A study in the May 1 issue of the journal SLEEP demonstrates that the use of a consistent bedtime routine contributes to improvements in multiple aspects of infant and toddler sleep, bedtime behavior and maternal mood.

Results indicate that the establishment of a nightly bedtime routine produced significant reductions in problematic sleep behaviors for infants and toddlers. Improvements were seen in latency and sleep onset and in the number and duration of night wakings. Toddlers were less likely to call out to their parents or get out of their crib/bed during the night. Sleep continuity increased and there was a significant decrease in the number of mothers who rated their child’s sleep as problematic. Maternal mood also significantly improved.

According to the study, sleep problems are one of the most common concerns of parents of young children; approximately 20 to 30 percent of infants and toddlers experience sleep difficulties. Previous studies have found that successful treatment of children’s sleep problems with behavioral interventions also result in improvements in parental well-being.

According to principal investigator, Jodi Mindell, PhD, professor of psychology at Saint Joseph’s University in Philadelphia, PA., creating a bedtime routine is an easy change that can significantly improve both the child’s sleep and the mother’s quality of life.

“There is no question that maternal mood and children’s sleep impact one another. The better a child sleeps and the easier bedtime is, the better a mother’s mood is going to be,” said Mindell. “In addition, a mom who is not feeling tense, depressed, and fatigued is going to be calmer at bedtime, which will help a child settle down to sleep.”

Data were collected from 405 mothers and their infant or toddler,(206 infants between the ages of 7 and 18 months and 199 toddlers between the ages of 18 and 36 months), who then participated in two age-specific three week studies. Families were randomly assigned to a routine or control group. The first week of the study served as a baseline, during which the mothers followed their child’s usual bedtime weeks. During the following two weeks mothers were instructed to conduct a specific bedtime routine, while the control group continued with their child’s normal bedtime procedure.

All children included in the study had a small to severe sleep problem, as identified by the mother. Problems included more than three nightly wakings, awakening for longer than 60 minutes per night, or having a total daily sleep duration of less than nine hours. All mothers completed an expanded version of the Brief Infant Sleep Questionnaire (BRISQ), and provided subjective data concerning their child’s sleep habits.

Parents in the infant routine group were given a three-step bedtime procedure to follow that included a bath, a massage and quiet activities (such as cuddling and singing); lights were to be turned out within 30 minutes of the end of the bath. Mothers then proceeded to put the child to sleep as they normally did, by either putting the child to bed while awake or rocking them to sleep. Thus, the only instituted change was the routine. The toddler group followed the same routine, except that mothers were instructed to apply lotion rather than give the child a massage.

Research shows that daily routines in general lead to predictable and less stressful environments for young children and are related to parenting competence, improved daytime behaviors and lower maternal mental distress.

Authors of the study were surprised by the fact that sleep during the night improved, with a decrease in the number and duration of wakings and improved sleep consolidation. Sleep may have improved because the use of a routine may have decreased arousal level, resulting in improved sleep throughout the night. Inclusion of the bath may also have positively impacted sleep quality, as previous studies have found that a bath before bed helped adults get to sleep by lowering the core body temperature.

According to the researchers involved in the study, primary care practitioners play a critical role in helping families implement positive sleep practices and improving sleep in infants and toddlers.

The results of this study highlight the importance of pediatricians emphasizing the importance and ease of creating a bedtime routine as a preventative measure and treatment option for young children with sleep problems.

The study: “A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood”

Disclosure


This study was supported by Johnson & Johnson Consumer Companies , Inc.

Source:
Kelly Wagner

American Academy of Sleep Medicine

Scientists funded by the National Institutes of Health have identified a gene associated with narcolepsy, a disorder that causes disabling daytime sleepiness, sleep attacks, irresistible bouts of sleep that can strike at any time, and disturbed sleep at night. The gene has a known role in the immune system, which strongly suggests that autoimmunity, in which the immune system turns against the body’s own tissues, plays an important role in the disorder.

“The link between narcolepsy and autoimmunity was proposed decades ago, but efforts to verify it have failed repeatedly. Current findings leave little doubt that autoimmunity plays a role,” says Merrill Mitler, Ph.D., a program director with the National Institute of Neurological Disorders and Stroke (NINDS). The study was funded principally by NINDS, with additional support from the National Institute of Mental Health (NIMH), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID), all components of NIH.

The new study, which appears in Nature Genetics, focused on narcolepsy with cataplexy - a sudden loss of muscle tone that can cause a person to collapse, with or without falling asleep. About 1 in 2,000 Americans have narcolepsy-cataplexy. The symptoms of narcolepsy-cataplexy have been shown to result from the death of a small group of brain cells that normally regulate the sleep-wake cycle by releasing chemicals called hypocretins.

