Lack of Sleep and Attention Deficit Disorder ADD Symptoms Seen In Patients with Sleep Apnea

WPXI-PITTSBURGH -- Can trouble sleeping affect an asthmatic's condition? Can it cause someone to develop the symptoms of attention deficit disorder?

New research says both are true.

Researchers at the big lung and critical care medicine meeting say that lack of sleep can play a role in both the day and night symptoms of asthma, and that sleep problems ranging from simple insomnia to sleep apnea can cause someone to have attention deficit disorder. "You seem short of breath and it gets worse and worse and then suddenly you can't breathe. It's like somebody strangling you." Mary Kane has asthma.

But her problems may not be limited to just breathing.

New research presented at the American College of Chest Physician's Annual Meeting shows asthmatics on the whole suffer significant sleep quality disturbances, and in turn, end up being sleepy during the daytime.

"So we have 487 patients, which I believe makes it the, of not one of the largest trials to look at sleep and asthma. And we found that their sleep is pretty bad. A full 30 percent of them categorize their sleep as poor or bad," says Dr. John Mastronarde, study researcher at Ohio State University.

50 percent of the patients studied reported waking up every night more than three times a week. The sleep disturbances translated into daytime sleepiness.

"We know from previous data in the literature that that has a significant consequences for public health, folks who are sleepy in the day have a high risk for car accidents, poor performance at work, etc," Mastronarde states.

There is also a chicken-egg scenario, in that the researchers found that not only does asthma create bad sleep, but that bad sleep in and of itself can worsen an asthmatic's breathing.

"We saw if your sleep is worse and then it gets better we saw that your overall quality of asthma got better as well," says Mastronarde.

Other research presented shows those with sleep apnea, a condition where a person stops breathing hundreds of times a night, can develop have a worsening of attention deficit disorder.

Of the patients studied with moderate to severe attention problems, 60 percent had their ADHD resolved after being placed on CPAP. The researchers believe that it doesn't just apply to sleep apnea, that any sleep problem can create ADHD-type symptoms.

Dr. Clifford Risk, the author of the study from the Marlboro Center for Sleep Disorders, says, "If they have ADHD the doctor should be asking them how their sleep is, do you snore or have sleep apnea and/or do you have insomnia at night?"

ADD symptoms were seen in patients with sleep apnea who had no prior history or evidence of ADD, meaning, the daytime sleepiness can actually cause add type symptoms.

Are Kids Snoring Their Way To ADHD? -Researchers Conclude Sleepiness And Sleep Apnea May Be Exhibited As Symptoms Of ADHD.

CNN Headline News -CHICAGO, Illinois (AP) -- New research suggests children who snore face nearly double the risk of being inattentive and hyperactive, providing fresh evidence of an intriguing link between sleep problems and attention deficit disorders.

CNN Headline News recently reported on a study that new research suggests children who snore face nearly double the risk of being inattentive and hyperactive, providing fresh evidence of an intriguing link between sleep problems and attention deficit disorders.

Children's behavioral problems may be linked to their sleep habits, according to a new study. Children who snore often are nearly twice as likely as other children to have attention and hyperactivity problems, found a new study by the University of Michigan Health System. The results, published in the March issue of the journal Pediatrics, provide some of the most solid evidence ever of a link between sleep problems and behavior. The link is strongest in boys under 8. Snorers in this group were more than three times more likely than non-snorers to be.

The National Commission on Sleep Disorders Research estimates that 38,000 cardiovascular deaths, due to sleep apnea, occur each year in the US. Over the long term, serious sleep apnea conditions have been linked to a greater risk of hypertension and cardiovascular diseases. However, sleep apnea was not well understood or recognized by the medical community until recently. And only a fraction of sufferers have been diagnosed and treated.

Treatment of Obstructive Sleep Apnea with a Chinstrap

Recently, anesthesiologists* in Japan released clinical trial information that demonstrates how a chinstrap alone improved obstructive sleep apnea (OSA) symptoms as well as or better than the use of continuous positive airway pressure (CPAP.) After obtaining permission from Kochi Municipal Hospital, the anesthesiologists conducted a limited pilot study that included 30 patients.

