One in three older adults take something to help them sleep but many don't talk to their doctors

The percentage of Americans age 65-80 who report trouble falling asleep. 

Sleep doesn't come easily for nearly half of older Americans, and more than a third have resorted to some sort of medication to help them doze off at night, according to new results from the National Poll on Healthy Aging.

30 sept 2017--But most poll respondents said they hadn't talked to their doctor about their sleep, even though more than a third said their sleep posed a problem. Half believe—incorrectly—that sleep problems just come naturally with age.
The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and is sponsored by AARP and Michigan Medicine, U-M's academic medical center.
Those who turn to medications may not realize that prescription, over-the-counter and even "natural" sleep aids carry health risks, especially for older adults, either alone or in combination with other substances. In fact, national guidelines strongly warn against prescription sleep medicine use by people over age 65.
Despite this, the nationally representative poll of people ages 65 to 80 finds that 8 percent of older people take prescription sleep medicine regularly or occasionally. Among those who report sleep troubles three or more nights a week, 23 percent use a prescription sleep aid. Most who use such drugs to help them sleep had been taking them for years. Manufacturers and the U.S. Food and Drug Administration say such drugs are only for short-term use.

Medication: not the only option

"Although sleep problems can happen at any age and for many reasons, they can't be cured by taking a pill, either prescription, over-the-counter or herbal, no matter what the ads on TV say," says poll director Preeti Malani, M.D., a U-M physician trained in geriatric medicine. "Some of these medications can create big concerns for older adults, from falls and memory issues to confusion and constipation," even if they're sold without a prescription.
"The first step for anyone having trouble sleeping on a regular basis should be to talk to a doctor about it," she continues. "Our poll shows that nearly two-thirds of those who did so got helpful advice - but a large percentage of those with sleep problems simply weren't talking about it."
She notes that non-medication-based sleep habits are the first choice for improving sleep in older people. Sleep and health
In all, 46 percent of those polled had trouble falling asleep one or more nights a week. Fifteen percent of the poll respondents said they had trouble falling asleep three or more nights a week.

This image shows what older Americans (age 65-80) are taking to help them get to sleep. National guidelines recommend that prescription sleep aids not be used by people in this age group. 

Other health conditions can contribute to sleep difficulties. Twenty-three percent of poll respondents who had trouble sleeping said it was because of pain. And 40 percent of those with frequent sleep problems said their overall health was fair or poor. Other reasons for sleep troubles included having to get up to use the bathroom at night, and worry or stress.
Insomnia and other irregular sleep patterns can interfere with daytime functioning, and are associated with memory issues, depression and an increased risk of falls and accidents. Even so, many said they didn't see sleep issues as a health problem - in fact, this belief was the most common reason that poll respondents said they didn't talk to their doctor about sleep.
This also highlights the need for doctors to ask their older patients about their sleep habits and what they're doing to address any issues they may be having
"We know that sleep is a critical factor for overall health as we age, and this new research highlights sleep problems as both a significant health issue for older adults and an underacknowledged one both by patients and their providers," says Alison Bryant, Ph.D., senior vice president of research for AARP. "We need to help people understand that lack of sleep is not just a natural part of aging."

More about medication use

In all, 14 percent of the poll respondents said they regularly took a prescription sleep medication, prescription pain medication, OTC sleep aid or herbal supplement to help them sleep. Another 23 percent took one of these options occasionally; most of the occasional users said they chose OTC sleep aids.
The most recent Beers Criteria established by the American Geriatrics Society, which guides the use of medications among older people, gives a strong warning against use of prescription sleep drugs, which are sold under such names as Ambien, Lunesta and Sonata.
Meanwhile, even though OTC sleep aids can be purchased without a doctor's guidance or prescription, they still carry health risks for older people, Malani notes. Most of them contain diphenhydramine, an antihistamine that can cause side effects such as confusion, urinary retention and constipation.
Among poll respondents with frequent sleep problems who took something occasionally to help them sleep, OTC sleep remedies were the most common choice. But among those with frequent sleep issues who took something on a regular basis to try to sleep, prescription sleep medications were the most common option, with 17 percent reporting use.
Use of melatonin and other herbal remedies may be perceived as safer, but less is known about their potential side effects and they are not subject to the FDA's approval process for medications, says Malani. But any issue that prompts someone to buy an OTC or herbal remedy on a regular basis is something they should discuss with their doctor, she adds.
The poll results are based on answers from a nationally representative sample of 1,065 people ages 65 to 80, who answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.
A full report of the findings and methodology is available at www.healthyagingpoll.org


Provided by University of Michigan

Expert panel recommends new sleep durations

12 feb 2015--The National Sleep Foundation (NSF), along with a multi-disciplinary expert panel, issued its new recommendations for appropriate sleep durations. The report recommends wider appropriate sleep ranges for most age groups. The results are published in Sleep Health: The Official Journal of the National Sleep Foundation.

The National Sleep Foundation convened experts from sleep, anatomy and physiology, as well as pediatrics, neurology, gerontology and gynecology to reach a consensus from the broadest range of scientific disciplines. The panel revised the recommended sleep ranges for all six children and teen age groups. A summary of the new recommendations includes:

• Newborns (0-3 months): Sleep range narrowed to 14-17 hours each day (previously it was 12-18)
• Infants (4-11 months): Sleep range widened two hours to 12-15 hours (previously it was 14-15)
• Toddlers (1-2 years): Sleep range widened by one hour to 11-14 hours (previously it was 12-14)
• Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13)
• School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11)
• Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)
• Younger adults (18-25): Sleep range is 7-9 hours (new age category)
• Adults (26-64): Sleep range did not change and remains 7-9 hours
• Older adults (65+): Sleep range is 7-8 hours (new age category)

"This is the first time that any professional organization has developed age-specific recommended sleep durations based on a rigorous, systematic review of the world scientific literature relating sleep duration to health, performance and safety," said Charles A. Czeisler, PhD, MD, chairman of the board of the National Sleep Foundation, chief of sleep and circadian disorders at Brigham and Women's Hospital, and Baldino Professor of Sleep Medicine at the Harvard Medical School. "The National Sleep Foundation is providing these scientifically grounded guidelines on the amount of sleep we need each night to improve the sleep health of the millions of individuals and parents who rely on us for this information."

A new range, "may be appropriate," has been added to acknowledge the individual variability in appropriate sleep durations. The recommendations now define times as either (a) recommended; (b) may be appropriate for some individuals; or (c) not recommended.

"The National Sleep Foundation Sleep Duration Recommendations will help individuals make sleep schedules that are within a healthy range. They also serve as a useful starting point for individuals to discuss their sleep with their health care providers," said David Cloud, CEO of the National Sleep Foundation.

The recommendations are the result of multiple rounds of consensus voting after a comprehensive review of published scientific studies on sleep and health. The expert panel included six sleep experts and experts from the following stakeholder organizations:

- American Academy of Pediatrics

- American College of Chest Physicians

- American Geriatrics Society

- American Neurological Association

- American Physiological Society

- American Psychiatric Association

- American Thoracic Society

- Gerontological Society of America

- Human Anatomy and Physiology Society

- Society for Research in Human Development

- American Congress of Obstetricians and Gynecologists

"The NSF has committed to regularly reviewing and providing scientifically rigorous recommendations," says Max Hirshkowitz, PhD, Chair of the National Sleep Foundation Scientific Advisory Council. "The public can be confident that these recommendations represent the best guidance for sleep duration and health."

