A lack of sleep can affect many aspects of a child’s life.  Sleep deprivation can affect a child’s mood, behaviour and academic performance, writes Paula Goodyer. What’s the difference between a child who’s overtired and one with a behaviour disorder? Not a lot, says sleep specialist Dr Chris Seton, recalling a US experiment in which 50 children with ADHD were put together in a hall with 50 sleep deprived children – and sleep physicians and ADHD experts were asked to tell them apart.

“Most of them couldn’t do it – there was one specialist who managed to identify 62 per cent of children accurately, but his was the highest score,” says Seton who works with the Sleep Disorders Clinic at Westmead Children’s Hospital in Sydney. “A tired five-year-old and a five-year-old with ADHD can both act in the same way. There’s probably a common pathway, but so far researchers have been unable to find what it is.” But he has no doubt that increasing numbers of Australian children are sleep deprived – and worse off for it. While some research links childhood obesity to lack of sleep, there’s stronger evidence that
children’s behaviour, academic performance and mood are impaired by chronic lack of sleep, says Seton who believes electronic media and mobile phone use take much of the blame. “Texting is worse than talking on the phone because kids stay awake waiting for the next message. Although we don’t have good figures on this in Australia, a study of 13-year-olds in the US that included checking mobile phone records, found that 45 per cent of them used their phones after 3am,” he says, urging parents to be more assertive about keeping computers and TVs out of children’s bedrooms, and making it a rule that mobiles stay on the kitchen bench until morning.

How much sleep at what age?

Seton says the best way to judge how much sleep a child needs is to assess whether it’s “enough for them to wake spontaneously – meaning without an alarm clock – on most mornings and avoid tiredness during the day at least until the last hour before bedtime”.

As a guide:

- Preschoolers: 12 hours’ sleep in a 24-hour period.

- Primary schoolchildren: nine-11 hours.

- 12- to 17-year-olds: nine-10 hours.

But these are averages from which some children may vary, Seton says.

Rewards and routines

Recently the parent of a seven-year-old was referred to Seton because her son’s attachment to Nintendo kept him awake until 11pm.  When Seton suggested strategies such as removing access to the game in the evenings, then rewarding him with Nintendo time during the day if his sleep improved, the boy’s mother said this was impossible. Her son was addicted, she said, and asked if Seton could prescribe medication.  While this is the pointy end of parents losing their grip over children’s sleep routines, Seton estimates he’d see a similar situation once each month.  But while technology is one issue that’s eroding children’s sleep, so are tightly packed schedules that make for later bedtimes as well as early morning starts, says Seton who sees an increasing trend for
primary schoolchildren – not just high school students – to have extra-curricular activities before their school day begins.

There’s also the fact that sleep’s contribution to general health and wellbeing has slipped off the public radar.“What we have in its place is an idea that functioning on too little sleep is heroic, a badge of courage,” Seton laments.”Sleep deprivation has become normalised, and ideally we need a public health campaign to re-educate people about the value of sleep and to give parents guidelines to help them get their children to sleep.”

The adolescent saboteur

For 20 per cent of adolescents the sleep saboteur is not so much electronic, but a glitch in their body clocks. It’s a problem called delayed sleep phasing in which they have a circadian rhythm of 25 to 27 hours, instead of the typical 24 hours, Seton explains.  For them, the surge of melatonin, the “sleep hormone” that helps us feel drowsy doesn’t kick in until 11pm or later – and it’s a condition that can run in families. About 80 per cent of his patients have a parent with the same problem. “But it’s possible to treat it by following a pre-bedtime ritual that helps cue the body for sleep and which gradually resets the teenagers’ internal clock to help them sleep better,” he says. Seton’s advice for any parent who’s concerned about their child’s sleep is to get help. “There are sleep clinics at many public hospitals, as well as private clinics. You don’t have to be sick to see a doctor.”

Article by: Paula Goodyer

Parasomnia is a broad term used to describe various uncommon disruptive sleep-related disorders.

Parasomnias are disruptive sleep-related disorders that can occur during arousals from REM sleep or partial arousals from Non-REM sleep.

Parasomnias are intense, infrequent physical acts that occur during sleep.Some common parasomnias include REM behavior disorder(RBD), sleepwalking, sleep talking, night terrors, nightmares, confusion arousals, teeth grinding, rhythmic movement disorders, sleep paralysis

Types of Parasomnia

Impaired Sleep Related Penile Erections:
This disorder occurs among men who are unable to maintain a penile erection during sleep that would be sufficiently severe enough to engage in sexual intercourse. Men usually experience erections as a part of REM sleep, and impaired sleep-related erections may indicate erectile dysfunction.