In the study, the use of CPAP shows substantial improvement in the patient’s OSA. However, the chinstrap appeared even more effective than CPAP. Additionally, the chinstrap improved the AHI better than CPAP and did not provoke the onset of sleep apnea episodes.

The anesthesiologists went on to report, “Maneuvers such as chin lift and jaw thrust improve airway patency and ventilation in anesthetized, spontaneously breathing children as well as in adults. In conclusion, lateral positioning combined with common airway maneuvers significantly improved airway patency.”

Notes:
OSA symptoms are often responsible for daytime sleepiness, motor vehicle crashes, hypertension, heart disease, and stroke. Treatments include weight loss, limiting alcohol consumption, CPAP, dental appliances and surgical interventions. *Young-Chang P. Arai, MD, Kayo Fukunaga, MD, Seiji Hirota, MD, and Shoji Fujimoto, MD - Department of Anesthesiology, Kochi Municipal Hospital; and Department of Anesthesiology, Kochi Medical School, Kochi, Japan

Could You Have a Sleep Disorder?

Are you spending enough time in bed, only to awake feeling exhausted and sleepy during the day? If so, you may be one of the estimated 40 million Americans with a sleep disorder. Relationships, along with school and job performance, often suffer because of persistent daytime fatigue that develops as a result of continuously disrupted sleep.

The most common sleep disorders are OSA, insomnia, restless legs syndrome and narcolepsy. Although sleep disorders can significantly affect your health, safety, and wellbeing, they can almost always be treated.

With the increased awareness in the doctor and patient communities, a growing number of new OSA patients are expected to be identified in the next few years.

Researchers and clinicians have recognized OSA as one of the most common sleep disorders and with perhaps the greatest medical and social impact on society in terms of morbidity and mortality. The syndrome strikes all sexes and all races, ages, socioeconomic strata, and ethnic groups, though it is less common in women prior to menopause, and may be more common in blacks than in whites.

Talk to your doctor if you have any of these signs of a sleep disorder:

• You consistently take more than 30 minutes each night to fall asleep.
• You consistently awaken several time each night and then have trouble falling back to sleep, or you awaken too early in the morning.
• You often feel sleepy during the day, you take frequent naps, or you fall asleep at inappropriate times during the day.
• Your bed partner says that when you sleep, you snore loudly, snort, gasp, make choking sounds, kick, and punch or stop breathing for short periods.
• You have creeping, tingling, or crawling feelings in your legs or arms that are relieved by moving or massaging them, especially in the evening and when trying to fall asleep.
• Your bed partner notices that your legs or arms jerk during sleep.

Children can have some of these same signs when they have a sleep disorder, but they often do not show signs of excessive daytime sleepiness. Instead they may seem overactive and have difficulty focusing or doing their best in school, which can be easily confused for ADHD.

How Much Sleep Is Enough?

Sleep needs vary from person to person, and they change throughout the lifecycle. Most adults need 7-8 hours of sleep each night. Newborns, on the other hand, sleep between 16 and 18 hours a day, and children in preschool sleep between 10 and 12 hours a day. Schoolaged children and teens need at least 9 hours of sleep a night. Teen girls between 14-17 years of age may need as much as 12-14 hours.

Love Handles and Fat Gain In Men

Men who suffer with OSA often gain weight in the abdomen due to the process of age. As men age, they typically get less and less sleep. With less deep sleep or slow wave sleep there is less bodily production of the growth hormone. That deficiency is associated with increased fat tissue and abdominal obesity, reduced muscle mass and strength, and reduced exercise capacity.

Sleepless Nights Can Cause Worse Problems Than Grumpiness

Most people take about 15 minutes to fall asleep, says researcher Thomas Roth, M.D.

Confession time: My husband has actually uttered the words "I'd rather take a nap than have sex." Is our marriage on the rocks? No, like 75 percent of adults, our problem is sleep -- he has insomnia; I snore.