More information: To view the full results and methodology of the report, please visit sleephealthjournal.org

Provided by National Sleep Foundation

Sleeping too little—or too much—associated with heart disease, diabetes, obesity

A new study by the Centers for Disease Control and Prevention (CDC) links too little sleep (six hours or less) and too much sleep (10 or more hours) with chronic diseases—including coronary heart disease, diabetes, anxiety and obesity—in adults age 45 and older. The American Academy of Sleep Medicine (AASM) encourages patients suffering from these common chronic conditions to speak with a sleep medicine physician who can evaluate their sleep patterns.

02 oct 2013--"It's critical that adults aim for seven to nine hours of sleep each night to receive the health benefits of sleep, but this is especially true for those battling a chronic condition," said Dr. M. Safwan Badr, president of the AASM. "Common sleep illnesses—including sleep apnea and insomnia—occur frequently in people with a chronic disease and can hinder your ability to sleep soundly. So if you're waking up exhausted, speak with a sleep physician to see if there's a problem. If you are diagnosed with a sleep illness, treating it could significantly improve disease symptoms and your quality of life."

"Some of the relationships between unhealthy sleep durations and chronic diseases were partially explained by frequent mental distress and obesity," said study co-author Janet B. Croft, PhD, senior chronic disease epidemiologist in CDC's Division of Population Health. "This suggests that physicians should consider monitoring mental health and body weight in addition to sleep health for patients with chronic diseases."

In the study, published in the October issue of the Journal Sleep, short sleepers reported a higher prevalence of coronary heart disease, stroke and diabetes, in addition to obesity and frequent mental distress, compared with optimal sleepers who reported sleeping seven to nine hours on average in a 24-hour period. The same was true for long sleepers, and the associations with coronary heart disease, stroke and diabetes were even more pronounced with more sleep.

"Sleeping longer doesn't necessarily mean you're sleeping well. It is important to understand that both the quality and quantity of sleep impact your health," said Badr. "A healthy, balanced lifestyle is not limited to diet and fitness; when and how you sleep is just as important as what you eat or how you exercise."

The study involved more than 54,000 participants age 45 or older in 14 states. Nearly one third of participants (31 percent) were identified as short sleepers, meaning they reported sleeping six hours or less on average. More than 64 percent were classified as optimal sleepers, and only 4 percent of participants were long sleepers.

More information: journalsleep.org/ViewAbstract.aspx?pid=29127

Provided by American Academy of Sleep Medicine

Surprising connections between our well-being and giving, getting, and gratitude

We all know that getting a good night's sleep is good for our general health and well-being. But new research is highlighting a more surprising benefit of good sleep: more feelings of gratitude for relationships.

22 jan 2013--"A plethora of research highlights the importance of getting a good night's sleep for physical and psychological well-being, yet in our society, people still seem to take pride in needing, and getting, little sleep," says Amie Gordon of the University of California, Berkeley. "And in the past, research has shown that gratitude promotes good sleep, but our research looks at the link in the other direction and, to our knowledge, is the first to show that everyday experiences of poor sleep are negatively associated with gratitude toward others – an important emotion that helps form and maintain close social bonds."

Social psychologists are increasingly finding that "prosocial" behavior – including expressing gratitude and giving to others – is key to our psychological well-being. Even how we choose to spend our money on purchases affects our health and happiness. And children develop specific ways to help others from a very young age. Gordon and other researchers will be presenting some of these latest findings at the Society for Personality and Social Psychology (SPSP) annual meeting today in New Orleans.

Sleeping to feel grateful

A large body of research has documented that people who experience gratitude are happier and healthier. In three new studies, Gordon and Serena Chen, also of the the University of California, Berkeley, explored how poor sleep affects people's feelings of gratitude.

In the first study, people who experienced a poor night's sleep were less grateful after listing five things in life for which they were appreciative than were people who had slept well the night before. The researchers adapted the Pittsburgh Sleep Quality Index, which measures sleep quality and number of hours slept, among other variables, to evaluate the previous night's sleep.

In the second study, participants recorded their sleep from the previous night for two weeks and their feelings of gratitude. The researchers found a decline in gratitude associated with poor sleep, and those participants reported feeling more selfish those days.

The final study looked at heterosexual couples and found that people tend to feel less grateful toward their romantic partners if either they or their partners generally sleep poorly. "In line with this finding, people reported feeling less appreciated by their partners if they or their partner tends to sleep poorly, suggesting that the lack of gratitude is transmitted to the partner," Gordon says.

"Poor sleep is not just experienced in isolation," Gordon says. "Instead, it influences our interactions with others, such as our ability to be grateful, a vital social emotion."

Giving away money to feel wealthy

Just as expressing gratitude confers benefits, so too does giving to others. New research shows that people all around the world – from Canada to Uganda, from South Africa to India – derive more happiness from spending money on others than they do on themselves.

"For the first time, we show that giving away money or spending it on others confers the ironic psychological benefit of increasing the giver's sense of wealth," says Michael Norton of Harvard Business School and co-author with Elizabeth Dunn of the University of British Columbia of the upcoming book Happy Money: The Science of Smarter Spending. In a suite of new, not-yet published, studies, Norton and colleagues showed that charitable giving makes people feel wealthier.

This research follows on other recent work published in Psychological Science by Norton and colleagues that shows that giving time to others – from helping with homework to shoveling a neighbors' driveway – actually makes people feel that they have more time. "In fact, giving time away alleviates people's sense of time famine even more than receiving unexpected windfalls of free time."

That people feel wealthier from spending money on others may explain why poor individuals tend to give away a higher fraction of their income than members of the middle class do. In one study, researchers reported that Americans earning less than $20,000 a year give a higher percentage of their income to charity than others earning up to $300,000 a year.

"Our results suggest when the poor give money away, that very act might mitigate their feelings of poverty," Norton says. "More broadly than this specific benefit, our investigation contributes to the growing body of research documenting the benefits of prosocial behavior, which include greater happiness, reduced mortality, and better immune function."

Buying experiences to feel happy

In related research, psychologists are finding that spending money on experiential purchases, such as vacations, concerts, and meals out, tends to bring us more happiness than material purchases, such as clothing, jewelry, or electronic gadgets. Amit Kumar and Thomas Gilovich of Cornell University are investigating one potential explanation for this difference: that experiences prompt storytelling more than possessions do.

In new research, they asked participants to recall either a significant experiential purchase or a significant material purchase. They then asked them how much they had talked about the purchase they recalled, and questions related to the satisfaction they derived from their purchase. Participants rated a higher satisfaction for experiences than for possessions, which was because they were more likely to talk about the experiences with other people.

In another experiment, the researchers measured what happens when people cannot talk about their purchases. They asked participants if they would be willing to pay a price to be able to talk about a beach vacation (experiential purchase) or an electronic good (material purchase). "Participants were more likely to switch from a better purchase that they could not talk about to a lesser purchase that they could talk about in the experiential condition than in the material one," Kumar says.

