tag:theconversation.com,2011:/fr/topics/sleep-disorders-2074/articlesSleep disorders – The Conversation2024-02-29T03:38:04Ztag:theconversation.com,2011:article/2246162024-02-29T03:38:04Z2024-02-29T03:38:04ZWhy Barnaby Joyce’s TV diagnosis of insomnia plus sleep apnoea is such a big deal<p>The <a href="https://theconversation.com/view-from-the-hill-how-does-david-littleproud-handle-the-latest-barnaby-joyce-embarrassment-223289">health</a> of Nationals MP Barnaby Joyce is in the news again, this time with a diagnosis of a sleep disorder made <a href="https://www.afr.com/companies/media-and-marketing/barnaby-joyce-to-be-diagnosed-with-a-sleep-disorder-on-live-tv-20240223-p5f79q">while filming</a> a TV documentary.</p>
<p>Joyce’s diagnosis of insomnia plus sleep apnoea arose while filming <a href="https://www.sbs.com.au/whats-on/article/australias-sleep-revolution-with-dr-michael-mosley/nuyko305b">Australia’s Sleep Revolution with Dr Michael Mosley</a> in 2023. SBS has confirmed episode three, in which my Flinders University colleagues reveal his sleep disorder, is set to air on March 20.</p>
<p>I was not involved in the program and have no knowledge of Joyce’s <a href="https://www.theaustralian.com.au/weekend-australian-magazine/australias-sleep-crisis-has-flinders-university-cracked-the-code-to-a-better-nights-sleep/news-story/d3b82617af33fff82487da2534722733">ongoing health care</a>. But I was part of the research team that in 2017 <a href="https://doi.org/10.1016/j.smrv.2016.04.004">coined the term COMISA</a> (co-morbid insomnia and sleep apnoea), the official name of Joyce’s on-screen diagnosis. Since then, I’ve led research into this <a href="https://doi.org/10.1016/j.smrv.2019.01.004">common</a> sleep disorder.</p>
<p>Here’s why it’s so important to diagnose and treat it.</p>
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Read more:
<a href="https://theconversation.com/view-from-the-hill-how-does-david-littleproud-handle-the-latest-barnaby-joyce-embarrassment-223289">View from The Hill: How does David Littleproud handle the latest Barnaby Joyce embarrassment?</a>
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<h2>What was Joyce’s diagnosis?</h2>
<p>People can be diagnosed separately with <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">insomnia</a> or <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/obstructive-sleep-apnoea">sleep apnoea</a>.</p>
<p>Insomnia includes frequent difficulties falling asleep at the start of the night or difficulties staying asleep during the night. These can result in daytime fatigue, reduced energy, concentration difficulties and poor mood. Over time, insomnia can start to impact your <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">mental health</a> and quality of life.</p>
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<p>Sleep apnoea (specifically, obstructive sleep apnoea) is when people experience repeated interruptions or pauses in breathing while they sleep. This reduces oxygen levels during sleep, and you can wake up multiple times at night. People with sleep apnoea may be aware of loud snoring, gasping for air when they wake up, or feeling exhausted the next morning. However, not all people have these symptoms, and sleep apnoea can go undiagnosed for years.</p>
<p>But in Joyce’s case, both insomnia and sleep apnoea occur at the same time.</p>
<p>We’ve known this could happen since <a href="https://doi.org/10.1126/science.181.4102.856">the 1970s</a>, with <a href="https://psycnet.apa.org/doi/10.1037/0022-006X.67.3.405">evidence growing</a> over <a href="https://doi.org/10.1378/chest.120.6.1923">subsequent decades</a>. Since then, sleep researchers and clinicians around the world have learned more about how <a href="https://doi.org/10.1016/j.smrv.2019.01.004">common</a> this is, its <a href="https://doi.org/10.1183/13993003.01958-2021">consequences</a> and how best to <a href="https://doi.org/10.1111/jsr.13847">treat it</a>.</p>
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Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
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<h2>How do you know if you have it?</h2>
<p>Many people <a href="https://doi.org/10.1016/j.sleep.2005.08.008">seek help</a> for their sleep problems because of fatigue, exhaustion, physical symptoms, or poor mood during the day.</p>
<p>If you think you have insomnia, a GP or sleep specialist can talk to you about your sleep pattern, and might ask you to complete <a href="https://www.sleepprimarycareresources.org.au/insomnia/assessment-questionnaires">brief questionnaires</a> about your sleep and daytime symptoms. You might also be asked to fill in a “sleep diary” for one to two weeks. These will allow a trained clinician to see if you have insomnia.</p>
<p>If you or your GP think you may have (or are at risk of having) sleep apnoea, you may be referred for a sleep study. This normally involves sleeping overnight in a sleep clinic where your sleep patterns and breathing are monitored. Alternatively, you might be set up with a recording device to monitor your sleep at home. A trained medical professional, such as a sleep and respiratory physician, will often make the diagnosis.</p>
<p><a href="https://doi.org/10.1016/j.smrv.2021.101519">Up to 50%</a> of people with sleep apnoea report symptoms of insomnia. About <a href="https://doi.org/10.1016/j.smrv.2021.101519">30–40%</a> of people with insomnia also have sleep apnoea. </p>
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Read more:
<a href="https://theconversation.com/health-check-heres-what-you-need-to-know-about-sleep-apnoea-26402">Health Check: here's what you need to know about sleep apnoea</a>
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<h2>What are the consequences?</h2>
<p>Insomnia and sleep apnoea (individually) are associated with reduced <a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">sleep quality</a>, <a href="https://theconversation.com/insomnia-and-mental-disorders-are-linked-but-exactly-how-is-still-a-mystery-212106">mental health</a> and <a href="https://theconversation.com/health-check-heres-what-you-need-to-know-about-sleep-apnoea-26402">physical health</a>. </p>
<p>Importantly, people with both at the same also tend to <a href="https://doi.org/10.3390/brainsci9120371">experience</a> worse sleep, daytime function, mental health, physical health and quality of life, compared with people with no sleep disorder.</p>
<p>For instance, we know having both conditions comes with an <a href="https://doi.org/10.1111/jsr.13563">increased risk</a> of diseases of the heart.</p>
<p><a href="https://doi.org/10.2147/NSS.S379252">In</a> <a href="https://doi.org/10.1183/13993003.01958-2021">three</a> <a href="https://doi.org/10.1016/j.sleepe.2022.100043">studies</a>, we found people with both insomnia and sleep apnoea have about a 50–70% higher risk of dying early from any cause, compared with people with neither sleep condition. People with insomnia alone and sleep apnoea alone did not have an increased risk of dying early.</p>
<p>However, there are effective treatments to reduce these health consequences.</p>
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Read more:
<a href="https://theconversation.com/sleep-apnoea-can-be-scary-but-heres-what-happened-when-first-nations-people-had-a-say-in-their-own-care-214641">Sleep apnoea can be scary. But here's what happened when First Nations people had a say in their own care</a>
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<h2>How is it treated?</h2>
<p>In general, it is best for people to access evidence-based treatments for both disorders. These treatments vary according to the patient and the severity of their condition.</p>
<p>For instance, wearing a <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/cpap-continuous-positive-airway-pressure">CPAP mask</a> while sleeping improves breathing during sleep and reduces many of the daytime consequences of obstructive sleep apnoea. However, other effective treatments may be recommended based on each person’s symptoms, such as weight management, avoiding sleeping on your back, <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/oral-appliances-to-treat-snoring-and-obstructive-sleep-apnoea-osa">oral devices</a> (which look a bit like a mouthguard), or surgery.</p>
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<p>The <a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">most effective</a> treatment for insomnia is cognitive behavioural therapy for insomnia, also known as <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a>. About four to eight sessions often lead to improvements in sleep, daytime function and mental health that are maintained for many <a href="https://doi.org/10.1080/16506073.2021.2009019">years</a>. This can be delivered by trained therapists such as psychologists, nurses or GPs, as well as via <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online</a> programs.</p>
<p>Last year, we drew together evidence from more than 1,000 people with both conditions. We found CBTi is an <a href="https://doi.org/10.1111/jsr.13847">effective treatment</a> for insomnia in people with treated and untreated sleep apnoea. </p>
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Read more:
<a href="https://theconversation.com/my-snoring-is-waking-up-my-partner-apart-from-a-cpap-machine-what-are-the-options-188825">My snoring is waking up my partner. Apart from a CPAP machine, what are the options?</a>
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<h2>New treatments and approaches</h2>
<p><a href="https://www.frontiersin.org/articles/10.3389/frsle.2024.1355468/abstract">We</a> and <a href="https://doi.org/10.1186/s13063-022-06753-4">other teams</a> internationally are developing and testing new ways of delivering CBTi.</p>
<p>Several groups are testing devices, which <a href="https://doi.org/10.1002%2Flio2.761">stimulate</a> the tongue muscles during sleep, to treat sleep apnoea in people with both disorders.</p>
<p>And we’re still working out the best order for patients to access treatments, and the best combination of treatments.</p>
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Read more:
<a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">How can I get some sleep? Which treatments actually work?</a>
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<h2>The power of TV</h2>
<p>Joyce’s public diagnosis of both insomnia and sleep apnoea will no doubt raise awareness of what we suspect is an underdiagnosed condition. </p>
<p>Based on how common insomnia and sleep apnoea are in Australia, we estimate Joyce is one of about <a href="https://doi.org/10.1016/j.sleep.2021.03.023">5–10%</a> of Australian adults to have both at the same time.</p>
<p>The Conversation contacted Joyce’s spokesperson for comment but did not hear back before deadline.</p><img src="https://counter.theconversation.com/content/224616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Sweetman is a Senior Program Manager at the Australasian Sleep Association, the peak sleep health scientific and advocacy body in Australia and New Zealand, and has academic status at Flinders University. Alexander Sweetman reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, Flinders Foundation, ResMed, Phillips, Cerebra, Re-Time, Sleep Review Mag, and Australian Doctor.</span></em></p>Having both conditions at the same time increases your risk of dying prematurely. But it can be treated. Here’s what’s involved.Alexander Sweetman, Research Fellow, College of Medicine and Public Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2146412023-11-08T03:04:39Z2023-11-08T03:04:39ZSleep apnoea can be scary. But here’s what happened when First Nations people had a say in their own care<p>Obstructive sleep apnoea is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623124/">twice as common</a> in First Nations people compared with non-Indigenous Australians.</p>
<p>But the truth is, this sleep-related respiratory disorder is significantly under-reported in First Nations communities.</p>
<p>A <a href="https://issr.uq.edu.au/article/2021/11/let%E2%80%99s-yarn-about-sleep">Let’s Yarn About Sleep</a> program in Queensland hopes to change that, by acknowledging the importance of sleep not just to physical and mental health, but to spiritual health. The program uses traditional knowledge as a key part of its culturally responsive model of care.</p>
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Read more:
<a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">The first sleep health program for First Nations adolescents could change lives</a>
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<h2>What is obstructive sleep apnoea?</h2>
<p>In obstructive sleep apnoea the upper airway is repeatedly wholly or partially blocked during sleep, resulting in lower blood oxygen levels. The sudden drop in blood oxygen levels, and the body’s frequent waking to restart breathing, affects sleep. These also strain the heart and blood vessels.</p>
<p>People with sleep apnoea often wake up feeling unrefreshed and experience significant daytime sleepiness. Sleep apnoea also <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(22)00005-0/fulltext">increases the risk of</a> obesity, heart disease, cognitive problems, poor mental health, productivity loss and driving accidents.</p>
<p>We suspect there are significantly more cases in First Nations communities than currently reported. That’s partly because the proportion of First Nations people over 50 has <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/population-groups-of-interest/indigenous-australians">grown</a> in recent years and obesity is <a href="https://www.indigenoushpf.gov.au/measures/2-22-overweight-obesity">more common</a> in this population. Both obesity and increased age are risk factors for sleep apnoea.</p>
<p>Another reason why we suspect sleep apnoea is under-reported is the
<a href="https://healthbulletin.org.au/articles/the-tyranny-of-distance-mapping-accessibility-to-polysomnography-services-across-australia/">lack of specialist sleep services</a> in rural and remote areas. Long wait times, plus logistical and financial challenges in accessing services not available locally, means people are not being assessed, diagnosed and treated.</p>
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Read more:
<a href="https://theconversation.com/health-check-is-snoring-anything-to-worry-about-68142">Health Check: is snoring anything to worry about?</a>
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<h2>A growing awareness</h2>
<p>So community members have advocated for expanding the existing Let’s Yarn About Sleep program – which was originally set up to manage sleep problems in First Nations <a href="https://theconversation.com/the-first-sleep-health-program-for-first-nations-adolescents-could-change-lives-206286">teenagers</a> – to cater for people with sleep apnoea.</p>
<p>This builds on insights from community yarns about the impact of poor sleep. These highlighted that dreaming in First Nations culture is considered an important opportunity to connect with ancestors, Country and cultural knowledge. So, poor sleep, through its impact on dreaming, also affects spiritual health.</p>
<p>Let’s Yarn About Sleep project coordinator and Kalkadoon woman Roslyn Von Senden says:</p>
<blockquote>
<p>Dreams are an important part of our life, a medium to connect with our ancestors to be guided, foresee things, connect with others, and get inspiration and ideas to express our artistic talent. Sleep loss deprives us of opportunities to connect with our culture, our ancestors and who we are as traditional custodians of the world’s oldest surviving culture. That leads to poor emotional and mental health, affects our wellbeing and results in chronic conditions.</p>
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<a href="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sleep coach with program participant showing him how to use CPAP machine" src="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557197/original/file-20231102-21-feolbl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sleep coach Karen Chong talks about sleep apnoea with program participant Neil Dunne.</span>
<span class="attribution"><a class="source" href="https://stories.uq.edu.au/news/2023/better-sleep-to-improve-health-in-indigenous-communities/index.html">UQ/Let's Yarn about Sleep program</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>The program’s yarn with community members also highlighted the lack of culturally secure services, low awareness of sleep apnoea treatment options and stigma in accessing services as the key contributors to high rates of undiagnosed/untreated sleep apnoea in First Nations communities.</p>
<p>Uncle Neil Dunne, a Pitta Pitta man, who has sleep apnoea and was a member of the program’s community steering group, says: </p>
<blockquote>
<p>Sleep apnoea is very common in our community, but many of our mob don’t get tested. There is still shame in talking about sleep apnoea. Not many people know what it means and how it affects our health. I was tested for sleep apnoea, and the doctor told me I stopped breathing 13 times [per hour] in my sleep. This is scary. It is important to educate our community on how we can get help and why it is important to get help for sleep apnoea.</p>
</blockquote>
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<em>
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Read more:
<a href="https://theconversation.com/my-snoring-is-waking-up-my-partner-apart-from-a-cpap-machine-what-are-the-options-188825">My snoring is waking up my partner. Apart from a CPAP machine, what are the options?</a>
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</p>
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<h2>So what does the program look like?</h2>
<p>The idea was to design a culturally responsive model for local diagnosis and management of, and education about, obstructive sleep apnoea in First Nations communities.</p>
<p>This has involved consultation with 12 First Nations communities, and training Aboriginal health workers and nurses to deliver the program.</p>
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<p>The Aboriginal health workers will educate community members about symptoms of sleep apnoea, its health impacts and pathways to seek clinical care. They’ll also screen for sleep apnoea in the community and start the referral process so people can be treated by GPs and nurses via their local community health service or Aboriginal medical service. </p>
<p>The program uses standard treatments for sleep apnoea, such as <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/cpap-continuous-positive-airway-pressure">continuous positive airway pressure</a> therapy, known as a CPAP machine. This includes a mask you wear at night to help open up your airway and help you breathe while sleeping. </p>
<p>But community Elders also guide the team to integrate cultural practices.</p>
<p>For example, the team will include didgeridoo sessions for men as part of the program. This Aboriginal musical instrument is not only an important part of cultural ceremonies, playing the didgeridoo <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360393/">reduces the severity</a> of sleep apnoea. It strengthens the muscles of the throat and the back of the tongue (key muscles associated with sleep apnoea).</p>
<p>Cultural protocols don’t support offering didgeridoo sessions for women. So we will seek guidance from community members to decide which other wind instruments can be used for women. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man playing didgeridoo outside" src="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557193/original/file-20231102-19-m7ytdt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Playing the didgeridoo will be part of therapy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-plays-didgeridoo-garden-697433446">Erich Haubrich/Shutterstock</a></span>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/friday-essay-the-remarkable-yidaki-and-no-its-not-a-didge-74169">Friday essay: the remarkable yidaki (and no, it's not a 'didge')</a>
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<h2>Locally-led, culturally responsive</h2>
<p>It’s early days for us to see any results from the program. But it shows we can develop locally led and culturally responsive models of care.</p>
<p>By co-designing with community members, integrating cultural knowledge into how we manage sleep apnoea, and building the First Nations sleep health workforce, the program aims to transform diagnosis and management for First Nations peoples.</p>
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<p><em>Timothy Skinner, Professor of Health Psychology, La Trobe University, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/214641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yaqoot Fatima is a member of the Australasian Sleep Association and is associated with the Sleep Health Foundation.
Yaqoot Fatima is supported by funding from the NHMRC Partnership Grant, MRFF Indigenous Health Research Grant, MRFF-EMCR grant, Tropical Australian Academic Health Centre grant and Beyond Blue for sleep health research.
</span></em></p><p class="fine-print"><em><span>Daniel Sullivan is a member of the Australasian Sleep Association and the Australian Psychological Society. Daniel Sullivan receives funding from a Medical Research Future Fund Early-Mid Career Researchers grant. </span></em></p><p class="fine-print"><em><span>Romola Bucks is a member of the Australasian Sleep Association, and the Sleep Health Foundation. Romola has received funding or currently receives funding from sources including the NHMRC, the Tropical Australian Academic Health Centre Seed Funding Scheme, and Indigenous Health Research Fund: MRFF.</span></em></p><p class="fine-print"><em><span>Shannon Edmed receives funding from the National Health and Medical Research Council (NHMRC) 2021 Medical Research Future Fund (MRFF) Early to Mid-Career Researchers Grant.
Shannon Edmed's research is supported partially by the Australian Research Council's Centre of Excellence for Children and Families over the Life Course (Project ID CE200100025).
She has also previously received funding from Government departments such as the Commonwealth Department of Health and Aged Care and the Commonwealth Defence Science and Technology Group.
</span></em></p><p class="fine-print"><em><span>Roslyn Von Senden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Poor sleep deprives First Nations people of the chance to connect with culture. So they co-designed a sleep apnoea program they’d actually use.Yaqoot Fatima, Associate Professor, UQ Poche Centre for Indigenous Health, The University of QueenslandDaniel Sullivan, Research Fellow, UQ Poche Centre for Indigenous Health, The University of QueenslandRomola Bucks, Pro Vice Chancellor (Health and Medical Science) & Director of the Raine Study (rainestudy.org.au), The University of Western AustraliaRoslyn Von Senden, Senior Project Officer, UQ Poche Centre for Indigenous Health, The University of QueenslandShannon Edmed, Research Fellow, Institute for Social Science Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129642023-10-25T19:09:58Z2023-10-25T19:09:58ZHow can I get some sleep? Which treatments actually work?<figure><img src="https://images.theconversation.com/files/549731/original/file-20230922-15-vh7iga.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-surrounded-by-different-pills-on-2132651521">Shutterstock</a></span></figcaption></figure><p><em>This article is the next in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>Do you have difficulty falling asleep? Do you stay awake for a long time at night? Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day? Has this been happening for months?</p>
<p>If so, you’re not alone. About <a href="https://www.sleephealthfoundation.org.au/special-sleep-reports/chronic-insomnia-disorder-in-australia">12-15%</a> of Australian adults have chronic insomnia.</p>
<p>You might have tried breathing exercises, calming music, white noise, going to bed in a dark and quiet bedroom, eating different foods in the evening, maintaining a regular sleep pattern, or reducing caffeine. But after three to four weeks of what seems like progress, your insomnia returns. What next?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>What not to do</h2>
<p>These probably won’t help:</p>
<ul>
<li><p><strong>spending more time in bed</strong> often results in more time spent <em>awake</em> in bed, which can make <a href="https://theconversation.com/how-do-i-stop-my-mind-racing-and-get-some-sleep-207904">insomnia patterns worse</a></p></li>
<li><p><strong>drinking coffee and taking naps</strong> might help get you through the day. But <a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">caffeine</a> stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it <a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">more difficult</a> to fall asleep in the evening</p></li>
<li><p><strong>drinking alcohol</strong> might help you fall asleep quicker, but <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">can cause</a> more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">Why do I fall asleep on the sofa but am wide awake when I get to bed?</a>
</strong>
</em>
</p>
<hr>
<h2>What to do next?</h2>
<p>If your symptoms have lasted more than one or two months, it is likely your insomnia requires targeted treatments that focus on sleep patterns and behaviours.</p>
<p>So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti">CBTi</a> for short). This is a four to eight week treatment that’s been shown to be <a href="https://doi.org/10.1016/j.smrv.2022.101687">more effective</a> than sleeping pills. </p>
<p>It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia.</p>
<p>You can do this one-on-one, in a small group with health professionals trained in CBTi, or via self-guided <a href="https://www.sleepprimarycareresources.org.au/insomnia/cbti/referral-to-digital-cbti-programs">online programs</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Counsellor or psychologist putting hand on shoulder of woman in group therapy" src="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550533/original/file-20230927-23-490yxo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can do this therapy in a group, one-on-one or online.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/men-women-sitting-circle-during-group-1316330951">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some GPs are trained to offer CBTi, but it’s more usual for specialist <a href="https://psychology.org.au/find-a-psychologist">sleep psychologists</a> to offer it. Your GP can refer you to one. There are some Medicare rebates to subsidise the cost of treatment. But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some. </p>
<p><a href="https://doi.org/10.12703%2Fr%2F11-4">About 70-80%</a> of people with insomnia sleep better after CBTi, with improvements lasting <a href="https://doi.org/10.1016/j.smrv.2019.08.002">at least a year</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
</strong>
</em>
</p>
<hr>
<h2>What if that doesn’t work?</h2>
<p>If CBTi doesn’t work for you, your GP might be able to refer you to a specialist sleep doctor to see if other sleep disorders, such as <a href="https://doi.org/10.1016/j.smrv.2016.04.004">obstructive sleep apnoea</a>, are contributing to your insomnia. </p>
<p>It can also be important to manage any mental health problems such as <a href="https://doi.org/10.5694/mja2.51200">depression and anxiety</a>, as well as physical symptoms such as pain that can also disrupt sleep. </p>
<p>Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>What about sleeping pills?</h2>
<p>Sleeping pills are <a href="https://www.sleepprimarycareresources.org.au/insomnia/pharmacological-therapy">not the recommended</a> first-line way to manage insomnia. However, they do have a role in providing short-term, rapid relief from insomnia symptoms or when CBTi is not accessible or successful.</p>
<p>Traditionally, medications such as benzodiazepines (for example, temazepam) and benzodiazepine receptor agonists (for example, zolpidem) have been used to help people sleep.</p>
<p>However, these can have <a href="https://doi.org/10.1136/bmj.38623.768588.47">side-effects</a> including a risk of falls, being impaired the next day, as well as tolerance and dependence. </p>
<p>Melatonin – either prescribed or available from pharmacies for people aged 55 and over – is also often used to manage insomnia. But the <a href="https://doi.org/10.1016/j.smrv.2022.101692">evidence suggests</a> it has limited benefits.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-reasons-why-you-should-avoid-sleeping-pills-10054">Some reasons why you should avoid sleeping pills </a>
</strong>
</em>
</p>
<hr>
<h2>Are there new treatments? How about medicinal cannabis?</h2>
<p>Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant).</p>
<p>These block the wake-promoting pathways in the brain. <a href="https://doi.org/10.4088/PCC.22nr03385">Early data suggests</a> they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines.</p>
<p>However, we don’t know if they work or are safe over the long term.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dropper bottles of medicinal cannabis oil" src="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552457/original/file-20231006-29-t56795.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Medicinal cannabis may be one option in the future. But trials so far have been mixed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/macro-detail-dropper-cbd-oil-cannabis-725041309">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1093/sleep/zsab149">Medicinal cannabis</a> <a href="https://doi.org/10.1111/jsr.13793">has only in recent years</a> <a href="https://doi.org/10.1093/sleepadvances/zpac029.048">been studied</a> as a treatment for <a href="https://doi.org/10.1093/sleepadvances/zpac029.005">insomnia</a>.</p>
<p>In an Australian survey, <a href="https://doi.org/10.2147/nss.s390583">more than half</a> of people using medicinal cannabis said they used it to treat insomnia. There are reports of <a href="https://doi.org/10.1371/journal.pone.0272241">significant benefit</a>. </p>
<p>But of the four most robust studies so far, <a href="https://doi.org/10.1093/sleep/zsab149">only one</a> (led by one of us, Jen Walsh) has demonstrated an improvement in insomnia after two weeks of treatment.</p>
<p>So we need to learn more about which cannabinoids – for example, delta-9-tetrahydrocannabinol, cannabidiol or cannabinol – and which doses may be beneficial. We also need to learn who can benefit most, and whether these are safe and effective over the long term.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-with-endometriosis-report-using-cannabis-to-ease-their-pain-126516">1 in 10 women with endometriosis report using cannabis to ease their pain</a>
</strong>
</em>
</p>
<hr>
<h2>What now?</h2>
<p>If you’ve had trouble sleeping for a short time (under about a month) and nothing you try is working, there may be underlying reasons for your insomnia, which when treated, can provide some relief. Your GP can help identify and manage these.</p>
<p>Your GP can also help you access other treatments if your insomnia is more long term. This may involve non-drug therapies and/or referral to other services or doctors.</p>
<hr>
<p><em>For more information about insomnia and how it’s treated, see the Sleep Health Foundation’s <a href="https://www.sleephealthfoundation.org.au/sleep-disorders/insomnia-2">online resource</a>.</em></p><img src="https://counter.theconversation.com/content/212964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Sweetman is a Senior Program Manager at the Australasian Sleep Association, the peak sleep health scientific and advocacy body in Australia and New Zealand, and has academic status at Flinders University. Dr Sweetman reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, Flinders Foundation, ResMed, Philips, Cerebra, Re-Time, and Australian Doctor.</span></em></p><p class="fine-print"><em><span>Jen Walsh is affiliated with the Centre for Sleep Science at The University of Western Australia and the West Australian Sleep Disorders Research Institute at Sir Charles Gairdner Hospital. She is a director of the Australian Sleep Association (ASA), and a member of the Australia and New Zealand Sleep Science Association (ANZSSA) and Sleep Health Foundation (SHF).
