleepers are people who have a natural need for ten or more hours of sleep per night. If these sleep requirements aren't met, they suffer from excessive daytime sleepiness and cognitive impairment as a result. Their sleep is structured much the same as "normal" sleepers with the same percentages of REM and Non-REM sleep. It's important to differentiate between being a Long Sleeper and having an underlying disorder that could cause the need for excessive sleep, such as Obstructive Sleep Apnea or Narcolepsy.
SLEEP MYTHS: CERTAIN FOOD CAUSES NIGHTMARES
	My mother always told me not to eat spicy foods too close to bedtime because they would give me bad dreams. Well, Mom, I'm sorry to say you were only half right on this one. Specific foods can't cause nightmares, but they can disrupt sleep. Many fans of spicy food can attest to waking during the night due to indigestion. Many times, these awakenings are during a stage of sleep in which no dreams are occurring. However, disruptions can happen during REM sleep, the stage of sleep in which we dream the most. Waking during a dream can lead to a better recall of the dream in the morning. So while those meatballs may not cause the dreams to be bad, they can lead to a better chance of remembering the dreams we do have.
SLEEP WALKING
	Sleepwalking, or Somnambulism, is probably one of the more "popular" sleep disorders. It tends to pop up in just about any conversation involving things that "go bump in the night." No wonder it's so talked about since its actual rate of occurrence is about 18 percent of the general population and is more prone to occur in children than in adults. The act of sleepwalking is fairly recognizable. The individual engages in a series of complex behaviors that result in he or she walking around the house! There are a number of things associated with sleepwalking that a concerned parent can watch for: The individual is usually very difficult to arouse from sleep during the episode. There is generally no knowledge of the episode after the individual has awakened. The episodes usually occur during the first third of the sleep period. There are also a number of things to look for that may lead to an episode of sleepwalking, including excessive fatigue or increased stress. Some steps that may be taken to help prevent a sleepwalker from causing injury to himself or herself during an episode include removing any objects that could cause harm and having the person sleep on the ground floor. Also, it's important to ensure that doors and windows can't be opened easily by the sleepwalker. As with any disorder, if the episodes become frequent, consulting a sleep physician may be in order. Treatment can be as simple as taking a medication prior to bedtime, which may not only help keep the sleepwalker in bed but also everyone else in the household.
SLEEPING SICKNESS
	Remember the tsetse fly? The innocuous little carrier of a protozoan-caused illness called "sleeping sickness"? There are actually a couple of forms of the disease: Gambian trypanosomiasis and Rhodesian trypanosomiasis. Both forms have much the same set of symptoms: high fever, headaches, and swelling of the feet and hands. Later stages of the disease can cause sleep fragmentation, which leads to increased sleepiness during the day. Lethargy, inactivity, and vacant facial expressions also develop. If untreated, the disease ends in death. The tsetse fly lives in tropical parts of Africa. So unless you're planning a safari, you need not worry too much. If you're planning one, be sure to get your shots!
SLEEP-RELATED ASTHMA ATTACKS
	There are a number of breathing disorders that can occur during sleep, the most prevalent of which is Obstructive Sleep Apnea Syndrome (OSAS). Awakenings with choking, coughing, and tightness in the chest are common features. These awakenings can lead to daytime sleepiness, fatigue, and even insomnia. For some, however, episodes such as this can occur during sleep and be totally unrelated to OSAS. People who suffer from asthma can have similar attacks during sleep as a result of their disorder. There are a number of precipitating factors that lead to these attacks, one of which is a natural increase in bronchial thickness during the early morning hours. Other factors include exposure to allergens during sleep and reaction to certain hormonal changes as a result of the body's internal clock. There also appears to be a good correlation between the frequency of nocturnal asthma attacks and the severity of the asthma. So, for those asthmatics who are noticing an increase in nocturnal awakenings, insomnia, and daytime sleepiness, a visit to your physician may be needed to better control your condition.
SUDDEN INFANT DEATH SYNDROME (SIDS)--PART 1 OF 2
	The sudden, unexplained death of an infant, generally under one year of age, is often classified as Sudden Infant Death Syndrome (SIDS). Autopsies of SIDS victims show no explainable cause of death. There have been a number of theories suggested to shed some light on a possible cause, but many researchers and physicians are beginning to believe SIDS is the combination of a number of factors. These factors include, but aren't limited to, problems with arousal during sleep and the body's inability to sense the build-up of carbon dioxide in the blood during sleep. There are a number of identified risk factors that parents should be alerted to. The risk for SIDS may increase if the baby: sleeps on his or her stomach is one of multiple births is premature has soft bedding in his or her crib is a sibling of a SIDS victim has a mother who smokes
SUDDEN INFANT DEATH SYNDROME (SIDS)--PART 2 OF 2
	As a result of increased awareness, since 1992, SIDS has decreased from the second to the third leading cause of death in infants between the ages of one month and one year. Researchers point out that one of the main preventative measures you can take is placing the child on his or her back or right side to sleep instead of on his or her stomach. Other preventative measures include providing a smoke-free environment and avoiding pillows and bean-bag and sheepskin mattresses. Interestingly enough, breast-feeding your baby is also recommended. Physicians also suggest using an apnea monitoring device for homes where a SIDS death has occurred. These devices can be purchased or rented through a medical equipment company and can provide a great deal of reassurance to parents with infant children.
VALERIAN AND ITS SLEEP-INDUCING PROPERTIES
	Many people who suffer from sleeplessness, either periodic or chronic, don't feel comfortable with the prospect of having to take an over-the-counter, or even prescribed, medication to help them sleep. Many such medications can leave a "hangover" effect the next day and, if taken on a regular basis, can lose their effectiveness. These people seek a more natural, homeopathic, alternative. One such alternative that has been used for centuries is Valerian, a perennial found in Europe, which still enjoys official pharmacopoeial status. When taken at bedtime, Valerian root (which comes in a variety of forms) can help to induce sleep. Dosages needed may vary, but most people who use it report that they awaken refreshed the next morning. Research into the active ingredient of the root continues, but there has been some evidence that it can have a sedating effect by binding to the neuro-receptors in our brains that usually accommodate benzodiazapines (a form of commonly prescribed sleeping pills). Whatever the case, the use of homeopathic remedies for the treatment of certain disorders continues to be a source of debate. However, research does continue into finding safer, more natural methods of getting a good night's sleep.
CAN LIFE EXPECTANCY BE AFFECTED BY TOO MUCH OR TOO LITTLE SLEEP?
	It's a question that has been asked for a number of years and has provided some interesting answers as well as more questions of its own. Looking at mortality rates and average sleep time, researchers have noted that people who tend to sleep less than four hours per night have a mortality rate of more than two times greater than normal length sleepers. They also found that people who slept longer than normal (averaging ten or more hours per night) had nearly the same rate of mortality. The more prevalent causes of death for both the long and short sleepers included cancer, suicide, and heart disease. Researchers are quick to point out that these studies don't prove causation (for example, too little or too much sleep equals early death), but that they simply illustrate trends. There could be a number of actual causes for increased morbidity, such as excessive life styles, shift work, and other contributing diseases that could lead to either insomnia or to excessive sleepiness. A good rule of thumb, however, is to take whatever steps are necessary to ensure your sleep is adequate and not being affected by any outside influence.