"Well-being is likely to be enhanced by shifting the balance of spending in our consumer society away from material goods and towards experiential ones," Kumar says. "This research also suggests that there are benefits to be had not only by nudging people to choose experiences over possessions, but also by encouraging people to share stories about their experiences."

Knowing what is best to help others

The roots for how we give to others form at a very young age. Children, it turns out, are very sophisticated givers – not only coming to someone's aid when needed but also coming up with the best strategy for doing so, often independent of an adult's instruction.

In new research, Kristina Olson of Yale University and Alia Martin have found that children often will act, thinking they know better than others what is best for them or others. In a series of experiments, the researchers investigate whether 3-year-old children will help someone by ignoring the specific request and instead offering a better alternative.

In one study, for example, when an experimenter asks the child for a specific marker, but the child knows that marker does not work, the child will instead offer up a better marker. In another study, a pre-recorded child asks the child participant to give her a piece of chocolate via a tube that supposedly connects them. If the participant knows that chocolate makes the other child sick, the participant will decide to give her fruit snacks instead.

"Perhaps most provocatively, children will selectively decide not to help in this way if they don't like the person," Olson says. "For example, if an experimenter has previously been mean, children won't warn the adult of a potential harm – such as something sharp in the container they are reaching in – but will if the experimenter was not mean."

"These results suggest that children are able to help adults and peers already by the preschool years in rather complex ways, even when the beneficiary is misguided about what he or she wants," Olson says. "Children don't just blindly do as they are requested, but rather consider a person's goal and consider alternative possible ways to achieve that goal."

Provided by Society for Personality and Social Psychology

Lack of sleep may increase calorie consumption

If you don't get enough sleep, you may also eat too much — and thus be more likely to become obese.

17 march 2012--That is the findings of researchers who presented their study at the American Heart Association's Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 Scientific Sessions.

"We tested whether lack of sleep altered the levels of the hormones leptin and ghrelin, increased the amount of food people ate, and affected energy burned through activity," said Virend Somers, M.D., Ph.D., study author and professor of medicine and cardiovascular disease at the Mayo Clinic, Rochester, Minn.. Leptin and ghrelin are associated with appetite.

The researchers studied 17 normal, healthy young men and women for eight nights, with half of the participants sleeping normally and half sleeping only two-thirds their normal time.

Participants ate as much as they wanted during the study.

Researchers found:

• The sleep deprived group, who slept one hour and 20 minutes less than the control group each day consumed an average 549 additional calories each day.
• The amount of energy used for activity didn't significantly change between groups, suggesting that those who slept less didn't burn additional calories.
• Lack of sleep was associated with increased leptin levels and decreasing ghrelin — changes that were more likely a consequence, rather than a cause, of over-eating.

"Sleep deprivation is a growing problem, with 28 percent of adults now reporting that they get six or fewer hours of sleep per night," said Andrew D. Calvin, M.D., M.P.H., co-investigator, cardiology fellow and assistant professor of medicine at the Mayo Clinic.

The researchers noted that while this study suggests sleep deprivation may be an important part and one preventable cause of weight gain and obesity, it was a small study conducted in a hospital's clinical research unit.

"Larger studies of people in their home environments would help confirm our findings," Calvin said.

Provided by American Heart Association

Women's study finds longevity means getting just enough sleep

A new study, derived from novel sleep research conducted by University of California, San Diego researchers 14 years earlier, suggests that the secret to a long life may come with just enough sleep. Less than five hours a night is probably not enough; eight hours is probably too much.

04 oct 2010--A team of scientists, headed by Daniel F. Kripke, MD, professor emeritus of psychiatry at UC San Diego School of Medicine, revisited original research conducted between 1995 and 1999. In that earlier study, part of the Women's Health Initiative, Kripke and colleagues had monitored 459 women living in San Diego (ranging in age from 50 to 81) to determine if sleep duration could be associated with mortality.

Fourteen years later, they returned to see who was still alive and well.

Of the original participants, 444 were located and evaluated. Eighty-six women had died. Previous studies, based upon questionnaires of people's sleep habits, had posited that sleeping 6.5 to 7.5 hours per night was associated with best survival. Kripke and colleagues, whose 1990s research had used wrist activity monitors to record sleep durations, essentially confirmed those findings, but with a twist.

"The surprise was that when sleep was measured objectively, the best survival was observed among women who slept 5 to 6.5 hours," Kripke said. "Women who slept less than five hours a night or more than 6.5 hours were less likely to be alive at the 14-year follow-up."

The findings are published online in the journal Sleep Medicine.

Kripke said the study should allay some people's fears that they're not getting enough sleep. "This means that women who sleep as little as five to six-and-a-half hours have nothing to worry about since that amount of sleep is evidently consistent with excellent survival. That is actually about the average measured sleep duration for San Diego women."

Researchers uncovered other interesting findings as well. For example, among older women, obstructive sleep apnea (pauses in breathing during sleep) did not predict increased mortality risk. "Although apneas may be associated with increased mortality risk among those under 60, it does not seem to carry a risk in the older age group, particularly for women," Kripke said.

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Co-authors of the study include Robert D. Langer of the Jackson Hole Center for Preventive Medicine; Jeffrey A. Elliot and Katharine M. Rex of the UCSD Department of Psychiatry; and Melville R. Klauber of the UCSD Department of Family and Preventive Medicine.

Study shows that elderly women sleep better than they think, men sleep worse

Westchester, Ill.05 oct 2009 —A study in the Oct.1 issue of the journal Sleep shows that elderly women sleep better than elderly men even though women consistently report that their sleep is shorter and poorer.

Women reported less and poorer sleep than men on all of the subjective measures, including a 13.2 minute shorter total sleep time (TST), 10.1 minute longer sleep onset latency (SOL), and a 4.2 percent lower sleep efficiency. When sleep was measured objectively, however, women slept 16 minutes lon¬ger than men, had a 1.2 percent higher sleep efficiency, and had less fragmented sleep. Multivariate regression analysis showed that these discrepancies were partly explained by determinants of sleep duration such as sleep medication use and alcohol consumption.

Principal investigator Henning Tiemeier, MD, PhD, associate professor of psychiatric epidemiology at the Erasmus Medical Center in Rotterdam, Netherlands, said he was surprised that women slept longer and better, and reported their sleep duration more accurately, than men.

"The difference between subjective and objective sleep quality arise not because women are more likely to be complainers, but because men strongly overestimate their sleep duration," said Tiemeier. The study involved 956 participants between the ages of 59 and 79 years; 52.3 percent were women. Information was obtained from the Rotterdam Study, a population-based cohort study aimed at assessing the occurrence of and risk factors for chronic diseases in the elderly.

Subjects used an actigraph that can be worn like a watch for an average of six consecutive nights to objectively measure sleep parameters. Subjective sleep quality was assessed with a sleep diary and the Pittsburgh Sleep Quality Index.