Jen Walsh has received research funding (past) from the NHMRC, Sir Charles Gairdner Hospital research advisory committee, Australia and New Zealand College of Anaesthetists (ANZCA), Oventus Pty Ltd, Nyxoah Pty Ltd, Zelira Therapeutics Ltd and Incannex Healthcare Ltd. She is currently receiving research funding from CHC Helicopter Australia and Chevron Australia Pty Ltd. She also receives consultancy fees from Invicta Medical and Melius Consulting.
Jen Walsh was the first author of a medicinal cannabis trial mentioned in this article.</span></em></p><p class="fine-print"><em><span>Nicole Grivell is involved in the Australasian Sleep Association as a co-chair of the Primary Care Council and as a member of the Conference Committee.
She currently has PhD funding from Flinders University and an NHMRC-funded Partnership Grant. She has previously received PhD funding from the Flinders Foundation in the form of a Nick Antic Sleep Research PhD Scholarship. </span></em></p>You’ve tried everything to get some sleep, but nothing’s working. Here’s what not to do, and what works.Alexander Sweetman, Research Fellow, College of Medicine and Public Health, Flinders UniversityJen Walsh, Director of the Centre for Sleep Science, The University of Western AustraliaNicole Grivell, Research Coordinator and final year PhD Candidate at FHMRI Sleep Health, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118232023-10-10T19:04:39Z2023-10-10T19:04:39ZWhat’s insomnia like for most people who can’t sleep? You’d never know from the movies<figure><img src="https://images.theconversation.com/files/547965/original/file-20230913-15-x9hiii.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-watching-movie-on-tv-2280957353">Shutterstock</a></span></figcaption></figure><p><em>This article is part of The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today. Read other articles in the series <a href="https://theconversation.com/au/topics/insomnia-series-144018">here</a>.</em></p>
<hr>
<p>Hollywood appears fascinated by sleep’s impact on the mind and body.
Blockbuster movies featuring someone living with insomnia include <a href="https://www.imdb.com/title/tt0108160/">Sleepless in Seattle</a> (1993), <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999) and <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a> (2002). </p>
<p>But how well do these and other portrayals compare with what it’s really like to live with insomnia?</p>
<p>As we’ll see, most movies tend to either minimise or exaggerate symptoms. Insomnia is rarely depicted as a treatable illness. And these portrayals have implications for the estimated <a href="https://www.sleep.theclinics.com/article/S1556-407X(22)00022-4/fulltext">one in three</a> of us with at least one insomnia symptom.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-short-history-of-insomnia-and-how-we-became-obsessed-with-sleep-211729">A short history of insomnia and how we became obsessed with sleep</a>
</strong>
</em>
</p>
<hr>
<h2>Back in the real world</h2>
<p>Insomnia is a common <a href="https://doi.org/10.1378/chest.14-0970">sleep disorder</a> where a person struggles to fall asleep, stay asleep, or wakes up too early – despite having adequate opportunity for sleep. </p>
<p><a href="https://doi.org/10.1111/j.1753-6405.2012.00845.x">Around 5%</a> of adults experience significant insomnia to the degree that it causes distress or impairs daily life.</p>
<p>It’s a common misconception that insomnia is only a night-time issue. <a href="https://www.healthdirect.gov.au/insomnia">Insomnia</a> can impact your ability to stay awake and alert during the day. It can also affect your <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental health</a>.</p>
<p>At work, you might be more prone to accidents, more forgetful, or make poorer decisions. At home, you might be irritable or short with your friends and family.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1678293771539161089"}"></div></p>
<p>So what is it like living with insomnia? Apart from the effects of poor sleep quality, many people experience <a href="https://doi.org/10.1016/j.smrv.2021.101583">anxiety or dread</a> about the night ahead from the moment they wake up. From early in the day, people plan how they can improve their sleep that night.</p>
<p><a href="https://doi.org/10.1016/j.smrv.2016.01.003">A review</a> found
people living with insomnia felt their sleep concerns were often trivialised or misunderstood by health-care professionals, and stigmatised by others.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-memoir-of-sleeplessness-posits-making-peace-with-our-ruptured-nights-but-risks-becoming-an-exhausting-read-209496">A memoir of sleeplessness posits making peace with our ruptured nights – but risks becoming an exhausting read</a>
</strong>
</em>
</p>
<hr>
<h2>Movies can minimise symptoms …</h2>
<p>Nicholas Galitzine’s character in the recent romcom <a href="https://www.imdb.com/title/tt10172266/?ref_=fn_al_tt_1">Red, White and Royal Blue</a> (2023) has insomnia. We’re briefly told he struggles to fall asleep at night. However, we never see any meaningful impact on his life or depiction of the difficulty living with insomnia entails.</p>
<p>That said, minimising the impact of insomnia can have benefits. It shows insomnia is an invisible illness, doesn’t have obvious visual symptoms and anyone can have it. </p>
<p>But this can perpetuate the expectation someone with insomnia should be able to function unencumbered. Or it can fuel the misconception having insomnia may be beneficial, as in <a href="https://www.imdb.com/title/tt0050543/?ref_=fn_al_tt_1">Insomnia Is Good for You</a> (1957).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gay-guys-can-do-missionary-how-red-white-and-royal-blue-brings-queer-intimacy-to-mainstream-audiences-211663">'Gay guys can do missionary?' - how Red, White & Royal Blue brings queer intimacy to mainstream audiences</a>
</strong>
</em>
</p>
<hr>
<h2>… or exaggerate symptoms</h2>
<p>But most Hollywood portrayals of insomnia tend to depict the most extreme cases. These usually feature insomnia as a symptom of another condition rather than a disorder itself, as is commonly experienced.</p>
<p>These movies tend to be psychological thrillers. Here, insomnia is often used as an enigma to keep the audience guessing about which events are real or figments of a character’s imagination.</p>
<p>Take <a href="https://www.imdb.com/title/tt0361862/?ref_=fn_al_tt_1">The Machinist</a> (2004), for example. The main character is emaciated, ostracised and plagued by paranoia, hallucinations and delusions. It’s only towards the end of the movie we learn his insomnia may be the result of a <a href="https://doi.org/10.9740/mhc.n101819">psychiatric disorder</a>, such as post-traumatic stress disorder.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-R4rQMImHwE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In The Machinist, the main character has paranoia, hallucinations and delusions.</span></figcaption>
</figure>
<p>Hollywood’s focus on extreme cases of insomnia is a recurring pattern (for instance, <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> 1999, <a href="https://www.imdb.com/title/tt0434165/?ref_=fn_al_tt_3">Lucid</a> 2005).</p>
<p>It’s understandable why Hollywood latches onto these extreme portrayals – to entertain us. Yet these portrayals of insomnia as something more severe or threatening, like psychosis, can increase anxiety or stigma among people living with insomnia.</p>
<p>While it’s true other medical conditions including <a href="https://theconversation.com/explainer-whats-the-link-between-insomnia-and-mental-illness-49597">mental illnesses</a> can lead to insomnia, insomnia often exists on its own. Insomnia is often <a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">caused by</a> more mundane things like too much stress, lifestyle and habits, or longer daylight hours at higher latitudes (such as in <a href="https://www.imdb.com/title/tt0278504/?ref_=fn_al_tt_1">Insomnia</a>, 2002).</p>
<p>Something these exaggerated portrayals do well is highlight the impact sleep deprivation can have on safety, albeit extremely dramatised. Regardless of profession, <a href="https://doi.org/10.1037/xge0000717">not getting enough sleep</a> at night can substantially impact cognitive function, increasing the chance of making a mistake.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/emIHzg4VH8A?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In Insomnia, one character has insomnia because of extended daylight hours.</span></figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/counting-the-wrong-sheep-why-trouble-sleeping-is-about-more-than-just-individual-lifestyles-and-habits-210695">Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits</a>
</strong>
</em>
</p>
<hr>
<h2>Movies rarely depict treatment</h2>
<p>It is rare to see insomnia depicted as a health condition requiring medical care. Very few characters struggling with insomnia seek or receive help for it. </p>
<p>An exception is the narrator in <a href="https://www.imdb.com/title/tt0137523/">Fight Club</a> (1999). But he has to pretend to have other illnesses to receive therapy, again suggesting insomnia is not a legitimate condition.</p>
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<figcaption><span class="caption">The narrator in Fight Club pretends to have other illnesses to receive therapy for insomnia.</span></figcaption>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-insomnia-and-what-can-you-do-about-it-36365">Explainer: what is insomnia and what can you do about it?</a>
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<h2>Why does accurate representation matter?</h2>
<p>Many people only learn about the symptoms and impact of sleep disorders through pop culture and film. These portrayals can affect how others think about these disorders and can impact how people living with these disorders think about themselves.</p>
<p>Uniform and stereotypical portrayals of insomnia can also impact people’s <a href="https://doi.org/10.1080/15402002.2011.620671">likelihood of seeking help</a>.</p>
<p>Most of these films show young or middle-aged men experiencing insomnia. Yet women are <a href="https://doi.org/10.1093/sleep/29.1.85">more likely</a> to have insomnia than men. Insomnia is also <a href="https://doi.org/10.1016/j.jsmc.2022.03.003">more common</a> in older adults, people with a lower socioeconomic background and those living alone. People at higher risk of developing insomnia might not recognise their risk or symptoms if their experience doesn’t match what they’ve seen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hallucinations-in-the-movies-tend-to-be-about-chaos-violence-and-mental-distress-but-they-can-be-positive-too-204547">Hallucinations in the movies tend to be about chaos, violence and mental distress. But they can be positive too</a>
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<h2>We can do better</h2>
<p>While the reality of living with insomnia may not be particularly cinematic, filmmakers can surely do better than using it as a convenient plot point. </p>
<p>There are a number of main characters living with different health conditions across pop culture. For instance, the movie <a href="https://www.imdb.com/title/tt4034228/">Manchester by the Sea</a> (2016) features someone with <a href="https://www.rcpsych.ac.uk/news-and-features/blogs/detail/cultural-blog/2017/07/08/manchester-by-the-sea">prolonged grief disorder</a> and the TV series <a href="https://www.imdb.com/title/tt6315640/?ref_=nv_sr_srsg_0_tt_8_nm_0_q_Atypical">Atypical</a> (2017-2021) features someone’s experience living with autism.</p>
<p>But if you’re looking for an accurate portrayal of insomnia, Hollywood still has some way to go. It’s about time insomnia is depicted in a way that accurately reflects people’s experiences.</p><img src="https://counter.theconversation.com/content/211823/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aaron Schokman is a member of the Sleep Health Foundation’s Consumer Reference Council </span></em></p><p class="fine-print"><em><span>Nick Glozier has received funding from the Australian Research Council and NHRMC for sleep health research, consults to organisations that provide digital and pharmacological insomnia treatments, and has IP in a sleep app.</span></em></p>Most movies tend to minimise or exaggerate insomnia symptoms. Insomnia is also rarely depicted as an illness that can be treated.Aaron Schokman, PhD Candidate, University of SydneyNick Glozier, Professor of Psychological Medicine, BMRI & Disciplne of Psychiatry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2110842023-08-25T13:39:37Z2023-08-25T13:39:37ZSetting the stage for a better understanding of complex brain disorders<p>We often compare the brain to a machine with wheels, cogs, and belts. In this analogy, when something breaks, the entire mechanism skips a beat or grinds to a halt. However, more often than not this isn’t what happens with our brains. Instead, they’re more like a theatre. Here, neurons are the musicians, actors, and dancers, and they improvise a performance that shapes our thoughts and lives.</p>
<p>I’m an electronic and computer engineer at the <a href="https://www.epu.ntua.gr/">DSS Lab</a> of the National Technical University of Athens. In December 2019, Ioannis Stavropoulos, a neuroscientist at King’s College London, introduced me to his colleague Elissaios Karageorgiou of the Neurological Institute of Athens. They wanted to talk about an idea they had about neurology and, in a way, theatre, over coffee.</p>
<p>In any piece of theatre, mistakes happen – a violin might miss a note, a drummer could skip a beat, an actor might muddle a line or a dancer stumble. Sometimes, many things go wrong simultaneously, and the audience is left wondering what’s going on. Was it the singer who was off? Was it the pianist who hit the wrong chord? Did the lights go off at the wrong time and confuse them both?</p>
<p>Complex brain disorders (CoBraD) are very much like that. These include Alzheimer’s disease, sleep problems, and epilepsy. We see their symptoms as performance missteps, yet it’s hard to group, label, and know their causes. When multiple symptoms show up at once, diagnosis becomes particularly challenging.</p>
<p>It would be hard to know what’s wrong in a musical or play by just listening to a second or two every half hour. Similarly, it’s tougher to diagnose a medical problem if we only check the patient briefly, such as during occasional doctor visits. As a result, CoBraDs may stay under- or undiagnosed for a long time or be misdiagnosed. More than one can exist at the same time, and the diagnosis and treatment are expensive, at times inaccessible for patients, and often ineffective.</p>
<h2>Paying attention to the whole performance</h2>
<p>Much like how a piece of theatre relies on each artist to play her or his part well for a captivating performance, diagnosing CoBraDs demands a wide range of accurate and harmonised data. Alzheimer’s, sleep disorders, and epilepsy are among the conditions that Ioannis and Elissaios are studying and treating. Recognising the limitations of traditional diagnostic methods, they turned their attention to real-world data (RWD), meaning data collected directly from patients not taking part in a clinical trial.</p>
<p>Data gathered from <a href="https://www.who.int/health-topics/clinical-trials">clinical trials</a> are more reliable than real-world data – they’re the result of experiments performed in strict and controlled conditions. However, they are often hard and expensive to get, limited in size, and they may not fully represent the complexity and variability of the real world.</p>
<p>In contrast, real-world data encompass a wider array of information sources, from electronic health records and patient visits to medical devices like MRIs and wearables. When aggregated, these diverse data points become “big data”, offering a more comprehensive view of patient health. This holistic approach can reveal patterns and insights that might be missed in more conventional, narrower diagnostic methods.</p>
<p>Collecting significant amounts of real-world data is just the beginning. The real challenge lies in harmonising and analysing it all to extract meaningful insights and then finding ways to use them to diagnose and treat patients. To achieve this, we sought expertise from various scientific disciplines. What became our vision was to create a digital platform where neuroscientists could store and share large amounts of data, analyse them, and use them to devise new diagnostic processes and criteria that would be more complex and nuanced than what human clinicians can handle.</p>
<p>These processes would be built into the platform to support clinicians in making decisions for their patients when diagnosing or treating them. These are called decision support systems, and when they use tools like artificial intelligence, enhancing the competences of human experts in a technical or scientific field, they’re called expert systems.</p>
<p>Scientists have proposed numerous ideas hinting that faint clues and varied signals might point to early detection of CoBraD. Many remain unproven, and some are tough to track without computers. For instance, slight changes in sleep, coupled with specific MRI signs, could suggest an early brain disorder. Rather than waiting years for clear symptoms to emerge, doctors could act swiftly, improving the patient’s prospects.</p>
<p>This is how the idea for the <a href="https://www.mes-cobrad.eu/">Multidisciplinary Expert System for the Assessment and Management of Complex Brain Disorders</a> (MES-CoBraD) was born. Bringing together with experts in medicine, engineering, and computer science, we are building a software platform and performing medical research using it.</p>
<h2>When doctors, practitioners, software engineers and AI work together</h2>
<p>MES-CoBraD evolved into an EU-funded project that now includes 14 universities, companies, and hospitals across Europe. The underlying concept is straightforward: data and observations produced by clinical practice are used by medical research to enhance that very practice.</p>
<p>This continuous circular collaboration can use technology as a link and an enabler. Researchers and clinicians collect and anonymise patient data and upload them to the platform. The researchers form scientific hypotheses, analyse the data, train AI models, and test their hypotheses.</p>
<p>Should they achieve a breakthrough, clinicians would be able to directly use the platform’s algorithms to diagnose patients and provide treatments. Related data would in turn will be anonymised and serve to test new hypotheses, aid new statistical analyses, train AI models, or refine existing ones.</p>
<p>The challenges are many. When designing new experiments, we must ensure our data are unbiased. We are also investigating and addressing the ethical implications of using artificial intelligence in medicine. For instance, how do we guarantee that its suggestions are understood by the clinician and can be explained to the patient? How can we be certain that they don’t inadvertently favour one patient group over another, or prioritise cost savings over human life? If AI makes a mistake, who takes responsibility?</p>
<p>In MES-CoBraD, we have been venturing into some uncharted territory, but always with specific goals in mind. Although the platform is being made to work in multiple medical fields, the focus now is finding ways of using a very detailed picture of patients’ health (a process called deep phenotyping) in conjunction with advanced analytics tools and AI to diagnose and manage CoBraDs. In essence, we aim to simultaneously tune the instruments, hone the actors’ lines, and adjust the score.</p>
<h2>A personal turn on the stage</h2>
<p>Interestingly, my own life’s “play” has its moments of dissonance, as I sometimes wake in the middle of the night and find it hard to get back to sleep. I don’t think it’s anything serious, but as a scientist and longtime researcher, I would never miss the chance to test our own methods and processes on myself. I thus signed up as a test subject for our sleep study and wore a device called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/actigraphy">“actigraph”</a> on my wrist for a week, and it kept track of my activities, diet, and sleep. I took memory tests and answered questions, and finally there was the main event: I got hooked up with around 40 or 50 cables, tubes and sensors, and slept in the clinic for the night. As a bonus, I offered months of smartwatch health data, which was anonymised and included in the platform.</p>
<p>I am happy to report that for now my sleep issues are likely to be stress-related. However, if deep phenotyping and AI end up diagnosing something worse – say, an early onset complex brain disorder – the question for someone in my position would be: “Should I worry or celebrate the scientific breakthrough if it does?”</p>
<hr>
<p><em>This article is the result of The Conversation’s collaboration with <a href="https://ec.europa.eu/research-and-innovation/en/horizon-magazine">Horizon</a>, the EU research and innovation magazine. In June the magazine published an <a href="https://ec.europa.eu/research-and-innovation/en/horizon-magazine/brain-disorders-trigger-search-new-clues-and-cures">interview with the authors about their research</a>.</em></p><img src="https://counter.theconversation.com/content/211084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christos Ntanos is the Project Coordinator of the "MES-CoBraD -- Multidisciplinary Expert System for the Assessment & Management of Complex Brain Disorders" project, which has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 965422.</span></em></p>Disorders such as Alzheimer’s and epilepsy are difficult to diagnose with only occasional doctor visits. A new approach would allow fathering of extensive real-world data directly from patients.Christos Ntanos, Research director at the Decision Support Systems (DSS) Laboratory, National Technical University of AthensLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2015272023-05-26T12:26:57Z2023-05-26T12:26:57ZA little-understood sleep disorder affects millions and has clear links to dementia – 4 questions answered<figure><img src="https://images.theconversation.com/files/527576/original/file-20230522-6205-s3h5qy.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5103%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Past age 50, men are much more likely to have REM sleep behavior disorder than women.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caucasian-man-sleeping-royalty-free-image/92305206?phrase=50+year+old+sleeping&adppopup=true">Jose Luis Pelaez/Stone via Getty Images</a></span></figcaption></figure><p><em>A little-known and poorly understood sleep disorder that occurs during the rapid eye movement, or REM, <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/rem-sleep">stage of sleep</a> <a href="https://www.scientificamerican.com/article/acting-out-dreams-predicts-parkinsons-and-other-brain-diseases/">has been garnering attention</a> for its role in foreshadowing neurodegenerative brain diseases such as <a href="https://www.nia.nih.gov/health/parkinsons-disease#">Parkinson’s disease</a> and <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">dementia with Lewy bodies</a>. The disorder, known as <a href="https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd#">REM sleep behavior disorder</a>, or RBD in the medical field, affects around 1% of the general population worldwide and <a href="https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print">about 2% of adults over 65</a>.</em> </p>
<p><em>The Conversation talked with <a href="https://uvahealth.com/findadoctor/Anelyssa-D%27Abreu-1891243507">Anelyssa D'Abreu</a>, a neurologist who specializes in geriatric neurology, to explain what researchers know about the condition’s links to dementia.</em></p>
<h2>1. What is REM sleep behavior disorder?</h2>
<p>Every night, you go through four to five sleep cycles. Each cycle, lasting about 90 to 110 minutes, has four stages. That fourth stage is REM sleep. </p>
<p>REM sleep only comprises <a href="https://www.ncbi.nlm.nih.gov/books/NBK526132/#">20% to 25% of total sleep</a>, but its proportion increases throughout the night. During REM sleep, your brain rhythms are similar to when you are awake, your muscles lose tone so you are unable to move, and your eyes, while closed, move quickly. This stage is often accompanied by muscle twitches and fluctuations in your respiratory rate and blood pressure.</p>
<p>But someone with REM sleep behavior disorder will act out their dreams. For reasons that are poorly understood, the dream content is usually violent – patients report being chased, or defending themselves, and as they sleep they shout, moan, scream, kick, punch and thrash about. </p>
<p>Injuries often result from these incidents; patients may fall from bed or accidentally harm a partner. Some 60% of patients and 20% of bed partners of people with this disorder <a href="https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print">sustain an injury</a> during sleep. </p>
<p>Appropriate testing, including <a href="https://sleepeducation.org/patients/sleep-study/">a sleep study</a>, are needed to determine if a patient has REM sleep behavior disorder, as opposed to another disorder, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK459252/#">obstructive sleep apnea</a>. This is a disorder in which breathing is interrupted during sleep. </p>
<p>REM sleep behavior disorder can occur at any age, but symptoms usually start with people in their 40s and 50s. For those younger than 40, antidepressants are the most common cause of REM sleep behavior disorder; in these younger patients, it affects biological males and females about equally, but past age 50, it’s more common in biological males.</p>
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<figcaption><span class="caption">If you suspect you have REM sleep behavior disorder, see a sleep specialist or neurologist.</span></figcaption>
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<h2>2. What causes REM sleep behavior disorder?</h2>
<p>The disease mechanism is not well understood. In some cases of REM sleep behavior disorder, a clear cause cannot be identified. In other cases, the disorder may be caused by something specific, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK459252/#">obstructive sleep apnea</a>, <a href="https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497#">narcolepsy</a>, psychiatric disorders, use of antidepressants, autoimmune disorders and brain lesions, which are areas of damaged brain tissue.</p>
<p>In both situations, REM sleep behavior disorder <a href="https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-021-00501-z#">may be associated with synucleinopathies</a>, a group of neurodegenerative disorders in which aggregates of the protein α-synuclein accumulate in brain cells. The most common of these neurodegenerative disorders is Parkinson’s disease. Others are <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">dementia with Lewy bodies</a>, <a href="https://www.ninds.nih.gov/health-information/disorders/multiple-system-atrophy">multiple system atrophy</a> and <a href="https://doi.org/10.1016%2Fj.mayocp.2019.03.009">pure autonomic failure</a>. REM sleep behavior disorder may precede these diseases or occur at any time during the disease process. </p>
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<figcaption><span class="caption">People with REM sleep behavior disorder can injure themselves – and their bed partners.</span></figcaption>
</figure>
<h2>3. What are the links between the sleep disorder and dementia?</h2>