CAN SLEEP PROBLEMS AFFECT PERFORMANCE IN CHILDREN?
	A number of children can be underachievers in school for a variety of reasons. Resent research from Tulane University suggests that the majority of these underachievers be tested for sleep-related disorders of breathing or other disorders of sleep. Many such disorders can cause sleep to be disrupted and lead to daytime sleepiness. It's this sleepiness, suggests researchers, that can lead to poor academic performance. The research also indicates that if the disorders are found and treated early, it can have a dramatic effect on school performance. If you're concerned your child may be suffering from a disorder that may be affecting his or her performance in school, contact you pediatrician or the school's guidance counselor for information on having him or her tested.
NARCOLEPSY GENE FOUND IN DOGS
	I remember sitting in Psychology class in college and watching a black and white film about narcoleptic puppies. They would play for awhile in their puppy-like fashion then suddenly fall over asleep. As an eighteen-year-old college freshman, I found it quite humorous, but as a somewhat older and wiser sleep professional, I don't find it as funny. Narcolepsy affects an estimated 200,000 people in the United States, most of whom go undiagnosed. Part of the most frustrating aspect of narcolepsy is that we don't know the cause of the potentially disabling disorder. Fortunately, hope may be on the horizon. Researchers at Stanford University have isolated the gene that causes narcolepsy in dogs. This could potentially lead to a better understanding of not only what causes narcolepsy in humans, but how better to treat the disease as well as gain greater knowledge of how and why we sleep.
SEASONAL AFFECTIVE DISORDER--PART 1 OF 2
	Seasonal Affective Disorder (SAD) is a form of depression that's, as the name suggests, linked with the change of seasons. It generally begins to appear in early fall as the days become shorter and can continue throughout the fall and winter if not treated. Researchers believe it's linked to some people's inability to regulate their natural "sleep/wake" rhythms as a result of less exposure to daylight. SAD has many of the typical symptoms normally associated with depression: feelings of sadness, listlessness, and dejection. It also has several not-so-typical symptoms that include overeating and weight gain, excessive daytime sleepiness, and decreased energy. As with normal depression, there tends to be a higher incidence of SAD in women, but studies have indicated that it can occur in approximately nine percent of the general population. Since the disorder is so closely linked to depression, physicians generally look to see if there's a personal or family history of depression before making a final diagnosis.
SEASONAL AFFECTIVE DISORDER--PART 2 OF 2
	Individuals suffering from Seasonal Affective Disorder (SAD) have an impaired ability to adjust to the change in "light cues" as the seasons change from summer to fall and winter. The reduced amount of daylight causes problems with structures in the brain that secrete neurotransmitters that can have a regulatory effect on our sleep/wake cycle and our moods. Treatment for SAD can include medications such as Fluoxetine (Prozac) or can take the form of bright light therapy. Studies have indicated that SAD sufferers can benefit from exposure to brighter than normal lights in the early morning and have seen results as quickly as a week after continued exposure. The method is simple--a special light unit is used that gives off as much as 10,000 Lux (a unit of illumination) for approximately one half to one hour in the early morning. Some homebuilders are even placing units such as this into the bathrooms and dressing rooms of some new homes for this specific use. There are several Web sites dedicated to devices used to treat the "winter blues." A simple search could start you on the road to finding relief for your condition, but, as always, a consultation with your physician is recommended if you feel that either depression or SAD may be affecting your holiday season.
HINTS FOR REMEMBERING YOUR DREAMS
	Many people believe dreams can provide us with important information about our lives. Some cultures feel dreams are "journeys" to other places, while others believe they're glimpses to aspects of our own lives. Research is currently being done around the world to try and signify what role dreams play. However, regardless of your belief system, being able to remember and record dreams and their content is essential to analyze them. Here are a few methods you can try to better remember your dreams: Prior to falling asleep, develop the "intention" that you'll remember your dreams. If you have an awakening during the night, try to become coherent as quickly as possible. Slow awakenings tend to lead to poor recall. Longer sleepers tend to have better recall since they have the opportunity to engage in more REM sleep than shorter sleepers. Arrange an awakening during REM sleep. Since REM is usually more intense toward the last third of the sleep period, you may be able to set your alarm 15 to 20 minutes earlier than normal in order to "catch" yourself in REM sleep.
SLEEP IN THE HOSPITAL
	If you've ever had an extended stay in the hospital, you know it seems next to impossible to get a solid night's sleep. Environmental noise, constant interruptions (do they really need to draw blood at 3AM?), and general discomfort all lead to disrupted sleep. A recent study from the University of Pennsylvania School of Medicine looked at the sleep patterns of patients in an Intensive Care Unit (one of the more noise-intensive units in a hospital) to determine if the patients were indeed sleep-deprived. They found there was quite a bit of sleep disruption from many of the factors noted above, but the patients weren't necessarily sleep deprived since they were able to nap during the majority of the day. The sleep they did get tended to consist mainly of stage 1 sleep (a very light stage of sleep), and the overall sleep architecture was abnormal. The study's recommendation was that further research is needed, but recovering as quickly as possible so you can go home and get some uninterrupted sleep couldn't hurt either.
WEIGHT LOSS SURGERY AND SLEEP APNEA
	Obstructive Sleep Apnea Syndrome (OSAS) is a serious condition that results in periodic disruptions in breathing during sleep. The condition is often made worse in situations where excessive weight is a contributing factor. Weight loss is often indicated in the treatment of OSAS but for many, traditional methods of weight reduction are extremely difficult. In a collaborative effort, the schools of medicine at the University of Sydney and the University of Gothenburg attempted to study the effects of weight reduction surgery on patients with OSAS. They studied 4,000 subjects (2,000 had surgery, and 2,000 used traditional weight loss methods) and found that, not surprising, those subjects that had surgery reported a dramatic decrease in the symptoms associated with OSAS: snores, witnessed apnea, and daytime sleepiness. They recommend that for those patients with morbid obesity, weight reduction surgery be considered as an option in controlling their OSAS. They do caution, however, that further research is needed.
CAN USING YOUR NOSE HELP YOU SLEEP?
	"A rose, by any other name, would still smell as sweet," but will it help you fall asleep? Perhaps not, but an investigation mentioned in "The Lancet," a British medical journal, suggests that the scent of lavender may be as helpful in helping insomniacs fall asleep as some medications. The researchers looked at four elderly insomniacs and had each of them discontinue their sleeping medications for a period of two weeks. After they had been weaned from their sleeping pills, they began sleeping with lavender oil near their beds. The subjects in the study reported sleeping just as well with the lavender scent as they did with their medications. The researchers point out that it's a very limited study, and that research involving smell is often very difficult to verify, but that further testing could prove useful toward providing an alternative to medications for some individuals.
FINDING SUPPORT
	As with any medical condition, the proper frame of mind can be a key component in finding relief and comfort. Sleep disorders are no different. Part of dealing effectively with a disorder is finding support not only from family and friends but from others who suffer from the disorder as well. There are a number of resources available regarding support groups for various sleep disorders. I've listed below a few of the national groups you can contact for information regarding your disorder and for groups you can join that meet locally: For individuals with Sleep Apnea, you can contact A.W.A.K.E. Alert, Well, And Keeping Energetic at https://www.angelfire.com/il/awake/ For individuals with Narcolepsy, contact The Narcolepsy Network at http://www.websciences.org/narnet/ For individuals with Restless Legs Syndrome, go to The Restless Legs Syndrome Support Page at http://www.rls.org/ Also, for more information and links to other sleep-related sites, visit the American Academy of Sleep Medicine site at http://www.asda.org/
STAY AWAKE AND HAVE FRESH BREATH!