We seem to be too busy to get enough sleep. On average, Americans sleep roughly 7 hours a night, 1 to 2 fewer hours per night than they did 40 years ago. And when we do hit the sack, sleep doesn't necessarily follow. No wonder my husband and I sometimes feel like zombies. Worse, there could be serious health repercussions due to our lack of shut-eye.

Do you have a sleep disorder?

How much sleep each person needs varies, though the differences may not be as great as you think, says Eve Van Cauter, Ph.D, professor of medicine at the University of Chicago. Studies have shown that sleep capacity - how long you'll sleep if you go to bed and get up whenever you want is about 8 hours and 45 minutes for healthy young males (the group that's been researched most). In three separate studies, that amount varied less than 30 minutes from person to person. "A lot of people who believe they need only 4 hours of sleep are unconsciously depriving themselves," Van Cauter says.

Most people need 7 to 8 hours a night, according to Lawrence Epstein, M.D., regional medical director for Sleep Health Centers in Boston, Massachusetts, and former president of the American Academy of Sleep Medicine.

"The idea shouldn't be to get into bed, fall asleep instantly, sleep a set number of hours, and wake up never having had your sleep disturbed," he explains. "The target should be to get an adequate amount of sleep to feel rested during the day."

How do you know you're not getting enough z's? "If you're falling asleep in 1 or 2 minutes, you're probably sleep deprived," says Thomas Roth, M.D., director of the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, Michigan.

On average, it takes most people about 15 minutes to fall asleep, though Roth notes that "it takes some people more time, some people less." Another way to tell if you're not sleeping enough is to monitor daytime sleepiness. Chronic daytime sleepiness is not normal, says Michael Twery, Ph.D., acting director of the National Center on Sleep Disorders Research. "People can live for decades and never appreciate that they have a sleep disorder and how it's affecting their lives."

The downside of running on empty

Scientists are finding more evidence that sleep deprivation can affect appetite, weight gain, diabetes risk, the strength of your immune system, and even your chance of developing depression.

In 2004, University of Chicago researchers restricted a group of men to only 4 hours of sleep per night. After just 2 nights, the men had an 18 percent decrease in leptin, a hormone that tells your brain when you are full, and a 28 percent increase in ghrelin, a hormone that triggers hunger. These results were reinforced last October by a study of almost 10,000 adults that found that people who slept fewer than 7 hours a night were more likely to be obese than those who got 7 hours of shut-eye. "

Chronic sleep deprivation causes changes in metabolism that produce a state that stimulates hunger," Epstein explains. Sleep deprivation can also affect how your body handles insulin; insulin resistance puts you at risk for weight gain and diabetes.

In a study that's still under way, Van Cauter and her colleagues are looking at chronic sleep loss in a group of normal-weight men and women under age 30. Over 6 months, those who slept fewer than 6.5 hours a night were more insulin-resistant than normal sleepers who logged 7.5 to 8 hours per night.

The short sleepers, the study shows so far, need to produce 30 to 40 percent more insulin to dispose of the same amount of glucose. Still other studies suggest that over time, sleep loss may play a role in the development of depression.

"Positive moods are lower in people with sleep loss," Van Cauter says, "and mood isn't stable over the 24-hour cycle. People have lower moods in the morning. They also have higher levels of cortisol, the stress hormone. All those changes are typical of clinical depression."

Whether its depression, diabetes, or a bigger dress size, the threat posed by sleep deprivation is real. Sleep disorders can be treated, but often patients fail to recognize the problem -- leading to more sleepless nights.

Restful Sleep Directly Related to Good Health

Clinical trials show that not getting enough sleep or getting poor quality sleep on a regular basis increases the risk of high blood pressure, heart disease, congestive heart failure, stroke and other medical conditions. The National Sleep Foundation reports that 70% of all congestive heart failure and 60% of all strokes is directly related to a sleep disorder.