<p>REM sleep behavior disorder may be <a href="https://doi.org/10.1016/j.nbd.2020.104996">the first symptom of Parkinson’s disease or dementia with Lewy bodies</a>. It is observed in 25% to 58% of patients diagnosed with Parkinson’s, 70% to 80% of patients with dementia with Lewy bodies and 90% to 100% of those with <a href="https://www.nhs.uk/conditions/multiple-system-atrophy/#">multiple system atrophy</a>.</p>
<p>In a long-term study of 1,280 patients with REM sleep behavior disorder who didn’t have <a href="https://my.clevelandclinic.org/health/diseases/22815-parkinsonism#">parkinsonism</a> – an umbrella term that refers to brain conditions, including Parkinson’s disease, that cause slowed movements, stiffness and tremors – or dementia, researchers followed participants to find out how many would develop these disorders. After 12 years, 73.5% of those with REM sleep behavior disorder had developed a <a href="https://doi.org/10.1093/brain/awz030">related neurodegenerative disorder</a>.</p>
<p>Some of the factors that independently increased the risk of developing a neurodegenerative disorder were the presence of irregular motor symptoms, abnormal dopamine levels, loss of sense of smell, cognitive impairment, abnormal color vision, erectile dysfunction, constipation and older age.</p>
<p>REM sleep behavior disorder may also be observed in other neurodegenerative disorders such as Alzheimer’s disease and Huntington’s disease, but at much lower rates. The association is also not as strong as that observed in the synucleinopathies.</p>
<h2>4. Does an early diagnosis help?</h2>
<p>For most neurodegenerative disorders, there is a phase that may last for decades in which brain changes are taking place but the patient either remains asymptomatic or develops symptoms without the full expression of the disease. RBD, in that scenario, is an early sign of those disorders. This provides an opportunity to study how the disease progresses in the brain and to develop therapies that could either slow this process or prevent it from happening. </p>
<p>At this time, there are no approved therapies to prevent the onset of these neurodegenerative diseases in those with REM sleep behavior disorder. There are, however, medications such as melatonin and clonazepam that may improve the symptoms. We also recommend measures to avoid injury, such as removing breakable objects from the room, protecting windows and padding floors. </p>
<p>Patients who are affected by REM sleep behavior disorder may choose to participate in research. Proper treatment of the disease can help prevent injury and improve quality of life.</p><img src="https://counter.theconversation.com/content/201527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anelyssa D'Abreu receives funding from ARDRAF </span></em></p>REM sleep behavior disorder is characterized by acting out dreams, which may include shouting, kicking and punching during sleep.Anelyssa D'Abreu, Associate Professor of Neurology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1933552022-10-28T15:14:40Z2022-10-28T15:14:40ZDracula at 125: how Bram Stoker’s vampire is a monstrous creation of terrifying sleep disorders<p>Having celebrated the 125th anniversary of its 1897 publication earlier this year, <a href="https://www.theguardian.com/books/2012/jun/24/dracula-stoker-review-colm-toibin#:%7E:text=The%20%22rather%20cruel%2Dlooking%22,how%20events%20twist%20and%20turn%22.">Dracula</a> is deservedly considered a classic – not least for the way its eponymous vampire remains a cultural icon. Bram Stoker’s novel has prompted a wide variety of critical interpretations, from the existential dread of cursed immortality to the threat of disease, intrusion and colonialism.</p>
<p>But Stoker’s vampire represents something else that has gone relatively unexplored: he is a monstrous personification of sleep disorders known as <a href="https://www.sleepfoundation.org/parasomnias">parasomnias</a>. These involve hallucinations, dreams and involuntary movement, and include phenomena such as sleepwalking, nightmares and <a href="https://www.nhs.uk/conditions/sleep-paralysis/#:%7E:text=Sleep%20paralysis%20happens%20when%20you,insomnia">sleep paralysis</a> (when you cannot move your muscles as you are waking up or falling asleep). </p>
<p>I have slept strangely ever since I was a child. I used to sleepwalk and hide my teddies around the house, or eerily stand in the corner of my parents’ bedroom. As a teenager, I began to have recurring nightmares about a malevolent figure in my life, and started to hallucinate, have bizarre <a href="https://www.sleepfoundation.org/dreams/lucid-dreams">lucid dreams</a> and experience sleep paralysis.</p>
<p>I often wake up to sinister shadows looming down at me. A few years ago, I saw a woman every night for a week, and each time she appeared she got closer to my bed. For a long time, I thought no one else experienced these things. I didn’t even know the phenomena had a name. There were times that I wondered if I was being haunted. </p>
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</figure>
<p>My work investigates representations of insomnia in literature. Reading about the science of sleep, I was astounded to find descriptions of the peculiar things that often happened to me at night. I learned about the natural paralysis of the body during sleep, and the way the brain can create <a href="https://www.sleepfoundation.org/how-sleep-works/hypnopompic-hallucinations#:%7E:text=Hypnopompic%20hallucinations%20occur%20while%20a,of%20these%20hallucinations%20involve%20sound.">“hypnopompic” hallucinations</a> when half-awake.</p>
<p>Crucially, I learned how common parasomnias were, and that I wasn’t so strange after all. But for all I now understand the scientific explanations, I am often momentarily drawn into the delusion that I <em>really</em> am seeing a ghost in my bedroom.</p>
<p>As I examined sleep-related passages in Dracula while researching my non-fiction book, <a href="https://www.thetimes.co.uk/article/night-terrors-why-we-have-nightmares-and-how-to-stop-them-nfh0hdc5q">Night Terrors: Troubled Sleep And The Stories We Tell About It</a>, I returned to Stoker’s novel with a different perspective, and what I found has changed the way I feel about it. Dracula’s power is not in his fangs, but in the way he disturbs the sleep of his victims.</p>
<h2>Unnatural sleep</h2>
<p>At the beginning of the novel, for example, Dracula claims his first victim, Lucy Westenra. The initial sign that she is under the vampire’s influence is her sudden habit of sleepwalking across the cliffs of Whitby. </p>
<p>It is through the character of Mina Harker, however, that Stoker really delves into the stranger side of sleep. “Tonight,” she writes in her journal, “I shall strive hard to sleep naturally.” Unfortunately, for Mina, it will be a long time before that happens.</p>
<p>As Dracula begins to attack her, she suffers nearly every parasomnia: she talks in her sleep, sees strange hallucinations and, notably, experiences Dracula’s power in the form of sleep paralysis. Seeing the vampire move towards her in the form of mist, she describes in her journal that “some leaden lethargy seemed to chain my limbs”.</p>
<p>For those of us unlucky enough to experience this parasomnia, too, Stoker’s description feels remarkably accurate. You feel pinned down, unable to move, and, worse still, you hallucinate a sinister presence sitting on top of you. When I have sleep paralysis, I often feel hands grasping my arms and neck, disembodied fingers tangling themselves in my hair. I’ve even been convinced of hands dragging me down the mattress by my ankles, only to wake and find I haven’t moved.</p>
<figure class="align-center ">
<img alt="A 18th-century painting of a woman in a deep sleep, arms thrown wide, with a demon sitting on her chest." src="https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Nightmare by John Henry Fuseli, 1781.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/5/56/John_Henry_Fuseli_-_The_Nightmare.JPG">Detroit Institute of Arts / Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Stoker and the Society for Psychical Research</h2>
<p>It’s clear, then, that there are obvious parallels between Stoker’s vampire and the symptoms of parasomnias. But why was he so fascinated by troubled sleep?</p>
<p>The answer may lie with a London-based paranormal society that was formed in 1882. <a href="https://www.spr.ac.uk/">The Society for Psychical Research</a> (SPR), which still meets today, investigated strange phenomena such as ghosts, telekinesis and mind-reading through experiments. Its members were keen to explain as much as they could through physical and scientific fact, in order to gather cases of truly inexplicable experiences.</p>
<p>In doing so, the SPR was at the forefront of certain areas of research – notably, sleep disorders. One of its founding members was Frederic Myers, a good friend of Bram Stoker who was known to visit Myers’ house for breakfast. While there’s no evidence of Stoker attending any SPR meetings, it’s not too wild to speculate that at these breakfasts, conversation would have turned to Myers’ involvement in the society.</p>
<p>What’s particularly illuminating is the similarity between certain aspects of Dracula and a major project, the <a href="https://archivesearch.lib.cam.ac.uk/repositories/2/archival_objects/630399">Census of Hallucinations</a>, undertaken by the society just before its publication. The SPR asked the general public if they had ever experienced a hallucination, and to describe what they had seen.</p>
<p>The results were compiled in the 1894 edition of their journal, <a href="https://archive.org/details/proceedingsofsoc10soci/page/n5/mode/2up">Proceedings of the Society for Psychical Research</a>, just three years before Dracula was published. One particular anecdote stands out as a possible influence on Stoker. A “Miss HT” describes seeing a figure in her bedroom on three occasions that “took the form of mist and then developed into a dark veiled figure, which came nearer to me”.</p>
<p>In Dracula, Mina describes a similar mist seeping into her room and forming the outline of a man before she experiences sleep paralysis. Again and again, the census anecdotes feature monsters, skeletons, beautiful women decaying into worm-eaten corpses – truly the stuff of horror novels.</p>
<p>With this research being undertaken around Stoker while he wrote Dracula, it’s no wonder that he chose to imbue his immortal vampire with the power to disturb sleep. It’s estimated that around <a href="https://doi.org/10.1016/j.sleep.2010.07.011">70% of us will suffer a parasomnia</a> at some point in our lives. </p>
<p>Dracula may be one of the most famous novels about the supernatural, but the vampire himself embodies phenomena you may well experience when you go to sleep tonight.</p><img src="https://counter.theconversation.com/content/193355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Vernon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dracula’s power is not in his fangs, but in the way he disturbs the sleep of his victims.Alice Vernon, Lecturer in Creative Writing and 19th-Century Literature, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1931922022-10-25T20:22:51Z2022-10-25T20:22:51ZDevelopment of vision in early childhood: No screens before age two<figure><img src="https://images.theconversation.com/files/491691/original/file-20221025-22-wx4aqi.jpg?ixlib=rb-1.1.0&rect=14%2C7%2C979%2C655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Electronic devices are not, in and of themselves, a source of visual problems. Using these devices inappropriately can interfere with the natural development of the eye, as well as reading and learning skills. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Things are busy on a rainy Saturday afternoon when I make a trip to the mall to finalize some back-to-school shopping. I pass by a lot of people, including several parents with young children under two years old, in strollers, and am struck by the fact that all of the children have a tablet or phone in their hands. Has technology become the ultimate tool for keeping children calm?</p>
<p>As an optometrist and eye health expert, this observation saddens me every time I see it, since I know all the harmful effects such exposure to electronic tools can have on children.</p>
<p>These effects are all the more critical during the first years of life, both on the <a href="https://pubmed.ncbi.nlm.nih.gov/34625399/">visual level</a> and on the <a href="https://pubmed.ncbi.nlm.nih.gov/36190219/">cognitive and social development of children</a>.</p>
<h2>Visual development of children</h2>
<p>The human eye develops <a href="https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/infant-vision-birth-to-one-year">through stimulation</a>. The quality of the optical stimulus influences the growth of the eyeball via a complex and balanced mechanism. At birth, the eye is hyperopic, that is to say, its power is not perfectly adjusted to its size. A child sees at short distances and is barely able to distinguish a shadow when grandpa comes to the bedroom door.</p>
<p>In the first few weeks, the eye grows, the retina matures and a balance is established between the growth of the eyeball and the power of the inner lens. At six months of age, each of the toddler’s two eyes has the vision of an adult eye. From this moment on, the eyes will develop their coordination, in order to generate vision in three dimensions. It’s also starting at the age of six months that the communication between the eyes develops in the visual brain as well.</p>
<p>Billions of neurological connections will have to be made during the <a href="https://opto.umontreal.ca/clinique/pdf/EFFETS%20DES%20ECRANS%20SUR%20LE%20D%C3%89VELOPPEMENT%20VISUEL%20DES%20ENFANTS.pdf">first eight years of life</a>. This maturation time is long, but necessary, considering that <a href="https://www.sciencedirect.com/science/article/pii/S0149763413001917">more than a third of the brain’s neurons are dedicated to vision</a>.</p>
<h2>A question of distance</h2>
<p>Electronic devices are not, in themselves, a source of visual problems. Rather, the inappropriate use of these devices can interfere with the natural development of the eye, as well as reading and learning skills.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two small children with glasses sitting on white chairs : a boy with a tablet computer, a girl with a cell phone" src="https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489407/original/file-20221012-17-g43eu3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For normal visual development, it is recommended that exposure to electronic devices be avoided between the ages of zero and two years.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The first thing to consider is viewing distance. The eye is designed to look at a near distance that is about equal to the length of the forearm (distance from the elbow to the fingertips of the hand). That means about <a href="https://www.sciencedirect.com/science/article/pii/S0042698913000795">30 cm for a young child, and 40 cm for an adult</a>. However, tablets and phones are held on average 20-30 cm from the eye, and this distance <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12453">becomes shorter with prolonged exposure</a>. The visual effort required to maintain a clear image at this distance is therefore doubled.</p>
<p>A distance that is too short influences the quality of the retinal image (and therefore visual development) and causes <a href="https://books.google.ca/books?hl=fr&lr=&id=jGGROHBFYt8C">excessive eye fatigue</a>. It is also important to understand that when eyes must accommodate short distances, they automatically converge towards the nose in order to focus at the normal reading distance. Too much effort spent accommodating the short distance is therefore accompanied by a greater than normal convergence. As the eye cannot maintain this prolonged effort over a long period of time, it will relax its effort and the perceived image will become blurred for a while, a sensory penalty that we want to avoid. After a period of rest, the eye will resume its effort, and this alternation between the clearness and the blur will continue as long as attention to the close image is required. So, ideally, the tablet or phone should always be kept at the distance of the forearm.</p>
<h2>Constant stimulation is not recommended</h2>
<p>The use of electronic tools, with games or videos, requires a constant attention span, without breaks. This is the second factor to consider. When a child draws in a notebook or reads a paper book, he or she will instinctively stop at some point, look elsewhere, far away, and become interested in something else around them. These pauses and breaks are beneficial <a href="https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/computer-vision-syndrome?sso=y">for the visual system to recover from its effort</a>. Focusing on targets at a distance is also beneficial to the child’s visual development. With electronic tablets, it is not uncommon to see children doing sessions of more than two to three hours continuously, without looking up from the screen.</p>
<p>The visual apparatus of children from zero to two years old is simply not sufficiently developed and robust to undergo such stress from constant stimulation in front of the screen. In particular, the structural elements of the sclera (the deep layer of the eye), which give the eye rigidity and determine its size, develop between zero and two years of age and then stabilize. The visual stimulus at these ages can interfere and therefore <a href="https://www.researchgate.net/publication/335108098_Scleral_structure_and_biomechanics">influence the development of visual defects and pathology in later life</a>.</p>
<p>It is also important to note that the screen can emit blue light. Children’s eyes do not filter these rays like those of an adult. This means that children are exposed to more blue light, which may stimulate nearsightedness and disrupt the secretion of melatonin, <a href="https://www.myopiainstitute.com/eye-care/how-blue-light-affects-your-vision-and-overall-health/">which regulates our biological clock</a>. This can disrupt the naps necessary for children of this age, as well as sleep during the night. Sleep loss can also lead to myopia.</p>
<h2>Let’s learn about electronics</h2>
<p>For normal visual development, it is therefore recommended to <a href="https://publications.aap.org/pediatrics/article/128/5/1040/30928/Media-Use-by-Children-Younger-Than-2-Years?_ga=2.208746386.1459529850.1665228699-655911314.1665228699?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000">avoid all exposure to electronic devices between the ages of zero and two</a>. The exception would be occasional video conversations, under the supervision of a parent, to say hello to a grandparent who lives far away, for a few minutes.</p>
<p>From the age of two years on, an hour of exposure per day can be considered, especially to consult educational sites, always accompanied by a parent or an educator.</p>
<p>When the visual system is mature, around the age of six to eight, exposure can be increased gradually, without exceeding two to three hours per day, with 10-minute breaks every hour. Electronic device use should be avoided during meals, family activities, and at least one hour before sleep.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young mother holding her cute, crying baby daughter, looking at a tablet during a virtual video call business or family meeting at a distance" src="https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489410/original/file-20221012-24-ip7l62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rare video conversations, with parental supervision, to wave to a grandparent from a distance, for a few minutes, can be considered.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Let’s play outside!</h2>
<p>The best advice for successful visual development is to encourage exposure to outdoor light for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678505/#:%7E:text=Each%20additional%20hour%20of%20daily,by%2013%25%20%5B23%5D.">at least one hour per day, ideally two hours</a>. We are talking about playing, walking, and activities that are done outside. The amount of light is then much greater than indoors, which would stimulate the production of dopamine, a chemical mediator essential to regulating the growth of the eye. This is the most effective way to prevent the onset of myopia in children.</p>
<p>It is also important to make sure that a child’s visual system is normal and developing naturally. Therefore, the first examination by an optometrist should be done at six months of age (to validate that the eye has normal optics and that there are no congenital defects), and then at three years of age to evaluate eye coordination. If everything is normal, the next examination will take place at five years of age, and annually thereafter, <a href="http://nada.ca/wp-content/uploads/2018/09/BK-ChildrenAndTheirVision-2018-EN.pdf">considering that vision can change rapidly</a>.</p>
<p>In the case of an abnormality, the earlier we intervene in the process, the easier it is to restore normal oculo-visual function, either by exercise or by optical means.</p>
<p>By following these recommendations for visual hygiene, we will protect children’s visual system and ensure their normal development.</p>
<p>And let’s not forget that the most beautiful screen in the world is nature! We should offer it to our children more often.</p><img src="https://counter.theconversation.com/content/193192/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The impact of using electronic devices is critical during the first years of life, both visually and on the cognitive and social development of the child.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1901292022-10-03T01:43:20Z2022-10-03T01:43:20ZMany parents use melatonin gummies to help children sleep. So how do they work and what are the risks?<figure><img src="https://images.theconversation.com/files/484778/original/file-20220915-18-1dz5mw.jpg?ixlib=rb-1.1.0&rect=14%2C5%2C1902%2C1431&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://pixabay.com/photos/baby-girl-sleep-sleeping-asleep-1151351/">Image by Daniela Dimitrova from Pixabay </a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Sleep is important for psychological and physiological health, but <a href="https://academic.oup.com/sleep/article/30/10/1371/2696851?login=false">many</a> <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079215001537?via%3Dihub">children</a> have trouble getting to sleep, or getting back to sleep when they wake in the night.</p>
<p>This can be exhausting for both children and parents, and some parents have turned to giving their kids lollies containing <a href="https://7news.com.au/lifestyle/health-wellbeing/melatonin-and-kids-how-exhausted-aussie-parents-are-buying-supplements-overseas-to-change-their-lives-c-8002693">melatonin</a>. These gummies, purchased overseas or online, are used to improve their children’s sleep.</p>
<p>I have spent the last 15 years researching diagnosing and treating children sleep problems and difficulties, and I’m also on the <a href="http://www.pedsleep.org/">International Pediatric Sleep Association</a>’s taskforce for melatonin use in children.</p>
<p>Here’s what the science says about the benefits and risks of melatonin gummies for children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child asleep with their toy." src="https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484809/original/file-20220915-1785-80hcei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep is important for psychological and physiological health.</span>
<span class="attribution"><a class="source" href="https://pixabay.com/photos/dream-baby-boy-sleeping-with-a-toy-5076100/">Image by Victoria_rt from Pixabay</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/led-face-masks-are-popular-on-social-media-for-glowing-skin-but-they-could-disrupt-your-sleep-170108">LED face masks are popular on social media for glowing skin – but they could disrupt your sleep</a>
</strong>
</em>
</p>
<hr>
<h2>What is melatonin?</h2>
<p>Melatonin is a naturally occurring hormone secreted in our brains. It is related to the timing and quality of our sleep and wake rhythms and determined by our internal body clock. </p>
<p>Melatonin makes us <a href="https://meridian.allenpress.com/jppt/article-abstract/26/1/4/450658/Melatonin-Use-in-Pediatrics-Evaluating-the?redirectedFrom=fulltext">sleepy</a> at certain times of the day. It <a href="https://academic.oup.com/book/31721">starts to secrete</a> when our bodies are getting ready to go to sleep and usually takes about 30 to 45 minutes to take full effect. </p>
<p>Melatonin secretion is at its highest in the middle of the night and gradually starts to decrease until we are ready to wake up and start our day.</p>
<h2>A lack of long-term research</h2>
<p>For children who have a diagnosis of autism spectrum disorder or Smith Magenis Syndrome, the Therapeutic Goods Administration (TGA) in Australia <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/32-melatonin">recommends</a> melatonin – but that this should be prescribed by a health professional only, and should only be used when sleep hygiene measures have been insufficient. </p>
<p>It <a href="https://www.tandfonline.com/doi/full/10.1080/14656566.2019.1674283">has been shown</a> to be very helpful, effective and with minimum side effects (mainly headaches, drowsiness and sometimes irritability). </p>
<p>But the TGA <a href="https://www.tga.gov.au/sites/default/files/auspar-melatonin-201027.pdf">does not recommend</a> melatonin for children who do not have autism spectrum disorder or Smith Magenis Syndrome.</p>
<p>This is mainly because there is a lack of long-term research, and because most child sleep problems can typically be managed with behavioural and psychological sleep techniques, instead of drugs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child sleeps in his bed." src="https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484812/original/file-20220915-4859-kaprw2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most child sleep problems can typically be managed with behavioural and psychological sleep techniques, instead of drugs.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/child-sleeping">Photo by zhenzhong liu on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Melatonin sales are increasing rapidly across the US and Canada (where it is available <a href="https://doi.org/10.1177/1403494812464446">without a prescription</a>) and across <a href="https://www.tandfonline.com/doi/full/10.1080/14656566.2019.1674283">Europe</a>.</p>
<p>In Australia, prescription melatonin has historically been given to adults to treat sleep disorders, but <a href="https://7news.com.au/lifestyle/health-wellbeing/aust-counter-access-arrives-for-sleep-drug-c-2991193">is now available</a> over-the-counter for adults aged 55 and above. It’s efficacy and safety has been established in adults.</p>
<p>This is not the case for melatonin use in all children. </p>
<p>Despite this, melatonin use in children <em>without</em> autism spectrum disorder or Smith Magenis Syndrome still occurs.</p>
<p>One recent yet-to-be-published study on this topic (which is yet to be peer-reviewed by other experts in the field) was by CQU researcher Alison Glass, with myself as supervisor. This study involved surveying 255 Australian parents (recruited from online groups and networks) of sleep-disordered children. Of these, about 70% used melatonin to help their children sleep. </p>
<p>Of those who used melatonin for their children, about 25% had children with a diagnosis of autism spectrum disorder or Smith Magenis Syndrome. But almost 75% used melatonin for their children even though there was no autism spectrum disorder or Smith Magenis Syndrome diagnosis.</p>
<h2>Is melatonin safe for otherwise healthy children?</h2>
<p>There are very few long-term research studies on this question and even less on the question of quality and safety of melatonin bought online.</p>