	Ah, the wonders of chewing gum! It can freshen your breath, help reduce cavities, and now it appears to be able to help you stay more alert at night. A recent study looked at both shift workers and student volunteers to determine whether the act of chewing gum could help them maintain their alertness during various times at night. They were tested at 10PM, 1AM, 4AM, and 7AM for sleepiness. The gum-chewing group of students reported less sleepiness, especially at 1AM and 4AM. The researchers added a bit of a twist with the shift workers, however. At each of the testing times, they had one group chew gum and another group take a 15-minute walk. Both groups reported less sleepiness, but again, the gum-chewing group showed to be less sleepy than the walkers.
THEY DON'T CALL IT BEAUTY SLEEP FOR NOTHING
	Red, puffy eyes aren't the only consequence of lost sleep. There's also daytime sleepiness, fatigue, memory problems, and so on. A recent study looked at the body's hormonal and endocrine systems during periods of lost sleep. It found that our bodies begin to exhibit signs that mimic the effects of aging during times of sleep deprivation. It appears that our metabolism is affected by the loss of sleep and can lead to increased or worsened symptoms of age-related illness. Hypertension, weight gain, diabetes, and memory loss could all be affected by sleep loss. Fortunately, the researchers noted that these effects could be lessened after periods of lost sleep by increasing the amount of sleep obtained over a short period of time. Sleeping a few extra hours a night for a few days seemed to repair the imbalance to the system and allow things to get back on track.
WALKING AND SLEEP
	A study recently presented at a meeting of the Gerontological Society of America illustrates one of the easiest methods of helping to improve sleep in older people. Investigators studied two groups of people who considered themselves to be "sedentary" and who were experiencing mild-to-moderate sleep problems. One group was instructed to do nothing (they acted as the "control" group). The other group was asked to exercise four times per week: two sessions of brisk walking and two sessions of light aerobics and strength training. After four months, the exercisers were sleeping on average one hour longer than the controls. They also reported falling to sleep faster and feeling more refreshed upon awakening. This isn't to say the exercise is a "cure all" for sleep problems in older populations, but if brisk walking a few times a week can help with some of the problems, why not give it a try?
A NEW LOOK AT AN OLD LEGEND
	The moon has inspired mankind from day one. One of the most popular and long lasting legends attached to the moon is that the full moon can cause "madness." A number of studies conducted over the past 50 years or so have found no evidence to support such claims. A recent article in the Journal of Affective Disorders offers a new take on the possible cause of the legend. Researchers speculate the moon could indeed cause "madness" by inducing sleep deprivation. Since the moon, at one time, was the major source of nocturnal illumination, it stands to reason that when the moon was especially bright (for example, when it was full), it could cause some difficulty sleeping. This wouldn't necessarily affect everyone, but some psychiatric disorders and certain forms of epilepsy can be affected by lost sleep.
HUMIDIFICATION CAN HELP WITH NASAL CPAP
	Nasal Continuous Positive Airway Pressure (CPAP) is a method of treatment used mainly for individuals who suffer from Obstructive Sleep Apnea Syndrome, a condition that causes repetitive interruptions in breathing during sleep. CPAP delivers a continuous stream of airflow to the wearer through a mask worn over the nose. Needless to say, there can be a number of problems associated with the use of CPAP. Many of those complications have been discussed in previous tips, but there's a continuing debate over the use of additional humidification along with the CPAP to enhance the comfort. Humidification adds additional moisture to the air being delivered to the patient and often takes care of problems with nasal dryness. There are two types of humidifiers that can be attached to the CPAP unit: pass-over humidifiers and heated humidifiers. Both deliver additional moisture, but the heated units can add more moisture than their pass-over cousins. The cost of the units can also play a role in the decision to humidify. Heated units are more expensive than pass-over units, but some insurance companies are beginning to become aware of the needs of some individuals who require a little extra help and are making allowances for humidifiers. Any questions CPAP users might have regarding either type of humidification can be answered by the durable medical equipment company that supplied the CPAP unit.
CAN SLEEP APNEA HINDER YOUR SEX LIFE?
	Obstructive Sleep Apnea (OSA), a condition that causes repetitive interruptions in breathing during sleep, affects an estimated 20 million Americans. The disorder occurs, as the name suggests, during sleep, but sleep isn't the only "bedtime" activity it can affect. The major symptom of OSA is daytime sleepiness, but it can also affect oxygen levels and mood. The combination of these symptoms can often lead to decreased sexual drive and, in men, an inability to obtain an erection. A recent study conducted through the National Naval Medical Center in Bethesda, Maryland, looked at sex drive, sexual behavior, orgasm, and fantasy in a number of patients with sleep apnea. Patients were questioned about each category before and after treatment for their OSA. They noted there was improvement in several of the categories, suggesting that treatment for OSA can improve patients' lives in more ways than just making them more alert during the day.
HELPING HOSPITAL PATIENTS GET BETTER SLEEP
	In previous tips, we've discussed the effect sleep deprivation can have on our body's ability to heal. Reduced immune function, fatigue, and body temperature fluctuations can all be the results of lost sleep. Unfortunately, noise levels in a hospital setting often contribute to sleep deprivation in patients. Researchers have taken a step toward alleviating this problem. The use of earplugs is being tested in environments that simulate an intensive care unit. Preliminary results show much what you'd expect--the percentage of sleep time is increased, and the number of awakenings is decreased in those wearing the earplugs.
INSOMNIA AND ACUPUNCTURE
	Many people who suffer from insomnia, an inability to achieve or maintain sleep, have difficult times finding relief from their sleeping disorders. Many are also reluctant to try medications as a treatment for various reasons and work to find alternate solutions. Recent research in the use of acupuncture for the treatment of insomnia may provide some with an alternative to traditional methods of treatment. Researchers tested 40 subjects with problems initiating or maintaining sleep and separated them into two groups for treatment. The first group received traditional acupuncture therapy while the second group received needle application at non-acupuncture points. After a series of three to five weekly treatments, each group was tested in a sleep laboratory for objective measures of sleep. Those in the group having the traditional acupuncture treatment showed significant improvement in their abilities to initiate and maintain sleep. The alternate group didn't show the same improvement. Researchers do point out that further research is needed but are hopeful that future findings will mimic their earlier success.
SLEEP IN ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)CHILDREN
	Attention-Deficit/Hyperactivity Disorder (ADHD), a fairly common mental disorder among children, affects three to five percent of all children and is approximately two to three times more common in boys than in girls. ADHD is a combination of symptoms that include inattention, hyperactivity, and a tendency to be impulsive. Many parents report sleep problems in their ADHD children as well. A recent study conducted through the University of Toronto looked at the problem of sleep disturbances in children with ADHD. It found that a number of the related sleep problems tended to be associated with either the stimulant medication used to treat the ADHD or with other associated medical problems already present. The study also reported an increase in movement disorders during sleep in ADHD kids, but those tended to occur in children suffering from separation anxiety as well. The study's final conclusion was that the relationships between sleep problems and ADHD in children is much more complex than anticipated. If your child is suffering from ADHD and sleep disturbances, you should seek the advice of your pediatrician or contact a sleep disorders center in your area for more information.