Nocturnal Leg Cramps:
Nocturnal leg cramps are sudden, involuntary contractions of the calf muscles that occur during the night or periods of rest. The cramping sensation may last from a few seconds to 10 minutes, but the pain from the cramps may remain for a longer period. The cramps can affect persons in any age-group, but they tend to happen in middle-aged and older populations.

Nocturnal Paroxysmal Dystonia (NPD):
Nocturnal paroxysmal dystonia (NPD) is a complex motor attack arising abruptly during sleep, especially nonrapid eye movement sleep. NPD is characterized by sudden arousal followed by motor agitation with dystonic posturing, and semi purposeful activity returning several times per night. Most evidence points to NPD being a form of epilepsy.

Nocturnal Seizures:
These seizures, which occur only during sleep, can cause the sufferer to cry, shout, walk, run about, or curse. Like other seizures, these are usually treated with medication.

REM Behavior Disorder [RBD]:
Rapid eye movement behavior disorder, or RBD, is a serious REM sleep disorder that can cause injuries. The body usually experiences atonia, or a temporary paralysis, during dreaming. This is a safety precaution that prevents us from physically acting out our dreams

The exact cause for the disorder is unknown. People can usually remember their dreams, but have no awareness of moving around while asleep. The condition can cause injuries to both the dreamer and family members.

RBD Treatment:
A polysomnography test is required to diagnosis RBD. If symptoms of RBD are severe enough, separate bedrooms may be required for the sufferer and their bed partner. Bedrooms should be on the ground floor to prevent the RBD sufferer from falling downstairs and dangerous objects in the bedroom should be removed.

REM Sleep Cardiac Arrhythmias:
A cardiac arrhythmia is a change from the regular rate or control of the hearts contractions. People who have coronary artery disease and whose blood oxygen is lowered by sleep-disordered breathing may be at risk for arrhythmias, which take place during REM sleep. Continuous positive airway pressure (CPAP) treatment may reduce this risk.

Sleep Enuresis (bedwetting):
Sleep Enuresis or Nocturnal Enuresis is an inability to control the flow of urine at night. There are two kinds of enuresis: primary and secondary. In primary enuresis, a person has been unable to have bladder control from infancy onward. In secondary enuresis, a person has accidental wetting after having had bladder control for six or more months.

Sleep Walking:
Sleepwalking, or somnambulism, is perhaps the best-known arousal disorder. Sleepwalking occurs when a person appears to be awake and moving around but is actually asleep.

Sleepwalkers have no memory of their actions. Sleepwalking most often occurs during deep non-REM sleep (stages 3 and 4 sleep) early in the night. It can occur during REM sleep in the early morning.

Sleepwalkers are usually children, although the disorder can occur in adults. Sleepwalking appears to run in families. The sleepwalker simply may be confused or disoriented for a short time upon awakening.

Although waking a sleepwalker is not dangerous, sleepwalking itself can be dangerous because the sleepwalker is unaware of his or her surroundings and can bump into objects or fall down.

Sleep Talking:
Sleep talking is a sleep-wake transition disorder. Sleep talking or somniloquy, is harmless and usually temporary. Although it usually is harmless, sleep talking can be disturbing to sleep partners or family members who witness it.

Talk that occurs during sleep can be brief and involve simple sounds, or it can involve long speeches by the sleeper. The sleeper usually has no memory of their action and it does not affect sleep. Sleep talking can be caused by external factors including fever, emotional stress or other sleep disorders.

Sleep Related Painful Erections:
Erections are a normal component of REM sleep for men. In some cases, however, erections become painful and cause a man to wake up. The treatment of sleep-related painful erections may involve drugs that suppress REM sleep.

Sleep Terrors / Night Terrors:
A person experiencing a night terror or sleep terror abruptly awakes from sleep in a terrified state. The person who has a sleep terror will have signs of intense fear, such as wide eyes with dilated pupils, racing heart, sweating, and rapid breathing.

Episodes usually occur during the first hour of falling asleep, the point at which deep sleep begins, and last about 15 minutes. After the episode, the person returns to sleep, unable to remember the incident in the morning because he or she was never fully awake.

Night terrors usually occur during stage 3 or stage 4 sleep, the deepest stages of sleep, and children have more deep sleep than adults. Night terrors are similar to nightmares, but night terrors usually occur during deep sleep.

People experiencing night terrors may pose dangers to themselves or others because of limb movements. Night terrors are fairly common in children aged three to five. Strong emotional tension and/or the use of alcohol can increase the incidence of night terrors among adults.

For children and adults, night terrors can be the result of stress, psychological disturbance or sleep deprivation. Sleeping in a different bed may also trigger episodes of night terrors.