The mean difference between diary-reported and actigraphic total sleep time was larger in men (estimated total sleep time of 7.01 hours versus 6.40 objectively measured hours) than in women (estimated total sleep time of 6.79 hours versus 6.65 objectively measured hours). Sleep medication use was more common in women (14.9%) than men (6.1%), and both sleep medication use and depressive symptoms were related to significantly shorter subjective sleep time in women. Men consumed twice as much alco¬hol as women (1.0 drink/day versus 0.5 drink/day), and only alcohol consumption decreased the sex difference in actigraphic total sleep time.

According to the authors, the sex differences in both self-reported and objective sleep measures may be explained by the fact that women may require more sleep than men, meaning the same amount of sleep may be satisfactory for men but not for women.

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Sleep is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. Sleep, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

Less than half of older Americans get the recommended 8 hours of nightly sleep

WESTCHESTER, Ill., 11 june 2009 –Older Americans with depressive symptoms and poor mental health tend to get seven hours of sleep per night or less, according to a research abstract that will be presented on Wednesday, June 10, at SLEEP 2009, the 23rd Annual Meeting of the Associated Professional Sleep Societies.

Results indicate that 55 percent of the total study population reported sleeping on average for seven hours or less per night over the past month, and 61 percent reported a sleep-onset latency of 15 minutes or less. Older adults who were more educated, had higher household incomes, were black, reported more depressive symptoms, were more active, complained of difficulties maintaining sleep, and complained of 'leg jerks' at night were the most likely to report more difficulty performing everyday functions as related to feeling sleep or tired.

According to lead author Karen Rose, PhD, at the University of Virginia in Charlottesville, older adults who were unmarried, black and who reported having more difficulties with initiating or maintaining sleep had statistically greater odds of having a shortened sleep duration. People who reported depressive symptoms were also more likely to have short sleep durations.

"We were surprised by the fact that the self-reported amount of physical activity did not predict functional outcomes of sleep. We anticipated that people who reported lower levels of physical activity would have more difficulty with sleep-related functional outcomes," said Rose. "We were also surprised to find that reported numbers of hours slept each night did not predict whether or not an individual experienced poor functional outcomes as a result of being sleepy or tired."

The study involved data from 1,570 men and women who were 60 years of age or older, who had completed telephone or in-home surveys. Of the total sample, 61 percent were non-Hispanic white, 20.4 percent were non-Hispanic black, and 15 percent were Mexican-Americans. A diagnosis of sleep apnea was reported by 5.4 percent of participants, 18 percent reported feeling 'unrested during the day' as 'often' or 'almost always,' and 11 percent reported frequent use of sleeping pills.

According to authors of the study, short sleep duration is a serious concern for older adults, as it has been associated with cardiovascular disease, insulin resistance, and an increased risk for falling in this demographic.

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For more information on sleep and aging, visit: http://www.sleepeducation.com/Topic.aspx?id=30

The annual SLEEP meeting brings together an international body of 6,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

Abnormal Sleep Schedule Linked to Adverse Effects

Lab study with 28-hour day linked to altered leptin, glucose, cortisol rhythm other changes

08 mar 2009-- An altered sleep-wake cycle such as that seen during jet lag and shift work can have wide-ranging metabolic and cardiovascular implications, according to research published online Mar. 2 in the Proceedings of the National Academy of Sciences.

Frank A.J.L. Scheer, Ph.D., of Brigham and Women's Hospital in Boston, and colleagues analyzed data from 10 healthy men and women aged 19 to 41 who underwent a 10-day laboratory study in which they lived in individual suites and ate and slept according to a 28-hour "day" without time cues. They ate four meals of equal calories during each day.

When subjects' eating and sleeping times were misaligned from normal, leptin was 17 percent lower, glucose and insulin were 6 and 22 percent higher, respectively, mean arterial pressure was 3 percent higher, sleep efficiency was reduced by 20 percent, and the daily cortisol rhythm was completely reversed, the researchers report.

"Approximately 8.6 million Americans perform shift work, which is associated with increased risk of obesity, diabetes and cardiovascular disease," the authors write. The effects of the circadian misalignment on glucose, leptin, sleep efficiency and other factors "may provide a mechanism underlying the increased risk for obesity, hypertension and diabetes in shift workers."

Abstract
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Study suggests that inflammation may be the link between extreme sleep durations and poor health

The activation of pro-inflammatory cytokines may be a mechanism by which short and long sleep durations affect health

Westchester, Ill., 01 feb 2009 — A study in the Feb. 1 issue of the journal SLEEP shows that sleep duration is associated with changes in the levels of specific cytokines that are important in regulating inflammation. The results suggest that inflammation may be the pathway linking extreme sleep durations to an increased risk for disease.

Each additional hour of self-reported sleep duration was associated with an eight-percent increase in C-reactive protein (CRP) levels and a seven-percent increase in interleukin-6 (IL-6), which are two inflammatory mediators. In contrast, each hour of reduction in sleep measured objectively by polysomnography was associated with an eight-percent increase in tumor necrosis factor alpha, another pro-inflammatory cytokine.

"The most surprising finding was that we found different relationships based on how sleep was measured," said lead author Dr. Sanjay R. Patel, assistant professor of medicine at Case Western Reserve University in Cleveland, Ohio.

According to the authors, research has linked both short and long sleep durations with an increased risk for mortality, coronary heart disease, diabetes and obesity. Chronic elevations in cytokines such as CRP and IL-6 also are associated with an increased risk of problems such as diabetes and heart disease.

The study involved 614 individuals from the Cleveland Family Study, a longitudinal family-based epidemiological cohort designed to study the genetics of obstructive sleep apnea (OSA). Participants completed questionnaires about sleep habits and underwent one night of polysomnography. In the morning a fasting blood sample was collected, and it was analyzed for five inflammatory cytokines.

Mean self-reported habitual sleep duration was 7.6 hours; mean sleep duration measured by polysomnography on the night prior to blood sampling was 6.2 hours. Those with long sleep durations, assessed by either measure, were significantly younger. Short sleep duration measured by polysomnography was associated with an increased prevalence of diabetes, hypertension and obstructive sleep apnea.

According to the authors the differing patterns of association with cytokine levels suggest that self-reported habitual sleep duration may measure chronic sleep exposure, while polysomnography may measure an acute exposure. They also note that the two methods of measuring sleep duration may be influenced differently by an underlying predictor of sleep habits such as stress or mood, which may have a direct effect on cytokine levels.

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SLEEP is the official journal of the Associated Professional Sleep Societies, LLC (APSS), a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The APSS publishes original findings in areas pertaining to sleep and circadian rhythms. SLEEP, a peer-reviewed scientific and medical journal, publishes 12 regular issues and 1 issue comprised of the abstracts presented at the SLEEP Meeting of the APSS.

Longer sleep tied to worse cholesterol in seniors

NEW YORK,09 jan 2009-- Older people who spend more time sleeping have higher cholesterol levels, and less "good" HDL cholesterol, Dutch researchers report.

People who sleep fewer than seven hours a night, as well as those who log more than eight hours may be more likely to develop heart disease, although it's not clear why, Dr. Julia F. van den Berg of Erasmus Medical Center in Rotterdam and colleagues note in the medical journal Psychosomatic Medicine.