Genetic and environmental factors both clearly play a role in narcolepsy-cataplexy. Until now, the best evidence for autoimmunity as a cause of the disorder was the discovery that nearly everyone with the disorder has unique variants of a gene called HLA-DQB1*0602. This is one of the genes that encodes HLA proteins, which dot the surface of the body’s cells and help the immune system identify foreign proteins. Some researchers theorize that the HLA variants found in people with narcolepsy-cataplexy predispose them to an autoimmune reaction that destroys their hypocretin-producing cells.

There are gaps in that theory, however, says Emmanuel Mignot, M.D., Ph.D., director of the Center for Narcolepsy at Stanford University School of Medicine in Palo Alto, Calif., and a Howard Hughes Medical Institute investigator. Dr. Mignot discovered the link between narcolepsy and the hypocretins, and helped establish the link to the HLA system. HLA proteins are found in many tissues including the brain, where they may affect brain development, he says.

HLA variations, however, do not fully account for narcolepsy-cataplexy. Dr. Mignot led a genome-wide association study to search for other genes associated with narcolepsy-cataplexy. These studies involve scanning the genome - the entire set of DNA - for small differences between people who have a disorder and people who do not. Dr. Mignot’s study included more than 4,000 individuals, all of whom had the HLA variants that predispose to narcolepsy-cataplexy but only about half of whom had the disorder. Participants were recruited so that many genetic groups were represented. Subjects were from the United States and eight countries in Europe and Asia; hundreds were African-American, Korean, and Japanese, groups known to have a high incidence of the disorder.

The researchers discovered that in addition to unique HLA variants, people with narcolepsy-cataplexy are also more likely to have unique variants of the TCRA gene, which encodes a receptor protein on the surface of T cells. T cells are the mobile infantry of the immune system. In concert with the HLA proteins, the T cell receptor enables T cells to recognize and attack foreign invaders, such as bacteria and viruses. Changes to the T cell receptor could increase the likelihood that the cells will direct their attack against the body.

The findings of Dr. Mignot’s group indicate that narcolepsy-cataplexy is linked to autoimmunity and involves T-cells. The research could lead to new approaches to prevention and treatment. One possibility may be preventing the disorder by stopping the effects of the autoimmune process. “If we can define the changes in the T cell receptor associated with narcolepsy-cataplexy, we might be able to develop drugs that block the protein’s abnormal activity and prevent the onset of the disorder,” says Dr. Mignot. Current treatments such as stimulant drugs for combating daytime sleepiness and antidepressants for cataplexy are only able to control symptoms, and do not address the underlying loss of hypocretin cells.

It is important to note that this study, like most genome-wide association studies, did not identify genetic variants that directly cause narcolepsy-cataplexy. Instead it identifies groups that are more likely to show narcolepsy-cataplexy and groups that are less likely to show the disorder. In people with the HLA variants that predispose to narcolepsy-cataplexy, there is about a 20-fold higher frequency of the disorder if variants in the TCRA gene are present. It is yet to be known which people with the genetic variants will go on to develop narcolepsy-cataplexy.

Other risk factors for narcolepsy-cataplexy remain to be discovered, and Dr. Mignot’s findings could provide clues to their identity. For example, further studies to characterize the T cells in people with narcolepsy-cataplexy could help reveal whether specific environmental factors - such as infections - contribute to the disorder. Dr. Mignot’s findings also could lead to a better understanding of other autoimmune diseases where HLA genes are known to play a role, such as multiple sclerosis and type 1 diabetes.

Reference:


Hallmayer J et al. “Narcolepsy is Strongly Associated with the TCR alpha locus.” Nature Genetics, published online May 3, 2009.

Source:
Daniel Stimson

NIH/National Institute of Neurological Disorders and Stroke

Sleeplessness is a big problem for millions of people, and it is often caused by stress and anxiety. With hectic lifestyles, hard economic times, and pressures from work and home, there are more people feeling the effects of stress at night when they can’t sleep.

There are countless anti-anxiety pills and sleeping pills on the market. Most of them can be addicting and can leave you feeling foggy, uneasy, and you might not get the quality night’s sleep that you really need to function. Many people turn to natural remedies and mild herbal sleep remedies for anxiety and sleeplessness. You should always pinpoint the source of your stress and sleeplessness before resorting to other remedies.

Here are some of the most widely used herbs for anxiety and sleeplessness:

Chamomile Tea: Unlike some other herbal sleep remedies, chamomile tea does not have to be used on a regular basis to have an effect on insomnia or sleeplessness. This herb is great for helping calm nerves and anxiety. Simple drink a cup of chamomile tea about 30 minutes before you go to bed to provide quick relief and relaxation.