Source: http://www.sleepdisordersguide.com/parasomnia.html

Peter Tripp: 201 Hours Awake

The New York DJ, Peter Tripp, set a world record for sleep deprivation in 1959. He went for 201 hours (8.4 days) without sleep. He spent most of the time in a glass booth in Times Square, and the rest in a hotel room across the street, set up as a laboratory to monitor his reactions.

The stunt produced strange results. After three days, Tripp began to find things hilarious that weren’t funny at all. At other times, he became upset for no reason. He was also confused, asking why there were bolts in the window frames.

By day four, he was suffering from hallucinations and paranoia. At first they were simple patterns – like cobwebs on the doctors’ faces, or imagining that paint specks on the table were insects.

But soon his hallucinations became 3D. Tripp imagined mice and kittens scurrying around the room…

Eventually, Peter Tripp became psychotic. He rummaged through draws looking for non-existent money. He accused a technician of trying to harm him. He then claimed he was not Peter Tripp but an imposter. Nothing made sense to him.

On reaching his 200-hour target, Tripp was made to stay awake for one final hour while doctors did more tests. They left the EEG in place as he finally closed his bloodshot eyes and entered a deep 13-hour slumber.

He may have been physically restored, but Tripp’s family soon noticed a difference in his personality. His wife said he was moody and depressed. He fought with his boss, became involved in the payola scandal, and was fired from his high profile job as a radio DJ. He went on to have four divorces. Some would say the sleep stunt changed Peter Tripp forever.

Randy Gardner: 260 Hours Awake

Randy Gardner beat the world record for sleep deprivation at the age of 17. A typical high school student from California, Gardner stayed awake for 264 hours (11 days) without using any stimulants. His stunt was part of a school science project on sleep patterns.

The effects of sleep deprivation on Randy Gardner included moodiness, problems with concentration and memory, paranoia and hallucinations. After four days, he had the delusion that he was a famous American football player winning the Rose Bowl. He also mistook a street sign for a person.

On the 11th day, he was asked to subtract seven repeatedly, starting from 100. He stopped when he got to 65… and said he had forgotten what he was doing.

Yet later that day, Randy Gardner held a press conference where he spoke without slurring his words and appeared to be in excellent health.

After his marathon, Gardner slept for nearly 15 hours and returned to a normal sleeping pattern within days. Unlike Peter Tripp (who incidentally used stimulants to stay awake) there were no reports of any long term personality changes.

Sleep medicine is a unique specialty, combining the work of many health professionals, from pulmonologists with expertise in sleep apnea to neurologists, psychiatrists and psychologists. And it’s not uncommon for these specialists to work together in the same clinic. Over the last 20 years, the field has grown so fast that the demand for trained sleep psychologists far exceeds the supply.

Indeed, Stepanski is only one out of about 150 board-certified sleep medicine specialists with a PhD in a behavioral field–a background that prepares them to provide behavioral therapies tailored to sleeping disorders, help patients comply with sleep apnea treatment plans, evaluate patients’ sleep studies and treat the depression and anxiety that often co-occur with sleep disorders.

Behavioral sleep medicine is such a booming field that the AASM has created a special committee to develop curricula for behavioral sleep medicine training programs and a specialized board exam for sleep psychologists–a move psychologists say should be acknowledged and applauded.
“How often is it that a medical society embraces what psychology has to offer?” asks Michael Perlis, PhD, director of the University of Rochester Sleep Research Laboratory.

The committee, founded under Buysse’s presidency, is also lobbying for more consistent reimbursement for sleep psychologists’ services. Right now, most sleep apnea treatments are regularly reimbursed by insurers, but other kinds of treatment, including cognitive-behavior therapy (CBT) and evaluating patients’ sleep studies, are less frequently covered.

The demand for sleep psychologists will only grow, says Buysse, as evidence attesting to the success of behavioral interventions such as CBT piles up.  For example, a well-publicized double-blind study in the Journal of the American Medical Association (Vol. 285, No. 14) by psychologist Jack D. Edinger, PhD, and colleagues found that CBT produced larger improvements than either progressive muscle relaxation or a placebo treatment.

Sleep-treatment pioneer Charles Morin, PhD, and colleagues found in a 1999 study, that while a combined behavioral-pharmacological approach produced the best short-term results, those who received cognitive behavior therapy sustained better long-term clinical gains, and the participants rated the behavioral therapy as more effective and satisfying.  And a new study, published in the European Archives of Psychiatry and Clinical Neuroscience (Vol. 251, No. 1) reports that CBT produced enduring treatment effects over a three-year follow-up period. Other studies have found that CBT is effective for insomnia patients who have co-occurring medical and psychological problems.