To investigate whether cholesterol might be a factor, van den Berg and her team compared sleep duration and total cholesterol levels, as well as the ratio of total to HDL cholesterol, in 768 men and women 57 to 97 years old.

The researchers used actigraphy to measure sleep duration, which involves using a wristwatch-like device to keep track of movement and has been shown to be a more reliable gauge of sleep time than a person's own report. People wore the device for five to seven days and nights.

None of the study participants used cholesterol-lowering drugs.

Overall, van den Berg's team found, people who slept longer had higher cholesterol levels. Among people younger than 65, spending a longer time in bed accounted for most of the relationship. For people 70 and older, the relationship was largely due to the fact that people with more fragmented sleep -- and therefore less sleep time -- had lower cholesterol levels.

It's possible that people who spend more time in bed may be less active, and hence have higher cholesterol levels, the researchers note, but the link between fragmented sleep and low cholesterol is more difficult to explain; underlying illness could be a possibility.

SOURCE: Psychosomatic Medicine, November/December 2008.

A Mysterious Link Between Sleeplessness and Heart Disease

By RONI CARYN RABIN
25 dec 2008--People who don’t get much sleep are more likely than those who do to develop calcium deposits in their coronary arteries, possibly raising their risk for heart disease, a new study has found.

The 495 participants in the study filled out sleep questionnaires and kept a log of their hours in bed. At night they also wore motion-sensing devices around their wrists that estimate the number of hours of actual sleep. At the beginning, none of the participants, who were ages 35 to 47, had evidence of coronary artery calcification.

Five years later, 27 percent of those who were sleeping less than five hours a night on average had developed coronary artery calcification for the first time, while only 6 percent of those who were sleeping seven hours or more had developed it. Among those who were sleeping between five and seven hours a night, 11 percent had developed coronary artery calcification, the study found.

After accounting for various other causes, the researchers concluded that one hour more of sleep per night was associated with a 33 percent decrease in the odds of calcification, comparable to the heart benefit gained by lowering one’s systolic blood pressure by 17 millimeters of mercury.

The study was published on Tuesday in the Journal of the American Medical Association. The data were drawn from the ongoing Coronary Artery Risk Development In Young Adults study.

Senior author Diane S. Lauderdale cautioned that the new report does not prove a cause-and-effect relationship between a lack of sleep and heart disease.

“It’s important to say that this is the first report and this does not yet prove the association is causal,” said Dr. Lauderdale, an associate professor of health studies at the University of Chicago Medical Center. “Until we know what the mechanism is -- that it’s really a direct or a causal relationship -- there is no point in making recommendations based on this.”

Although a number of studies have suggested that people who sleep less are at greater risk of heart disease and death, this is the first investigation to measure how much its subjects actually are sleeping, said Dr. Sanjay Patel, assistant professor of medicine at Case Western Reserve University and expert in sleep medicine. Patients’ own self-assessments can be very inaccurate, he added.

What isn’t clear is whether reduced sleep triggers physiological changes that increase heart disease risk, or whether a third, unrelated factor causes both changes, he said.

“It’s possible, for example, that people who are under more stress may be both sleeping less and at higher risk of heart disease,” Dr. Patel said.

If so, he added, “If we got those people to sleep more but they still were under a lot of stress, it wouldn’t change their risk of heart disease.”

Higher education levels are also associated with both a lower risk of heart disease and a tendency to get more sleep, said Dr. Lauderdale.

But it is also possible that lack of sleep leads to certain changes, like increasing blood levels of the stress hormone cortisol, which can raise the risk of coronary artery disease over time, Dr. Lauderdale said.

Another possible mechanism could be through the effect that sleep has on average blood pressure levels over a 24-hour period. Blood pressure usually dips when people are asleep, which could provide health benefits for those who get more sleep, Dr. Lauderdale suggested.

Landmark study links sleep, memory problems in elderly African-Americans

15 oct 2008--A landmark study led by North Carolina State University researchers shows that African-American seniors who have trouble falling asleep are at higher risk of having memory problems – raising the possibility that identifying and treating sleep difficulties in the elderly may help preserve their cognitive functioning. The study is the first to examine the link between sleep and cognitive functioning in older African-Americans.
The study, led by NC State psychology Ph.D. student Alyssa A. Gamaldo, shows that older African-Americans who reported having trouble falling asleep tended to do much worse on memory tests than those study participants who did not have trouble falling asleep. Gamaldo says that the difference was particularly apparent in tests related to "working memory," which is the ability to multitask or do two things at once. The study examined 174 subjects between the ages of 65 and 90.
Gamaldo says the findings raise additional questions, which will have to be addressed in future research. For example, Gamaldo says, "it is not clear if lack of sleep is the issue. Is it the quantity of sleep, the quality of sleep, or something else altogether?"
The study raises questions for future research on both sleep and cognitive functioning in the elderly. The findings indicate that sleep may need to be accounted for as a confounding variable in cognition studies targeting seniors. In addition, the findings show that sleep research may need to increase its focus on older adults in order to fully explore the impacts of sleep problems on cognition in seniors.
"If we can better understand how sleep quantity, as well as quality, influences general cognitive functioning, perhaps we could better maintain memory throughout life – including later in life," Gamaldo says.
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The study, "The Relationship Between Reported Problems Falling Asleep and Cognition Among African American Elderly," will be published in the November issue of Research on Aging. The study's co-authors are Dr. Jason C. Allaire, assistant professor of psychology at NC State, and Dr. Keith E. Whitfield, professor of psychology and neuroscience at Duke University.
Note to editors: The study abstract follows.
"The Relationship Between Reported Problems Falling Asleep and Cognition Among African American Elderly" Authors: Alyssa A. Gamaldo, Dr. Jason C. Allaire, North Carolina State University; Dr. Keith E. Whitfield, Duke University Published: November 2008 in Research on Aging
Abstract: This study examined the relationship between elders' cognitive performance and self-reported trouble falling asleep. Analyses were conducted on 174 older independently living, community dwelling African Americans (M age = 72.74; range = 65 to 90). Cognitive performance was measured using the Mini-Mental State Examination, Forward Digit Span task, Backward Digit Span task, Alpha Span task, and California Verbal Learning Test. Results suggested that individuals who reported trouble falling asleep tended to perform significantly worse than individuals who did not report trouble falling asleep on measures tapping short-term memory and working memory after controlling for age, education, gender, depression, and current health. These results demonstrate that a self-report of sleep difficulty may be a unique predictor of cognitive performance.

