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Monday, March 03, 2008

Americans Need More Sleep

Most of Americans sleep less than recommended by experts.

The Center for Disease Control surveyed 19589 adults in the states of Delaware, Hawaii, New York and Rhode Island. They were questioned about how many days within the past month they slept less than needed. The survey found that 70% of questioned adults lack daily sleep. 10% reported lack of sleep for every single day of the past month. 38% reported lack of sleep for 7 days of the past month.

13.3% of questioned younger adults aged from 18 to 34 reported lack of sleep, compared to 7.3% adults of age of 55 and older. Surveyed adults from Hawaii appeared to have less sleepless nights, compared to the rest of surveyed people. However, the survey didn't ask how many hours a day adults sleep.

CDC also examined data during the period from 1985 to 2006 about how many hours adults lack in sleep. Data showed that Americans lacking sleep increased during this period from 1985's 20% to 2006's 30%. These adults were having an average of 6 hours or even less daily sleep.

The survey showed no difference in sleep graphic between genders and different racial groups. All of them suffer from sleep disorders equally. However, those who have retired or are not able to work because of health conditions have better sleeping habits. Most of them reported to sleep normally every night.

National Sleep Foundation recommends from 7 to 9 hours of daily sleep for adults, from 8.5 to 9.5 hours for those aged from 11 to 17, and from 9 to 11 hours for those aged from 5 to 12.

Experts worn that sleep disorders may lead to 'obesity, diabetes, high blood pressure, stroke, cardiovascular disease, depression, cigarette smoking, excessive drinking.'

Experts urge everyone to sleep the recommended hours daily, because sleep is an important factor affecting health. Everyone must consider healthy sleeping as an important part of healthy lifestyle.