The evidence is clear, say sleep specialists: CBT is just as effective as pharmacological treatments in the short term and even more effective in the long term for sleep disorders such as insomnia.
“At this point, there’s no question about the potency and the power of CBT for insomnia,” says Perlis. “This is one of the places where psychology really shines. Now, what we need more than anything is to attract new health-care providers who want to learn CBT and become certified in behavioral sleep medicine.”

However, experts caution that appropriate training is a must. For students interested in behavioral sleep medicine, Edinger suggests applying to graduate schools with an AASM-accredited sleep program or with a faculty member with expertise in sleep and finding a sleep-related internship site. Practicing psychologists can get up to speed through training at national sleep meetings or by putting in some learning time at a local sleep clinic.

“While it’s relatively easy to learn how to do CBT for sleep disorders, there are a number of things about it that make the practice hard,” explains Perlis. “Mentored or formal training is a must. While we want to grow the field, we need to make sure the people who are practicing in the area of behavioral sleep medicine are experts.”

Source: http://www.apa.org/monitor/oct01/sleepdemand.aspx

A meal of starchy rice four hours before bedtime may solve your insomnia problems, new research from the University of Sydney has found.

The University of Sydney’s Dr Chin Moi Chow and colleagues found that carbohydrates that quickly raise blood sugar (those with a high glycemic index) may hasten sleep.The researchers studied 12 healthy men, 18-35 years old, who had no sleep problems. Over three nights at the researchers’ sleep lab they fasted for five hours before being served a meal.

The meal of rice with steamed vegetables in tomato puree varied only in the type of rice and serving time.

“Two of the meals included jasmine rice and were served one hour before bedtime and four hours before bedtime respectively,” said Dr Chow. “The third meal, which included a type of long-grain rice that was low in glycemic index, was also served four hours before bedtime.”

Dr Chow and her colleagues altered the type of rice used in order to measure the effects of carbs with high and low glycemic indices. “Jasmine rice has a high glycemic index, while the long-grain rice we used in this study has a lower glycemic index,” Dr Chow said.

Dr Chow’s team changed the timing of the meal to see what impact that would have on sleeptime. The men were free to go to bed whenever they wanted; the researchers timed how long it took the men to fall asleep once in bed.

Eating the jasmine rice meal four hours before bedtime proved to be the best way to hasten sleep: the men fell asleep after nine minutes, on average, that night. It took nearly 15 minutes, on average, to fall asleep after eating the jasmine rice meal one hour before bedtime.

The men were slowest to fall asleep after eating the long-grain rice meal four hours before bedtime – taking nearly 18 minutes, on average, to fall asleep. The study, recently published in The American Journal of Clinical Nutrition, found the meals had no other observable effect on the men’s sleep.

Dr Chow’s team doesn’t know exactly how carbs with a high glycemic index affect sleep. “These kinds of foods may boost tryptophan and serotonin, two brain chemicals involved in sleep“, Dr Chow said. Adding protein to the meal might change the results, she added.

Dr Chow and her team plan to carry out further studies this year. “We are fine-tuning the meal contents and meal sizes so they are suitable for everybody, including diabetics, whilst still helping people to fall asleep.”

Source: Afaghi, A., O’Connor H, Chow CM. The American Journal of Clinical Nutrition, February 2007; Vol. 85: pp. 426-430.

Job-deadlines, running around, lots of unexpected outcomes — that sort of thing can result in constant emotional stress and a hyperactive shen.

The aim to improve the body’s ability to adapt to stress. With acupuncture (which is ideal for many since it’s safe and free of side effects), a minimum of six sessions is typically needed to inspire change. “Acupuncture has a cumulative effect,” he explained. He encouraged me to forgo coffee, even on my most tired days, and suggested a diet free of stimulants, tobacco, and sugar as well, which work to deplete yin, the body’s inward, feminine energy.

During each treatment, Lu inserted thin, three-inch needles into 16 to 20 points around my body, concentrating mostly on my legs and feet, my forearms and hands, my ears, and the top of my head. “Points in the legs correlate to the liver; arms and hands to the heart; and the top of the head to the brain,” Lu said. “Needling them all together has a synergistic effect.” The needles didn’t hurt going in, but I was quite aware of them once they were in, especially when Lu rotated them to increase their effect. Once they were in place, I cooked beneath low-heat lamps meant to further stimulate the needles’ effectiveness. Remarkably, the heat worked to warm me to sleep. A midday nap is a near-miracle for me. (Now, if only I could convince Lu to come home with me, I thought.)