<p>One <a href="https://www.semanticscholar.org/paper/Melatonin-Natural-Health-Products-and-Supplements%3A-Erland-Saxena/823e2e0f552708c95307f95075d0ea7d1ad2c68e">Canadian study</a> investigated 31 brands of melatonin supplements. The researchers found huge inconsistencies in the labelled amount of active melatonin and a contaminant (in this case, serotonin) in 26% of the supplements.</p>
<p>In other words, the exact quality or quantity of melatonin present in gummies may be unknown. That raises the question of whether giving these relatively unresearched drugs to children is warranted. </p>
<p>The TGA’s Advisory Committee on Medicines Scheduling <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/32-melatonin">said</a> in 2017 that </p>
<blockquote>
<p>Methods of deterring the increasing volume of personal imports, which are often inappropriate unregistered medicines, should be considered.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A kid sleeps in bed." src="https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484813/original/file-20220915-8999-aziql2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What can sleep-deprived parents do? Talk to healthcare professionals.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/child-sleeping">Photo by Brett Durfee on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Talk to health-care professionals</h2>
<p>Parental sleep deprivation can be debilitating and dangerous. It is understandable parents of sleep-disturbed children will seek out the fastest way to get children to sleep. But there is a dearth of long-term research about use of melatonin by children.</p>
<p>So what can sleep-deprived parents do?</p>
<p>Talk to health-care professionals. This is crucial when considering any medication for children; continual follow up to monitor side effects and progress is important.</p>
<p>Before considering melatonin or any other sedative, ask your health-care provider about behavioural techniques you can use to promote healthy sleep habits. </p>
<p>Behavioural techniques are well documented, successful and effective in <a href="http://dx.doi.org/10.4236/psych.2012.33035">children from infancy</a> to adolescence. </p>
<p>Well trained paediatric sleep psychologists and clinicians are available for referrals from health professionals. The <a href="https://www.sleep.org.au/">Australasian Sleep Association</a> lists specialist health professionals across Australia.</p>
<p>Sleep deprivation is exhausting and parents are understandably desperate. </p>
<p>However, I advise caution in buying melatonin online or without the guidance of a qualified health professional.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-brown-noise-can-this-latest-tiktok-trend-really-help-you-sleep-188528">What is brown noise? Can this latest TikTok trend really help you sleep?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Blunden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>But the Therapeutic Goods Association does not recommend melatonin for children who do not have autism spectrum disorder or Smith Magenis Syndrome.Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1767962022-05-19T20:01:33Z2022-05-19T20:01:33ZTreating sleep apnoea can improve memory in people with cognitive decline<figure><img src="https://images.theconversation.com/files/453490/original/file-20220322-23-1cjkuzd.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4791%2C2683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There is increasing recognition of the important role sleep plays in our brain health. Growing evidence suggests disturbed sleep may increase the risk of developing dementia. </p>
<p>I and University of Sydney colleagues have published a <a href="https://www.atsjournals.org/journal/ajrccm">new study</a> showing treating sleep apnoea in older adults with mild cognitive impairment can improve memory, but not other areas of cognition, in the short term.</p>
<p>As there is no current treatment or cure for dementia, increasing efforts have focused on developing novel approaches to slow its progression. Mild cognitive impairment is the stage between the expected cognitive decline of normal ageing and the more serious decline of dementia. </p>
<p>In mild cognitive impairment, the individual, family and friends notice cognitive changes, but the individual can still successfully carry out everyday activities. Mild cognitive impairment is associated with an increased risk of developing dementia in subsequent years. </p>
<p>Researchers believe this is the optimal time to intervene to help prevent a future dementia diagnosis. Finding new ways to slow cognitive decline in those with mild cognitive impairment is therefore important.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">What causes Alzheimer’s disease? What we know, don’t know and suspect</a>
</strong>
</em>
</p>
<hr>
<h2>How is sleep important for our brain health?</h2>
<p>Sleep optimises the ability of our brains to stabilise and consolidate newly learned information and memories. These processes can occur across all the different stages of sleep, with deep sleep (also known as stage 3 or restorative sleep) playing a key role. </p>
<p>We also now know the glymphatic system, or the waste management system of the brain, is <a href="https://pubmed.ncbi.nlm.nih.gov/24136970/">highly active during sleep</a>, especially during deep sleep. This process allows waste products, including toxins, our brain has built up during the day to be cleaned out. </p>
<p>Toxins in the brain include beta-amyloid, one of the key proteins in the development of Alzheimer’s disease. Disturbing sleep could disrupt this cleaning process and lead to more accumulation of <a href="https://pubmed.ncbi.nlm.nih.gov/29632177/">beta-amyloid in the brain</a>.</p>
<p>The important role of sleep in these vital processes has led to the investigation of whether sleep disruption, including sleep disorders, could be associated with changes in our cognition when we age, and a possible link to the development of dementia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman holding hands with young person" src="https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453492/original/file-20220322-22-1tus7qx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep is important for our brain health, so researchers are looking at disrupted sleep and dementia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-our-brain-needs-sleep-and-what-happens-if-we-dont-get-enough-of-it-83145">Why our brain needs sleep, and what happens if we don’t get enough of it</a>
</strong>
</em>
</p>
<hr>
<h2>What is sleep apnoea?</h2>
<p>Sleep apnoea is estimated to affect <a href="https://pubmed.ncbi.nlm.nih.gov/31300334/">1 billion people</a> worldwide. In Australia, <a href="https://www.sleephealthfoundation.org.au/files/Special_reports/Social_Economic_Cost_of_sleep_disorders_20042021.pdf">5-10% of adults</a> are diagnosed with the condition. Sleep apnoea causes the throat (also called the upper airway) to close either completely (an apnoea) or partially (a hypopnoea) during sleep.</p>
<p>These closures or obstructions can range from ten seconds up to one minute and can lead to a drop in blood oxygen levels. To start breathing again, a short awakening occurs without the individual being aware. </p>
<p>In a person living with severe sleep apnoea this process can happen 30 times or more an hour, causing very fragmented sleep. People with sleep apnoea may snore, toss and turn, and others may notice them stopping breathing, choking or gasping for air during sleep. These repeated disruptions to sleep can cause sleepiness and reduce alertness during the day which, for some people, leads to difficulties performing tasks.</p>
<h2>Does sleep apnoea increase our risk of dementia?</h2>
<p>The sleep fragmentation, as well as the drops in blood oxygen at night time, are a double blow in dementia risk. Studies have shown sleep apnoea to be associated with a <a href="https://pubmed.ncbi.nlm.nih.gov/28846764/">26% increase</a> in the development of cognitive impairment, as well as <a href="https://pubmed.ncbi.nlm.nih.gov/29125327/">greater amounts of beta-amyloid</a> in the brain. However, it is not clear if treating sleep apnoea could reduce this risk.</p>
<p>The gold-standard treatment for sleep apnoea is continuous positive airway pressure therapy, commonly known as CPAP, in which a mask connected to a pump blows continuous air down the upper airway, keeping it open. When the machine is being used it stops the airway from closing. It is not known whether treating sleep apnoea will reduce the risk of dementia. Our new research, however, shows CPAP could be beneficial for memory in the short term.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/six-things-you-can-do-to-reduce-your-risk-of-dementia-93061">Six things you can do to reduce your risk of dementia</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man in bed with mask on his face and tubes linked to a machine." src="https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453493/original/file-20220322-25-1w1xaqn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CPAP machines force the airways to stay open.</span>
<span class="attribution"><span class="source">Shutterstock.</span></span>
</figcaption>
</figure>
<p>Our study aimed to understand whether treating older adults with both sleep apnoea and mild cognitive impairment could improve thinking and memory skills in the short term.</p>
<p>The trial assessed the effect of CPAP treatment on memory and thinking skills compared to no treatment. This was a crossover study, which means all participants had both CPAP and no treatment during the trial, but at different times. Some had CPAP first, then swapped. The others had no treatment first, then swapped. Trained staff helped participants get established with the therapy, and after using it for three months, participants underwent a series of cognitive tests.</p>
<p>The researchers found that compared to not treating sleep apnoea, thinking skills were not improved with CPAP, whereas some improvements in memory were observed. This suggests treating sleep apnoea could potentially improve outcomes in the short term, but it is unknown whether it would have any impact on long-term cognitive decline. </p>
<p>A previous study suggested CPAP could slow cognitive changes over one year in older adults with mild cognitive impairment and <a href="https://pubmed.ncbi.nlm.nih.gov/30724333/">sleep apnoea</a>. However, studies of longer duration are needed before we can say what the long-term effects look like.</p><img src="https://counter.theconversation.com/content/176796/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Camilla Hoyos receives funding from NHMRC (NHMRC-ARC Dementia Research Development Fellowship- GTN1104003) and the National Heart Foundation (Future Leader Fellowship). The study was funded by a Dementia Australia Research Grant (DGP1300034) and RESMed provided CPAP machines in kind but were not involved in any aspect of the study.</span></em></p>A new study has found in those with cognitive decline, memory can be improved by treating sleep apnoea.Camilla Hoyos, Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1683632021-11-04T12:27:38Z2021-11-04T12:27:38ZRacial discrimination is linked to suicidal thoughts in Black adults and children<figure><img src="https://images.theconversation.com/files/426017/original/file-20211012-17-1b7su46.jpg?ixlib=rb-1.1.0&rect=58%2C29%2C6437%2C4874&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are exploring the impacts that racial discrimination is having on Black Americans' emotional and psychological health.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/let-me-help-you-royalty-free-image/939030782?adppopup=true">PeopleImages via Getty Images</a></span></figcaption></figure><p>Frederick Douglass is regarded as one of the most prominent abolitionists the world has ever seen. Alongside his extraordinary contributions as an influential <a href="https://liberalarts.utexas.edu/coretexts/_files/resources/texts/c/1852%20Douglass%20July%204.pdf">speaker</a>, <a href="https://docsouth.unc.edu/neh/douglass55/douglass55.html">writer</a>
and human rights advocate, Douglass – who was born into slavery and gained freedom in <a href="https://docsouth.unc.edu/neh/douglass/douglass.html">September 1838</a> – also wrote openly about his struggles with suicidal thoughts. </p>
<p><a href="https://www.loc.gov/collections/frederick-douglass-papers/about-this-collection/">Douglass’ writings</a> are both revolutionary and transformative, particularly when considering that he lived during a time when several anti-literacy laws prevented enslaved Black persons from learning to read and write. </p>
<p>Douglass published his <a href="https://docsouth.unc.edu/neh/douglass/douglass.html">first autobiography</a> – “Narrative of the Life of Frederick Douglass” – in 1845. In it, he boldly shared, “I often found myself regretting my own existence, and wishing myself dead; and but for the hope of being free, I have no doubt that I should have killed myself, or done something for which I should have been killed.” </p>
<p>It’s not hard to imagine why formerly enslaved persons like Douglass would consider ending their own lives. It may, however, be harder for some to understand the links between racism, discrimination and thoughts of suicide among Black Americans today. </p>
<figure class="align-center ">
<img alt="Portrait photograph of Frederick Douglass." src="https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=844&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=844&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=844&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1060&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1060&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427295/original/file-20211019-27-1awg672.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1060&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frederick Douglass described how his feelings of despair were countered by his hope of becoming free.</span>
<span class="attribution"><a class="source" href="https://www.nps.gov/media/photo/gallery-item.htm?pg=2813693&id=3020EE0B-1DD8-B71C-075CB26DC2D69D44&gid=3020ED03-1DD8-B71C-07C2C1EA7AD31EF7">Frederick Douglass National Historic Site/NPS</a></span>
</figcaption>
</figure>
<p>The United States abolished chattel slavery through the <a href="https://www.senate.gov/artandhistory/history/common/generic/CivilWarAmendments.htm">13th Amendment</a> in 1865. However, Black Americans are still grappling with the effects of both <a href="https://doi.org/10.1126/science.abj7779">structural</a> and <a href="https://books.google.com/books?hl=en&lr=&id=1XA5DQAAQBAJ&oi=fnd&pg=PP1&dq=philomena+everyday+racism&ots=afTXYfxkGI&sig=McgPlpVf3dOf5BPJcEUdk9RoaEQ#v=onepage&q=philomena%20everyday%20racism&f=false">everyday </a> forms of racism that permeate U.S. customs, culture and laws. </p>
<p>As a <a href="https://neubauerassistantprofessors.uchicago.edu/faculty/janelle-goodwill/">researcher and assistant professor</a> at the University of Chicago Crown Family School of Social Work, Policy and Practice, I <a href="https://scholar.google.com/citations?user=Z5Ihr7IAAAAJ&hl=en">explore how factors</a> like discrimination, stigma and depression contribute to suicide risk in Black Americans. I also assess how positive psychological forces – like having a sense of life purpose or receiving social support from others – may improve an individual’s mental health outcomes. </p>
<p><a href="https://doi.org/10.1146/annurev-clinpsy-032814-112728">Several studies</a> have reported that exposure to discrimination is related to negative mental and physical health outcomes in Black Americans. These can include increased rates of depression, hypertension and sleep disturbance. Fewer studies have explored how racial discrimination is related to suicidal risk.</p>
<p>Therefore, in 2019 I <a href="https://doi.org/10.1080/13811118.2019.1660287">led a study</a> that examined whether racial discrimination was linked to depression and suicidal thoughts in adult Black men. </p>
<p>The <a href="https://theconversation.com/pain-of-police-killings-ripples-outward-to-traumatize-black-people-and-communities-across-us-159624">events that have unfolded</a> since this study was published underscore the need for this line of research.</p>
<p>My work, along with research done by a host of other scholars, affirms that any attempt to systematically address inequitable treatment of Black Americans – such as the <a href="https://www.whitehouse.gov/briefing-room/presidential-actions/2021/10/19/executive-order-on-white-house-initiative-on-advancing-educational-equity-excellence-and-economic-opportunity-for-black-americans/">recent White House executive order</a> on advancing educational equity and economic opportunity – should also account for the ways in which racial discrimination has impacted mental health outcomes among this particular population. </p>
<h2>Racial discrimination and mental health</h2>
<p>My co-authors and I analyzed survey responses from more than 1,200 African American men ages 18 to 93 who resided in different states across the U.S. Data was originally collected from 2001 to 2003 through the <a href="https://doi.org/10.1002/mpr.177">National Survey of American Life</a>. This project was led by the late social psychologist James S. Jackson, <a href="https://www.psychologicalscience.org/observer/james-jackson-tribute">whose groundbreaking career</a> shifted the way that Black Americans were represented and studied in research. </p>
<p><a href="https://doi.org/10.3886/ICPSR20240.v8">This survey</a> is one of the few nationally representative data sources that uses probability – or random – sampling to explicitly address the mental health experiences of Black adolescents and adults. </p>
<p>We decided to focus our study on Black men because historically, Black males have been four to six times <a href="https://doi.org/10.1177%2F1049731517702745">more likely to die by suicide</a> compared to Black females. </p>
<p>Participants in this national survey were asked to indicate how frequently they encountered discrimination in their everyday lives. The experiences surveyed ranged from being treated with less courtesy or respect to being harassed and followed in stores, along with being perceived as dishonest, not smart or not as good as others. </p>
<p>We analyzed men’s responses with a series of statistical tests that measured whether different forms of discrimination were related to negative mental health outcomes. <a href="https://doi.org/10.1080/13811118.2019.1660287">We found that</a> Black men who reported more frequent encounters with racial discrimination were more likely to experience depression symptoms and thoughts of suicide at some point during their lifetime. </p>
<p>These <a href="https://doi.org/10.1080/13811118.2019.1660287">findings suggest</a> that experiences of discrimination do not have to be overt or extreme in order to be harmful. Rather, regularly occurring acts of racial discrimination that may initially seem minor can become increasingly stressful over time.</p>
<p>When interpreting these results, it is important to note that we analyzed findings from a cross-sectional study. This means that surveys were administered to participants at only one point in time. Therefore, we were able to establish associations among the variables, but cannot use this data to confirm that racial discrimination caused subsequent thoughts of suicide. </p>
<p>Nonetheless, our findings still offer an important step forward by establishing that links between racial discrimination, depression symptoms and lifetime suicidal thoughts do exist. </p>
<h2>Mental health of Black children and youth</h2>
<p>Our study builds on other research that has also identified links between racial discrimination and suicidal thoughts in Black Americans. </p>
<p>For example, University of Houston clinical psychologist Rheeda Walker and her colleagues <a href="https://doi.org/10.1111/sltb.12251">found that among 722 Black children</a>, experiences of racial discrimination were linked to more depression and greater odds of suicidal thoughts two years later. Members of the research team contacted participants two times and asked the same survey questions - once at age 10 and again at age 12. </p>
<p>Findings generated from <a href="https://doi.org/10.1111/sltb.12251">their 2017 study</a> are particularly meaningful because the authors analyzed data over time, which allowed them to confirm that racial discrimination significantly predicts an increase in suicidal thoughts, and <a href="https://doi.org/10.1111/sltb.12251">not the other way around</a>. </p>
<p>Since then, clinicians, researchers and organizational leaders have partnered with members of the <a href="https://cbc.house.gov/">Congressional Black Caucus</a> to call attention to the urgent mental health needs of Black youth. In 2019, this group created an emergency task force and released a <a href="https://watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf">powerful report</a> that carefully describes the current state of suicide among Black youth. </p>
<p>As detailed in various studies, <a href="https://doi.org/10.1001/jamapediatrics.2018.0399">Black children ages 5 to 12 </a>
were two times more likely to die by suicide relative to white children, with <a href="https://doi.org/10.1001/jamapediatrics.2015.0465">young Black boys</a> being particularly vulnerable to suicide risk. Notably, rates of suicide have also significantly increased among Black teenage girls in <a href="https://doi.org/10.1016/j.jaac.2021.08.021">recent years</a>. </p>
<p>In response to these concerns, leaders at the National Institutes of Health have <a href="https://www.nimh.nih.gov/about/director/messages/2020/addressing-the-crisis-of-black-youth-suicide">allocated research funds and invited applications</a> for projects promoting suicide prevention among Black youth. </p>
<p>Researchers have also begun to explore the links between structural forms of racism and suicide risk. For instance, <a href="https://doi.org/10.1016/j.jad.2019.11.128">a study published in 2020</a> found that being unfairly fired from a job and experiencing abuse from the police were linked to suicidal thoughts, plans and attempts among Black adults.</p>
<p>Despite these advances in research, it remains unclear whether any existing suicide prevention interventions account for the specific ways that racial discrimination impacts Black Americans’ psychological and emotional well-being. </p>
<p>Therefore, it will be essential for researchers, clinicians and community members to work together in promoting the mental health needs of Black children and adults, while simultaneously encouraging Black Americans to hold on to the hope that Frederick Douglass professed more than 175 years ago.</p><img src="https://counter.theconversation.com/content/168363/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janelle R. Goodwill does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The evidence is growing that experiencing both systemic and everyday race-based discrimination may lead some Black Americans to become depressed and think about suicide.Janelle R. Goodwill, Assistant Professor of Social Work, Policy, and Practice, University of ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1604312021-06-02T21:23:54Z2021-06-02T21:23:54ZSimple, fast, wide-awake diagnosis of sleep apnea could enable better surgical care and improve sleep<figure><img src="https://images.theconversation.com/files/403775/original/file-20210601-396-1qerz2p.jpg?ixlib=rb-1.1.0&rect=629%2C253%2C4820%2C3374&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obstructive sleep apnea is a common sleep disorder that often goes undiagnosed and untreated.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Obstructive sleep apnea (OSA) is a very common sleep disorder, but one that is widely underdiagnosed. Its many symptoms and effects may include <a href="https://doi.org/10.1016/j.amjcard.2008.10.035">cardiovascular disease</a> or <a href="https://dx.doi.org/10.5665%2Fsleep.2374">memory impairment</a>. Fatal accidents can occur when undiagnosed or untreated drivers with OSA <a href="https://doi.org/10.5665/sleep.4486">fall asleep whilst driving</a>.</p>
<p>One reason why there are so many undiagnosed and untreated OSA cases is that accurate diagnosis usually requires an expensive, labour-intensive overnight sleep study called polysomnography (PSG). But new technology <a href="https://bme.eng.umanitoba.ca/bmelab/">developed at the University of Manitoba</a> can tell patients if they have OSA in 30 seconds, just by analysis of their breathing sounds while they are wide awake.</p>
<h2>Obstructive sleep apnea (OSA)</h2>
<p>OSA is the <a href="https://sleepeducation.org/sleep-disorders/sleep-apnea/">temporary cessation of breathing while asleep</a>. An apnea event is a pause in breathing that lasts more than 10 seconds and results in a drop of more than three per cent in the level of oxygen in the blood. Similarly, a reduction in respiratory flow of more than 50 per cent that lasts more than 10 seconds, combined with a drop in blood oxygen level of greater than three per cent, is called a hypopnea event.</p>
<p>The number of apnea and hypopnea events per hour of sleep is called apnea/hypopnea index (AHI), a measure of OSA severity. </p>
<p>A very high AHI, for example 200, means that during one hour of sleep, breathing stops (or is reduced more than 50 per cent) 200 times, each time for more than 10 seconds. Most of these events are accompanied by blood oxygen level decreases that may lead to hypoxia, which may <a href="https://doi.org/10.1016/j.ccm.2019.02.008">trigger the brain to wake up to restore the oxygen level</a>.</p>
<p>A person with a high AHI has a very broken sleep. Indeed, they may never reach a deep sleep. For that reason, they always feel tired and sleepy during the day. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of a man's neck with a band holding a small microphone to his throat" src="https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=472&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=472&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=472&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=593&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=593&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403768/original/file-20210601-19-11vw3f5.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=593&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">AWakeOSA diagnoses sleep apnea by listening to breathing sounds using a microphone connected to the trachea.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>While a full overnight PSG records more than 15 different biological signals, there are many portable PSG devices that can be used by people in their own homes that record three to five signals and give a relatively accurate diagnosis. </p>
<p>However, for sleep apnea cases that need treatment, a full PSG assessment in a sleep lab is needed, during which sleep technicians try different manoeuvres to determine best treatment. For example, for determining the optimal air pressure for a continuous positive airway pressure (CPAP) machine to keep the patient’s airway open during different stages of sleep. </p>
<p>The <a href="https://doi.org/10.1093/sleep/20.9.705">widespread underdiagnosis</a> of sleep apnea becomes crucial for those who need general anesthesia before a surgery, because <a href="https://doi.org/10.1097/ALN.0000000000000053">apneic patients need special care after surgery</a>. Being able to detect OSA within a few minutes when a patient is awake would help ensure these patients receive the care they need. That is what <a href="https://doi.org/10.1038/s41598-019-47998-5">AWakeOSA</a> technology promises.</p>
<h2>Wide-awake identification of obstructive sleep apnea</h2>