Study shows that older adult caregivers of people with dementia have worse sleep than noncaregivers

Westchester, Ill, 16 aug 2008—A study in the August 15 issue of the Journal of Clinical Sleep Medicine shows that the sleep patterns of older adults who live with and provide direct care during the night for a person with dementia are significantly worse than other older adults.
When sleep was measured objectively, and after adjusting for depressive symptoms, age, health condition and education, adults who take care of a person suffering from dementia took longer to fall sleep and had less total sleep than noncaregivers. Caregivers slept for an average of about 6.5 hours per night, which was about 33 minutes less than noncaregivers, and they took about 10 minutes longer to fall asleep. Caregiver sleep also was more variable from night-to-night, and caregivers reported lower subjective sleep quality, had higher scores of daytime sleepiness on the Epworth Sleepiness Scale and had higher depressive symptom scores.
"On average, caregivers only slept about six -and-a-half hours a night and took almost 23 minutes to fall asleep," said primary investigator Meredith Rowe, PhD, associate professor at the University of Florida. "Using the sleep diary data that subjects kept at the same time, however, depression was the primary determinant of poor sleep with depressed subjects reporting less time asleep and more wake time over the week."
According to Rowe, the most surprising finding of the study was that the caregiver group took a longer time to fall asleep, which is consistent with the greater worry and concern that caregivers may have. The researchers had expected the caregivers' main sleep problem to be more time awake in the middle of the night when the person with dementia needed supervision. The difference between groups was not significant, however, as both caregivers and noncaregivers had an average of more than 40 minutes of time awake during the night after initially falling asleep.
Sleep patterns were measured by actigraphy for three to seven nights for the 31 caregivers in the study, each of whom lived with and provided direct care to a person with dementia who had nighttime awakenings. Seven nights of data were collected by actigraphy for the 102 noncaregivers in a previous study on sleep in older adults who were relatively healthy, living in the community and not diagnosed with sleep disorders other than insomnia. In general, both groups were predominantly female, white and currently married. Ages ranged from 60 to 89 years for noncaregivers and 60 to 86 years for caregivers. The noncaregiver sample had a significantly greater level of education than the caregiver sample.
Other measurement tools used in the study included daily sleep diaries, the Epworth Sleepiness Scale and the Fatigue Severity Scale. Participants were also assessed for depressive symptoms.
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The caregiver study was supported by grants from the National Institute of Nursing Research.
Information for the public about sleep and sleep disorders is available from the AASM at http://www.sleepeducation.com.
The Journal of Clinical Sleep Medicine is the official publication of the AASM.
For a copy of the study, "Sleep Pattern Differences Between Older Adult Dementia Caregivers and Older Adult Noncaregivers Using Objective and Subject Measures," or to arrange an interview with an AASM spokesperson, please contact Kelly Wagner, AASM public relations coordinator, at (708) 492-0930, ext. 9331, or kwagner@aasmnet.org.

Older people may need less sleep, study finds

25 july 2008--Along with all the other changes that come with age, healthy older people also lose some capacity for sleep, according to a new report published online on July 24th in Current Biology, a Cell Press publication. When asked to stay in bed for 16 hours in the dark each day for several days, younger people get an average of 9 hours of shuteye compared to 7.5 for older people, the researchers report.
" The most parsimonious explanation for our results is that older people need less sleep," said Elizabeth Klerman of Brigham and Women's Hospital & Harvard Medical School. "It's also possible that they sleep less even when given the opportunity for more sleep because of age-related changes in the ability to fall asleep and remain asleep," she added, noting that the new results apply only to healthy individuals taking no medication and having no medical conditions or sleep disorders.
The study also found that most healthy people, and young people in particular, don't get as much sleep as they need.
The idea that sleep changes markedly across the life span isn't new. In fact, insomnia is a common complaint among older people. But whether age-related changes in sleep were due to changes in social factors, circadian rhythms, or shifts in an internal "set point" for sleep need or the ability to sleep had remained unresolved.
In the new study, Klerman and her colleague Derk-Jan Dijk, of the University of Surrey in the UK, set out to compare the capacity for sleep in young people (between the ages of 18 and 32) compared to older people (age 60 to 72) under conditions that controlled for circadian rhythms by allowing the chance to sleep during both the night and the day and by controlling individual choices in sleep opportunities.
" While humans can sometimes override the homeostatic set point and not sleep when tired, there is no evidence that they can sleep when they are not tired," Klerman explained.
Given the same amount of time in bed, older people take longer to fall asleep and sleep for less time than younger people do, they found. When required to remain in bed for 16 hours a day, older people slept 1.5 hours less on average than younger people, they showed. That age-related decline in sleep included an even split between rapid eye movement (REM) sleep, which is associated with dreaming, and non-REM sleep, they found.
Most younger subjects slept for many more hours during the study than their usual self-selected sleep times. Given the evidence that insufficient sleep is associated with increased risk of accidents, errors, and metabolic changes similar to diabetes, Klerman emphasized that younger people should sleep more.
The findings may also influence treatment for insomnia in older people, Klerman said.
" If older people believe that they need more sleep than they can achieve even when they spend extra time in bed, then they may complain of insomnia: being awake when wanting to be asleep. They may start using medications needlessly. If they are tired during the day, they should consider evaluation for a sleep disorder that may be interfering with their ability to obtain good sleep at night."
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The researchers include Elizabeth B. Klerman, Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and Derk-Jan Dijk, Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.

Can You Catch Up on Lost Sleep?

By Molly Webster
11 may 2008--Let's do some sleep math. You lost two hours of sleep every night last week because of a big project due on Friday. On Saturday and Sunday, you slept in, getting four extra hours. Come Monday morning, you were feeling so bright-eyed, you only had one cup of coffee, instead of your usual two. But don't be duped by your apparent vim and vigor: You're still carrying around a heavy load of sleepiness, or what experts call "sleep debt"—in this case something like six hours, almost a full nights' sleep.Sleep debt is the difference between the amount of sleep you should be getting and the amount you actually get. It's a deficit that grows every time we skim some extra minutes off our nightly slumber. "People accumulate sleep debt surreptitiously," says psychiatrist William C. Dement, founder of the Stanford University Sleep Clinic. Studies show that such short-term sleep deprivation leads to a foggy brain, worsened vision, impaired driving, and trouble remembering. Long-term effects include obesity, insulin resistance, and heart disease. And most Americans suffer from chronic deprivation. A 2005 survey by the National Sleep Foundation reports that, on average, Americans sleep 6.9 hours per night—6.8 hours during the week and 7.4 hours on the weekends. Generally, experts recommend eight hours of sleep per night, although some people may require only six hours of sleep while others need ten. That means on average, we’re losing one hour of sleep each night—more than two full weeks of slumber every year.The good news is that, like all debt, with some work, sleep debt can be repaid—though it won't happen in one extended snooze marathon. Tacking on an extra hour or two of sleep a night is the way to catch up. For the chronically sleep deprived, take it easy for a few months to get back into a natural sleep pattern, says Lawrence J. Epstein, medical director of the Harvard-affiliated Sleep HealthCenters.Go to bed when you are tired, and allow your body to wake you in the morning (no alarm clock allowed). You may find yourself catatonic in the beginning of the recovery cycle: Expect to bank upward of ten hours shut-eye per night. As the days pass, however, the amount of time sleeping will gradually decrease.For recovery sleep, both the hours slept and the intensity of the sleep are important. Some of your most refreshing sleep occurs during deep sleep. Although such sleep's true effects are still being studied, it is generally considered a restorative period for the brain. And when you sleep more hours, you allow your brain to spend more time in this rejuvenating period.As you erase sleep debt, your body will come to rest at a sleep pattern that is specifically right for you. Sleep researchers believe that genes—although the precise ones have yet to be discovered—determine our individual sleeping patterns. That more than likely means you can't train yourself to be a "short sleeper"—and you're fooling yourself if you think you've done it. A 2003 study in the journal Sleep found that the more tired we get, the less tired we feel.So earn back that lost sleep—and follow the dictates of your innate sleep needs. You’ll feel better. "When you put away sleep debt, you become superhuman," says Stanford's Dement, talking about the improved mental and physical capabilities that come with being well rested. Finally, a scientific reason to sleep in on Saturday.