Slowly but surely, my symptoms decreased with each session. At first, I still woke up but started falling back asleep faster as the treatments progressed. Three weeks later, I’m waking up maybe once or twice a week, a vast improvement if not perfection. Following Lu’s suggestion, I’ve started writing out my to-do lists before I go to sleep to “release them from my mind.” Since the most significant underlying cause of my sleeplessness seems to be the one thing I’m not willing to change — that is, a job that’s fun and fulfilling and often incredibly stressful — I’m faced with a challenge. As Lu said, there’s no cure for my insomnia, but with some careful effort toward finding time for myself — a recurring difficulty — and continued acupuncture, my body can gradually find restful balance. I’m hoping.

Connecting the Dots
TCM links each of the body’s meridians to an emotion. Use the following guide to help you figure out the roots of your imbalance. For an accurate diagnosis and treatment, visit a licensed TCM acupuncturist.

Meridian: Heart
Emotions: Anxiety
Insomnia Characteristics: Waking up easily; difficulty falling asleep

Meridian: Liver
Emotions: Anger, stress, frustration
Insomnia Characteristics: Difficulty falling asleep; waking between 1 a.m. and 3 a.m.

Meridian: Lungs
Emotions: Grief
Insomnia Characteristics: Waking between 3 a.m. and 5 a.m.

Meridian: Spleen
Emotions: Worry, obsessiveness.
Insomnia Characteristics: Waking at the same time every night; dream-disturbed sleep.

Proper rest is essential to good health, and sleeplessness is a sign of imbalance. If your sleep is habitually disturbed it can be very damaging to the vital energy of the body and immune system. If this is the case it is important that you inform your acupuncturist so that you can work together to determine the cause of the imbalance and treat it appropriately. You will be amazed at how a good night’s sleep can change your life. With more rest your energy and focus improve, the immune system and your body’s ability to deal with stress are strengthened, and nagging health conditions resolve more easily.

In Chinese medicine, sleep is seen as one’s yang energy moving inward to be enfolded by yin. Many different patterns of imbalance can hinder this process. Sleep can be disrupted by pain, hormonal imbalances, digestive or cardiovascular disorders, anxiety and depression, and many medications have the side effect of sleeplessness. The effects of imbalance can be as simple as difficulty quieting the mind when preparing for sleep, or sleep which is easily disturbed by light or sound, to very restless, agitated or dream disturbed sleep.

Our own energy is ruled by the energy of the world around us and the rhythm of our days should naturally reflect the sun’s course. As the sun is setting the ruling energy is that of yang (day) transforming into yin (night). This is the appropriate time to start slowing down, quieting the mind and preparing for sleep. This of course is not always possible, but those suffering from sleeplessness should be aware of the influences of universal energy and try to adjust their habits to better reflect this natural pattern. Stimulating food and drink including spicy foods, heavy meats, rich sauces, alcohol and caffeine should be avoided in the evening. Stressful mental work should be avoided if possible in the evenings and vigorous exercise should be scheduled earlier in the day. Activity should be restful, meditation or gentle stretching and breathing exercises can help prepare the body for sleep. Some people find a tea of chamomile or valerian beneficial, for some soaking the feet in warm water helps to draw the energy down from the head and quiet the mind, a gentle foot massage can relax the body and the mind as well. For more serious sleep disturbance a personalized herbal remedy can be prescribed along with acupuncture treatments directed at benefiting sleep and restoring balance.

Children will also benefit from proper sleep. Many parents whose children are poor sleepers, or wake frequently or early, worry that an earlier bedtime would make things worse. Just the opposite can be true. An earlier bedtime can lead to a deeper more restful sleep with fewer interruptions. Chronic or frequent colds, ear infections, extremes of energy (highs and lows) throughout the day, can be brought into balance with good restful sleep.

In our fast paced society sleep can be taken for granted, and many of us develop unhealthy patterns of sleep early in life, but lack of proper sleep does eventually take its toll. Those with chronic sleep disturbance know too well what they are missing. If you feel that you are not getting the rest you should, take steps to change it now; you will be truly grateful for the benefits you receive.

Insomniacs know all too well what it’s like to lie awake in a tangle of sheets, the day’s worries parading through the brain as the minutes tick past with agonizing slowness. With studies linking troubled sleep to a variety of health problems including heart attacks and obesity, it’s enough to keep anyone awake at night.

An estimated 30 million Americans wrestle with chronic insomnia. Many suffer in silence. A 2005 National Sleep Foundation survey found that only one-third of patients with insomnia were asked by their primary care physicians about the quality of their sleep. Insomnia sufferers are equally unlikely to raise the issue with their doctors, studies show. And that’s too bad, experts say.