<p>AWakeOSA is a smart technology with an app that provides instructions for recording breathing sounds with a small microphone. It records tracheal breathing sounds through five breaths taken while breathing through the nose and another five cycles while breathing through the mouth. The recording is done while the person is awake and lying on their back. </p>
<p>This technology has been under development since 2010. Our rationale for using awake tracheal breathing sounds for detection of OSA is based on the upper airway structure, which is different in people with sleep apnea compared to that of people without apnea, even while awake. Tracheal breathing sounds are affected by a change in the upper airway structure. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/lm6TkjuAUL8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Applications for AWakeOSA technology include fast diagnosis of OSA before surgery, and diagnosis in rural and remote areas where PSG assessment is unavailable.</span></figcaption>
</figure>
<p>These changes in breathing sounds cannot be detected by human ears, but by using advanced signal processing and machine learning techniques we have been able to show that indeed the breathing sounds are reflecting the upper airway pathology. However, showing a high correlation between the OSA and the features of breathing sounds does not guarantee a highly accurate detection of OSA. </p>
<p>Detecting OSA by only breathing sounds analysis is challenging because of the heterogeneity of sleep apnea, which can have different causes resulting in different characteristics of breath sounds. Also, there are many variables including age, gender, height, weight and smoking history that affect breathing sounds’ characteristics. </p>
<p>To overcome these challenges, we came up with a smart diagnostic scheme that considers the impact of all these confounding variables. With the help of a sophisticated machine learning algorithm (AWakeOSA), <a href="https://bme.eng.umanitoba.ca/research/sleep-apnea/">our team</a> can now reliably and accurately detect the severity of OSA during wakefulness. Validation of the technology in a much larger population is planned.</p>
<h2>Surgical patients</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Miniature microphone, amp box and cord" src="https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=805&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=805&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=805&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1012&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1012&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403771/original/file-20210601-27-1590bx6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1012&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A microphone embedded in a specially designed chamber, and a small pre-amp box. The hardware can be connected to an app on phones or a computer to do the recording.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>One important application is for surgical patients with unknown OSA status who are going under general anesthesia. For that application, sensitivity of the test (detecting those who do have sleep apnea) is more important than the specificity (detecting those who do not have sleep apnea). </p>
<p>The beauty of the smart decision-making of the AWakeOSA algorithm is that we can increase its sensitivity at a minor cost to its specificity. That means accurately identifying all patients with sleep apnea is the key priority — as it would be with surgical patients — we can increase OSA detection accuracy with only a minor increase in false positive findings. </p>
<p>Depending on its application, there is some flexibility to adjust the sensitivity/specificity of the test, depending on which one is more important. </p>
<p>The AWakeOSA technology can also <a href="https://doi.org/10.3390/diagnostics11050905">determine those in need of treatment for sleep apnea</a> with greater than 89 per cent accuracy. That means it can be used as an accurate screening tool to reduce the number of people needing full PSG assessment, saving millions of dollars in costs to the health-care system.</p><img src="https://counter.theconversation.com/content/160431/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zahra Moussavi receives funding from Natural Science Engineering Research Council (NSERC) of Canada and Canadian Institutes of Health Research (CIHR) for relevant topics.</span></em></p>Diagnosing obstructive sleep apnea usually requires a labour-intensive overnight sleep study. But new technology can tell patients if they have OSA in 30 seconds, while they are wide awake.Zahra Moussavi, Professor of Biomedical Engineering, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1525002021-01-12T10:16:19Z2021-01-12T10:16:19ZAre sleep trackers accurate? Here’s what researchers currently know<figure><img src="https://images.theconversation.com/files/378058/original/file-20210111-17-1smupng.jpg?ixlib=rb-1.1.0&rect=13%2C13%2C8661%2C5761&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleep trackers use an algorithm to estimate how much time you spent asleep based on body movements.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-man-sleeping-smart-watch-his-1219812262">Andrey_Popov/ Shutterstock</a></span></figcaption></figure><p>An estimated <a href="https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/">one in three people</a> report regular sleep complaints. So it’s hardly surprising people are more concerned than ever about getting enough sleep. This blossoming interest has seen an explosion of sleep trackers which measure how many hours of sleep you get each night. </p>
<p>As we sleep, we go through cycles of “deep”, “light” and “rapid eye movement” (REM) sleep. The “deep” portion of our sleep is mainly what leaves us feeling refreshed the next day. Most sleep trackers are a watch worn on the wrist, and work by monitoring your body movements as you sleep to determine how much time you probably spent awake versus asleep. Some devices also look at heart rate changes during sleeping to estimate how much time you spent in each sleep cycle.</p>
<p>Despite their popularity, only a few studies have investigated how accurate sleep devices are. So far, research has found that compared to polysomnography tests – which experts use to diagnose sleep disorders – sleep trackers are only accurate <a href="https://pubmed.ncbi.nlm.nih.gov/31154154/">78% of the time</a> when identifying sleep versus wakefulness. This accuracy drops to <a href="https://pubmed.ncbi.nlm.nih.gov/31154154/">around 38%</a> when estimating how long it took participants to fall asleep. </p>
<p>Polysomnography tests are the most accurate because they track a person’s brain waves, heart rate, breathing, blood oxygen levels, and body and eye movements during sleep through electrodes attached to the skin and scalp. Analysing brain wave patterns is the only definitive way of knowing whether someone is awake or asleep, and to know what stage of sleep they’re in.</p>
<p>But since sleep trackers are worn on the wrist, they make their estimates of nightly sleep by measuring body movement and sometimes heart rate data. As we move frequently during all stages of sleep, movement provides few clues about what sleep stage we’re in. Many sleep devices also fail to differentiate one stage of sleep from another <a href="https://pubmed.ncbi.nlm.nih.gov/14998254/">based on motion alone</a>.</p>
<p>Given many consumer sleep devices haven’t been compared against polysomnography tests, it’s difficult to <a href="https://pubmed.ncbi.nlm.nih.gov/31621129/">determine their accuracy rate</a>. Furthermore, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109647/#:%7E:text=Key%20Limitations%20of%20Wrist%20Actigraphy,sleep%20in%20certain%20patient%20groups">algorithms which companies use</a> to make predictions about sleep are unknown, making it difficult for scientists to identify whether the assumptions made by the sleep devices are valid. </p>
<p>Studies also show sleep devices underperform in people with insomnia. People with insomnia tend to remain very still in bed in an attempt to fall asleep. But as sleep trackers only measure movement, one study found watches were unable to <a href="https://pubmed.ncbi.nlm.nih.gov/31621129/">differentiate sleep from wakefulness</a> in people with insomnia.</p>
<p>Watches that incorporate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760396/">heart rate data</a> tend to be <a href="https://pubmed.ncbi.nlm.nih.gov/32215550/">slightly more accurate</a> when measuring sleep duration because <a href="https://www.nature.com/articles/s41598-019-49703-y">heart rate fluctuates</a> during different sleep stages. However, even in devices that do track heart rate, many experts are still uncertain of their accuracy because of the limited research on them, and because of the differences between each device. For example, one study of heart rate sleep trackers showed that two consumer devices tended to underestimate the amount of deep sleep wearers obtained by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6760396/">as much as 46 minutes</a>.</p>
<h2>Sleep anxiety</h2>
<p>Ultimately, this leads to the question of whether knowing about our sleep is actually beneficial to us. After all, one of the best ways to stay awake is to <a href="https://pubmed.ncbi.nlm.nih.gov/16809056/">try really hard to go to sleep</a>. It sounds counterintuitive, but we see this clinically in patients with chronic insomnia, for whom excessive pre-occupation with sleep causes anxiety and low mood over sleep loss – <a href="https://academic.oup.com/sleep/article/29/2/232/2708051?login=true&fbclid=IwAR0aucBM7TITmyS1Ws0Tan33xffKVHQAmNUsJrtwfApRc76_KPlaRCTMuvs">leading to further sleeplessness</a>. </p>
<figure class="align-center ">
<img alt="Woman with insomnia lying awake in bed, struggling to sleep." src="https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378061/original/file-20210111-13-15lycd8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Knowing how much – or little – sleep we got could cause anxiety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/picture-young-woman-insomnia-lying-on-1064573882">Sergey Mironov/ Shutterstock</a></span>
</figcaption>
</figure>
<p>A study published by <a href="https://pubmed.ncbi.nlm.nih.gov/29989248/">our research group</a> showed this effect can be worsened by sleep watches. Participants were given sleep watches and asked to complete measures of mood, daytime thinking processes and sleepiness at regular periods throughout the day. However, the “sleep score” given by their watches was manipulated to show either an increased or a decreased quality of sleep. The amount and quality of sleep participants in both groups got was the same.</p>
<p>The study found that those who were told they had a poor night’s sleep showed lower mood, difficulties with daytime thinking processes and increased sleepiness. Those who were told they had a great night’s sleep showed the opposite. </p>
<p>This shows us that data from these sleep trackers could change your emotional state and concentration levels during the day – even if the readings are accurate. Given people who experience poor sleep may be more likely to use sleep tracking devices, this could be a concern as it may potentially <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579636/">worsen mental health issues</a>. </p>
<p>While few studies have examined this link so far, one report highlighted more patients are seeking treatment for <a href="https://jcsm.aasm.org/doi/full/10.5664/jcsm.6472?fbclid=IwAR1KxcxhdpG9CSoB-72R4cOA_o5iVidnDecoeh8-yzRsf-uhkf42WIPx9qw&">perceived sleep difficulties</a> as a result of feedback from sleep trackers. Even when such complaints are refuted by a polysomnography test, watches continue to provide a source of sleep-related anxiety. Since studies have shown <a href="https://www.tandfonline.com/doi/abs/10.1080/19325037.2020.1767004?journalCode=ujhe20.">overuse of wearable devices</a> (such as those used during exercise) increase <a href="https://www.researchgate.net/publication/343942681_When_smartwatches_contribute_to_health_anxiety_in_patients_with_atrial_fibrillation">health anxiety and depression</a>, there’s concerns sleep devices may have a similar effect. </p>
<p>While sleep devices might be useful for those who have generally good sleep but are interested in tracking or establishing a better routine, people who have poor sleep or mental health conditions may want to avoid them. But the best metric for measuring how good your sleep was is to see how you feel each day. If you’re tired and struggling to concentrate, then going to bed a bit earlier each night may help you feel more rested – no device necessary.</p><img src="https://counter.theconversation.com/content/152500/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Reid does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite the appeal of sleep trackers, they could cause unwanted anxiety for some.Matthew Reid, Post Doctoral Researcher, Sleep and Circadian Neurosciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1214832019-08-13T11:24:37Z2019-08-13T11:24:37ZWant better sleep? Try a warm bath or shower 1-2 hours before bedtime, study suggests<figure><img src="https://images.theconversation.com/files/287448/original/file-20190809-144838-9cnmbf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's a biological reason why a warm bath before bedtime can improve sleep quality.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pretty-african-american-girl-taking-1465345844?src=cQzTSDveZSsR4xYvFxO6pw-5-65">iordani/Shutterstock.com</a></span></figcaption></figure><p>Do you struggle trying to fall asleep? Do you feel you don’t get enough sleep and you feel sleepy during the day? You are not alone. The <a href="https://aasm.org/resources/factsheets/insomnia.pdf">American Academy of Sleep Medicine</a> has found that one in three American adults have symptoms of insomnia. <a href="https://www.nsc.org/road-safety/safety-topics/fatigued-driving">Data</a> show there are about 100,000 crashes each year related to drowsy driving which results in 1,550 fatalities and 71,000 injuries. The <a href="https://doi.org/10.17226/11617">Institute of Medicine</a> reported that the long-term effects of sleep deprivation can cause serious health consequences such as hypertension, diabetes, heart attack, stroke and depression.</p>
<p>Many people try over-the-counter or prescribed sleep aids. But is there any way to fall asleep faster and get better sleep without medication?</p>
<p>I am sleep researcher and graduate student in biomedical engineering at the University of Texas. In a recently published <a href="http://dx.doi.org/10.1016/j.smrv.2019.04.008">study</a> in collaboration with the UT Health Science Center at Houston and the University of Southern California, colleagues and I showed that a warm bath or shower one to two hours before bedtime can significantly improve your sleep.</p>
<h2>Warm bath, cool body</h2>
<p>Like so many people, I had sleep problems. I struggled falling asleep, I would wake up in the middle of the night, restless and would wake up not feeling rested. I didn’t have a sleep schedule. After I started looking into the data, I realized how many people live their lives in a sleep deprived state. I was not interested in taking drugs, so that made me interested in studying about non-pharmacological methods to help improve sleep.</p>
<p>My team and I reviewed more than 5,000 studies related to bathing and sleep. Seventeen of these studies met our study criteria to explore the effects of warm bath or shower on sleep. We used a statistical procedure for combining data from multiple studies and to find the optimal timing for the bath. </p>
<p>We found that a warm bath, of around 104 and 109 degrees Fahrenheit, for as little as 10 minutes can significantly improve overall sleep efficiency. In other words, a warm bath led to more time spent in actual sleep rather than turning or tossing and trying to fall asleep, compared to usual sleep without taking bath. When scheduled one to two hours before bedtime, a warm bath can also hasten the speed of falling asleep by about 36%. </p>
<p>We also found that whether people reported feeling rested and like they had a great night’s sleep improved by a warm bath or shower, in most of the studies. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287711/original/file-20190812-71913-v84125.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman taking a shower, which can also help to lower core body temperature.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-women-taking-shower-bathroom-she-793717723?src=hdCw0OzAsT_VsfCBSKMNOQ-1-24">TORWAISTUDIO/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Why does the warm bath or shower help? There is science behind it. Our body temperature is not constant during 24 hours. It is higher in the morning and evening, and it is lowest during nighttime sleep. The body temperature needs to <a href="https://doi.org/10.3109/07420529409055899">drop</a> to initiate good sleep. When we take a warm bath or shower, the body brings large amount of blood flow to the surface, especially hands and feet. This blood flow brings the heat from the core to the surface and rejects the heat to the environment and causes a drop in body temperature. Therefore, if you take a warm bath/shower at the right biological time – one to two hours before bedtime – it will aid your natural circadian process and improve your sleep.</p>
<p>As a next step, we are now working to design a commercially viable bed system with technology that mimics the effect of warm bath. The bed of the future!</p>
<p>[ <em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=youresmart">You can read us daily by subscribing to our newsletter</a>. ]</p><img src="https://counter.theconversation.com/content/121483/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shahab Haghayegh does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions of people struggle with falling asleep. A review of thousands of studies shows a possibly simple solution: a warm bath.Shahab Haghayegh, Doctoral candidate, biomedical engineering, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/931162018-07-26T10:38:08Z2018-07-26T10:38:08ZDon’t lose sleep over it: Even if you don’t get enough shut-eye, most fixes are easy<figure><img src="https://images.theconversation.com/files/217608/original/file-20180503-83693-i2gar1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Millions of Americans are sleep-deprived, but stressing over it won't help.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sleepy-tired-girl-bad-wake-stirring-443201446?src=A3O_Wz-A5vTkUOPqu04_Fw-1-3">Antonio Guillem/Shutterstock.com</a></span></figcaption></figure><p>The serious consequences of sleep deprivation perennially capture society’s attention. And, as kids head back to school, sleep and a lack of it are of particular concern.</p>
<p>Compared to historical norms, how have our contemporary expectations of sleep changed? What are the effects of inadequate sleep? What can be done to optimize the experience of sleep, especially in the context of insomnia?</p>
<p>I am a clinician and sleep researcher who treats people with sleep problems. I think there is little reason to suspect that our collective sleep needs have dramatically changed in the recent past, rooted as they are in immutable physiological processes. We should, however, be paying attention to our sleep needs, and that isn’t as hard as it sounds. </p>
<h2>What is sleep anyway?</h2>
<p>From a clinical perspective, sleep is defined as a reversible behavioral state of unresponsiveness and perceptual disengagement from the environment. It is dependent on the balance between sleep drive – the desire for sleep that builds during wakefulness and is linked to the <a href="https://www.ncbi.nlm.nih.gov/pubmed/7185792">accumulation and clearance of chemicals within the brain like adenosine – and the circadian alerting signal</a>. The circadian rhythm coordinates processes of the body to the environmental patterns of light and darkness. Adequate sleep is and always has been restorative to the body. Giving sleep respect, and preserving it to the benefit of health, has not been so permanent.</p>
<p>Researchers have learned more about sleep in the past 100 years than in all the preceding millennia combined. </p>
<p>The advent of, and inexpensive access to, artificial light no doubt marked a significant shift in this history. Scientific understanding of sleep continues to evolve and remains incomplete. </p>
<p>Nevertheless, it does seem that people are sleeping less now than they have in the past several decades. Recent <a href="https://sleepfoundation.org/sites/default/files/RPT495a.pdf">self-reported national polling</a> among American adults consistently suggests that Americans are not getting adequate sleep. This begs the question: How much sleep do people really need?</p>
<h2>Sleep needs change over the lifespan</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217612/original/file-20180503-83693-1kkk45p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The need for sleep changes over the lifespan. Babies need the most sleep.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-waking-on-sunny-340095359?src=0VNrqvxL2KzIiwMZX7sYOA-1-4">FamVeld/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Sleep needs change over one’s lifetime. Toddlers may require <a href="http://www.sleephealthjournal.org/article/S2352-7218(15)00015-7/abstract">11 to 14 hours of sleep</a> to feel rested and typically take naps. </p>
<p>Through adolescence, the need for sleep diminishes until it approaches the adult average. A typical adult <a href="https://www.ncbi.nlm.nih.gov/pubmed/27250809">requires from seven to nine hours of sleep</a> nightly to avoid the effects of sleep deprivation. Adults older than 65 years may require just <a href="https://www.ncbi.nlm.nih.gov/pubmed/26039963">seven to eight hours of sleep</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/21368739">Surveys suggest</a> that 35 to 40 percent of the adult population sleeps less than seven to eight hours on weekdays. This self-reported sleep data <a href="https://www.ncbi.nlm.nih.gov/pubmed/17993045">may overestimate</a> the objectively measured sleep <a href="https://www.ncbi.nlm.nih.gov/pubmed/17993045">obtained by up to one hour</a>, due to time spent falling or getting back to sleep. We are in trouble.</p>
<p>If someone eats too many calories, or too few, the effects on the body become apparent. Unfortunately, there is no “sleep scale” to step onto to gauge the physical tolls of sleep deprivation. Sleep deprivation, either from not allotting enough time to get sufficient sleep or due to sleep disorders like insomnia, may have important consequences.</p>
<h2>Bad for the brain?</h2>
<p>Beyond sleepiness, sleep deprivation <a href="https://www.ncbi.nlm.nih.gov/pubmed/21075236">wreaks havoc on the brain</a>, affecting mood and worsening depression, exacerbating pain and undermining executive functions that affect judgment, planning, organization, concentration, memory and performance. <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0010062">Hormones influencing weight and growth</a> become imbalanced. Immune dysfunction, leading to an increased susceptibility to illness, and a <a href="https://link.springer.com/article/10.1007%2Fs00424-011-1044-0">pro-inflammatory state develop</a>.</p>
<p>Sleep deprivation can become deadly, too. The increased risk of fatal traffic accidents associated with lost sleep <a href="https://www.ncbi.nlm.nih.gov/pubmed/11012861">parallels that linked to alcohol consumption</a>. Those who sleep fewer than five hours per night have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845795/">two to three times the risk of a heart attack</a>. Chronic sleep loss may slowly undermine the central pillars of health.</p>
<h2>Ditch the digital devices, keep a routine</h2>
<p>How can we avoid the perils of inadequate sleep? </p>
<p>First, prioritize sleep and ensure that you are obtaining sufficient hours to feel rested. Ensure an easy transition to sleep by maintaining an hour to unwind with relaxing activities before going to bed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217611/original/file-20180503-153914-qmpl42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Using a laptop and other digital devices before going to bed can be harmful to your sleep.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lovely-young-woman-working-on-laptop-262331945?src=9dQpYn_rNCz6I4Noo154Ig-2-21">GaudiLab/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Reserve the bedroom as a space for sleep: leave electronic devices elsewhere. </p>
<p>Keep a regular sleep-wake schedule, especially fixing the wake time, including on weekends. </p>
<p>Get 15 to 30 minutes of sunlight upon awakening, or at sunrise. </p>
<p>Always go to bed feeling sleepy, even if that means delaying bedtime a little. </p>
<p>As needed, consider reducing the time in bed if more than 30 minutes is consistently spent awake. </p>
<p>Be physically active. </p>
<p>Moderate the use of alcohol and caffeine. </p>
<p>When sleep problems persist, get help.</p>
<p>If these do not work, consider evaluation by a board-certified sleep physician. Chronic <a href="https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167">insomnia</a> may respond well to cognitive behavioral therapy for insomnia. This treatment is increasingly accessible via trained therapists, workshops, online courses and books. </p>
<p>Symptoms such as frequent or early awakenings, excessive daytime sleepiness, snoring, witnessed pauses in breathing, frequent peeing at night, night sweats, teeth grinding, and morning headaches may suggest the presence of <a href="https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631">sleep apnea</a>. A comprehensive evaluation and appropriate testing may lead to an effective treatment.</p>
<p>Sleep should come naturally. It should never become an additional source of stress. Simple adjustments can yield benefits quickly. </p>
<p>Fortunately, the first step to better sleep is recognizing its importance – an objective that has hopefully been achieved. Now, consider making a few changes and, as necessary, access further resources to yield the long-term benefits to health and well-being that only sleep may provide.</p><img src="https://counter.theconversation.com/content/93116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon Peters-Mathews does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Are you sleep deprived? Don’t worry. That might make the situation worse. Instead, make some simple adjustments, such as staying off digital devices an hour before bedtime.Brandon Peters-Mathews, Clinical Affiliate, Stanford UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/919592018-03-08T11:44:07Z2018-03-08T11:44:07ZWant better sex? Try getting better sleep<figure><img src="https://images.theconversation.com/files/208694/original/file-20180302-65544-1e7umuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleep affects sex, and sex affects sleep. It's important to pay attention to both. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-beautiful-young-couple-sleeping-499192603?src=yH4KX0edA356PgbPhELeKA-1-4">VGstockstudio/Shutterstock.com </a></span></figcaption></figure><p><a href="https://www.cdc.gov/media/releases/2016/p0215-enough-sleep.html">One in 3 American adults</a> do not get enough sleep. Sexual issues are also common, with as many as <a href="https://link.springer.com/article/10.1007/s11920-996-0006-2">45 percent of women and 31 percent of men</a> having a concern about their sex life. While these might seem like distinct concerns, they are actually highly related. </p>