"Virtually all heart attacks come down to a failure to deliver oxygen to the hardworking heart muscle,1" Philip Stavish, M.D. OSA causes a drop in blood oxygen saturation (SaO2) and an increase in the blood's carbon dioxide (CO2). When the SaO2 drops, the heart will start pumping more blood. With each beat, the SaO2 continues to drop and the heart beats faster and faster. As the CO2 increases the brain will try to drive the person to breathe. The effort and action of the abdomen and chest will increase. Eventually that action can become severe enough to cause an arousal, (but the arousal does not fully awaken the person) causing the person to "catch their breath," clearing the upper airway blockage and allowing the person to breathe. Then it happens all over again.

It is also important to remember that when the immune system is compromised by a lack of oxygen, we are more susceptible to opportunistic bacteria, viral, and parasitic infections and colds, as well as flu. Oxygen deprivation can also lead to life-threatening disease, such as cancer. Cancer and most other infections or disease cannot live in an oxygen-rich environment. "Cancer has only one prime cause. It is the replacement of normal oxygen respiration of the body's cells by an anaerobic (i.e., oxygen deficient) cell respiration2 ."

During sleep time, your body produces valuable hormones. Deep sleep triggers release of growth hormones which fuels growth in children and helps build muscle mass and repair cells and tissues in children and adults. Like growth hormones, cytokine increases during sleep and works to fight various infections. This might explain why a good nights sleep helps keep you from getting sick and shortens recover time when you do get sick.

Hormones released during sleep also affect how the body uses energy. Studies find that the less people sleep, the more likely they are to be overweight or obese, to develop diabetes, and to prefer eating foods that are high in calories and carbohydrates.

Can Snoring Kill? Dental Surgeons Say They've Found Why Snoring Can Kill

Snoring Can Indicate Serious Upper Airway Disorders. Blocked Airways Increase Blood Pressure, Damaging Arteries and Leading To Stroke

WASHINGTON (Reuters) Dental surgeons discover why snoring can kill: It can actually cause damage to the arteries.

Although considered harmless, snoring can actually indicate a serious medical condition called sleep apnea. Marked by irregular breathing, sleep apnea often causes sufferers to stop breathing completely for up to several seconds and has even been linked to stroke and heart disease in some patients.

"When persons with sleep apnea fall asleep, their tongue falls back into their throat, blocking their airway," Dr. Arthur Friedlander, an oral surgeon who worked on the study conducted at University of California's School of Dentistry, said in a statement.

"As they struggle for breath, their blood pressure soars...This rise in blood pressure damages the inner walls of the carotid arteries lining the sides of the neck," he added. "Cholesterol and calcium stick to the injury sites and amass into calcified plaques, which block blood flow to the brain. The result is often a massive stroke."

According to Dr. Friedlander, these deposits of calcium deposits are merely the tip of the iceberg. "The X-ray can't show the true size of the plaque, which is also made up of fat, platelets, and other soft tissue." When a person is suffering from sleep apnea, air cannot flow in or out of the nose or mouth. Oxygen is not taken in so carbon dioxide builds to dangerous levels in the blood.

"It's like pressing a pillow over someone's face, "Friedlander said.

Performance

We need restful sleep to think clearly, react quickly, and create memories. In fact, the pathways in the brain that help us learn and remember are very active when we sleep. Studies show that people who are taught mentally challenging tasks do better after a good night's sleep. Other research suggests that sleep is needed for creative problem solving.

Sleep also affects mood. Insufficient sleep can make you irritable and is linked to poor behavior and trouble with relationships, especially among children and teens. People who chronically lack sleep are also more likely to become depressed.

OSA is among the most common and most dangerous types of sleep disorders. An estimated 16% of the global population has the condition. OSA sufferers never get a "good nights sleep" because repeated arousals deprive patients of REM (deep sleep stage) leading to chronic daytime exhaustion and long-term cardiovascular stress. People who are obese are likely to have OSA due to the excess weight around the throat and neck. Those with receding chin lines are also at higher risk for developing obstructive sleep disorder.

Importance of Restful Sleep

In humans, it has been demonstrated that the metabolic activity of the brain decreases significantly after 24 hours of sustained wakefulness. Sleep deprivation results in a decrease in body temperature, a decrease in immune system function as measured by white blood cell count (the soldiers of the body), and a decrease in the release of growth hormone. Sleep deprivation can also cause increased heart rate variability.