Kava Kava: This is a very effective remedy for sleeplessness and anxiety. Studies have shown it can be effective as soon as 30 minutes after taking it.

Ginseng: Ginseng root is often thought of as a stimulant but it also has the effect of balancing the entire body and calming the system.

Lemon Balm: Several studies have shown that lemon balm combined with other herbal sleep remedies for anxiety, such as valerian or kava kava, helps reduce anxiety and sleeplessness.

St. John’s Wort: This herb is not a sleep-inducing herb, but it has been shown to enhance the overall quality of sleep. It is best used in conjunction with other calming and relaxing herbs.

Valerian: This is one of the best selling herbs in America and it is well known for its positive effects on sleeplessness and anxiety. People who take this herb report a calming and relaxing effect, which leads to a shorter time needed to fall asleep.

You can try these herbs individually or use them together. Be sure to purchase herbs and herb mixtures from reputable sellers. Most people see results in a couple of weeks.

I wanted to share with you some little tricks to stop snoring. Conventional wisdom is completely non-existent when it comes to snoring. People don’t understand why it happens and they don’t understand what they can do about it. I suppose the main reason people are oblivious to it is that snoring doesn’t affect them. They’re sound asleep when they snore, so it doesn’t bother them. It is the people around you that have to put up with sounds. They’re the ones you’re keeping up at night. There are things you can do to fix this problem, so I’m going to share my little tricks to stop snoring.

People that snore are usually on their backs and there is a specific thing that happens in this case. Loose tissue is pulled down into the airways by gravity. You’re definitely going to have vibrations when you do this and you’ll get the sounds. Rolling onto your sides clears this up completely, but how do you stay on your side all night? Just sew a tennis ball into the back of a shirt. This way when you try to roll onto your back, the ball will be in the way and you’ll go back onto your side.

Another one of my little tricks to stop snoring is a jaw supporter. Another characteristic of something that snores is that their mouth is wide open. This actually puts pressure on the throat and squeezes it. The less room for air to travel, the more likely you’re going to get vibrations. A jaw supporter holds your jaw up and will stop snoring completely because your throat expands.

In this busy life with our jobs/careers, children, errands, obligations, bills, e-mail and the like, it seems as though sleep has become more of a luxury than a necessity. It is something that has been pushed aside because there are way too many other things that need to be done. After all, it’s easy to assume that the only price we pay after not getting a good night’s sleep is just being tired and cranky the next day. Most of us can deal with that and get over it as the day progresses, but what about what’s really happening to our bodies when we cut out this necessary function?

Although many may say that there simply is just not enough time to sleep, what happens when you become ill and must take off of work to go see a doctor? Consistent lack of sleep will manifest itself in ways that are much more time consuming than getting your 7-8 hours a night. Of course it is not always easy to get in a full night’s sleep every night. It is a challenge and time is a factor that most of us struggle with on a daily basis. However, there are ways to manage your day and your time so that you can do what you need to do while maintaining good health.

Below are some examples of how it affects our minds, bodies and overall health.

A good night’s sleep will help to:

- Reduce stress

- Keep your heart healthy

- Improve your mood

- Bolster your memory

- Make you more alert

- Reduce inflammation in the body

- Reduce your risk for depression

- Improve concentration

When we are lacking adequate sleep, our bodies produce stress hormones and go into a state of high alert. This can bring about significant anxiety, nervousness, irritability, and so on. The body also depends on adequate amount of sleep so that it can repair itself in order to function properly and maintain optimal health.

It seems as though if we miss a few hours of sleep during the week, we can make up for it on the weekends. Unfortunately it doesn’t work this way. Each stage of sleep provides the body with specific functions that benefit our health. This only works in our favor when we are consistently getting the proper amount of sleep we need as opposed to a few hours during the week and all day on a Saturday or Sunday. If we cut down the number of hours of sleep we are getting, we cut out the proper number of cycles our bodies need to repair and restore themselves. This is what typically leads to physical illness and overall stress. Adults typically need 7-8 hours of sleep while teens and children require a little more. Although life gets hectic, you may want to do yourself a favor and get that extra hour or two of shut-eye that you’ve been sacrificing. I can assure you that it will be well worth it!

Finding a stop snoring solution can be a difficult challenged even to the best Internet surfer. And a cure for snoring is an extremely important thing especially if you are married. My wife has spent countless nights with a pillow over her head and elbowing me in the side. I have heard more than a few times the words roll over and shut up! We were pretty desperate to find a solution to the noise I was making every night.

We tried just about every thing short of surgery to eliminate my snoring problem. I wore those sticky nose strips that either cam off during the night or left red splotches on my nose for hours in the morning. We tried piling up pillows to help me sit up while I slept. No way could I get a good nights sleep in that position. My wife finally resorted to wearing earplugs every night. It was either that or she was going to sleep in the other room and I for one did not like that idea.