<p>How are sleep and sex related? I’ll state the obvious: We most commonly sleep and have sex in the same location – the bedroom. Less obvious but more important is that lack of sleep and lack of sex share some common underlying causes, including stress. Especially important, lack of sleep can lead to sexual problems and a lack of sex can lead to sleep problems. Conversely, a good night’s sleep can lead to a greater interest in sex, and orgasmic sex can result in a better night’s sleep.</p>
<p>I am a sex educator and researcher who has published several studies on the effectiveness of self-help books in enhancing sexual functioning. I have also written two sexual self-help books, both based in research findings. My latest book, “<a href="http://drlauriemintz.com/books/becoming-cliterate/">Becoming Cliterate: Why Orgasm Equality Matters – and How to Get It</a>,” is aimed at empowering women to reach orgasm. More pertinent to the connection between sleep and sex, my first book, “<a href="http://drlauriemintz.com/books/a-tired-womans-guide-to-passionate-sex/">A Tired Woman’s Guide to Passionate Sex</a>,” was written to help the countless women who say they are too exhausted to be interested in sex. </p>
<h2>The effect of sleep on sex among women</h2>
<p>The reason I wrote a book for women who are too tired for sex is because women are disproportionately affected by both sleep problems and by low sexual desire, and the relationship between the two is indisputable. <a href="https://sleepfoundation.org/sleep-topics/women-and-sleep">Women are more likely than men to have sleep problems</a>, and <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2002.01002.x/full">the most common sexual complaint that women bring to sex therapists and physicians is low desire</a>. Strikingly, being too tired for sex is the top reason that women give for their loss of desire. </p>
<p>Conversely, getting a good night’s sleep can increase desire. <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsm.12858/full">A recent study</a> found that the longer women slept, the more interested in sex they were the next day. Just one extra hour of sleep led to a 14 percent increase in the chances of having a sexual encounter the following day. Also, in this same study, more sleep was related to better genital arousal. </p>
<p>While this study was conducted with college women, those in other life stages have even more interrelated sleep and sex problems. Menopause involves a complicated interaction of biological and psychological issues that are associated with both sleep and sex problems. Importantly, <a href="http://online.liebertpub.com/doi/pdf/10.1089/jwh.2009.1800">a recent study</a> found that among menopausal women, sleep problems were directly linked to sexual problems. In fact, sleep issues were the only menopausal symptom for which such a direct link was found. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208730/original/file-20180302-65544-z1986.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Motherhood is great, but the demands of a new baby can exhaust a new mother. Sleep can become more appealing than sex as a result.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-holding-her-newborn-child-329743067?src=f1ribZpMHQnw-hVqRW2jGg-1-13">FamVeld/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Interrelated sleep and sexual issues are also prevalent <a href="https://sleepfoundation.org/sites/default/files/Poll%20Release%20-%20FINAL.pdf">among mothers</a>. Mothers of new babies are the least likely to get a good night’s sleep, mostly because they are caring for their baby during the night. However, ongoing sleep and sexual issues for mothers are often caused by having too much to do and the associated stress. Women, who are married with school-age children and working full time, are the most likely to report insomnia. Still, part-time working moms and moms who don’t work outside the home report problems with sleep as well.</p>
<p>While fathers also struggle with stress, there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/10825779">evidence</a> that stress and the <a href="http://www.apa.org/news/press/releases/stress/2010/gender-stress.pdf">resulting sleepless nights</a> dampen women’s sexual desire more than they do men’s. Some of this is due to hormones. Both <a href="https://www.ncbi.nlm.nih.gov/pubmed/9415946">insufficient sleep</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703719/">stress</a> result in the release of cortisol, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880087/">cortisol decreases testosterone</a>. Testosterone plays a major role in the sex drive of women and men. Men have significantly more testosterone than women. So, thinking of testosterone as a tank of gas, the cortisol released by stress and lack of sleep might take a woman’s tank to empty, yet only decrease a man’s tank to half full. </p>
<h2>The effect of sleep on sex among men</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208731/original/file-20180302-65547-kslsni.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even young men can lose interest in sex if they are sleep-deprived.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/front-view-tired-man-sleeping-on-339327623?src=SqCH9BDwf03dBpL7NNHsjA-1-32">Antonio Guillem/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Although lack of sleep and stress seems to affect women’s sexual functioning more than men’s, men still suffer from interrelated problems in these areas. <a href="https://jamanetwork.com/journals/jama/fullarticle/1029127">One study</a> found that, among young healthy men, a lack of sleep resulted in decreased levels of testosterone, the hormone responsible for much of our sex drive. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2009.01372.x/full">Another study</a> found that among men, sleep apnea contributed to erectile dysfunction and an overall decrease in sexual functioning. Clearly, among men, lack of sleep results in diminished sexual functioning. </p>
<p>I could not locate a study to prove this, as it stands to reason that the reverse is also true. That is, it seems logical that, as was found in the <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsm.12858/full">previously mentioned study among women</a>, for men a better night’s sleep would also result in better sexual functioning.</p>
<h2>The effect of sex on sleep</h2>
<p>While sleep (and stress) have an effect on sex, the reverse is also true. That is, sex affects sleep (and stress). <a href="https://www.cnn.com/2017/06/01/health/sex-sleep-kerner/index.html">According to sex expert Ian Kerner</a>, too little sex can cause sleeplessness and irritability. Conversely, there is some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703719/">evidence</a> that the stress hormone cortisol decreases after orgasm. There’s also <a href="https://www.cqu.edu.au/cquninews/stories/research-category/2016/can-sex-be-repositioned-as-a-sleep-therapy">evidence</a> that oxytocin, the “<a href="https://www.psychologytoday.com/basics/oxytocin">love hormone</a>” that is released after orgasm, results not only in increased feelings of connection with a partner, but in better sleep. </p>
<p>Additionally, <a href="https://www.cnn.com/2017/06/01/health/sex-sleep-kerner/index.html">experts claim</a> that sex might have gender-specific effects on sleep. Among women, orgasm increases estrogen, which leads to deeper sleep. Among men, the hormone prolactin that is secreted after orgasm results in sleepiness.</p>
<h2>Translating science into more sleep and more sex</h2>
<p>It is now clear that a hidden cause of sex problems is sleeplessness and that a hidden cause of sleeplessness is sex problems. This knowledge can lead to obvious, yet often overlooked, cures for both problems. Indeed, experts have suggested that <a href="http://online.liebertpub.com/doi/pdf/10.1089/jwh.2009.1800">sleep hygiene can help alleviate sexual problems</a> and that <a href="https://www.cqu.edu.au/cquninews/stories/research-category/2016/can-sex-be-repositioned-as-a-sleep-therapy">sex can help those suffering from sleep problems</a>. </p>
<p>Perhaps, then, it is no surprise that both sleep hygiene suggestions and suggestions for enhanced sexual functioning have some overlap. For example, <a href="https://www.cnn.com/2017/06/01/health/sex-sleep-kerner/index.html">experts suggest</a> sticking to a schedule, both for sleep and for sexual encounters. They also recommend decreasing smartphone usage, both before bed and when spending time with a partner. The bottom line of these suggestions is to make one’s bedroom an exclusive haven for the joys of both sleep and sex.</p><img src="https://counter.theconversation.com/content/91959/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Mintz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research demonstrates a two-way relationship between sleep problems and sexual problems, as well as between satisfying sex and sound sleep. If you want better sex, you need better sleep.Laurie Mintz, Professor of Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/918032018-03-07T11:41:25Z2018-03-07T11:41:25ZWhy are we so sleep deprived, and why does it matter?<figure><img src="https://images.theconversation.com/files/208934/original/file-20180305-146645-8d89su.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As many as 70 million Americans may not be getting enough sleep. Men get fewer hours of sleep than women.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/monday-morning-again-186566120?src=xq4hLhcCUpruA-fFOIbQfQ-1-28">Akos Nagy/Shutterstock.com</a></span></figcaption></figure><p>As we prepare to “spring forward” for daylight saving time, many of us dread the loss of the hour’s sleep we incur by moving our clocks forward. For millions, the loss will be an added insult to the inadequate sleep they experience on a daily basis.</p>
<p>Surveys show that <a href="https://www.cdc.gov/sleep/data_statistics.html">40 percent of American adults get less</a> than the nightly minimum of seven hours of sleep recommended by the American Academy of Sleep Medicine and the National Sleep Foundation. The National Institutes for Health estimate that between <a href="https://www.ncbi.nlm.nih.gov/pubmed/20669438">50 million and 70 million people</a> do not get enough sleep. These recommendations for minimal sleep are based on a review of many scientific studies evaluating the role of sleep in our bodies and the effects of sleep deprivation on our ability of our body to function at our peak performance level. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=q5xsCiYAAAAJ&hl=en">neurologist</a> at the University of Florida who has studied the effects of both traumatic brain injury and sleep impairment on the brain. I have seen the effects of sleep impairment and the significant effects it can have.</p>
<p>According to the National Sleep Foundation, American adults currently average <a href="http://news.gallup.com/poll/166553/less-recommended-amount-sleep.aspx">6.9 hours of sleep</a> per night compared with the 1940s, when most American adults were averaging 7.9 hours a night, or one hour more each night. In fact, in 1942, 84 percent of Americans got the recommended seven to nine hours; in 2013, that number had dropped to <a href="http://news.gallup.com/poll/166553/less-recommended-amount-sleep.aspx">59 percent</a>. Participants in that same Gallup poll reported on average they felt they needed 7.3 hours of sleep each night but were not getting enough, causing an average nightly sleep debt of 24 minutes. <a href="https://finance.yahoo.com/news/exclusive-fitbits-6-billion-nights-sleep-data-reveals-us-110058417.html">Fitbit</a> in January 2018 announced results of a study it conducted of 6 billion nights of its customers’ sleep and reported that men actually get even less than women, about 6.5 hours. </p>
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<h2>Why sleep matters</h2>
<p>The problems caused by sleep shortage go beyond tiredness. In recent years, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27397854">studies</a> have shown that adults who were short sleepers, or those who got less than seven hours in 24 hours, were more likely to report <a href="https://www.cdc.gov/sleep/data_statistics.html">10 chronic health conditions</a>, including heart disease, diabetes, obesity, asthma and depression, compared to those who got enough sleep, that is, seven or more hours in a 24-hour period.</p>
<p>There are more challenges for children, as they are thought to have an increased sleep need compared to adults. The <a href="http://jcsm.aasm.org/ViewAbstract.aspx?pid=30652">American Academy of Sleep Medicine recommends</a> that children 6 to 12 years of age should sleep nine to 12 hours a day and teens 13 to 18 should sleep eight to 10 hours daily on a regular basis to promote optimal health.</p>
<p>A Sleep Foundation poll of parents suggested that American children are getting one hour of sleep or more per night less than what their body and brain require.</p>
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<p>Researchers have found that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978403/">sleep deprivation of even a single hour</a> can have a harmful effect on a child’s developing brain. Inadequate sleep can affect synaptic plasticity and memory encoding, and it can result in inattentiveness in the classroom.</p>
<p>Every one of our biological systems is affected by sleep. When we don’t sleep long enough or when we experience poor quality of sleep, there can be serious biological consequences.</p>
<p>When we are sleep deprived, our bodies become more aroused through an enhanced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538178/">sympathetic nervous system</a>, known as “fight or flight.” There is a greater propensity for increased blood pressure and possible risk of coronary heart disease. Our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538178/">endocrine system</a> releases more cortisol, a stress hormone. The body has less glucose tolerance and greater insulin resistance, which in the long term can cause an increased risk of Type 2 diabetes. Also, sleep deprivation causes a reduction in growth hormone and muscle maintenance.</p>
<p>We also rely on sleep to maintain our metabolism. Sleep deprivation can lead to decreased release of the hormone leptin and increased release of the hormone ghrelin, which can be associated with increased appetite and weight gain. </p>
<p>The human body also relies on sleep to help with our immune system. Sleep deprivation is associated with increased inflammation and decreased antibodies to influenza and decreased resistance to infection.</p>
<p>Inadequate sleep has been associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538178/">negative effect on mood</a> as well as decreased attention and increased memory difficulty. In addition, someone who is sleep deprived may experience a decrease in pain tolerance and in reaction times. Occupational studies have associated sleep deprivation with decreased performance, increased car accidents, and more days missed from work. </p>
<h2>The role of the brain</h2>
<p>Researchers have known for a while that brain health is an important aspect of sleep. Notably, sleep is an important part of memory consolidation and learning. </p>
<p>Newer research has suggested another important aspect of sleep for our brain: There is a system for the elimination of <a href="https://www.nih.gov/news-events/nih-research-matters/how-sleep-clears-brain">possibly harmful proteins</a> such as abnormal variants of amyloid. This waste removal process, using what is known as the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28859995">glymphatic system</a>, relies on sleep to effectively eliminate these proteins from the brain. These are the same proteins found to be elevated in patients with Alzheimer’s disease. Studies show that older adults with less sleep have greater accumulations of these proteins in their brains.</p>
<p>Our sleep-wake cycle is regulated by the <a href="https://theconversation.com/understanding-the-genes-that-make-our-circadian-clocks-tick-67356">circadian system</a>, which helps signal the brain to sleep using the release of the natural hormone melatonin. It turns out that our body’s system for regulating melatonin and our sleep schedule is most powerfully controlled by light. </p>
<p>There are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812508/">cells in the retina of our eye</a> that communicate directly with the brain’s biological clock regulators located in the hypothalamus and this pathway is most affected by light. These neurons have been found to be most affected by light waves from the blue spectrum or blue light. This is the kind of light <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734149/">most prominent in electronic</a> lights from computers and smartphones. This has become a modern challenge that can adversely affect our natural sleep-wake cycle.</p>
<p>Additional factors that can hamper sleep include pain conditions, medications for other conditions, and the increased demands and connectedness of modern society.</p>
<p>As we prepare for daylight saving time, we can be mindful that <a href="https://www.tandfonline.com/doi/abs/10.3109/02699052.2014.983978">many athletes have been including planned sleep extensions</a> (sleeping longer than usual) into their schedule to enhance performance and that many professional sports teams have hired sleep consultants to help assure their athletes have enough sleep. Perhaps we should have a similar game plan as we approach the second Sunday in March.</p><img src="https://counter.theconversation.com/content/91803/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael S. Jaffee does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Few things seem to matter to our health as much as a good night’s sleep, but fewer and fewer of Americans are getting it. A neurologist explains why sleep is so important.Michael S. Jaffee, Vice chair, Department of Neurology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816612017-09-11T00:26:35Z2017-09-11T00:26:35ZDoes marijuana affect your sleep?<figure><img src="https://images.theconversation.com/files/184991/original/file-20170906-9823-mrt3sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Results may vary.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-teenage-boy-smoking-drugs-lying-110426945">Stokkete/shutterstock.com</a></span></figcaption></figure><p>If you speak to someone who has suffered from insomnia at all as an adult, chances are good that person has either tried using marijuana, or cannabis, for sleep or <a href="https://doi.org/10.1016/j.addbeh.2017.08.001">has thought about it</a>. </p>
<p>This is reflected in the many variations of cannabinoid or cannabis-based medicines available to improve sleep – like Nabilone, Dronabinol and Marinol. It’s also a <a href="https://doi.org/10.1016/j.addbeh.2017.08.001">common reason</a> why many cannabis users seek medical marijuana cards. </p>
<p>I am a sleep psychologist who has treated hundreds of patients with insomnia, and it seems to me the success of cannabis as a sleep aid is highly individual. What makes cannabis effective for one person’s sleep and not another’s? </p>
<p>While there are still many questions to be answered, existing research suggests that the effects of cannabis on sleep may depend on many factors, including individual differences, cannabis concentrations and frequency of use.</p>
<h1>Cannabis and sleep</h1>
<p>Access to cannabis is increasing. As of last November, 28 U.S. states and the District of Columbia had <a href="http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx">legalized cannabis</a> for medicinal purposes.</p>
<p>Research on the <a href="http://doi.org/10.1007/s11920-017-0775-9">effects of cannabis on sleep</a> in humans has largely been compiled of <a href="http://doi.org/10.1007/s11920-014-0487-3">somewhat inconsistent studies</a> conducted in the 1970s. Researchers seeking to learn how cannabis affects the sleeping brain have studied volunteers in the sleep laboratory and measured sleep stages and sleep continuity. Some studies showed that users’ ability to fall and stay asleep improved. A small number of subjects also had a slight <a href="http://doi.org/10.1002/cpt1975174458">increase</a> in slow wave sleep, the deepest stage of sleep. </p>
<p>However, once <a href="http://doi.org/10.1093/sleep/31.6.901">nightly cannabis use</a> stops, sleep clearly worsens across <a href="http://doi.org/10.1016/j.sleep.2010.02.013">the withdrawal period</a>. </p>
<p>Over the past decade, research has focused more on the use of cannabis for medical purposes. Individuals with insomnia tend to use medical cannabis for sleep at a <a href="http://doi.org/10.1016/j.addbeh.2017.08.001">high rate</a>. Up to 65 percent of former cannabis users identified poor sleep as a reason for <a href="http://doi.org/10.1016/j.jsat.2008.01.002">relapsing</a>. Use for sleep is particularly common in individuals with <a href="http://doi.org/10.1016/j.copsyc.2016.12.001">PTSD</a> and <a href="http://doi.org/10.1002/cbdv.200790150">pain</a>. </p>
<p>This research suggests that, while motivation to use cannabis for sleep is high, and might initially be beneficial to sleep, these improvements might wane with chronic use over time.</p>
<h1>Does frequency matter?</h1>
<p>We were interested in how sleep quality differs between daily cannabis users, occasional users who smoked at least once in the last month and people who don’t smoke at all. </p>
<p>We asked 98 mostly young and healthy male volunteers to answer surveys, keep daily sleep diaries and wear accelerometers for one week. Accelerometers, or actigraphs, measure activity patterns across multiple days. Throughout the study, subjects used cannabis as they typically would.</p>
<p><a href="http://doi.org/10.1080/10550887.2015.1132986">Our results</a> show that the frequency of use seems to be an important factor as it relates to the effects on sleep. Thirty-nine percent of daily users complained of clinically significant insomnia. Meanwhile, only 10 percent of occasional users had insomnia complaints. There were no differences in sleep complaints between nonusers and nondaily users. </p>
<p>Interestingly, when controlling for the presence of anxiety and depression, the differences disappeared. This suggests that cannabis’s effect on sleep may differ depending on whether you have depression or anxiety. In order words, if you have depression, cannabis may help you sleep – but if you don’t, cannabis may hurt.</p>
<h1>Future directions</h1>
<p>Cannabis is still a schedule I substance, meaning that the government does not consider cannabis to be medically therapeutic due to lack of research to support its benefits. This creates a barrier to research, as only one university in the country, <a href="https://pharmacy.olemiss.edu/ncnpr/research-programs/cannabis-research/">University of Mississippi</a>, is permitted by the National Institute of Drug Abuse to grow marijuana for research.</p>
<p>New areas for exploration in the field of cannabis research might examine how various cannabis subspecies influence sleep and how this may differ between individuals. </p>
<p>One research group has been exploring <a href="http://doi.org/10.1016/j.addbeh.2015.06.032">cannabis types or cannabinoid concentrations</a> that are preferable depending on one’s sleep disturbance. For example, one strain might relieve insomnia, while another can affect nightmares. </p>
<p><a href="http://doi.org/10.1016/j.addbeh.2015.06.032">Other studies</a> suggest that medical cannabis users with insomnia tend to prefer higher concentrations of cannabidiol, a nonintoxicating ingredient in cannabis.</p>
<p>This raises an important question. Should the medical community communicate these findings to patients with insomnia who inquire about medical cannabis? Some health professionals may not feel comfortable due to the fluctuating legal status, a lack of confidence in the state of the science or their personal opinions.</p>
<p>At this point, cannabis’s effect on sleep seems highly variable, depending on the person, the timing of use, the cannabis type and concentration, mode of ingestion and other factors. Perhaps the future will yield more fruitful discoveries.</p><img src="https://counter.theconversation.com/content/81661/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deirdre Conroy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many hope that marijuana will help their insomnia. A sleep psychologist examines the evidence.Deirdre Conroy, Clinical Associate Professor of Psychiatry, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/740612017-03-20T03:16:03Z2017-03-20T03:16:03ZHealth Check: is sleepwalking problematic and can it be ‘cured’?<figure><img src="https://images.theconversation.com/files/160653/original/image-20170314-10724-17pqxxg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's a myth that waking up a sleepwalker is dangerous. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>People have long been fascinated with sleepwalkers — by those who roam during the night without awareness, climbing out of windows, walking down the street, urinating in a cupboard, or moving furniture.</p>
<p>Sleepwalking is one of a number of behaviours that can occur during deep sleep, know as the “non-rapid eye movement” (non-REM) period of sleep. Others may include talking, sitting up, or just making odd body movements. It’s a relatively common sleep phenomenon with an <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164769">estimated 7% of people</a> sleepwalking at some time during their lives. </p>
<p>Sleepwalking isn’t necessarily considered a sleep disorder, unless it occurs repeatedly, includes amnesia (that is they have no memory of sleepwalking or what they did while sleepwalking), and causes distress or impairment.</p>
<p>Sleepwalking seems to be more common in children, with estimates that about <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164769">5% of children</a> have sleepwalked at least once in the previous 12 months compared with <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164769">1.5% of adults</a>. The decrease in observed sleepwalking is not well understood, but may be the result of brain maturation, decreased non-REM sleep as we get older and hence fewer opportunities to sleepwalk, or adults being less likely to be observed sleepwalking than younger children.</p>
<p>It is not yet known why some people sleepwalk and others don’t. Sleepwalking happens when some parts of our brain, particularly the limbic system (responsible for emotions) and the motor cortex (responsible for complex motor movements) are awake, while the rest of the brain is asleep. </p>
<p>The underlying cause of sleepwalking is not known. Sleepwalker have their eyes open, but are relatively unresponsive to what is going on around them. They perceive the environment differently and don’t recognise people they know.</p>
<p>For most people, sleepwalking doesn’t cause any problems and sleepwalkers often consider it an interesting quirk. However, some people may suffer injuries while sleepwalking, from falls or bumping into things. Children who frequently sleepwalk may be worried about going on school camps or sleepovers for fear of sleepwalking. Adults may forgo travelling. </p>
<p>On rare occasions, <a href="https://academic.oup.com/brain/article/135/11/e219/270715/Sleep-related-violence-alcohol-and-sleepwalking">sleepwalkers have been violent towards others</a>, thinking they were responding to someone threatening. Some sleepwalkers have also sexually assaulted someone else during sleepwalking, known as sexsomnia. On very rare occasions, sleepwalkers have died while sleepwalking and have <a href="http://www.thetimes.co.uk/article/sleepwalker-brian-thomas-admits-killing-wife-while-fighting-intruders-in-nightmare-sv79ljzk7lh">killed other people</a>. </p>
<p>In research we conducted that’s yet to be published, violence during sleepwalking is mediated by biological, psychological and social risk factors that affect impulse control.</p>