For our nervous systems to work properly, sleep is needed. Sleep deprivation makes a person drowsy and unable to concentrate the next day. It also leads to impairment of memory and physical performance and reduced ability to carry out mathematical calculations. If sleep deprivation continues, hallucinations and mood swings may develop.

Release of growth hormone in children and young adults takes place during deep sleep. Most cells of the body show increased production and reduced breakdown of proteins during deep sleep. Sleep helps humans maintain optimal emotional and social functioning while we are awake by giving rest during sleep to the parts of the brain that control emotions and social interactions.

Why Sleep Is Good for You and Skimping On It Isn't

Does it really matter if you get enough sleep? Absolutely. Thanks to sleep studies conducted over the past several decades, it is now known that sleep has distinctive stages that cycle throughout the night. Your brain stays active throughout sleep, but different things happen during each stage.

For instance, certain stages of sleep are indeed vital for us to feel well rested and energetic the next day, and other stages help us learn or make memories.

Not only does the quantity of your sleep matter, but the quality of your sleep (restful sleep) is essential to good health. When sleep is interrupted or cut short, one might not get enough of certain stages of sleep. In other words, how well rested you are and how well you function the next day depends on your total sleep time and how much of the various stages of sleep you receive each night.

A number of vital tasks carried out during sleep time help maintain good health and enable people to function at their best. On the other hand, not getting enough restful sleep can be dangerousfor example, you are more likely to be in a car crash if you drive when you are drowsy.

Sleep Stages

Human sleep can be described as a succession of five recurring stages: four non-REM stages and the REM stage. A sixth stage, waking, is often included. Waking, in this context, is actually the phase during which a person falls asleep.

Waking

In this stage the body prepares for sleep. All people fall asleep with tense muscles and their eyes moving erratically. As a person becomes sleepier, the body begins to slow down, muscles relax and eye movement slows to a roll.

Stage 1

Stage 1 sleep, or drowsiness, is often described as first in the sequence. The eyes are closed during Stage 1 sleep, but if aroused from it, a person may feel as if he or she has not slept. Stage 1 may last for five to 10 minutes.

Stage 2

Stage 2 is a period of light sleep during which the heart rate slows and body temperature decreases. At this point, the body prepares to enter deep sleep.

Stages 3 AND 4

These are deep sleep stages, with Stage 4 being more intense than Stage 3. Stages 1-4 are non-REM sleep stages and lasts from 90 to 120 minutes, each stage lasting anywhere from 5 to 15 minutes. Stages 2 and 3 repeat backwards before REM sleep is attained. A normal sleep cycle has this pattern: waking, stage 1, 2, 3, 4, 3, 2, REM. Typically, REM sleep occurs approximately 90 minutes after sleep onset.

Stage 5 - REM Sleep

REM sleep is distinguishable from NREM sleep by changes in physiological states, including its characteristic rapid eye movements. Intense dreaming occurs during REM sleep as a result of heightened cerebral activity, but paralysis occurs simultaneously in the major voluntary muscle groups. It is generally thought that REM-associated muscle paralysis is meant to keep the body from acting out the dreams that occur during this intensely cerebral stage. The first period of REM typically lasts 10 minutes, with each recurring REM stage lengthening, and the final one lasting an hour.

Lack of Sleep Linked To Weight Problems

American Diabetes Association Clinical Trials Suggest Lack of Sleep Linked To Overweight and Obesity

In addition to the known health problems caused by lack of sleep, research suggests that too little sleep causes hormone changes that might lead to obesity. 924 people, 18 to 91 years of age were divided into four groups: normal weight, overweight, obese, and extremely obese. The researchers compared body mass to total sleep time and concluded that the less people slept, the heavier they tended to be (except in the extremely obese group.)

In addition to diet and exercise, quantity of sleep may be a key part of any weight-loss program. Overweight people are encouraged to examine their sleep quantity to improve weight-loss progress and results.