Finally after a lot of searching on the Internet and talking with some friends online I found a stop snoring solution that actually worked. Realize that it was not a simple fix I did have to commit to the program to actually see results. However, it was really a small sacrifice to be able to offer my wife a decent nights sleep. Not only does she sleep much better but I feel more rested on the morning as well. Apparently I breath better a so I rest better.

Repeatedly going to work when ill significantly boosts the chances of having to take long term sick leave later on, reveals research published ahead of print in the Journal of Epidemiology and Community Health.

Going to work when ill is an increasingly recognised phenomenon known as “sickness presence,” but relatively little is known about the long term impact of this behaviour.

The researchers randomly selected almost 12,000 Danes of working age, who had been in continuous employment for at least a year, to answer questions on their attitudes to work, preparedness to take time off when ill, and general health.

They were asked how many times in the preceding year they had gone to work ill when it would have been reasonable to have stayed at home.

Their responses were married up with official records detailing periods of sick leave taken, and lasting at least a fortnight, over the next 18 months.

Poor general health, a heavy workload, work-family life conflicts, a good level of social support, holding a senior post, and obesity featured most often among those who repeatedly came to work, despite being ill.

Workers who had done this at least half a dozen times were 53% more likely to end up going off sick for two weeks, and 74% more likely to take more than two months of sick leave, compared with those who did not come to work when ill.

These findings held true even after taking account of known risk factors for long term sick leave, previous bouts of lengthy sickness absence, and prevailing health.

Short periods off sick may allow workers to cope better with the stresses of a demanding job, and, overall, the evidence is that employment is good for health, say the authors. But long term sick leave is associated with difficulties finding work, they warn.

Source
British Medical Journal

A study in the May 1 issue of the journal SLEEP suggests that babies born to mothers with depression are more likely to suffer from significant sleep disturbances at 2 weeks postpartum that continue until 6 months of age. Findings of the study are of particular importance, as sleep disturbances in infancy may result in increased risk for developing early-onset depression in childhood.

Results indicate that infants born to mothers with depression had significant sleep disturbances compared to low-risk infants; the high-risk group had an hour longer nocturnal sleep latency, shorter sleep episodes and lower sleep efficiency than infants who were born to mothers without depression. Although average sleep time in a 24 hours did not differ by risk group at eight two or four weeks, nocturnal total sleep time was 97 minutes longer in the low-risk group at both recording periods. High-risk infants also had significantly more daytime sleep episodes of a shorter average duration.

Previous studies have found that levels of cortisol, a hormone that is associated with stress, is increased during pregnancy and after delivery in depressed mothers, indicating that the mother’s hormone level may affect the infant’s sleep.

According to the lead author, Roseanne Armitage, PhD, director of the Sleep and Chronophysiology Laboratory at the University Of Michigan Depression Center, while maternal depression does have a negative effect on infants’ sleep, the damage may be reversible.

“We do think that we could develop a behavioral and environmental intervention to improve entrainment of sleep and circadian rhythms in the high risk infants,” said Armitage. “However, whether it is maternal hormones that “cause” the sleep problems in infants is not yet known. It could genetic, hormonal, or both. Regardless of the cause, they may still be modifiable since brain regulation is very plastic and responsive in childhood.”

The study involved 18 healthy full term infants, half of whom were male. Seven infants were born to women with no personal or family history of depression and 11 were born to women diagnosed with depression or with elevated levels of depression symptoms. Five women were experiencing a Major Depressive Disorder (MDD) episode during the beginning of the study.

Infants who were born to mothers who has past or present MDD according to the DSM-IV or who scored high for postnatal depression were placed in a high-risk group for depression; all other infants were considered to be low-risk. Both the mother and infants’ sleep was measured with light and motion sensor actigraphy over the course of seven consecutive days at two-weeks postpartum and monthly thereafter for six months. Mothers were also asked to complete daily sleep/wake diaries. Mothers were recruited during the last trimester of pregnancy through perinatal mood disorders or obstetrics clinics at the University of Michigan.

Authors state that findings of this study claim that future work should attempt to determine if sleep in infancy is modifiable and to define the optimal conditions for entrainment of sleep to the nocturnal period. According to previous studies, untreated infant sleep problems can become chronic, with implications for the mental health and well-being of both the child and the mother. The difficulties of mothers who are already vulnerable to anxiety and depression will be exacerbated if they also are deprived of sleep.

The study: “Early Developmental Changes in Sleep in Infants: The Impact of Maternal Depression”

Source:
Kelly Wagner

American Academy of Sleep Medicine