More and safer medications for sleep problems are available. And with a growing list to choose from, doctors can target prescriptions more precisely to specific complaints: trouble falling asleep, for instance, versus trouble staying asleep.

Remedies to help people fall asleep have been around for centuries, from laudanum in the 1800s to barbiturates more recently. “Unfortunately, most of them were addictive and potentially deadly,” said Dr. David Neubauer, associate director of the Sleep Disorders Center at Johns Hopkins University School of Medicine in Baltimore. “The history of sleep medications is really a tale of improving safety.”

A big advance came in the 1970s with the introduction of benzodiazepine drugs like Halcion, Xanax and Restoril. Although far safer than barbiturates, these sleep medications can still cause dependence and withdrawal symptoms like rebound insomnia. That prompted the Food and Drug Administration to approve them only for short-term use, usually no more than two weeks.

The same restrictions remained in place when a new generation of hypnotic drugs, known as nonbenzodiazepines or “Z” drugs, hit the market, starting with Ambien in the early 1990s.

“But it soon became evident that Ambien was really quite different, that it didn’t have the same withdrawal effects or dependency,” said Dr. Michael Thorpy, director of the Sleep-Wake Disorders Center at Montefiore Medical Center in the Bronx.

In one recent study, researchers at Duke University Medical Center pitted Ambien-CR, a controlled-release formulation, against a placebo. After taking the drug for six months, volunteers reported no rebound insomnia when they stopped. Almost 90 percent said the drug helped them sleep, compared with just under 60 percent of the placebo group. Those on the active drug also reported less morning sleepiness and greater ability to concentrate during the day.

Newer nonbenzodiazepines like Lunesta and Sonata have no restrictions on how long they can be used. Even so, they remain on the federal list of controlled substances because of their potential for abuse.

The latest sleeping pill to win F.D.A. approval, called Rozerem, is the first sleeping pill not on that list, because there appears to be little chance it will be abused. The drug, which targets receptors in the brain for the sleep hormone melatonin, represents the first new class of sleep medication in several decades.

Safer sleep medicines are particularly welcome for people whose insomnia is caused by chronic pain or other persistent medical conditions, Dr. Thorpy said. “These are people who are never going to get a good night’s sleep without medication, and who may need hypnotics for the rest of their lives,” he said.

But those people are the exceptions — most insomniacs will not require pills indefinitely. Indeed, medications are generally considered the first-line treatment not for chronic sleep problems but for acute, short-term insomnia brought on by, say, unusual stress at work or the aftermath of surgery.

“Medications can help nip insomnia in the bud, and may prevent it from becoming a chronic problem,” said Wilfred Pigeon, assistant professor of psychiatry at the Sleep and Neurophysiology Research Laboratory at the University of Rochester.

Doctors are increasingly exploiting the differences among nonbenzodiazepines to tailor their prescription to particular sleep complaints.

Chief among these differences is a drug’s half-life, a measure of how long the active ingredients remain in the body, which can range from one to seven hours for the top sleep aids. If the problem is falling asleep, a drug with a short half-life, like Sonata or Rozerem, may be the best choice. If a patient complains about waking in the middle of the night, a medicine with a longer half-life, like Ambien-CR or Lunesta, may work best.

Although the F.D.A. has not yet approved sleeping pills specifically to be taken when people find themselves wide awake in the middle of the night, “many people take Sonata that way, because it has a very short half-life,” Dr. Thorpy said.

A 2006 study by researchers at the Clinilabs Sleep Disorders Institute at St. Luke’s-Roosevelt Hospital Center in New York found that Sonata taken in the middle of the night caused less next-day sleepiness than Ambien, a drug with a longer half-life.

But even the newer sleep medicines have side effects, including reports of people having no memory of raiding the refrigerator or getting behind the wheel the night before. And because sleep medications address only the symptoms of insomnia and not the causes, many experts agree that the best approach when sleep problems persist is cognitive-behavioral therapy, which teaches strategies like better sleep habits and restricting the amount of time spent awake in bed.

“Drugs can help relieve people’s acute anxiety about being able to fall asleep or stay asleep,” Dr. Pigeon said. Behavioral approaches, which in practice are often combined with sleep drugs, “help make lasting changes in the quality of people’s sleep,” he said.

But changing sleep habits takes time, and a shortage of therapists trained in behavioral sleep medicine means that option is not available to everyone who might benefit. Harried physicians often find it easier to write out a prescription than to discuss sleep hygiene with patients, who likewise often seek the quick relief offered by pills.

Small wonder that pharmaceutical researchers are continually in search of novel insomnia drugs. One drug under development, for example, works in a new way to enhance slow-wave sleep, the deepest stage of slumber, with a goal of making people feel more refreshed in the morning.