SLEEPING ALONE VERSUS SLEEPING WITH A PARTNER
	When I was young, I was always intrigued by the fact that Lucy and Ricky (from "I Love Lucy") slept in separate twin beds. Television censors and cultural/moral values notwithstanding, it turns out they may have had good reason. Studies show that body movements and arousals from sleep often coincide with the movement and arousal of a bed partner. Interestingly, men tend to move more during sleep, and women have more frequent arousals from sleep. These trends tend to be seen more in younger couples, however. Alternately, when questioned about their quality of sleep as it pertains to the presence or absence of their bed partners, individuals report poorer quality sleep when their partners aren't present.
A NEW LOOK AT GENDER DIFFERENCES IN SLEEP
	Sleep researchers are always trying to find better and more effective ways to monitor sleep. The use of a relatively simple device called an actigraph has proven useful in a number of cases. The actigraph is a watch-like device that measures movement and can be worn for up to weeks at a time on either the wrist or the ankle. The information is then downloaded at a sleep lab or similar facility for analysis. The Department of Psychiatry at the University of California, San Diego recently used actigraphy to examine differences between the way men and women sleep. It found that women in the study showed to have better quality sleep with fewer transitions from sleep to wakefulness. They also reported that women slept more than men and had shorter sleep latencies according to the actigraph.
AGE, WORKING, AND SLEEP QUALITY
	Researchers in France recently looked at nearly 3,000 working people separated into three age groups: 32, 42, and 52 years of age. They wanted to assess the affect age, shift-work, and job satisfaction had on sleep. Interestingly, they noted two major findings. First, they noted that sleep was rated poorer in quality as the participants went up in age. The second major finding was that perceived job difficulty was more related to sleep dissatisfaction than either of the other categories for all age groups.
ALLERGIC RHINITIS AND SLEEP
	Allergic rhinitis, inflammation of the mucous membranes in the nose as a result of an allergic response, is estimated to affect nearly 42 percent of the population in the United States. Stuffiness is one of the minor complications of allergic rhinitis. Often, disturbed sleep is a result, along with daytime fatigue, an inability to concentrate, memory problems, and so on. Allergic rhinitis can be treated in a number of ways, but physicians tend to prefer the use of non-sedating antihistamines since they don't tend to exacerbate some of the daytime symptoms of sleep lost to the rhinitis. As always, if you're experiencing symptoms similar to those mentioned above, relief can be as close as a simple phone call to your primary care physician.
AN INTERESTING SOLUTION FOR BEDTIME PROBLEMS
	Crying and/or getting out of bed after "lights out" is a common problem many parents face with young children. Persistent problems at bedtime often result in one of two solutions: ignoring the crying or allowing the child to sleep in the parents' bed. The Clinical Services Department at Father Flanagan's Boys' Home in Boys Town, Nebraska, has tried a novel approach to this frustrating dilemma. It introduced a "bedtime pass" scenario for use on an outpatient population. The bedtime pass is a one-time allowance to leave the bedroom after bedtime for a short period of time. The preliminary information suggests that the method can be extremely useful. Participating parents and pediatricians rated the process as a much better alternative to either of the previously mentioned methods (ignoring it or sleeping in the parents' bed).
CAN CPAP HELP IMPROVE YOUR MOOD?
	Many people suffering from Obstructive Sleep Apnea Syndrome (OSAS), a disorder that causes periodic disruptions in breathing during sleep, show signs of a number of symptoms: daytime sleepiness, fatigue, difficulty with memory, and changes in mood. Generally, these symptoms resolve once the sleep apnea is treated. One of the most effective treatments for OSAS is the use of a device called CPAP (Continuous Positive Airway Pressure) that delivers a stream of air to the patient through a mask worn over the nose during sleep. It has often been thought that mood changes associated with OSAS and the subsequent relief from those changes once CPAP is initiated was a product of the treated OSAS. Researchers from South Korea have completed a study that may prove otherwise. Looking at patients with OSAS, researchers placed some of the patients on an effective CPAP therapy and some on a "placebo CPAP" (CPAP that wasn't effective enough to treat the patient's OSAS). They noted that mood changes occurred in both groups of patients. This may indicate that simply initiating some form of treatment, whether it's completely effective, can help with the symptoms of depression that are often secondary to sleep apnea in some patients.
ETHNIC DIFFERENCES IN SLEEP
	A recent study conducted through the Department of Psychiatry at the UCLA Medical Center took a look at differences in sleep patterns between different ethnic groups. Four groups were examined: African-Americans, Asians, Caucasians, and Hispanics. Interestingly, the results showed no differences between Caucasian and Asian participants but did find differences in the remaining two groups. African-American participants showed an increase in Stage 1 and Stage 2 sleep and decreased Stage 4 sleep. Hispanic participants seemed to have more dense, or "intense" REM sleep. Since sleep disturbances can often be associated with psychological stress and disorders, researchers hope to use these findings to assess patients from various ethnic backgrounds in order to better understand and treat any psychological problems (especially ones with sleep-related complaints) they may face.
IDIOPATHIC HYPERSOMNIA
	Daytime sleepiness is often one of the first indications that a specific sleep disorder is present. Generally, a trip to a qualified sleep physician can provide some insight into the disorder and associated treatment. There can be a number of causes for daytime sleepiness including sleep apnea, periodic limb movement disorder, and narcolepsy. Another, less common disorder of daytime sleepiness is Idiopathic hypersomnia. Idiopathic hypersomnia is very similar to narcolepsy. Both have a major symptom of daytime sleepiness--however, narcolepsy carries additional symptoms that aren't seen in Idiopathic hypersomnia (for example, catapexy, hypnogogic hallucinations, and sleep paralysis). Treatment is much the same for both disorders. The use of stimulant medications can provide considerable relief from the associated sleepiness and lead to much more productive waking hours. You can find more information about daytime hypersomnia by visiting http://www.sleepnet.com
SLEEP "MUST-DOS"
	Always try to stop working at least two hours prior to bedtime. Allow yourself time to "wind down." If you find yourself unable to sleep due to excessive worry about unfinished tasks, make a list of those things that need to be completed. Use the "to-do" list to unclutter your mind as much as possible and then set it aside until the morning. You'll sleep much better as a result and possibly even be more organized!
TRANSIENT VERSUS ALL-NIGHT NOISE: WHICH SLEEP STAGES ARE MOST AFFECTED?
	Nighttime noise is never easy to deal with, especially in cases of insomnia. Initiating sleep with noise present is often difficult and, with some, impossible. Once sleep is achieved, however, "things that go bump in the night" can still easily disrupt it, but some stages of sleep are less susceptible to disruption by noise than others. All stages can be affected by different types of noise, both continuous and transient, but Rapid Eye Movement (REM) sleep has shown to have a much higher threshold for interruption by transient noises than either stage 2, 3, or 4 sleep. Research from the University School of Medicine in Maebashi, Japan, suggests that REM sleep can also be more affected by continuous noise during the night than the other sleep stages. Comparing transient and all-night noise, researchers found that the percentage of REM sleep decreased more as a result of continuous noise than did the other stages. Their research lends yet more support to the "paradoxical" nature of REM sleep.