Insomnia patients with mental conditions often denied sleep treatment


Patients with insomnia who are diagnosed with accompanying mental health ailments often are not prescribed medication that will help them sleep - which could then make related anxiety or depression worse, new research suggests.
Scientists examining treatment patterns for insomniacs say that their findings suggest that many doctors appear to be reluctant to prescribe sleep aids, even those that pose no risk of dependence, if patients also have depression, anxiety or mood disorders. An exception is psychiatrists, who were found to be twice as likely as primary care physicians to prescribe medication for insomnia.
“Insomnia can cause you to have anxiety and depression, and depression and anxiety can cause you to have insomnia. It’s a chicken-and-egg type of story. But research has shown that if one of the conditions is left untreated it can exacerbate the other condition,” said senior study author Rajesh Balkrishnan, the Merrell Dow professor of pharmacy at Ohio State University.
“What this calls for is specific guidelines related to the treatment of insomnia that takes into consideration these different types of patients, because insomnia has become such a big public health problem.”
An estimated 20 percent of Americans have occasional sleep problems, with about one in 10 suffering from chronic insomnia.
Balkrishnan acknowledges concerns that physicians might have about prescribing certain medications that can cause dependence, especially to patients with mental health disorders. Older sleep aids, a class of drugs called benzodiazepines, are muscle relaxants with addictive properties and high potential for abuse. However, since the early 1990s, a new class of drugs for insomnia called non-benzodiazepines has been on the market. They are effective sleep aids that don’t carry the risk of addiction, Balkrishnan said, and for that reason, patients should have ready access to these medications.
“This research highlights the need to take into account that many patients who see their doctors with complaints of insomnia also have a psychiatric condition. But the presence of those mental conditions should not preclude them from being appropriately treated for their insomnia,” he said.
The study is published in the January issue of the Journal of Medical Economics.
Balkrishnan and colleagues collected data from the National Ambulatory Medical Care Survey, which tracks Americans’ annual outpatient medical visits. The researchers identified 5,487 physician visits by patients with insomnia between 1995 and 2004, which was calculated to represent about 161 million U.S. patients over that 10-year period.
According to the analysis, an estimated 6.5 million Americans who saw a doctor for insomnia also were diagnosed with a mental health disorder. Of the visits examined, 38 percent of patients with insomnia were diagnosed with at least one other condition, and at least four of every 10 of those accompanying conditions related to mental health. The most common additional condition was anxiety (15.6 percent), followed by episodic mood disorders (14.9 percent), high blood pressure (10.1 percent), depression (7 percent) and diabetes (3.5 percent).
The study showed that insomnia patients with mental health disorders were 36 percent less likely to receive medication for their sleeping problems than were patients without the mental health diagnosis. Those with anxiety were the least likely to receive a sleep aid, with a 45 percent decreased likelihood of receiving medication for insomnia compared to patients without anxiety.
Balkrishnan said that with generic forms of nonaddictive insomnia medication available by prescription, even patients taking antidepressants and anti-anxiety drugs can safely – and affordably – add a sleep aid to their regimen. The most common forms of antidepressants prescribed in the United States are a class of drugs called selective serotonin reuptake inhibitors (SSRIs).
“Physicians might perceive that drowsiness is induced by medications such as SSRIs so there might be a general fear about combining them with insomnia medications,” Balkrishnan said. “But I think those fears are somewhat unfounded because we found that psychiatrists don’t have any problems prescribing sleep medications in patients who have accompanying mental conditions; they know there is no danger of a drug-to-drug interaction.”
According to the analysis, patients visiting psychiatrists had two times higher odds of receiving medication for insomnia than patients visiting family practice or internal medicine physicians. The study showed that 33 percent of patients with insomnia saw family practice or internal medicine physicians, 30 percent visited psychiatrists and 9 percent went to neurologists.
The study identified other factors associated with insomnia medication prescribing patterns – for example, older and established patients were more likely to receive insomnia medications than were younger patients or those seeing the doctor for the first time. But Balkrishnan said a clear theme emerged from the analysis.
“There is a divide in who gets appropriate medication and who is not appropriately medicated,” he said. “It might not be happening willfully, but it points to a knowledge gap between different types of physicians and the need to develop widely accepted insomnia treatment guidelines. And the guidelines should be ratified by essentially all physicians treating the condition.”

Snoozing Worms Help Researchers Explain Evolution Of Sleep


The roundworm C. elegans, a staple of laboratory research, may be key in unlocking one of the central biological mysteries: why we sleep. Researchers at the University of Pennsylvania School of Medicine report in this week's advanced online edition of Nature that the round worm has a sleep-like state, joining most of the animal kingdom in displaying this physiology. This research has implications for explaining the evolution and purpose of sleep and sleep-like states in animals.

In addition, genetic work associated with the study provides new prospects for the use of C. elegans to identify sleep-regulatory genes and drug targets for sleep disorders.

First author David M. Raizen, MD, PhD, Assistant Professor of Neurology, in collaboration with other researchers at the Penn Center for Sleep, showed that there is a period of behavioral quiescence during the worm's development called lethargus that has sleep-like properties. "Just as humans are less responsive during sleep, so is the worm during lethargus," explains Raizen. "And, just as humans fall asleep faster and sleep deeper following sleep deprivation, so does the worm."

By demonstrating that worms sleep, Raizen and colleagues have not only demonstrated the ubiquity of sleep in nature, but also propose a compelling hypothesis for the purpose for sleep.

Because the time of lethargus coincides with a time in the round worms' life cycle when synaptic changes occur in the nervous system, they propose that sleep is a state required for nervous system plasticity. In other words, in order for the nervous system to grow and change, there must be down time of active behavior. Other researchers at Penn have shown that, in mammals, synaptic changes occur during sleep and that deprivation of sleep results in a disruption of these synaptic changes.

In addition, the research team used C. elegans as a model system to identify a gene that regulates sleep. This gene, which encodes a protein kinase and is regulated by a small molecule called cyclic GMP, has been previously studied but not suspected to play a role in sleep regulation. The findings suggest a potential role for this gene in regulating human sleep and may provide an avenue for developing new drugs for sleep disorders.