“People come in complaining about their sleep,” Dr. Neubauer said. “But of course what we’re really looking for is better wakefulness.”

Author: PETER JARET from the New York Times

Pilot fatigue is becoming a global problem that requires urgent attention as airlines compete in an increasingly cut-throat environment, industry experts have warned.

A fatigued pilot is more prone to mistakes than someone who has consumed alcohol, pilot advocates say, and new regulations should be put in place to help prevent it.

“Over the years there have been quite a number of accidents in which fatigue has played a part and it’s estimated that as many as 20 per cent of accidents have fatigue as a significant factor,” said Capt Philip Smith, a flight safety expert with the British Airline Pilots Association (Balpa).

International guidelines were urgently needed to create a “level playing field”, Capt Smith said, and to prevent airlines putting profits before safety in the increasingly competitive environment.

The issue of fatigue came to the fore in Europe yesterday, when pilots from 36 nations gathered to protest against new European regulations that experts say ignore the latest scientific research on fatigue and may undermine more stringent national guidelines.

The European Cockpit Association, representing up to 38,200 pilots, said the EU’s European Aviation Safety Agency refuses to act on a report by an independent experts that recommends fewer flight hours to combat fatigue in pilots and cabin crews.
The protests also coincided with a statement by Emirates Airline yesterday that it was responding to the US Federal Aviation Authority (FAA) over a complaint about fatigue made through the regulator’s anonymous hotline last year.
Emirates said it had been requested to provide details of its flight and duty times and fatigue management risk system.

The airline said it was a leader in managing tiredness among its crews, limiting its pilots to flying 100 hours in any 28-day period and 900 hours per year.
In March, a Dubai-bound Emirates flight carrying 275 people struggled to get airborne in Melbourne when a pilot entered the weight of the aircraft incorrectly into flight computers.

The pilot had flown 98.9 hours over the previous month, close to the 100-hour maximum allowed by Emirates, but a preliminary report by the Australian Transport & Safety Bureau indicated that it found no evidence that fatigue was a factor in the accident.

Emirates stressed that there had been two complete sets of flight crew on board the plane, and refuted allegations in the Australian press that its crews were not getting enough inflight rest.

Dr Martin Moore-Ede, chief executive of Circadian, a workforce safety consultancy that is studying the issue of fatigue for several major airlines, said introducing regulations to combat flight fatigue is complicated, and simply limiting the number of hours a pilot flies was an outdated idea. How those hours were scheduled, the time of day and whether flights were long- or short-haul, all affected how tired a pilot could become. “Airlines need to introduce fatigue risk management systems, which is a comprehensive safety management system addressing all the parts of fatigue, not just hourly limits,” Dr Moore-Ede said.

“Pressure on pilots is growing,” said Jim McAuslan, the general secretary of Balpa. “With competition between airlines now so brutal, safety must be beyond question and competition should be on the basis of the product, not by working pilots beyond what is safe.”

Source: lmorris@thenational.ae

Transportation risk managers and commercial drivers are grappling with the problem of sleep apnea, a condition that contributes to daytime drowsiness, as they try to find ways to improve safety on the road.

According to a 2002 Federal Motor Carrier Safety Administration commissioned study, out of 3.4 million licensed commercial drivers, approximately 26% of drivers suffering from some form of sleep apnea. Studies have shown that sleep apnea can severely impact driving performance by greatly increasing fatigue, boosting the risk of crashes.

Though the commercial trucking industry is aware of the prevalence of sleep apnea among drivers, there still is much to be learned in the way the condition is diagnosed, treated and monitored, experts say.

Sleep apnea is a condition in which the airway is constricted due to muscular relaxation while sleeping, with interruptions in breathing lasting several seconds at a time, often accompanied by loud snoring and resulting in non-restful sleep.

Individuals considered at risk for sleep apnea are those with a body mass index of 30 or greater and a neck circumference of 17 inches or more, experts say, adding that such people often suffer from additional health problems related to obesity, such as diabetes and heart problems.

Many people with sleep apnea don’t even know they have it, researchers say, adding that the sleep disorder often results in daytime sleepiness, which has severe effects on reflexes and cognitive and motor skills.

“I promise you there are thousands of commercial drivers out there that have some form of sleep apnea,” said Don Osterberg, vp of safety and driver training for Green Bay, Wis.-based Schneider National Inc. “Many drivers don’t want to talk about it, or are in denial that they have a medical condition, or don’t even know they have it. They are not educated on sleepiness, and they might think that daytime sleepiness is normal to them and they don’t realize it is abnormal.”