UPPER AIRWAY RESISTANCE SYNDROME
	Sleep-related breathing disorders can have a profound effect on the individuals who suffer from such disorders. One of the most common, and easily treated, sleep-related breathing disorders is Obstructive Sleep Apnea Syndrome (OSAS). A variant of OSAS is Upper Airway Resistance Syndrome (UARS). UARS can have many of the same symptoms of OSAS: daytime sleepiness, disrupted sleep, and hypertension. Treatment for UARS can often be as easy as it is for OSAS. Often, Continuous Positive Airway Pressure (CPAP) can help. Other treatment options include weight loss, adopting a side position during sleep, and the use of tongue-retention devices that help create a more "open" airway during sleep.
A DRIVING LESSON: HOW TO DEAL WITH SLEEPINESS
	It's 2 a.m. and you're driving home from a business trip. You still have two hours of road in front of you, and you find yourself nodding off. What do you do? Roll down the window and turn on the radio, of course. WRONG ANSWER! Research indicates that cold air and listening to the radio aren't the best solutions to driver sleepiness. They may help in the short term, but for an extended drive, you'll need to take better measures to ensure your (and the other drivers') safety. In general, caffeine or a brief nap has shown to improve driver alertness more effectively than the air conditioner or Jimmy Buffett ever could.
A SLEEP DISORDER MAY THREATEN YOUR JOB
	The importance of on-the-job safety has become a major topic of discussion within the past several years in many corporate boardrooms. And, as knowledge of sleep disorders and sleep medicine becomes more available to the general public, it too has entered into those discussions. Many corporations and government agencies have adapted policies to address sleep disorders. For example, the Federal Aviation Administration has some very specific guidelines regarding pilots who suffer from Obstructive Sleep Apnea Syndrome (OSAS), a breathing disorder during sleep that causes, among other things, excessive daytime sleepiness. Its policy includes requirements for specific documentation from a certified sleep specialist regarding the treatment of OSAS, compliance with treatment, and the effectiveness of treatment in those pilots who suffer from the disorder. As more work places begin to include provisions in their policies regarding sleep disorders, it makes proper and timely diagnosis and treatment for the disorder much more important. If you feel your work is being affected by a sleep disorder, contact a sleep disorders center in your area. Not only can it provide relief from the problem, but it can also furnish documentation for your employer that the problem has been addressed and taken care of.
ANTIDEPRESSANTS AND SLEEP
	Antidepressant medications have been in use for a number of years. They have proven to be helpful in the treatment of certain psychological disorders, but they have also been effective in the treatment of various sleep disorders. However, one interesting side effect of antidepressants is the effect they have on sleep stages, particularly Rapid Eye Movement (REM) sleep. Studies have shown that most antidepressants decrease the amount of REM sleep in patients for which they've been prescribed. The decrease in REM sleep doesn't appear to have any adverse effects on the individual. For more information on antidepressants and other medications used to treat sleep disorders, visit http://www.iris-publishing.com
CPAP USER ADVICE: WHAT TYPE OF MACHINE TO USE
	As with any industry, providing a variety of products to the consumer is a "win/win" situation. The competition spurs the production of newer, better products, and the consumer has a variety of choices. The technology used for the treatment of Obstructive Sleep Apnea is no exception. Continuous Positive Airway Pressure (CPAP) devices have come a long way over the past 20 years. The device itself is basically a controlled air compressor. It delivers a specific amount of pressure to the user via a mask connected by hose to the unit (discussed in earlier tips). Just as the masks come in all shapes and sizes, the CPAP units can vary greatly from dealer to dealer. Most units include a number of options: *A ramp that allows the pressure to be increased gradually over a period of time allowing the user to fall asleep *A humidifier that provides extra moisture to the air being delivered *An alarm that sounds if the mask is inadvertently removed during the night *A usage meter that measures the number of hours the unit has been in use Not every patient will need all, or even some, of the options mentioned above. The equipment company that supplies the unit as well as the sleep disorders center that provides the testing can explain each option in relation to your specific needs, helping to make the transition to CPAP use a little less frightening and a lot more comfortable!
GREAT MINDS ON SLEEP
	Sir Thomas Browne: "Sleep is a death; oh, make me try By sleeping what it is to die, And as gently lay my head On my grave as now my bed" (I wonder if he was an insomniac?)
IRON AND RESTLESS LEGS SYNDROME
	Restless Legs Syndrome (RLS) is a disorder that causes a "creeping" sensation in the legs that's relieved with movement. It's often discussed in conjunction with Periodic Limb Movement Syndrome (PLMS), which causes repetitive movements in the legs during sleep. Both disorders can lead to disrupted sleep and result in daytime sleepiness. Researchers from Johns Hopkins University recently took a look at a fairly common form of treatment for RLS and PLMS: the use of supplemental iron tablets. They studied 27 people who suffered from RLS or PLMS and looked at the levels of iron in their blood. They found that those who had iron levels of 50 mcg/l or greater tended to have fewer arousals associated with their PLMS, although the overall number of leg movements didn't decrease. Lower levels of iron were associated with increased severity of symptoms and decreased sleep efficiency.
NASA IS ON THE BALL
	The folks at the National Aeronautics and Space Administration (NASA) never cease to amaze. Since 1980, they have had in place a program to address problems associated with fatigue and sleepiness. Called the "Z Team," its mission statement includes goals such as *To determine the extent of fatigue, sleep loss, and circadian disruption in flight operations *To determine the impact of these factors on flight crew performance *To develop and evaluate countermeasures to mitigate the adverse effects of these factors *To maximize flight crew performance and alertness You can learn more about its endeavors at http://olias.arc.nasa.gov/zteam/
NEW SLEEP MEDICATION FOR INSOMNIA ON THE HORIZON
	Sepracor, a pharmaceutical company that develops and commercializes potentially improved versions of widely prescribed drugs, recently completed two clinical trials that demonstrated the activity of Racemic zopiclone, a non-benzodiazepine hypnotic in the treatment of sleep disorders such as insomnia. The effects of the medication occur rapidly and can be seen for up to six hours. This duration of action may result, researchers suggest, in better maintenance of sleep with a lower incidence of nocturnal awakening. The medication is currently available in other countries but has not yet been approved for sale in the U.S. It will be marketed by Rhone Poulenc-Rorer under the brand names of Imovane(r) and Amoban(r). It hopes to have FDA approval by 2001.
NIGHT OWL OR EARLY BIRD
	Each of us has a period of the day we prefer. Some feel at their best in the early morning and others are more alert in the evening hours. Much of the influence toward "mornings" or "evenings" has to do with our circadian rhythms (the body's internal clock). Some recent research from Stanford University is shedding light on this topic. Researchers have identified a particular variation of a gene (called the "CLOCK" gene) that's present in people who are at their peak in the evening. They studied 410 adults and found that those who carried the unique variation of the "CLOCK" gene were more likely to be "evening people." They are quick to point out that the findings need to be studied further, but the implications for sleep disorders medicine could be significant. For example, if you're trying to go to bed at 11 p.m. but your body doesn't want you to sleep until 2 a.m., you could present symptoms of insomnia. In reality, your circadian rhythms, thanks to the "CLOCK" gene, could be responsible (or you can blame your parents since they gave you the gene in the first place).