<h2>Does anything need to be done?</h2>
<p>If you or someone in your family is a sleepwalker, there are some things you can do to help minimise the risk of injury, including keeping furniture in the same place and not having things left on the floor that could be a tripping hazard. </p>
<p>Deadlocks on doors and windows can help prevent sleepwalkers from wandering outside, but it is important to ensure they can escape in case of a fire. Sleepwalkers who are violent can minimise harm to themselves and others by removing objects that could be potential weapons from bedside tables.</p>
<p>It was once thought you shouldn’t wake a sleepwalker because it could harm them — there is no evidence for this. But because they are in the deepest stage of sleep, they will be confused if woken. While sleepwalking doesn’t normally cause daytime tiredness, most likely because the sleepwalker is still asleep, waking the sleepwalker may disrupt their sleep, which in turn may affect how they feel in the morning. </p>
<p>If someone in your home is sleepwalking, it is best to just tell them to go back to bed, or gently lead them to their room.</p>
<p>To date, there have been <a href="http://www.sleepandhypnosis.org/ing/abstract.aspx?MkID=217">no clinical trials</a> evaluating the effectiveness of treatments for sleepwalking, though myriad psychological and pharmacological treatments have been used. </p>
<p>If parents are concerned about their child sleepwalking, one of the most promising treatments that doesn’t have side-effects, is <a href="http://dx.doi.org/10.5350/Sleep.Hypn.2016.18.0118">scheduled waking</a>. This involves waking the child about 20 minutes before they normally sleepwalk. Once they are awake, you let them go back to sleep. This should be continued nightly for about three weeks. For older children and adults, hypnosis may be effective.</p>
<p>Adults without a history of sleepwalking in childhood, seldom start in adulthood. If that occurs it’s best to have it checked out by a medical practitioner as it could be caused by medication or a neurological problem.</p><img src="https://counter.theconversation.com/content/74061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Stallman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have long been fascinated with sleepwalkers. Is it dangerous?Helen Stallman, Senior Lecturer - Clinical Psychology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/518282015-12-23T10:27:15Z2015-12-23T10:27:15ZWhy children who sleep more get better grades<figure><img src="https://images.theconversation.com/files/105789/original/image-20151214-9501-sb31jj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teenagers need nine hours sleep a night. </span> <span class="attribution"><span class="source">junpinzon/www.shutterstock.com</span></span></figcaption></figure><p>Sleep plays a fundamental role in the way we learn. Emerging <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsr.12119/abstract">evidence</a> makes a compelling case for the importance of sleep for language learning, memory, executive function, problem solving and behaviour during childhood. </p>
<p>A <a href="http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01717/abstract">new study</a> that my colleagues and I have worked on illustrated how an optimal quantity of sleep leads to more effective learning in terms of knowledge acquisition and memory consolidation. Poor quality of sleep – caused by lots of waking up during the night – <a href="http://www.ncbi.nlm.nih.gov/pubmed/24329882">has also been reported</a> to be a strong predictor of lower academic performance, reduced capacity for attention, poor executive function and challenging behaviours during the day. </p>
<p>Many <a href="https://theconversation.com/explainer-why-does-the-teenage-brain-need-more-sleep-29557">adolescents are sleep-deprived</a> as they gain less sleep than the average recommended level – around nine hours for this group. But due to school commitments, teenagers are required to wake up early at a set time even if they have not achieved the optimal number of hours sleep. </p>
<p>Along with these early start times, teenagers also experience <a href="http://sleepscience.com.br/sleepscience/pdf/articles/vol1/SleepScience_vol1_issue01_art09.pdf">pubertal phase delay</a> – meaning pubertal teenagers will sleep even less due to biological factors. Combined with late night activities, this can have a significant negative effect on the quality of sleep and therefore their behaviour during the day. </p>
<p>Insufficient and poor quality of sleep appear to be pervasive during adolescence. These can have <a href="http://www.sciencedirect.com/science/article/pii/S1087079203900037">various consequences</a> such as an excessive daytime sleepiness, poor diet and in turn impairments in cognitive control, risk-taking behaviour, diminished control of attention and behaviour, as well as poor emotional control.</p>
<h2>More sleep versus better sleep</h2>
<p>In a <a href="http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01717/abstract">recent study</a> involving 48 students between 16 and 19-years-old recruited through an independent sixth form college in central London, my colleagues and I at the <a href="http://lilaslab.weebly.com/">Lifespan Learning and Sleep Laboratory</a> at UCL examined the link between sleep, academic performance and environmental factors.</p>
<p>Our results showed that the majority of the teenagers achieved just over seven hours of sleep, with an average bedtime at 11.37pm. Our study showed that a longer amount of sleep and earlier bedtimes – measures of sleep quantity – were most strongly correlated with better academic results obtained by the students on a number of tests taken at school. In contrast, measures that were indicative of sleep quality were mostly linked with students’ performances on verbal reasoning tests and on grade point averages on tests at school. </p>
<p>So it appears from our results that “longer sleep” is more closely related to academic performance, while “good night sleep” is more closely related to overall cognitive processing. </p>
<h2>Why teens are getting less and less sleep</h2>
<p>Our study also confirms findings from <a href="http://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15015676">previous research</a> showing that teenagers are getting at least two to three hours less sleep than is needed for their optimal brain development and a healthy lifestyle. </p>
<p>There are several modern lifestyle factors that have shown to impact on sleep. We found that consumption of energy drinks and coffee, and social media use half an hour before habitual bedtime were strongly associated with poorer sleep.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106122/original/image-20151215-23186-keeifr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Too much late night snapchat.</span>
<span class="attribution"><span class="source">CandyBox Images/www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Our study has also shown that the negative impact of poor sleep on academic functioning is not always matched by a realisation of this fact by students themselves, therefore they may have little motivation to alter bad sleep habits. Unlike for adults, adolescence is a crucial time because of continual changes in the brain – so sleep is particularly important for a teenager’s health. </p>
<h2>Conditions that can impact sleep</h2>
<p>There is an added complexity to the sleep patterns of children with developmental disorders, despite the fact that they are more likely to suffer from sleep problems. So far, we have examined sleep, and cognitive and behavioural functioning in children with Down Syndrome, Williams Syndrome and ADHD. All our <a href="http://lilaslab.weebly.com/dagmara-dimitriou.html">studies</a> show that sleep has a very important impact on cognitive and daytime functioning of children with these conditions. </p>
<p>When we <a href="http://www.ncbi.nlm.nih.gov/pubmed/25441742">examined levels</a> of sleep biomarkers – melatonin and cortisol – in children with Williams syndrome, a rare genetic disorder, it revealed that they had elevated levels of cortisol and dampened levels of melatonin. High cortisol and low melatonin levels before bedtime were strongly linked with delayed sleep onset – taking around 50 minutes in comparison to the typical 20 minutes to fall asleep. </p>
<p>Since cortisol is often described as a stress hormone, high levels of this hormone before bedtime may potentially cause sleep problems including difficulty in relaxing and falling asleep. This is an important result to consider before a child is prescribed a <a href="http://www.webmd.com/sleep-disorders/tc/melatonin-overview">melatonin supplement</a> – which might not be necessary to help solve their actual sleep problem.</p>
<p>The effects of the sleep disturbances extend beyond the individual. Parents of children with developmental disorders often experience heightened levels of stress and sleep problems because they are kept awake by their children. </p>
<p>All this shows how crucial it is for teenagers to get the right amount of sleep – otherwise it could have long-term impacts on their health and on their grades.</p><img src="https://counter.theconversation.com/content/51828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dagmara Dimitriou receives funding from The British Academy, The Waterloo Foundation and Williams Syndrome Foundation, UK.</span></em></p>Make sure your teenager doesn’t stay up all night.Dagmara Dimitriou, Director, Lifespan Learning & Sleep Lab, Department of Psychology and Human Development, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/483192015-12-17T00:40:54Z2015-12-17T00:40:54ZHidden and unexplained: feeling the pain of fibromyalgia<figure><img src="https://images.theconversation.com/files/98795/original/image-20151019-7780-tl94to.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fibromyalgia can be made more difficult when the pain doesn't seem to have a visible cause</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shitsuren/4904341484/in/photolist-8to2RN-4X7hMc-bUKXf9-7Y1isf-6yEpBk-ce2LSm-dtEpX2-dveXaK-xe9cn5-c2B6h5-66McvJ-qnAtkg-8svFP7-6VpBou-jbFPK1-3ufH6f-8fs4o8-7WZfgM-9WBGsu-mDPKmX-9muCe5-wtbz54-e9Cgqt-6cHmaC-9BwjCn-9WBGuo-7Ej7ZR-asbJv-duCLzk-duCLvx-4mnysH-dCFk4u-5Nhvo-dbu6y-cs3kb1-w45C7b-vfkWGM-9pttue-wk2LMG-w45DX7-4MwSo5-bcFxaD-4emb3T-txbGq6-tx3NMm-djEJ7P-CkP9f-2zEhNw-66CQtU-bXpF8E">Silvia Sala/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>For some people, waking up every day means the start of persistent pain that affects their mood, thinking and relationships. This experience is more difficult when the pain doesn’t seem to have a cause; at least not a visible one. </p>
<p>That’s the reality for people with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/">fibromyalgia</a>, a chronic disorder characterised by pain and muscle tenderness throughout the body where even the slightest touch can be sensitive. Sufferers often <a href="http://www.ncbi.nlm.nih.gov/pubmed/2306288">have other health issues</a>, including sleep difficulties and fatigue. </p>
<p>For a long time, fibromyalgia was thought of as a medical mystery. Technological advancement has allowed us to look closer. Today, it is a recognised disorder, part of a group of chronic pain syndromes described as <a href="http://americanpainsociety.org/about-us/press-room/fibromyalgia-clauw">central nervous system disorders</a>. </p>
<p>The condition affects more than four times as many women as it does men. With <a href="http://www.ncbi.nlm.nih.gov/pubmed/7818567">as many as 2-5% of the developed world</a> living with fibromyalgia, it is far from uncommon. Yet targeted and effective treatment options aren’t available for the condition. And compared to fibromyalgia’s impact, this area of research remains highly underfunded.</p>
<h2>Chicken or egg?</h2>
<p>Fibromyalgia has a long history of stigma. Some explanations even pinned it <a href="http://scopeblog.stanford.edu/2013/08/13/fibromyalgia-living-with-a-controversial-chronic-disease/">down to being psychosomatic</a>, “made up” and “all in your head”, as well as a condition people needed to “just get over”. </p>
<p>There may be some truth in saying fibromyalgia is “all in your head”, but more as a reflection of associated brain changes than a figment of the imagination. An <a href="http://www.hindawi.com/journals/prt/2012/585419/">explosion of recent research</a> has shown <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258006/">brains</a> of fibromyalgia sufferers are made up differently. There are variations, for instance, <a href="http://www.jneurosci.org/content/27/15/4004.full">in regions key to how we think and feel</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=441&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=441&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=441&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100125/original/image-20151029-15322-b3eoqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Even the slightest touch can be sensitive for fibromyalgia sufferers.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/vaxzine/2642346629/in/photolist-52uHAv-pp7YBE-goCmpj-2kjSVv-gjn8K4-4QTDnm-veQ41f-zeen7c-5JywNQ-hgrWBb-pb9vUY-zDuRPi-9pn552-wN61eQ-pLM4Fq-aWz48r-5V3DUx-vpTg1L-6L12vv-h6bNVm-aeZNE2-zwVBuA-bnCWMZ-hkyUXn-aexdvy-bjSowZ-6vYLeq-gwXzyC-apcXUo-6yYVAK-6L4xdj-KzR53-gRVQ5S-8nEmvz-nxjKe1-6noCBP-5JsNAa-6CWBgP-6mdMbb-dwLgYp-5G9Ycs-pEPUfR-8yYFSu-bRXyo8-8HYk6L-7EnZAj-duCLte-5qPk8m-k4pFrn-jNYM1">vaXzine/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Although our understanding has taken a dramatic leap in the last few decades, we can’t shut the book on fibromyalgia’s exact cause or causes. The reported brain changes pose a real chicken and egg scenario: are these brain changes causing fibromyalgia, or is fibromyalgia causing the brain changes? </p>
<p>The condition may have multiple causes. Some suggest biological factors, including a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17187510">genetic basis</a> for the disorder. Other research shows a history of <a href="http://www.ncbi.nlm.nih.gov/pubmed/20722042">sexual, emotional and physical abuse</a> among sufferers. <a href="http://www.arthritis-research.com/content/6/3/98">Psychological factors</a>, including responses to chronic stress, have also been shown to contribute to its cause. </p>
<p>None of these are likely to be independent of each other.</p>
<h2>Links to mood disorders</h2>
<p>Further complicating explanations of fibromyalgia include its <a href="http://www.hindawi.com/journals/prt/2012/486590/">link to other illnesses</a>, such as mood disorders like depression. This relationship likely reflects the fact they share some of the same biological processes, such as inflammation. </p>
<p>Inflammation occurs when injury or infection triggers the production of messenger molecules that flood to the site of injury as part of an immune response. <a href="http://www.nature.com/nrn/journal/v9/n1/full/nrn2297.html">It is now believed </a> that, like injury to the body, psychological adversity and mental illness can trigger the same immune response affecting the brain.</p>
<p>And recent research suggests the <a href="http://www.researchgate.net/publication/279299589_Bidirectional_Association_Between_Depression_and_Fibromyalgia_Syndrome_A_Nationwide_Longitudinal_Study">occurrence of fibromyalgia or depression may increase the likelihood</a> of the other. Regardless of what came first, though, the presence of mood disorders in fibromyalgia is <a href="http://www.researchgate.net/publication/45439877_Fibromyalgia_syndrome_and_depressive_symptoms_Comorbidity_and_clinical_correlates">linked to more pain</a> and reduced quality of life.</p>
<p>It comes as no surprise, then, that if medical professionals and scientists can’t explain what causes fibromyalgia, it is even harder for the person living with the condition. In fact, those diagnosed have <a href="http://www.ncbi.nlm.nih.gov/pubmed/22820966">a significantly harder time</a> understanding or explaining their pain to people with other disorders, like arthritis for instance.</p>
<h2>Treatment options</h2>
<p>It can take years to receive a fibromyalgia diagnosis, and some may have been misdiagnosed with one or more other conditions beforehand. This can be very frustrating for the patient as well as their doctor. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100126/original/image-20151029-15355-114v0a9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Despite the poor response rate, pharmaceutical methods are the main treatment option for fibromyalgia.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fatmandy/125282049/in/photolist-c56Zk-65PyUt-7bcRAo-7b93mX-7bcSbd-aiJisn-a4Np1S-7bcTtj-7b942v-7b91Lt-7b977K-7bcSNb-7bcPoY-r7nCL-7bcPPu-4moWD6-4qzzzv-8ZpNUe-7Dsout-NsGJW-9ZYKte-bqCnhN-66xQyU-f1Vmj-89jusq-ebNVM8-nsnjck-dgA1YX-nAcUbq-e5PSvZ-Gj9AL-5f3ocG-qVvXtf-qgicVF-qg5Wtd-tJtjct-68UMtV-tJkbky-t4U6RW-7rhB2d-7b6fb7-6gnfen-AeS5k9-8ZiU7L-7qU1Bc-q2oo56-ceYBEy-pgHs4Z-cFe563-cy5SLS">Chris Frewin/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Currently, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/2306288">best method</a> of diagnosis is classification-based. Physicians assess the number of possible body areas where someone experienced pain in the last two weeks, and the severity of other symptoms, including fatigue and cognitive function. </p>
<p>Following diagnosis, there is no universally effective treatment plan. It usually includes a multi-method pain management regime from a team of health care providers. But <a href="http://annals.org/article.aspx?articleid=713152">responses to treatments</a> can be no better than chance, regardless of whether these are pharmacological or others such as acupuncture or hypnotherapy.</p>
<p>Despite the poor response rate, pharmaceutical methods are the main treatment option. <a href="http://www.sciencedirect.com/science/article/pii/S014067369904088X">Prescriptions are commonly</a> made out for non-steroidal anti-inflammatory drugs (such as ibuprofen), opioid analgesics (such as codeine), antidepressants, or anticonvulsants (drugs used to control seizures that also affect pain signals). </p>
<p>Because there is no clear treatment target for fibromyalgia, drug doses needed to manage symptoms have significant side effects. These include problems with thinking, drowsiness and the risk of drug dependency. </p>
<p>We don’t know exactly what causes fibromyalgia, but treatments need to be developed based on what we do know. For instance, we know there are brain changes. One promising treatment may therefore be brain stimulation techniques like <a href="http://www.maprc.org.au/dr-bernadette-fitzgibbon">Transcranial Magnetic Stimulation</a> (rTMS); a non-invasive technique that can change the activity of neurons in the brain.</p>
<p>There is a clearly an urgent need to provide targeted and effective treatment options for fibromyalgia sufferers. Considering how far we have come in explaining the unexplained pain of the condition, there is real hope for the future.</p>
<hr>
<p><em>This article is part of a series focusing on Pain. Read other articles in the series <a href="https://theconversation.com/au/topics/pain-series">here</a>.</em></p><img src="https://counter.theconversation.com/content/48319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bernadette Fitzgibbon receives funding from National Health and Medical Research Council and Arthritis Australia. </span></em></p>Unexplained, chronic pain known as fibromyalgia affects up to 5% of the population. Yet there are no effective treatment options for the millions for whom each day begins with persistent pain.Bernadette Fitzgibbon, Neuroscientist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/485092015-10-05T05:29:27Z2015-10-05T05:29:27ZUnderstanding sleep paralysis: a terrifying but unique state of consciousness<figure><img src="https://images.theconversation.com/files/97039/original/image-20151002-23058-1jkcmoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Imagine being unable to talk or move when faced with an evil intruder.</span> </figcaption></figure><p>“I awake in bed … In the corner of the room there are two men. I cannot see them but I know that they are there, and what they look like. I can hear them talking. They are talking about murder. I cannot move. One of the men comes and stands directly above me … He spits, and his spit lands in the socket of my closed eye. I can feel the impact, the wetness, the trail of slime.”</p>
<p>This may sound like a scene from the X-Files, but it is actually a personal account of a real experience – told as part of a <a href="http://www.thesleepparalysisproject.org/">project on sleep paralysis</a>. This is an unusual condition where one wakes up in the night, unable to move, and often experiences a wide range of bizarre and terrifying hallucinations. </p>
<p>On October 9 a new documentary, <a href="http://www.imdb.com/title/tt3317522/">The Nightmare</a>, directed by <a href="http://www.imdb.com/name/nm0038896/">Rodney Ascher</a>, is being released in the UK. The film tracks eight people’s experiences of sleep paralysis, brilliantly recreating their terrifying visions on screen. However, it does not touch on the increasing amount of scientific study into the condition. This is a shame, as researchers are slowly getting closer to unravelling its mystery.</p>
<h2>Hallucinations and risk factors</h2>
<p>Sleep paralysis episodes typically occur either early in the night, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2005.00477.x/abstract">as someone is falling asleep</a>, or towards the end of the night, as someone is waking up.</p>
<p>There are <a href="http://link.springer.com/article/10.1023%2FA%3A1025373412722">three categories of hallucinations</a>. Intruder hallucinations consist of a sense of evil presence in the room, which can also manifest into hyper realistic multisensory hallucinations of an actual intruder. Incubus hallucinations often co-occur with intruder hallucinations, and describe a sensation of pressure on the chest and feelings of being suffocated. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97037/original/image-20151002-23105-h9ahcu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">‘My Dream My Bad Dream’ by Fritz Schwimbeck in 1915.</span>
<span class="attribution"><span class="source">Fritz Schwimbeck/wikimedia</span></span>
</figcaption>
</figure>
<p>The third category include so-called vestibular-motor hallucinations, which typically don’t occur with the other two, and consist of “illusory movement experiences” such as floating above the bed. </p>
<p>Sleep paralysis is more common than you may think. In a <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsr.12282/abstract;jsessionid=544DEAD3A886C8C7FA3091D307D94B08.f04t03">recent UK study</a>, nearly 30% of respondents said that they had experienced at least one episode of sleep paralysis in their lifetime. A smaller percentage, around 8% of the 862 participants, reported more frequent episodes. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3156892/">A systematic review</a> of over 30 studies from a variety of countries reported a more conservative estimate, of around 10%.</p>
<p>Sleep paralysis is a <a href="http://www.narcolepsy.org.uk/about-narcolepsy/what-is-narcolepsy">common symptom of narcolepsy</a>, a sleep disorder where the brain’s ability to regulate a normal sleep-wake cycle becomes disrupted. It also appears to be more common in a number of psychiatric conditions, particular <a href="http://www.ncbi.nlm.nih.gov/pubmed/16094659">post-traumatic stress disorder</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=sharpless+2010+sleep+paralysis">patients with panic disorder</a>. </p>
<p>But many individuals suffer from sleep paralysis without any apparent psychiatric or neurological condition. In a recent study, we looked at <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsr.12282/abstract;jsessionid=544DEAD3A886C8C7FA3091D307D94B08.f04t03">potential risk factors</a> and found that stressful life events, anxiety, and sleep quality all had an impact. This is supported by other studies showing that groups of people who experience disrupted and irregular sleep, such as shift workers, are at a <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1819.2001.00853.x/abstract">higher risk</a> of sleep paralysis. </p>
<p>We also looked at the <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsr.12282/abstract;jsessionid=818AAFC9F9D3C775A3CCE6162F73A595.f02t01">role of genetics</a>, by comparing the frequency of sleep paralysis in identical twins, who share almost 100% of their genes, with the occurrence in non-identical twins, who on average share about 50% of their genes. We found that there was indeed a genetic link. <a href="http://onlinelibrary.wiley.com/doi/10.1111/jsr.12282/abstract;jsessionid=818AAFC9F9D3C775A3CCE6162F73A595.f02t01">Our research even suggested</a> that a particular variation in a gene involved in the regulation of our sleep wake cycle may be associated with sleep paralysis. But more studies are needed to confirm this.</p>
<h2>Laboratory studies</h2>
<p>Every night, we pass through a number of different sleep stages (see figure below). After falling asleep, we pass through stages one to three, reflecting a deepening level of unconsciousness, known collectively as non-REM (rapid eye movement) sleep. After coming back to stage one sleep we enter a period of rapid eye movement sleep, which is unique for a number of reasons. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=422&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=422&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97050/original/image-20151002-23101-vzhsin.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=422&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sleep cycles.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>REM sleep is a period of heightened brain activity, associated with vivid dreaming. During REM sleep our muscles are completely paralysed (apart from the eyes and respiratory system). It is assumed that this paralysis mechanism is in place to stop us acting out our dreams, based on rare cases where the paralysis fails – and patients <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902006/">physically act out the contents of their dreams</a>.</p>
<p>A team of Japanese researchers were recently able to <a href="http://www.ncbi.nlm.nih.gov/pubmed/11833865">induce episodes of sleep paralysis</a> by systematically depriving participants of REM sleep. They found that if they interrupted enough periods of REM, the sleepers would eventually enter sudden-onset REM (SOREM), which is where one falls straight into REM sleep from waking, bypassing the other sleep stages (this is indicated by the dotted line in the figure). It was found that following these SOREM periods, participants were more likely to have an episode of sleep paralysis – backing up previous studies showing that disrupted sleep increases the risk.</p>
<p>These studies also tell us that sleep paralysis is closely tied to REM sleep. What appears to be happening in sleep paralysis is you wake up and become consciously aware of your surroundings while still in a state of REM sleep, meaning your muscles are paralysed. It could be said that your mind wakes up but your body doesn’t. </p>
<p>Recordings of brain activity during sleep paralysis show it to be a unique state of consciousness. A recent study showed that a participant’s brain activity during sleep paralysis <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=sleep+paralysis+terzaghi">was indistinguishable</a> from a brain recording created by combining a recording from when they were awake, and when they were in REM sleep.</p>
