According to a study published in the July 2009 issue of Pediatrics, children who wet the bed at night or who are overweight are more likely to have obstructive sleep apnea.

Overnight sleep studies were done in 149 children with obstructive sleep apnea (OSA) between the ages of 5 and 15 and 139 comparable controls. There was found to be a fivefold increased risk of OSA among children with bedwetting and a fourfold increased risk among the overweight.

These two factors were not, however, associated with each other. Therefore, overweight children are not more likely to wet the bed and those who wet the bed are not more likely to be overweight.

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Though the Internet may often be the last thing those suffering from insomnia may need to sleep through the night, a new study suggests it may also be the right tool for some.

In a small study reported in the Archives of General Psychiatry, a novel approach to therapy was employed through the use of software called Sleep Healthy Using the Internet, or SHUTi.

This interactive program gives advice, including specific bedtimes, based on the user's sleep diary data, which is a summary of sleep over a period of days or weeks. The patients learn better sleep habits through stories, quizzes, and games.

In the study, 22 of 45 adults with moderate insomnia were assigned to the Internet program for nine weeks and the others received no treatment. Even after six months, the treated group woke up fewer times and spent less time awake during the night.

The therapy may represent a low-cost alternative, especially for those without access to in-person therapists. Its design is based on cognitive behavioral therapy which helps patients change thinking patterns that contribute to poor sleep. This therapy is often effective in improving sleep among insomniacs without the side effects of medications.

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What are the causes of some of the most common sleep disorders? Although the answer is often unknown, we are slowly learning what might contribute to the various disruptions in sleep.

Take a few minutes to review these causes and discover what just might be keeping you up at night.

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According to the National Sleep Foundation, nearly 18 million Americans suffer from sleep apnea. This is a chronic disorder in which one repeatedly stops breathing during the night, and it can have major, life-threatening consequences.

There are three simple steps one can take to cut your risk of sleep apnea. These lifestyle changes include:

• Eliminate alcohol as it can relax the muscles of the upper airway.
• Lose weight as it contributes to obstruction of the airway.
• Quit smoking as this can cause swelling of the tissues in the airway.

These steps will improve your health in general, but they may also reduce the risk or severity of sleep apnea.

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Recent reports suggest that Michael Jackson may have been using Diprivan, or Propofol, to help him sleep. This intravenous drug is not approved for this use, and this may have had fatal consequences.

In general, medications are approved by the Food and Drug Administration (FDA) for specific uses based on pharmacological and clinical research trials. After approval, some medications are found to be effective for other conditions not specifically tested with the research. This is commonly called an "off-label" use and occurs with many medications.

Diprivan is approved by the FDA for use in general anesthesia (such as would occur in an operating room), monitored anesthesia care sedation, and as sedation for mechanically ventilated patients in the intensive care unit. Its reported off-label uses include sedation for procedures or intubation and also the treatment of headaches. It is not standardly used for sleep induction in those with insomnia, though as a hypnotic agent it would be effective for this.

As for the risks of off-label use of Diprivan, these would likely be similar to the established risks of the drug. It most commonly causes pain at the site of injection (in up to 28.5% of people), nausea or vomiting, and muscle twitches. Serious reactions may occur, including a slow heart rate (in 4.8%), apnea (when breathing stops), or even heart failure (in up to 10%).

These risks certainly suggest that any drug use should be carefully considered, and that when this use is off-label there can be unexpected and dangerous consequences. It remains to be seen whether Michael Jackson was a victim of this practice.

_{Source: "Propofol." Micromedix. Last updated May 4, 2009.}

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The Associated Press reports that Michael Jackson may have suffered insomnia over the past months and in his quest for sleep he may have turned to a powerful and dangerous sedative.

A registered nurse and nutritionist, Cherilyn Lee, worked with Jackson and says she repeatedly rejected his demands for an intravenous drug called Diprivan or Propofol. It is a powerful hypnotic drug that is given intravenously. It is most often used for anesthesia in the operating room and is common in intensive care units to keep patients sedated while they are intubated.

Lee describes Jackson as "desperate" to get some sleep. Propofol is highly effective in inducing unconsciousness, but it is also dangerous. One of its most serious reactions is cardiac arrest, which is the reported cause of the singer's death.

The final results of his autopsy, including toxicology reports, will not be available for a few weeks. If true, this could shed light on the misery and dangers of the most common of sleep disorders.

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Mood disorders -- such as anxiety and depression -- may share a common genetic link with insomnia, according to a recent study of children and adolescents.

Researchers examined 1,442 twin pairs and found that about one third of those diagnosed with depression or anxiety also had insomnia. The twins studied were aged eight to 17. Only 1.3% of the sample had depression, but 18% had symptoms of anxiety. Among those with either diagnosis, 32.4% had insomnia compared to 16.5% of adolescents with insomnia who were free of these mood disorders.

If one of the children in a monozygotic, or identical, twin pair had insomnia, his or her twin was more likely to have it as well. This study adds to the evidence that children diagnosed with anxiety or depression should also be screened for insomnia.

In one of William Shakespeare's most famous plays, Hamlet, the title character muses, "To sleep, perchance to dream." But if a new study is accurate, that dream-filled sleep may have been a perfect chance for him to problem solve as well.

Researchers report in the June 2009 issue of The Proceedings of the National Academy of Sciences that naps including rapid eye movement (REM) sleep led to improved problem-solving abilities.

In the study, 77 volunteers were given word-association tests before and after spending a day without a nap, napping without REM sleep, and napping with REM sleep. Everyone did slightly better on the evening exam as compared to their first attempt in the morning, but those who took naps improved their results even more. For those who napped long enough to have REM sleep, they enjoyed a nearly 40 percent improvement over their initial performance.

So next time you find yourself burdened with a seemingly impossible problem, take a nap and you may potentially dream yourself to a solution.

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Middle-aged adults who are chronically sleep deprived may be at increased risk for developing high blood pressure.

Researchers have observed that missing an average of one hour of sleep nightly over five years raised the risk of developing high blood pressure by 37 percent. The study was released in the June 2009 issue of the Archives of Internal Medicine.

The study evaluated 578 adults with an average age of 40. The amount of nightly sleep and blood pressure measurements were followed. The volunteers slept an average of six hours, and only 1 percent slept eight hours or more. Those who slept five hours compared to six hours had a 37 percent increased risk of developing high blood pressure.

Sleep deprivation has been shown to be related to many health consequences in adults, including: obesity, increased risk of infections, heart disease, stroke, and cancer. High blood pressure affects one third of Americans and contributes to 7 million deaths each year.

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Even among those of relatively normal weight, obstructive sleep apnea may be to blame in up to half of those who complain of excessive daytime sleepiness.

Researchers examined the records of more than 28,500 patients who underwent polysomnography. They found that 54% of normal weight individuals were diagnosed with obstructive sleep apnea. This disorder is commonly associated with the overweight and obese, so it was surprisingly that so many of normal weight were afflicted. These individuals did tend to have less severe disease, as measured by the AHI.

This suggests that even thin or normal weight individuals who complain of excessive daytime sleepiness should be evaluated for obstructive sleep apnea as a potential cause of their symptoms.

_Source:

Yeligulashvili, T. Obstructive sleep apnea in non-obese patients: age, gender and severity. SLEEP 2009; 32: A186.

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