NOISE AND DREAMS
	In previous tips, we've mentioned the effect noise can have on certain sleep stages, causing some to be shortened due to the disruption. A recent study adds an interesting twist to the plot! Researchers were looking at the effect different types of stimulation, either auditory (noise) or somatosensory (touch) had on Rapid Eye Movement (REM) sleep. They tested animals under several combinations and intensities of the stimulation and measured REM sleep. They found that both types of stimulation affected REM duration, making the REM period last longer than normal. Interestingly, they also found that the number of REM periods during the night (usually four to five) decreased, resulting in no real increase in the TOTAL amount of REM sleep during the night.
SLEEP AND EASTERN PHILOSOPHY
	Some eastern philosophies utilize principles of energy and the affect they can have on health and well-being. It's believed that the body has certain "fields" of energy and that having the body's "fields" in proper alignment with natural occurring fields (such as the magnetic fields that give us directions: north, south, east, and west) is beneficial. The art of Fen Shui provides us with some very specific advice toward sleeping better. Each guideline is based on the direction your head points during sleep. They are listed below: North: The best direction for obtaining restful, refreshing sleep South: This promotes wakefulness Northeast: This could give you nightmares! West: Can help you find more contentment and romance in your life Devices that create magnetic fields of their own (electric alarm clocks, lamps, and televisions) can interfere with the natural fields and should be avoided.
MOST DREAMS ARE BLACK AND WHITE
	False. The majority of dreams are, indeed, in color. However, when people are awakened from a dream they tend not to remember the detail of color. It has been reported that up to two thirds of people awakened in a sleep laboratory during Rapid Eye Movement (REM) sleep, the stage in which we do the majority of our dreaming, remember color from their dreams. The rest simply lose the detail of color as a result of waking up.
SLEEP POSITION AND ITS EFFECT ON SLEEP STAGE
	Do you prefer to sleep on your back? What about your side, or even your stomach? There are a number of factors that can influence the position in which we tend to sleep. They can include positional sleep apnea, a breathing disorder of sleep that's mainly present while lying on your back, physical comfort, and the preference of your bed partner. While any of these factors can affect our sleep position, is the reverse true? Does our sleep position have anything to do with the way we sleep? Researchers from Canada decided to try and answer this question. Looking at 50 normal sleepers from five age groups, they report that there can be developmental trends in sleep position, but the position overall doesn't affect how we sleep. Sleep stages and percentages were normal for all sleep positions between the age groups.
COFFEE AND SLEEP
	Don't have that second (third or fourth!) cup of coffee--especially late in the day. Stimulants such as caffeine can have a detrimental effect on your sleep. You may be able to fall asleep as usual, but your sleep will be lighter and more prone to interruption. The same goes for you smokers. You guessed it--nicotine is a stimulant too and should be avoided at night.
KIDS AND TELEVISION
	We've heard it before--TV is bad for you. The truth of that has yet to be determined. However, a recent study out of Rhode Island appears to add some strength to the argument. Researchers surveyed nearly 500 parents and teachers and found that 25 percent of the kids had televisions in their rooms. These children were also more likely to have trouble falling asleep and wake up more often during the night. The researchers suggest that parents should pay more attention to children's viewing habits at bedtime and bedtime viewing should be limited.
NATIONAL SLEEP AWARENESS WEEK
	The week of March 27 through April 2 has been set aside as the official National Sleep Awareness Week. What does this mean to you? Watch for articles on several aspects of sleep and sleep medicine on television and in print. The main goal of any such "awareness" week is self-evident--to make the public more aware of the problems that can be associated with sleep disorders and the effects those disorders can have on your health. Of course, if you're reading this tip, you're already ahead of the game! For more information about Sleep Awareness Week, contact the National Sleep Foundation at (202) 347-3471 or visit its Web site at http://www.sleepfoundation.org
THE SAD ROLE OF FATIGUE
	Pilot fatigue is being cited as a significant factor contributing to the 1997 crash of a Korean Air jet in Guam, resulting in the deaths of 228 people. Investigators with the National Transportation Safety Board say the captain was unable to properly execute the landing approach or respond quickly enough to break off the approach as a result of his fatigue.
WHERE A CHILD SLEEPS
	Some of our past tips have mentioned the importance of instilling good sleep hygiene in children. Having your child stay in his own bed is a primary aspect. To add further justification for proper sleep habits, the Consumer Product Safety Commission reports that between 1990 and 1998, 515 babies died due to sleeping in adult beds. Of these deaths, 121 were due to suffocation caused by someone (parent, caregiver, or sibling) rolling over on top of the child. The rest were the result of the child's head becoming trapped in some structure of the bed.
DENTISTS TO THE RESCUE
	In some cases, getting a better night's sleep could involve a trip to the dentist! A sleep disorder called Bruxism, which involves grinding your teeth at night, is usually first identified by your dentist (if the associated jaw pain and sharp morning headaches weren't clues enough). Small, hairline fractures in your tooth enamel are usually one of the first indications there's a problem, and the dentist is best equipped to identify them. Fortunately, the dentist can help treat the problem as well. A simple mouth guard worn at night, often supplied through the dentist office, can dramatically improve the problem and save that pretty smile of yours.
DREAM EMOTIONS
	A number of investigations have reported a trend toward negative emotions in dreams as documented in dream diaries. Researchers in Mannheim, Germany's Central Institute of Mental Health, recently took a look at the different methods used to evaluate dream content and came up with a reason for the negative trend. They investigated the three major methods of measuring dream emotions: dream's intensity rated by the dreamer, intensity rated by a judge, and scoring of explicitly mentioned emotions in interviews with the dreamer. They found only in the cases where emotions were rated by an external judge did negative emotions outweigh the positive ones. They found this is mainly due to an underestimation of the positive emotions on the part of the judge. Ratings by the dreamer themselves and those coming from the interview with the dreamer were shown to be more positive, lending support to the notion that the best interpreter of the dream may well be the dreamer.
EXCESSIVE SLEEPINESS
	Excessive Daytime Sleepiness (EDS) can be an important indicator of improper or insufficient sleep. We've all had periods during the day, typically just after lunch, when we feel a bit tired, but at what point do we become too sleepy? The National Sleep Foundation wants to help you find out if your level of daytime sleepiness is too much. Visit its Web site at http://www.sleepfoundation.org You can take an online test that can give you an indication of your overall daytime fatigue. The test is based on a clinically validated test used in many sleep disorder centers around the globe. So what should you do if you find out you have an above normal amount of sleepiness? Fortunately, the folks at the Sleep Foundation also have links to resources in your area that can help provide you with more information.
HEART ATTACKS AND SLEEP
	Did you know that most heart attacks occur during the hours of 4 a.m. and 10 a.m.? Scientists believe that increased adrenaline plays a large role since adrenaline levels are higher during the early morning hours. It's also believed that sleep-disordered breathing may play a part. Sleep apnea, disrupted breathing during sleep, can increase the amount of stress on your cardiovascular system and decrease the amount of oxygen in your blood. The combination can lead to irregular heartbeats (arrhythmia) during sleep. Sleep apnea is often most severe during the early morning hours as well. If you have a history of heart problems as well as difficulty sleeping, check with your physician about an evaluation for sleep apnea. For more information, you may also want to visit http://www.sleepdisorders.com
HERBAL PILLOWS
	People who suffer from insomnia can sometimes find relief in a variety of nontraditional ways. Homeopathic remedies abound for the problem of sleeplessness, but generally in the form of a remedy that's ingested (through tea or supplements). However, drinking the herbs may not be the only way--try sleeping on them! Herbal pillows are simple to make and can have a calming effect. Using a strong, fine-grain cotton cloth, fill the pillow with a combination of scents that are either recommended by someone with experience in homeopathic medicine or with a number of scents you find personally soothing. Dried lavender, hops, and chamomile can get you started. It's important to remember that the herbs will lose their fragrance after about nine to twelve months and should be replaced.