<p>Unfortunately, to date there have been no systematic trials investigating possible medical treatments for sleep paralysis though <a href="http://www.nhs.uk/Conditions/Sleep-paralysis/Pages/Treatment.aspx">antidepressants may be prescribed in some severe cases</a>. However, research certainly suggests that trying to maintain a healthy, regular sleep pattern would be a good strategy for trying to reduce the frequency of episodes. </p>
<p>Anecdotal evidence also hints at a number of possible prevention strategies –including changing sleeping position, adjusting sleeping patterns and improving diet and exercise. In a study that asked people who were using such a strategy how successful it was, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25315810">79% believed it worked</a>. Another approach is to try to disrupt episodes rather than prevent them by attempting to move body parts such as a finger, or trying to relax. Of people who try to disrupt episodes, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25315810">54% believed them to be effective</a>. </p>
<p>While sleep paralysis can be a terrifying ordeal to go through, those who do experience it should try to remember that it is a temporary and harmless event. What’s more, help may be on the way. As researchers are slowing learning more about what causes the condition, chances are that effective treatment may one day be possible.</p><img src="https://counter.theconversation.com/content/48509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dan Denis receives funding from an Economic and Social Research Council (ESRC) Advanced Quantitative Methods PhD studentship. He is also the researcher for The Sleep Paralysis Project</span></em></p>Sleep paralysis is an enigmatic, terrifying condition in which the mind is awake but the body is asleep. But how much do we actually know about it?Dan Denis, PhD student in Psychology, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/450402015-09-15T20:17:43Z2015-09-15T20:17:43ZThe big sleep: science is waking up to the curious story of narcolepsy<figure><img src="https://images.theconversation.com/files/91254/original/image-20150810-12487-1ya9hr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Popular characters such as Sleeping Beauty illustrate our enduring interest in tales of people who sleep continuously or cannot stay awake.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/sofi01/4722580506/">Sofi/flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Perhaps because we all need sleep, we have an enduring interest in tales of people who sleep continuously or cannot stay awake – popular characters such as <a href="https://en.wikipedia.org/wiki/Sleeping_Beauty">Sleeping Beauty</a> and <a href="http://www.enotes.com/topics/rip-van-winkle">Rip Van Winkle</a> are just two examples. </p>
<p>Totally somnolent characters in films, such as <a href="http://www.imdb.com/title/tt0250687/">Rat Race</a> (2001), <a href="http://www.imdb.com/title/tt0203009/">Moulin Rouge!</a> (2001) or <a href="http://www.imdb.com/title/tt0205000/">Deuce Bigalow: Male Gigolo</a> (1999) all highlight our fascination – and amusement – with such sleepy individuals. But funny as they may seem, the sad fact is that these characters are all almost certainly based on the medical condition known as narcolepsy.</p>
<p>Narcolepsy is characterised by a constant, irrepressible need for sleep. The disorder affects about one in 3,000 people, mostly starting in teenage years. </p>
<p>It was first named by a French physician, <a href="http://www.ncbi.nlm.nih.gov/pubmed/9132972">Jean-Baptiste-Édouard Gélineau</a>, from the Greek terms for “stupor” and “seizures”. Gélineau also observed <a href="http://www.narcolepsy.org.uk/about-narcolepsy/what-is-narcolepsy/cataplexy">cataplexy</a>, which is the hallmark of classic narcolepsy.</p>
<p>Cataplexy entails loss of muscle activity in the face or body – resulting in sagging of the head to full body collapse to the ground – triggered by strong emotional responses, such as laughter. One of Gélineau’s patients <a href="http://link.springer.com/article/10.1007/s12026-014-8513-4/fulltext.html">reported</a> collapsing to the ground at the Paris Zoo watching monkeys making faces. </p>
<h2>Disturbed slumber</h2>
<p>Subsequent <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=487873">research</a> based on better understanding of the sleeping brain showed cataplexy was the loss of postural muscle activity we all get during rapid-eye movement (REM, or dreaming) sleep, intruding on the waking state. This loss of muscle activity can be as subtle as a partial closure of the eyes due to loss of activity in the muscles encircling the eye, or as obvious as a total body collapse.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=836&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=836&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=836&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1051&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1051&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92887/original/image-20150825-17755-s9vb6k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1051&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Jean-Baptiste-Édouard Gélineau coined the term narcolepsy from the Greek terms for ‘stupor’ and ‘seizures’.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Jean_Baptiste_Edouard_G%C3%A9lineau.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Other intrusive REM phenomena common in narcolepsy include the inability to move immediately before falling asleep or on waking (sleep paralysis), or visual hallucinations caused by awake dreaming. </p>
<p>Despite the profound sleepiness and drive to sleep exhibited by people with narcolepsy, most would describe their night-time sleep as disturbed. Essentially, it’s difficult for them to maintain wakefulness or sleep for consistent periods, so they have insomnia with constant micro-sleeps during the day. </p>
<p>Some people are also described as having “partial narcolepsy”, when they have irrepressible sleepiness without any of these REM intrusive behaviours. But only a few people have true partial narcolepsy, while many others may have sleepiness due to other causes.</p>
<p>These days, it’s understood that people with classic narcolepsy have a faulty “<a href="http://www.nature.com/nature/journal/v437/n7063/full/nature04284.html">sleep switch</a>”. Just as a faulty light switch results in a light flickering on and off, their sleep-wake transition is constantly going on and off. </p>
<p>The “sleep switch” is actually a complex brain system acting as master controller for all aspects and behaviours associated with sleep. It’s located predominantly in the lateral hypothalamus and adjacent brain areas. A dominant part of the switch is a small cluster of brain cells containing the neurotransmitter hypocretin, which regulates appetite, wakefulness and arousal, and is also known as orexin. </p>
<p>In classic narcolepsy, there’s a degeneration or complete loss of hypocretin neurones, while adjacent neurones with other neurotransmitters are preserved. In effect, narcolepsy is a highly selective degeneration of hypocretin neurones, which makes it very different to other brain degenerative disorders with more widespread effects, such as Alzheimer’s or Parkinson’s diseases. </p>
<h2>A hundred years of sleep</h2>
<p>But why do some people get such a selective neurodegeneration? To answer that question, we need to go back to World War I, when Austro-Hungarian flying ace <a href="http://ibro.info/wp-content/uploads/2012/12/Economo-Constantin-von.pdf">Constantin von Economo</a> was dragged out his precarious profession by his wealthy parents and pushed into the safer pursuit of neuropathology. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92233/original/image-20150818-12447-8ae4q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with narcolepsy fight an irrepressible need for sleep.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/erix/352986141/">Erich Ferdinand/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>He <a href="https://books.google.com.au/books?id=Eem9QwAACAAJ&dq=inauthor:%22Constantin+Freiherr+von+Economo%22&hl=en&sa=X&ved=0CCYQ6AEwAGoVChMIiq2Tg_yuxwIVBCmmCh23cgC4">observed</a> that victims of the <a href="https://theconversation.com/a-viral-infection-of-the-mind-the-curious-case-of-encephalitis-lethargica-660">mysterious encephalitis lethargica epidemic</a> that followed the H1N1 Spanish flu had either severe sleepiness or insomnia. They also had lesions in the areas of the brain now known to contain the “sleep switch”. </p>
<p>These historic findings have led researchers over the years to believe that narcolepsy has an environmental trigger in people susceptible to the condition. One vulnerability factor is a group of genes, called HLA genes, that determine immune responses. </p>
<p>In 1984, the late <a href="http://onlinelibrary.wiley.com/store/10.1111/j.1440-1819.2009.02037.x/asset/j.1440-1819.2009.02037.x.pdf;jsessionid=017BB22D63FBA98140FBB91E7EA73251.f04t03?v=1&t=id5aobw9&s=199a6713de0dee915b22941a35ca29033820b327">Yutaka Honda</a> identified that <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=HLA+antigens+in+Japanese+patients+with+narcolepsy+1984">100%</a> of his patients with classic narcolepsy had a particular type of HLA gene, in contrast to 25% of the general population. Other researchers in <a href="http://ac.els-cdn.com/S0140673685920720/1-s2.0-S0140673685920720-main.pdf?_tid=ebd47506-447f-11e5-bef4-00000aacb361&acdnat=1439775371_117bef51ce4882032c721ee2b6e6b13c">Europe</a> and <a href="http://link.springer.com/chapter/10.1007%2F978-3-642-83387-8_7#page-1">North America</a> confirmed these findings. </p>
<p>Some years before his death, along with a number of others, I had dinner with a very jetlagged Honda, who exhibited frequent micro sleeps during the main course. The irony of this scene never left me – and it’s probably a very good way to understand how someone with narcolepsy feels.</p>
<h2>Solving the mystery</h2>
<p>Recently, 1,300 cases of classical narcolepsy <a href="http://www.nature.com/nrneurol/journal/v10/n11/full/nrneurol.2014.191.html">were observed</a> in people who were given <a href="http://news.sciencemag.org/biology/2015/07/narcolepsy-link-pandemic-flu-vaccine-becomes-clearer">GSK’s Pandemrix H1N1 flu vaccine</a> (out of a total of 30 million Europeans given the vaccine). This led to a flurry of activity to try to identify diagnostic blood factors for narcolepsy, as well as proteins responsible for this side effect. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=893&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=893&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=893&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1122&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1122&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92026/original/image-20150817-5114-kpgr19.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1122&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Constantin von Economo identified narcolepsy among encephalitis lethargica sufferers.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Constantin_von_economo_1910.jpeg">Baron Constantin von Economo, his life and work</a></span>
</figcaption>
</figure>
<p>There were a number of dead ends, and one paper had to be <a href="http://news.sciencemag.org/brain-behavior/2014/07/key-narcolepsy-influenza-vaccine-findings-retracted">retracted</a> due to failure to replicate initial lab findings, but last month major progress was made. Scientists <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=Antibodies+to+influenza+nucleoprotein+cross-react+with+human+hypocretin+receptor+2">found</a> a part of the H1N1 virus that resembled the hypocretin receptor. They used antibodies from Finnish patients who had developed narcolepsy following Pandemrix vaccination, and added them to cells that were engineered to have a human hypocretin receptor on its surface.</p>
<p>The antibodies <a href="http://journals.lww.com/neurotodayonline/Fulltext/2015/08060/New_Evidence_Associates_Narcolepsy_with_Pandemic.2.aspx">bound to the hypocretin receptors</a>, suggesting they may also latch onto these receptors in people and cause degeneration of the hypocretin system in the brain and, therefore, narcolepsy. </p>
<p>This insight, as well as some <a href="http://www.sciencedirect.com/science/article/pii/S1474442214700754">evidence</a> that antibodies from some non-vaccinated patients with H1N1 infection binds to the hypocretin receptor, provides more data that viral agents act as a trigger for narcolepsy.</p>
<p>By understanding how environmental factors trigger narcolepsy, we may be able to develop treatments that could protect the hypocretin receptor, or allow it to recover. At present, treatment for narcolepsy involves using stimulant drugs such as dexamphetamine or modafinil to keep people awake, and certain types of antidepressants to prevent cataplexy. </p>
<p>The “date-rape” drug <a href="https://en.wikipedia.org/wiki/Gamma-Hydroxybutyric_acid">gamma-hydroxybutyrate</a> (GHB) is a powerful agent in people who have severe cataplexy and who don’t respond to antidepressants. GHB blocks the emotional triggering of loss of muscle tone and also improves sleep quality at night. It has just become available in Australia but is appropriate for only carefully selected patients.</p>
<p>Narcolepsy has <a href="http://www.theguardian.com/uk-news/2015/jul/13/woman-narcolepsy-swine-flu-jab-no-quality-life">devastating effects</a> on quality of life; promising young students’ careers are stopped in their tracks, and sufferers are often unemployable as they try to deal with intractable sleepiness and cataplexy attacks. </p>
<p>Often, it takes years to get diagnosed, with a further cost to their lives. But people treated with appropriate therapy combinations, quality specialist care and flexible employers can do well over time. </p>
<p>The mystery of narcolepsy is slowly being solved by painstaking research. There’s hope that sufferers of this unusual condition will not indefinitely stay sleeping beauties.</p><img src="https://counter.theconversation.com/content/45040/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ron Grunstein does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Perhaps because we all need sleep, we have an enduring interest in sleep disorders such as narcolepsy, which causes a constant irrepressible need for sleep.Ron Grunstein, Professor of Sleep Medicine, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/464642015-09-01T20:13:20Z2015-09-01T20:13:20ZWhy screen time before bed is bad for children<figure><img src="https://images.theconversation.com/files/93138/original/image-20150827-340-l70bx1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Limiting screen time before bedtime is beneficial for sleep.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Sleep is an essential part of our development and wellbeing. It is important for learning and memory, emotions and behaviours, and our health more generally. Yet the total amount of sleep that children and adolescents are getting is <a href="http://www.smrv-journal.com/article/S1087-0792(11)00034-7/abstract">continuing to decrease</a>. Why?</p>
<p>Although there are potentially many reasons behind this trend, it is emerging that screen time – by way of watching television or using computers, mobile phones and other electronic mobile devices – may be having a <a href="http://www.smrv-journal.com/article/S1087-0792(14)00081-1/abstract">large and negative impact</a> on children’s sleep.</p>
<h2>Electronic devices intrude on time for sleep</h2>
<p>The presence and use of these devices is incredibly widespread. A 2006 <a href="http://sleepfoundation.org/sites/default/files/2006_summary_of_findings.pdf">survey</a> showed that nearly all adolescents have at least one electronic device in their bedroom. </p>
<p>Given this, and the increasing exposure to screen time – particularly in the hours before bedtime – it is perhaps not surprising that screen time is now associated with insufficient and poor quality sleep. </p>
<p>A <a href="http://www.smrv-journal.com/article/S1087-0792(14)00081-1/abstract">2014 review</a> found consistent evidence that sleep was hampered by screen time, primarily in relation to shortened sleep duration and a delay in the timing of sleep. The latter finding was reported in 90% of the studies reviewed.</p>
<p>But the relationship between screen time and sleep is more complex than that. Screen time could be negatively influencing sleep in many ways.</p>
<p>The timing of screen time is one important factor. The use of these devices can lead to <a href="http://www.smrv-journal.com/article/S1087-0792(14)00081-1/abstract">delays</a> in the time that children and adolescents go to bed and, consequently, shorter sleep overall. </p>
<p>These negative impacts on sleep can be due to screen time in the evening cutting into the time that children would normally be preparing for bed and sleeping, delaying sleep onset and reducing the overall duration of sleep. There is simply less time available for it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/93146/original/image-20150827-326-4qefnh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Lights, games and dramas are stimulating, which delays sleep.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<h2>Bright lights and alertness</h2>
<p>It has also been <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1838348">suggested</a> that longer screen times may be affecting sleep by reducing the time spent doing other activities – such as exercise – that may be beneficial for sleep and sleep regulation.</p>
<p>Screen time in the hours directly prior to sleep is problematic in a number of ways other than just displacing the bed and sleep times of children and adolescents. The content of the screen time, as well as the light that these devices emit, <a href="http://www.sleep-journal.com/article/S1389-9457(10)00163-2/abstract">may also be responsible</a> for poorer sleep.</p>
<p>The content, or what we are actually engaging with on the screen, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2005.00463.x/full">can be detrimental to sleep</a>. For example, exciting video games, dramatic or scary television shows, or even stimulating phone conversations can engage the brain and lead to the release of hormones such as adrenaline. This can in turn make it more difficult to fall asleep or maintain sleep.</p>
<p>Less obvious, but still just as important, is the impact that light has on sleep and on our sleep-wake patterns in general. Many of the devices that are now routinely used by our youth emit bright light. Exposure to these light emissions in the important evening hours before sleep can increase <a href="http://www.smrv-journal.com/article/S1087-0792(07)00100-1/abstract">alertness</a>. </p>
<p>Bright light at night can also disrupt the body’s naturally occurring circadian (or daily) rhythms by suppressing the release of the hormone melatonin, which is <a href="http://link.springer.com/chapter/10.1007%2F978-3-642-25950-0_7">important</a> for maintaining and regulating our sleep-wake cycle.</p>
<h2>Limiting screen time to improve sleep</h2>
<p>The number of devices and amount of screen time children and adolescents are exposed to is continually increasing. Given these early associations with reduced sleep quality, and the importance of sleep in healthy development and ageing, this is an issue that is not likely to go away any time soon. </p>
<p>Sleep should be made a priority, and we can combat this growing problem in a number of ways.</p>
<p>It is becoming increasingly clear that <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1852609">limiting screen time</a> in the period leading up to bedtime is beneficial for sleep. In relation to this, removing electronic devices from the bedroom provides a good sleep environment and promotes good sleep practices.</p>
<p>Although it is yet to be established how much is too much when it comes to screen time, <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines">public guidelines</a> recommend that children under the age of 13 are limited to two hours per day, and children below five to less than one hour.</p>
<p>There are many advantages to the advancements in technology that go alongside the exposure to screen time, such as broader opportunities for learning and communicating, and development in general. However, the worrying trend of increased screen time at the cost of essential behaviours such as sleep should not be ignored. </p>
<p>With a more balanced approach to screen time and the use of electronic devices, the clear benefits can be obtained while still maintaining and prioritising sleep, health and development.</p><img src="https://counter.theconversation.com/content/46464/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Loughran receives funding from NHMRC.</span></em></p>Screen time – by way of watching television or using computers, mobile phones and other electronic mobile devices – may be having a large and negative impact on children’s sleep.Sarah Loughran, Research Fellow, University of WollongongLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/264022015-04-05T22:50:16Z2015-04-05T22:50:16ZHealth Check: here’s what you need to know about sleep apnoea<figure><img src="https://images.theconversation.com/files/75796/original/image-20150324-17672-1rnazp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with sleep apnoea often complain of daytime sleepiness, and have difficulty concentrating.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/joohander/4641901032">oohander/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p><a href="https://theconversation.com/explainer-what-is-obstructive-sleep-apnoea-9884">Sleep apnoea</a> is a condition where people repeatedly stop breathing while asleep. People with sleep apnoea often complain of daytime sleepiness, difficulties concentrating, and they tend to have high blood pressure. The people around them usually complain about their nightly snoring, gasping, and choking noises.</p>
<p>About 5% of people have treatable <a href="http://www.ncbi.nlm.nih.gov/pubmed/7735600">moderate or severe sleep apnoea</a>, which means they stop breathing 15 times or more times per hour while asleep. A larger number of people – as many as 20% of middle-aged folk – have mild sleep apnoea, which means they stop breathing around five to 15 times an hour. Although this may sound pretty scary, it’s still not clear that this mild version causes ill health.</p>
<p>Left untreated, sleep apnoea will <a href="http://www.ncbi.nlm.nih.gov/pubmed/24733978">not only shorten your life</a> by hastening a string of illnesses, it may also increase your risk of suffering from depression. And the general sleepiness of people with the condition is thought to as much as <a href="http://www.ncbi.nlm.nih.gov/pubmed/20465027">triple their risk for car accidents and injury</a>.</p>
<h2>Stroke risk</h2>
<p>The prevalence of sleep apnoea <a href="http://www.ncbi.nlm.nih.gov/pubmed/23589584">increases in ageing societies that are getting heavier</a>, along with other age and obesity-related diseases. But studies from around the world show your risk of developing these diseases is strongly influenced by whether or not you have sleep apnoea in the first place. In particular, the condition has been linked to stroke and cancer.</p>
<p>The consequences of stroke can range from between temporary inconvenience to serious life-altering disability and death. Smoking, cholesterol, and high blood pressure are <a href="http://strokefoundation.com.au/prevent-stroke/risk-factors/">three key causes of stroke</a> that you can control. And, unfortunately, sleep apnoea has a big impact on the latter. </p>
<p>The condition causes your daytime blood pressure to <a href="http://www.ncbi.nlm.nih.gov/pubmed/10805822">increase a little bit</a> over the long term. And, while you’re asleep, it causes <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970937">massive spikes in blood pressure</a>. Sleep apnoea also might make your <a href="http://www.ncbi.nlm.nih.gov/pubmed/21527567">ability to process cholesterol</a> a little less efficient. </p>
<p>So it’s not terribly surprising that <a href="http://www.ncbi.nlm.nih.gov/pubmed/16888274">studies from Spain</a>, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/20339144">United States</a>,
and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24733978">Australia</a> have all found people with untreated sleep apnoea are three times more likely to have a stroke.</p>
<h2>And cancer</h2>
<p>One of the more surprising recent research findings is sleep apnoea’s influence on cancer risk. Researchers really weren’t expecting to find this because we’d always thought sleep apnoea mainly influenced heart disease. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75793/original/image-20150324-17720-zfq4pa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The families of people with sleep apnoea often complain of their snoring, gasping, and choking noises.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/hayworthfamily/2921890898">Joshua Hayworth/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>But <a href="http://www.ncbi.nlm.nih.gov/pubmed/22610391">in study</a> after <a href="http://www.ncbi.nlm.nih.gov/pubmed/23155146">study</a> from around the world we’ve seen that sleep apnoea <a href="http://www.ncbi.nlm.nih.gov/pubmed/24733978">increases the risk of cancer</a> as well. And this association is not explained by other known cancer risks. </p>
<p>At this stage, we don’t think sleep apnoea causes cells to become cancerous. It might be that if you have a few cancer cells in your body, the constant up and down of oxygen levels in your blood while you sleep causes those <a href="http://www.ncbi.nlm.nih.gov/pubmed/23149216">cells to grow more quickly</a>. So instead of having a cancer that you never even realise you have or a slow-growing one, you get a <a href="http://www.ncbi.nlm.nih.gov/pubmed/18445039">faster growing and more aggressive version</a>.</p>
<p>It’s yet to be confirmed but melanomas are thought to be <a href="http://www.ncbi.nlm.nih.gov/pubmed/24659545">particularly likely to proliferate</a> quickly when you have sleep apnoea.</p>
<h2>Some good news</h2>
<p>Being the harbinger of bad news isn’t much fun so I’d like to give you some good news now. If you’ve only got <a href="http://www.ncbi.nlm.nih.gov/pubmed/24733978">mild sleep apnoea</a>, or <a href="http://www.ncbi.nlm.nih.gov/pubmed/22942501">you just snore a bit</a>, you probably don’t have an increased risk of illness. </p>
<p>In fact, if you have mild sleep apnoea, you might be able to manage your risk <a href="http://www.ncbi.nlm.nih.gov/pubmed/24560188">quite effectively with dietary changes</a>, which will improve your overall heath and stop you from developing a more severe version of the condition. </p>
<p>If you’ve got severe sleep apnoea, it’s really serious but still treatable, so it’s time to see a sleep doctor and get something done about it. More good news: if you do have severe sleep apnoea and you get it treated, your <a href="http://www.ncbi.nlm.nih.gov/pubmed/18714778">risk is much</a>, much <a href="http://www.ncbi.nlm.nih.gov/pubmed/15781100">lower</a>.</p>
<p>What all this adds up to is that sleep apnoea needs to be taken seriously; it’s not just a nuisance snoring condition. Not only will treatment help make you feel better, it will also reduce your risk for all kinds of attendant bad things from happening.</p><img src="https://counter.theconversation.com/content/26402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathaniel Marshall receives funding from the Australian National Health and Medical Research Council</span></em></p>Often the cause of snoring, sleep apnoea is actually a serious condition that can have a big impact on health and the development of chronic diseases.Nathaniel Marshall, Senior Lecturer in Sleep and Clinical Trials, University of SydneyLicensed as Creative Commons – attribution, no derivatives.