Mr. Osterberg said at least 17% of drivers at Schneider are afflicted with severe sleep apnea. To deal with the issue, Mr. Osterberg said Schneider recently funded an initiative to help diagnose and treat their drivers as a way to help mitigate health care costs and reduce the crash risk on the road.

As a result, Mr. Osterberg said Schneider has seen a “significant reduction” in the frequency and severity of crashes.

“Making this a safety priority has paid back dividends,” he said.

Drivers who are diagnosed with sleep apnea are required by the FMCSA to be “disqualified until diagnosis of sleep apnea is ruled out or has been treated successfully.”

According to Christina Cullinan, director of workplace and fleet safety with the American Trucking Assn., a FMCSA certified medical examiner must ultimately determine whether a driver can continue driving.

If an examiner decides a driver likely suffers from sleep apnea, a sleep study will be advised, including the use of a continuous positive airway pressure—or CPAP—machine. Treatment can last anywhere between one and four weeks, depending on the condition’s severity.

It should be noted the FMCSA provides no guidance on how to identify commercial drivers at risk for sleep apnea. The administration includes a question on its commercial driver medical certification form that asks specifically about sleep disorders, but it’s up to medical examiners if they want the driver to go through a sleep study, or screening.

The FMCSA’s medical review board made a recommendation in January 2008 that the FMCSA should require screening for sleep apnea in all drivers with a BMI more than 30, however there has been no action on that recommendation to date.

Gary Hull, who has worked for eight years as a long-haul trucker and is a member of Kansas City, Kan.-based chapter of AWAKE Truckers with a Cause, a support group for truckers with sleep apnea, said he thinks testing and treatment for sleep apnea has improved over the years, though he said putting jobs at risk because of the condition is not fair.

Mr. Hull said drivers are not always honest about health problems out of concern that they will lose their jobs. He added that there needs to be more research on the effects of sleep apnea on truck drivers and its relationship to crashes.

“We can have millions of accident-free miles, but unfortunately if it’s found that you have sleep apnea or signs of it, you are shut down,” said Mr. Hull. “If they were safe to drive yesterday, why should they be disqualified today because of sleep apnea? They most likely have been living with it for years.”

Mr. Hull said there needs to be some form of standardized testing for drivers at the federal level, but said drivers want the testing—and any restrictions placed on drivers—to be “based on good science.”

Deborah Luthi, director of enterprise risk management solutions for Matheson Inc., a trucking company based in Sacramento, Calif., said motor carriers are concerned about this issue, but said Matheson does not specifically test drivers for sleep apnea outside of its driver medical screening process.

Ms. Luthi said Matheson has taken an active approach in promoting health and safety with its drivers, including fatigue abatement training to drivers and supervisors. She also said Matheson is working with its broker, Marsh & McLennan Cos. Inc., in the development of a training module linking driver fatigue with sleep apnea.

Sleep apnea first was classified as a sleep condition in 1965 but only recently has gotten significant attention, said Ed Grandi, executive director of Washington-based American Sleep Apnea Assn.

In May, the ASAA, FMCSA and ATA will co-host a sleep apnea and trucking conference in Baltimore. The hope, Mr. Grandi said, is to bring all parties to the table to discuss how best to address the problem.

“A loss exposure exists, and trucking companies and drivers need to recognize this,” Mr. Grandi said.

Source: By Jeff Casale at http://www.businessinsurance.com/article/20100221/ISSUE01/302219975

Sutherlands Transport has recently implemented in more than 50% of their fleet the latest fatigue management technology- Optalert™ Road System.

Furthering their commitment to transport safety, the company has installed the Optalert Road system in three trucks that are operating under the Intelligent Access Program (IAP). The trucks are fitted with Transtech Driven (IAP), 24/7 real time GPS tracking, Optalert™  the latest fatigue management technology, and they are speed limited to 95 kms per hour.

“The integration of the IAP technology with Optalert™ and the ability for real time direct tracking of driver fatigue levels is a big step forward into the future” says Managing Director, Chris Sutherland.  “The systems also provide both our customers and the Roads and Traffic Authority with the assurance that these vehicles will remain on their designated routes.”  Optalert™ was featured in the recent documentary Dead Tired.

The Optalert™ system, developed and manufactured in Australia is the world’s first scientifically proven system that alerts a driver to a pending episode of drowsiness, thus dramatically reducing the risk of accidents.

“Not only does Optalert™ serve as a fatigue management safety device for our drivers, our operations staff utilises the Optalert™ monitoring reports to better design and enhance our fatigue management policies. These three trucks alone undertake over 1300 trips per annum and the investment in the Optalert™ technology is a worth while investment in our safety and our future” says Co-Director Tony Sutherland.

Source: http://www.optalert.com