Poor Sleep Signals a Greater Cardiovascular Risk for Women

By Judith Groch
DURHAM, N.C, March 11 -- Women who can't get to sleep have higher levels of biomarkers for cardiovascular disease and diabetes than do men who sleep poorly, a study here found.
Women who are poor sleepers also have greater psychological distress than men who sleep poorly, Edward Suarez, Ph.D., of Duke University, and colleagues reported online in Brain, Behavior, and Immunity.
Sleep quality ratings were similar in men and women, but women had dramatically different risk profiles, including high levels of C-reactive protein, interleukin-6, and insulin, the researchers found.
Recent observations from large epidemiological studies have suggested that poor sleep is more strongly associated with higher risks of cardiovascular disease and hypertension in women than in men, but no study has examined the physiological mechanisms that could explain the gender differences, the researchers wrote.
Their study was designed to investigate whether gender moderates the relation of sleep and sleep-related symptoms to indices of inflammation, coagulation, insulin resistance, and psychosocial distress, all factors associated with an increased risk of cardiovascular and metabolic disorders.
The researchers recruited 210 apparently healthy non-smoking middle-age men (115) and women (95) without a history of sleep disorders. Participants (ages 18 to 65) were recruited from the surrounding community.
The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and frequency of sleep symptoms.
Because over-the-counter sleep medications may influence a number of variables, all analyses were also done on patients (92%) who reported no use of medicine during the previous month.
About 40% of the men and women were classified as poor sleepers, defined as problems falling asleep, taking 30 minutes or more to fall asleep, or awakening frequently. However, their sleep profiles were dramatically different.
Age was not associated with the total sleep quality index except for daytime disturbance, for which increasing age was linked to fewer problems with daytime sleepiness. Self-reported sleep quality and symptoms of sleep problems did not differ by ethnicity.
In multivariate-adjusted models, overall poor sleep quality, more frequent problems falling asleep (>2 nights/week) and longer periods to fall asleep (>30 min) were associated with greater psychosocial distress (hostility, anger, depression, and social support), and higher fasting insulin, fibrinogen, and inflammatory biomarkers, but only for women.
The average number of hours slept was not associated with inflammatory biomarkers. However, the time it took to fall asleep was significant, such that among women, longer time to falling asleep was associated with IL-6 (b=0.001, t=22.40, P=0.02) and C-reactive protein (b=0.01, t=1.97, P=0.05).
On the other hand, time to fall asleep was not associated with inflammatory biomarkers in men.
The total sleep quality score did not predict fibrinogen levels, the researchers said. However, women, but not men, who had trouble falling asleep had higher fibrinogen levels than those reporting no problems falling asleep (adjusted mean SEM) = 231.0 mg/dL) than those reporting no problems (adjusted mean SEM = 210.8 mg/dL).
Higher C-reactive protein and fibrinogen levels have been shown to indentify individuals at risk of becoming diabetic due to insulin resistance but not poor insulin secretion, the researchers said.
Interestingly, Dr. Suarez said, it appears that it is not so much overall poor sleep quality that was associated with greater risk, but rather the length of time it takes to fall asleep. Of women who took half an hour or more to fall asleep, 35% had C-reactive protein levels at or above 3.0 mg/L, and 32% had insulin-resistance values above 1.96.
The results also indicated that poor sleep quality was associated with higher BMI in women (b=0.50, t=2.16, P=0.03) but not in men. Daytime dysfunction was also worse for these women, but not for men.
For men, higher levels of testosterone may blunt the damaging consequences of poor sleep. Higher testosterone is associated with lower C-reactive protein, greater insulin sensitivity, and lower BMI, the researchers said.
One possible explanation for these findings, the researchers said, is that they reflect differences in the actions of the amino acid tryptophan, the neurotransmitter serotonin, and the neurohormone melatonin. Some studies have suggested gender differences for the direct and indirect effects of these substances on sleep and sleep onset.
Study limitations included the fact that the study was not designed to test directionality, leaving open the question of whether, for example, sleep disturbances promote psychological stress, or vice versa.
Use of the self-report scale in assessing sleep problems was another limitation, and an important caveat, the investigators said, was recruitment that was not targeted to individuals with a history of sleep disorders.
That sleep is a modifiable factor suggests its usefulness as a target for clinical intervention programs aimed at reducing primary disease risk, the researchers said.
This study was supported by a grant from the National Institutes of Health. No financial conflicts of interest were reported.
Primary source: Brain, Behavior, and ImmunitySource reference:Suarez EC, et al "Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance, and psychological distress: Evidence for gender disparity" Brain, Behavior, and Immunity 2008; DOI:10.1016/j.bbi.2008.01.011.

Long workweeks keeping Americans up late


Hey you! Dozing at your desk! Wake up, go home and get more sleep! That could be the message from a survey released Monday by the National Sleep Foundation. The survey of 1,000 people found participants average six hours and 40 minutes of sleep a night on weeknights, even though they estimated they'd need roughly another 40 minutes of sleep to be at their best.
Roughly one-third of those surveyed said they had fallen asleep or become very sleepy at work in the past month.
Just how big a deal that is depends, of course, on your job. Last week, the chairman of the Nuclear Regulatory Commission acknowledged it should have done more to investigate a tip that security guards routinely took naps while on the job at a Pennsylvania nuclear plant.
It wasn't until a videotape of guards sleeping in a "ready room" at the Peach Bottom plant in south-central Pennsylvania surfaced several months after it got the tip that the NRC announced in September a special investigation.
While sleepy workers know they're not performing as well as they could during the day, work is what's keeping them up nights, according to the survey, which found workdays are getting longer and time spent working from home averages close to four-and-a-half hours each week.
It seems people are also trying to squeeze in more time for themselves and their families, even if it means less sleep. The average wake up is at 5:35 a.m. and it's followed by about two hours and 15 minutes at home before heading out to work, according to the survey. Average bedtime is 10:53.