"It opens up an entire new line of inquiry into the functions of sleep," notes Penn Center for Sleep Director and co-author Allan I. Pack, MB, Chb, PhD.

AASM On Sleep Medications And Insomnia Treatment

Insomnia and Sleep Medications
Insomnia occurs when people have trouble falling asleep or staying asleep, and it is a common sleep compliant. While a brief case of insomnia can arise due to temporary stress, excitement or other emotion, more than 20 million Americans report having a chronic form of insomnia that keeps them from sleeping well nearly every night. As a result, the insomnia, which is a serious and often debilitating condition, can lead to severe daytime fatigue, poor performance at school and work, physical symptoms such as headaches, and in some cases depression.
People suffering from insomnia need to know that there are effective insomnia treatments and their sleep can improve. The American Academy of Sleep Medicine recommends that people who experience insomnia see a sleep medicine specialist or primary care physician for proper diagnosis and to discuss treatment options before treatment with medications is undertaken. This evaluation should also look for specific causes of insomnia such as restless legs syndrome or depression.
Sleep medications are often used for the short-term treatment of insomnia and, on occasion, for more chronic insomnia. Medications that currently are available by prescription are known to improve sleep by reducing the amount of time it takes to fall asleep, increasing sleep duration and/or reducing the number of awakenings during sleep. While modern hypnotics are considered safe, individuals should be aware that, like all medications, side effects may occur in a minority of patients. These side effects can include sleep walking, sleep eating and other complex sleep behaviors as well as difficulty with memory.
RECOMMENDATIONS FOR PATIENTSBehavioral therapies and medications have been shown to be effective therapies for insomnia. Behavioral therapies use nonpharmacologic methods to improve sleep and are effective and long lasting. Sleep medications are effective and safe treatments for insomnia when used properly and judiciously by a patient who is under the supervision of a sleep medicine or primary care physician.
The American Academy of Sleep Medicine offers the following recommendations for individuals who use sleep medications:
  • Read carefully the package insert and all information provided by your physician and pharmacist for your sleep medication. This information will help guide you in the safe use of the medication.
  • Especially read the package insert and all information to learn the side effects of the medication.
  • Adhere strictly to the indicated use of your sleep medication. Do not take it for purposes other than to sleep.
  • Follow the prescription carefully and do not take more than the dosage your doctor prescribes.
  • Allow time for a full night of sleep when using sleep medication to avoid morning or daytime drowsiness.
  • Avoid combining sleep medication with alcohol.
  • Ask your doctor any questions you have about the intended use, dosage and side effects. Communication with your physician will help ensure safe use of the medication.
  • Inform your doctor right away of any problems you have while taking a sleep medication.
  • Make your doctor aware of any other medications, prescriptions or over-the-counter, that you use. Mixing medications may cause adverse effects.
  • Make your doctor aware of other medical conditions, including other sleep disorders, you may have. Sleep medications can be dangerous when treating sleep disruption that may arise from another disorder.
  • Visit www.SleepEducation.com for more information about insomnia, treatment options and to find a sleep center.
RECOMMENDATIONS FOR PHYSICIANS The American Academy of Sleep Medicine is committed to educating sleep medicine and primary care physicians about treatment options for insomnia. Behavioral therapies and medications have been shown to be effective therapies for insomnia. The American Academy of Sleep Medicine offers the following recommendations for primary care physicians who see patients with insomnia :
  • Read the practice guidelines for chronic insomnia created by the American Academy of Sleep Medicine.
  • Become intimately familiar with sleep medications you prescribe, including the indications for use and side effects.
  • Educate your patients about the sleep medicine you are prescribing to them, including the indications for use, dosage and side effects. Ensure your patients fully understand the intended use and potential effects.


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