LESS SLEEP
	Americans aren't the only ones not getting enough sleep. A recent survey of nearly 400 Tokyo residents revealed that half of the respondents get only six hours of sleep per night. Nearly 25 percent of those taking part in the poll report getting five or less hours per night! The researchers cite increasing work and social demands as well as an increase in commuting time as contributors to the problem.
MORE ON MELATONIN
	Melatonin, a neurotransmitter secreted by the pineal gland, has long been thought to play a role in some of the sleep problems associated with aging. It was believed levels of melatonin decreased as we got older, but recent information from the National Institute of Health states that levels, in fact, do not decrease with age. They compared people ages 65 to 81 with others ages 18 to 30 years. Their results showed no difference between the melatonin levels of either group.
POST TRAUMATIC STRESS DISORDER AND INSOMNIA
	Post Traumatic Stress Disorder (PTSD) is a syndrome of anxiety and hyperarousal associated with a traumatic event. The sufferer often has a preoccupation with the trauma and often relives the event through flashbacks, nightmares, and night terrors. Chronic insomnia is also often associated with PTSD. Patients with PTSD can benefit from some form of psychotherapy, but may, in more severe cases, require medication to help with the insomnia. Over time, and with consistent treatment, the associated nocturnal symptoms such as insomnia and nightmares are often resolved. For more information on PTSD and the effects it can have on your sleep, visit the National Center for PTSD Web site at http://www.ncptsd.org
SLEEP APNEA VERSUS A SIX PACK
	Stanford University researchers found that people with mild to moderate Sleep Apnea performed as badly, or worse, on reaction time tests than people who were legally drunk. Looking at the reaction times of 113 patients diagnosed with Sleep Apnea, a breathing disorder during sleep that causes periodic sleep disruption, researchers compared times with 80 adults who had a blood alcohol level of .08 (the legal limit in many states). They found the Apnea patients were just as, or more, impaired as a result of their fatigue than the other alcohol-impaired people.
SLEEP DON'TS
	Drastic changes in your diet can be disruptive to your sleep. You may end up having awakenings due to hunger (if you've drastically reduced the number of calories you're eating) or due to digestive problems (if you've made changes in the types of foods you're eating). Try making any dietary changes gradually and allow your body to adapt.
SUPPORT FROM FAMILY AND FRIENDS
	Many types of sleep disorders require treatment that's long term. The use of a Continuous Positive Airway Pressure (CPAP) device for the treatment of Obstructive Sleep Apnea (OSA) can, and often is, a life-long therapy. Various treatment programs for insomnia can take several months to achieve effectiveness. As with many treatment programs, support from family and friends is often essential for success, but support from peers and others who suffer from the same disorder can also be vital to long-term effectiveness. There are a number of resources available for sleep disorder patients. Listed below are a few Web sites that can get you started. For forums on sleep disorders: http://www.sleepnet.com/wwwboard/wwwboard.html For information about patient advocacy and what you can do to help others: http://www.stanford.edu/~dement/
THE COST OF INSOMNIA
	The Unity Sleep Medicine and Research Center at St Luke's Hospital in Missouri recently compiled cost information on medication, physician visits, and lost wages in an attempt to put a dollar figure on the economic impact of insomnia. They found that the total cost for substances used to treat insomnia was $1.97 billion, less than half of which was for prescription medication. Health care services for insomnia totaled $11.96 billion, 91 percent of which is attributable to nursing home care. Finally, the total direct costs in the United States for insomnia in one year were estimated to be $13.9 billion. The researchers suggest that more research into public education about sleep disorders and sleep hygiene and research into the underlying mechanisms of insomnia could help reduce the amount of lost income as well as lost sleep!
TRAVEL TIP
	Taking an especially long trip? Want to sleep well when you get there? Try to avoid alcohol during the flight. Alcohol may cause you to feel drowsy shortly after drinking, but sleep tends to be disrupted as the alcohol causes your body to dehydrate, especially at higher altitudes.
A HEAD START FOR MONDAY MORNING
	Sunday night insomnia can be a real pain for some of us. You know the feeling--you wake up at midnight, and you're awake until 1 a.m. You then feel groggy all morning on Monday. One good way to help avoid this kind of situation is to have regular wake time every day--even on the weekend. We have a tendency to want to sleep later on the weekend than we do during the week. A regular wake time helps to "solidify" your sleep so when Monday rolls around, you're as alert as if it were Saturday!
NOT NOW HONEY, I HAVE A HEADACHE
	Hypnic headache syndrome is a rare, sleep-related headache disorder. Sufferers awaken from sleep with complaints of severe headache pain. Happening more often in women, hypnic headaches tend to occur between 1 a.m. and 3 a.m.. They usually last for approximately two hours and occur as often as four times per week. Studies have shown that the average age of onset is approximately 60 years. Neurological examination, laboratory testing, and brain imaging fail to provide physicians with a cause for the headaches, but they've had some treatment success with certain medication.
VIOLENCE AT NIGHT
	Researchers from Stanford University School of Medicine are taking an in-depth look at reports of violence as a result of movement disorders that occur during sleep. Their investigation focuses on disorders that occur during different stages of sleep. Their initial results indicate that people who suffer from disorders like sleepwalking (which occurs during non-REM sleep) tend to suffer more self-inflicted injury as a result of their walking around. Those who suffer from a disorder of REM sleep that causes them to move around at night have very few reported incidences of injury to themselves or others. The researchers point out that it's important to rule out other disorders such as seizure activity as a cause of the nocturnal wanderings.
THE IMPACT OF INSOMNIA--PART 1 OF 2
	The National Sleep Foundation in association with the Gallup Organization recently conducted telephone interviews with a group of 1,000 Americans to determine the prevalence and nature of difficulty with sleep. In line with other national studies, about one-third of Americans reported some type of sleep problem. Approximately one in four reported occasional insomnia, while nine percent reported that their sleep difficulty occurred on a regular nightly basis. The most often reported problem by insomniacs was waking up in the morning feeling drowsy or tired, followed by waking up in the middle of the night, difficulty going back to sleep after arousing, and difficulty falling asleep initially. Interestingly, insomniacs rarely visited a physician to discuss their sleep problem, and four out of ten insomniacs self-medicated with either over-the-counter medications or with alcohol. Two-thirds of the insomniacs reported that they didn't have an understanding of available treatments for insomnia.
THE IMPACT OF INSOMNIA--PART 2 OF 2
	Further information from the National Sleep Foundation and the Gallup Organization survey of 1,000 randomly selected Americans addressed the daytime consequences and correlations of insomnia. The respondents were grouped as having occasional insomnia, chronic insomnia, or no insomnia. There were dramatic differences in reported waking behaviors and psychosocial measures by insomniacs compared to those who didn't report sleep difficulty. Problems included impaired concentration, difficulty with memory, reduced ability to finish simple daily tasks, and reduced enjoyment of interpersonal relationships. Importantly, most of these factors became worse as the sleep disturbance increased. Their findings suggest that insomnia can negatively impact aspects of waking function related to quality of life.