Sleep Duration Linked to Diabetes Risk


NEW YORK, Dec. 3 -- Too little sleep or too much may increase the risk of type 2 diabetes, according to investigators here.Sleeping an average of five hours or less or nine hours or longer increased the odds for diabetes onset by about 50% compared with seven hours, James E. Gangwisch, Ph.D., of Columbia, and colleagues reported in the December issue of Sleep.Shorter and longer sleep duration remained significant predictors of diabetes even after controlling for more conventional risks, such as older age and higher body mass index.
Action Points
Explain to interested patients that sleep duration, either short or long, may be associated with an increased risk of diabetes.
Emphasize that the cause for the association is unclear.
Emphasize also that the findings are based on self-reported information from a survey, not a clinical study.
The findings are consistent with evidence suggesting that short sleep duration increases insulin resistance and decreases glucose tolerance, the authors noted. However, the association between diabetes and longer sleep duration has no obvious explanation.
"We are not aware of any plausible physiologic explanations whereby long sleep duration could play a role in the pathogenesis of diabetes," the authors concluded. "It is more likely that long sleep duration occurs in parallel to, and as a consequence of, diabetes and other conditions associated with chronic inflammation."
Modern lifestyle factors may play a role. For example, the average sleep duration has decreased from an estimated nine hours in 1910 to seven hours in 2003, the authors noted.
To examine the association between sleep duration and diabetes more closely, Dr. Gangwisch and colleagues performed multivariate longitudinal analyses of data from the first National Health and Nutrition Examination Survey (NHANES I). The analysis included 8,992 non-institutionalized persons ages 32 to 86 who were followed from 1982 to 1992.
The analysis showed that 430 (4.8%) of the NHANES I sample developed diabetes during the follow-up period. Dr. Gangwisch and colleagues examined the association between sleep duration and diabetes by means of three logistic regression models: an unadjusted model and two different models adjusted for a variety of confounding variables.
In the unadjusted model, comparison of diabetes cases and reported sleep duration showed that participants reporting five or fewer hours of sleep had an odds ratio for diabetes of 1.91 (95% CI: 1.37 to 2.67) compared with participants who averaged seven hours of sleep. Those who reported averaging nine or more hours of sleep had an unadjusted diabetes risk of 1.85 (95% CI: 1.32 to 2.60).
In the fully adjusted model, participants reporting five or fewer hours of sleep had a diabetes odds ratio of 1.47 (95% CI: 1.03 to 2.09), and participants reporting nine or more hours of sleep had an odds ratio of 1.52 (95% CI: 1.06 to 2.17).
Acknowledging the study's limitations, the authors cited the potential for reverse causation; that is, short or long sleep duration could be a diabetes prodrome. Additionally, estimated sleep duration was self-reported, not objectively measured. Finally, the investigators had no way to assess the influence of a diabetes diagnosis and treatment on subsequent sleep patterns.
Dr. Gangwisch had no disclosures, but several co-authors disclosed multiple relationships with the medical industry. The study was supported by the National Institute of Mental Health and the National Heart, Lung, and Blood Institute.
Primary source: SleepSource reference:Gangwisch JE, et al "Sleep duration as a risk facto for diabetes incidence in a large U.S. sample"Sleep 2007; 30: 1667-1673.

Mortality Increases with Too Little Sleep and Too Much


LONDON, Dec. 3 -- Staying alive depends on getting just the right amount of shuteye and maintaining that sleep pattern, according to a prospective study.
Action Points
Explain to interested patients, that this study found that sleeping about seven to eight hours a night was ideal for health, whereas regularly sleeping five or fewer hours or more than nine hours increased the mortality risk.
Those who sleep five hours or less or nine hours or more have higher rates of all-cause mortality than those who get six, seven, or eight hours, said Jane E. Ferrie, Ph.D., of the University College Medical School here, and colleagues.
Moreover, they reported in the Dec. 1 issue of Sleep, a decrease to five hours or less of sleep over time carried a 110% excess risk of cardiovascular mortality and an increase was associated with a 110% excess risk of noncardiovascular mortality.
Fewer hours of sleep and greater levels of sleep disturbance have become widespread in our industrialized society, the researchers said.
To study the effects of changes in sleep duration on mortality, the researchers used longitudinal data from the Whitehall II study of British civil servants, ages 35 to 55, working in 20 civil service departments.
The final cohort for this study included 10,308 participants -- 3,413 women and 6,895 men. Of the participants, 9,781 were included in the baseline (phase 1) analysis with a clinical examination and self-administered questionnaire. Data were collected from 1985 through 1988.
Of those original participants, 7,729 were included in the later 1992-1993 analysis (phase 3), which also included a clinical exam and a questionnaire.
Mortality data was tracked until Sept. 30, 2007, giving 17 years of follow-up for phase 1 participants and 12 years for those in phase 3 of the study.
Short sleep was defined as five or fewer hours and extended sleep nine or more hours.
U-shaped associations were observed between sleep (≤5, 6, 7, 8, ≥9 hours) at phase 1 and phase 3 and subsequent all-cause, cardiovascular and noncardiovascular mortality, the researchers reported.
A decrease in sleep duration among participants sleeping six, seven, or eight hours at baseline was associated with a more than 110% excess risk of cardiovascular mortality (hazard ratio: 2.4 (95% confidence interval: 1.4 to 4.1), the investigators said.
However, an increase in sleep dura­tion among those already sleeping seven or eight hours at baseline was also associated with a 110% excess risk of noncardiovascular mortality (HR: 2.1, 95% CI: 1.4 to 3.1).
Adjustment for socio-demographic factors, existing morbidity, and health-related behav­iors left these associations largely unchanged, the researchers reported.
Other findings:
The association between BMI and sleep was complex. A higher BMI was associated with short and long sleep in women at baseline but with only short sleep in men. By the phase 3 analysis, there was no mortality association in women, but a U-shaped association for mortality among men.
All the other covariates conformed to the classic U-shape observed for mortality, with the exception of high alcohol consumption, systolic blood pressure, diastolic blood pressure (women only), and cholesterol, which were unrelated to sleep.
There was an indication that mortality was lower among those who slept five or six hours at baseline, but who reported extended hours of sleep at the second analysis, suggesting that extending sleep duration in short sleepers has health benefits.
On the other hand, the finding that an increased duration of sleep among those sleeping seven to eight hours is associated with higher mortality suggests that sleep restriction should be considered.
Recent research suggests that short sleep may have harmful effects on endocrinology, immunology, and metabolism. Short sleep, for example, has been shown to be a risk factor for weight gain, insulin resistance, and type 2 diabetes. Short sleep is also accompanied by increased cortisol levels and has been associated with hypertension and some cardiovascular diseases.
By contrast, the researchers said, it appears that no potential mechanisms by which long sleep could be associated with increased mortality have yet been investigated. Several suggestions have included depression, low socioeconomic status, and cancer-related fatigue.
The main limitation of the study was the single-item, self-reported measures of sleep duration, which were not identical in the two phases and did not explicitly ask participants to differentiate between sleep and bedtime (a possibility for older non-working individuals).
Loss to follow-up was 19% between the two phases. Although this was a potential source of bias, it was much below that of the 50% loss in other studies, the researchers said.
A further limitation was that this was an occupational cohort, ages 35 to 55 at baseline, and almost exclusively white-collar, so that the findings may not apply to wider populations.
Patients reporting a decrease in sleep should be regarded as being at higher risk for cardiovascular and all-cause mortality. However, further work is required to determine the factors that contribute most to the excess noncardiovascular deaths among people whose sleep duration increases, the investigators concluded.
In terms of prevention, consistently sleeping seven to eight hours a night is optimal for health, they said.
The Whitehall II study was supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart, Lung, and Blood Institute, U.S.; the National Institute on Aging, U.S.; the Agency for Health Care Policy Re­search; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Develop­ment and Socioeconomic Status and Health.
Dr. Ferrie held a Medical Research Council grant.
Primary source: SleepSource reference:Ferrie JE, et al "A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort"Sleep 2007; 30: 1659-1666.