A NEW MEDICATION FOR NARCOLEPSY
	Clinical trials are beginning for a new medication used to treat some of the symptoms associated with narcolepsy, a disorder that causes excessive daytime sleepiness. Orphan Medical, a Minnesota-based biopharmaceutical company, is continuing research and development of GHB (Xyrem) for treatment of cataplexy, hypnogogic hallucinations, and sleep paralysis associated with narcolepsy. For more information about the medication and sites where the drug is being tested, visit the Narcolepsy Network Web site at http://www.websciences.org/narnet/whatsnew.htm
SLEEP IN CYBERSPACE
	There have been great strides made over the past several years in bringing information about sleep and sleep disorders into the public eye. The Internet has an incredible number of resources available that can provide not only information about specific disorders, but also places to contact if you feel you need a sleep physician's advice, support groups for people who are suffering from the same type of disorder, and hundreds of avenues for research on sleep problems. >From time to time, we'll spotlight sites that provide easy-to-use information as well as topical advice and even humorous anecdotes about sleep and related problems. A great place to start for sleep information on the Internet is http://www.sleepnet.com Sleepnet.com is filled with information and links covering a variety of sleep-related topics and a column written by Dr. William Dement, one of the founding fathers of sleep medicine.
WHY DO WE YAWN?
	Yawning used to be such a simple thing. You're tired, you yawn. You're bored, you yawn. Well, nothing is simple anymore, and yawning is no exception. A lot of research has been done on the burning question of what causes a yawn and, as with many burning questions, the answer seems to be "lots of things"! Listed below are a few of the suspected reasons for yawning: A reduction in brain metabolism, which is increased by the flexing of muscles in the neck and head An attempt to enhance alertness by causing arousal in certain areas of the brain A symptom of certain problems such as tumors, motion sickness, chorea, and encephalitis An expression of emotions such as boredom
A CHANGE FOR SLEEPY TEENS
	Many teenagers attend classes and participate in after-school functions where they're impaired by chronic sleep deprivation. The sleepiness they experience has a profound effect on their schoolwork, health, safety, and productivity. Research has shown that older adolescents require approximately nine hours of sleep to be alert during the day. Many secondary schools in America start between 7:30 a.m. and 8:30 a.m. Students frequently fall asleep in their morning classes or while performing other duties, such as driving. As a result, many school districts across the nation are asking if students and taxpayers are best served by early starting times. In an attempt to facilitate a change, Congresswoman Zoe Lofgren of California has proposed a bill to address the effects of sleep deprivation on students' performance and safety. The Z's to A's Act encourages school districts to move their starting times to 9 a.m. for secondary schools by providing a grant of up to $25,000 to help with the costs involved in shifting the schools' start times.
A SLEEP DON'T
	Don't eat a large, fat-laden meal for dinner. It may make you feel drowsy, but it won't help you sleep through the night. Instead, try a light dinner and a small snack before bed.
ADJUSTING TO SHIFT WORK
	Switching to a new work schedule, especially a third-shift schedule, can cause many problems for the worker. Dealing with family and social demands as well as adjusting to the different pace of work on the new shift can be the least of your worries. Our bodies can often respond with a number of physiological problems, including headaches, sleeplessness, and stomach problems. Researchers with the Biological Rhythms Research Lab at Rush-Presbyterian-St. Luke Medical Center in Chicago recently researched ways to help people adjust to new work schedules. It has long been known that exposure to bright light (5000 lux or more) can cause a shift in the body's "biological clock." The researchers wanted to see if there was any way to augment or even replace the bright light therapy with something else. They chose to test exercise against light therapy and found that light therapy (six 40-minute sessions) far exceeded exercise in changing the "clock." In fact, they found that exercise had absolutely no effect on the circadian rhythms of their subjects.
DON'T TOSS AND TURN
	Nothing is worse than tossing and turning in your bed while trying to go to sleep. Here are a few things you might try the next time you have this problem: *If you can't fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Try to avoid bright light during this time. *Avoid taking naps during the day. If you absolutely can't, keep the naps to under one hour. *Take a hot bath about 90 minutes before bedtime. The heat will raise your body temperature, but that isn't what will make you sleepy. The ensuing drop in temperature might. *Don't watch TV, do work, or pay your bills in bed. Save your bed for sleeping (and sex).
HANDEDNESS AND DREAMS
	Research conducted recently through the Department of Psychology at San Jose State University measured the relationship between handedness (left or right) and recollection of vivid dreams. To do this, the study asked groups of right-, mixed-, and left-handed university students to respond to a dream scale. The results demonstrated that left-handers were significantly more likely to recall types of dreams that classified as vivid. This supports the profile of the right hemispheric talent that's thought to characterize left-handers.
IS HYPNOSIS SLEEP?
	While being hypnotized may seem very similar to sleep for the individual, it most definitely isn't a sleep state. There have been no observed changes in brain waves or other bodily functions that resemble sleep in a hypnotized person. In fact, there's no physiological way to determine if a person is hypnotized. It's also important to note that one major factor separates sleep and hypnosis: Sleep is necessary, being hypnotized is not.
NAPPING AS A CONSTITUTIONAL RIGHT
	Senator Rod Tam of Oahu, Hawaii, recently introduced legislation giving workers in his fair state the explicit right to take naps during their work breaks. "Recent scientific research indicates that a short nap during the work day is beneficial to the human mind and body...a short nap restores and refreshes a worker to continue to work after the nap in a more efficient and proficient manner," he states. And he's correct. Research does show that naps can increase efficiency and daytime alertness especially in workers who are a little sleep-deprived as it is (like most of us!).
SLEEP QUIZ
	Question: Is sleep a time for your body and brain to shut down so you can rest? Answer: No. Although sleeping is a time when your body rests and restores itself, sleep is a very active state that can affect both your physical health and mental well-being. Sufficiently restful sleep, just like diet and exercise, is critical to overall good health. Insufficient restful sleep can result in mental and physical health problems and should be addressed as quickly as possible.
SLEEP QUOTE
	"The future belongs to those who believe in the beauty of their dreams." - Eleanor Roosevelt
SNORING, HYPERTENSION, AND PREGNANCY
	The University Hospital in Umea, Sweden, recently reported findings regarding pregnancy-induced hypertension, snoring, and the effect they can have on the growth of the fetus. After questioning 502 pregnant mothers and examining the children after birth, the researchers found that, in those patients who reported snoring during the pregnancy (approximately 115), seven percent of the children had reduced birth weights. They're quick to point out that snoring during pregnancy doesn't necessarily mean the baby will be smaller, but it can be part of a more complex problem, including hypertension, which contributes to developmental problems.
THE REAL WORLD EFFECTS OF FATIGUE
	In 1997, an Australian researcher decided to compare the effect of fatigue with the effect of alcohol on human performance. His findings help illustrate the impact of sleepiness caused by various sleep disorders. He found that being awake for 24 hours was roughly equivalent to having a blood alcohol level of 1.0. Some "sobering" advice: Get more rest!