Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

Olympic swimmers are considered the masters of controlled breathing. With holding their breaths and only having certain moments to breath while doing laps, one would guess those moments of air are very significant. However, what if your oxygen supply is already diminished due to decreased base lung capacity? This is something swimmer Cody Miller knows all too well.

Miller was diagnosed with Pectus excavatum at a young age. The hallmark of the condition is a sunken appearance of the chest. The condition also limits the person’s lung capacity forcing them to take more breaths than an average person. Though not all bad, Cody Miller actually has his diagnosis to thank for starting his career in swimming. At age 8 he started swimming because of his condition to monitor his heart and breathing- now he is a 2016 Olympic swimmer.

Not Defined by Condition

The shocking part is he is not just a swimmer, but a breaststroker. The world’s best breaststrokers are 6’3” to 6’5”, and he is 5’10”. Yet Miller takes longer and fewer strokes than anyone. Miller never let his condition define who he was or stop him from going the distance. He became a junior national champion, set national age-group records (15-16) in the 100- and 200-yard breaststrokes and was chosen for the national junior team. 2016 will be his first Olympic appearance. In tests at the U.S. Olympic Training Center in Colorado Springs, Colorado, he was the most symmetrical swimmer that the judges have ever seen. Possibly due to his caved-in chest.

Cody Miller will compete in the 100m men’s breaststroke at the Rio Olympics.

Pectus Excavatum

Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall. Pectus Excavatum affects about 200,000 Americans. It causes respiratory issues and deficient lung capacity. Severe cases of pectus excavatum can eventually interfere with the function of the heart and lungs. The cause of pectus excavatum is not known.

Story originally published:

http://www.raredr.com/news/rare-disease-rio-cm

Recently researchers performed a test where a group of women and a group of men (test conducted separately and in isolation) were made to experience 28 hour days, over a 10 day period. What they intended to do was to disrupt all participants ‘body clock’ and then test their ability to perform tasks at times when they would have normally been asleep. There is a considerable amount of literature that looks at circadian rhythm, fatigue, sleep restriction and the resulting clear physiological and mental impairment. However this study looked to concentrate on the differences between males and females in the specific context of circadian rhythm (one ½ of our drive to sleep). The lead researcher, Professor Derk-Jan Dijk from the University of Surry noted that women are often excluded from sleep research due to hormonal differences to men. What they have found in this instance was that both males and females showed decreased performance during the times they would have otherwise been asleep (if not participating in the study). Interestingly though, they also found that the performance of women decreased more significantly than did the men. We do need to be mindful this study was limited to small sample sizes (not strong evidence) but it does highlight that in future, if we are looking to understand the effect of circadian on human sleep, we should not limit ourselves to only men.

Story Source:

http://www.abc.net.au/news/2016-04-19/women-may-be-more-affected-by-shift-work-than-men/7335368

Scientists are getting closer to unraveling the mystery of sleep, having now figured out what happens in the brain at the exact moment when it falls into a slumber. For some time, researchers have sought to locate the body’s “sleep homeostat”, which tracks certain physiological changes in order to decide when it needs to go to sleep. The authors of a new study in Nature now claim that, while they are still no closer to deciphering exactly what this “internal bookkeeper” measures, they have at least figured out how it flips the sleep switch in the brain.

The team conducted their work using fruit fly brains, which have previously been shown to contain a cluster of neurons in a region called the dorsal fan-shaped body (dFB) that appear to control the transition from wakefulness to sleep. Also found in many mammals – including humans – dFB neurons remain silent when we are awake, but become active when they need to send us to sleep.

In previous studies, researchers have artificially played around with the activity of these neurons, discovering that doing so causes the flies to wake up or fall asleep on cue. However, the mechanisms controlling this fluctuating neural activity have so far remained elusive.

To try and shed light on the matter, the study authors used a technique called optogenetics to artificially stimulate the release of dopamine in the dFB of fruit flies. This, they discovered, caused the neurons in this part of the brain to become activated, causing the flies to fall asleep. Conversely, when dopamine was inhibited, dFB neurons fell silent, causing sleeping flies to wake up.

When we smoke cigarettes, dozens of genes important for immune defence are altered in the epithelial cells that line the respiratory tract. Several of these changes likely increase the risk of bacterial infections, viruses, and inflammation. Now, UNC School of Medicine scientists report that vaping electronic cigarettes alters those same genes and hundreds more that are important for immune defence in the upper airway.

The finding, published in the American Journal of Physiology, suggests that inhaling the vaporized flavoured liquids in e-cigarettes is not without consequences, at least on the level of epithelial cell gene expression – the critical process by which our genes give rise to proteins important for various functions in cells.

The discovery cannot yet be linked to long-term health effects of e-cigarette use or the risk of diseases usually associated with long-term cigarette smoking such as cancer, emphysema, or chronic obstructive pulmonary disease.

So far, though, the evidence suggests that long-term e-cigarette use will not be harmless.

E-cigarettes have only been on the market in the United States since 2006, and usage skyrocketed just a few years ago. The more than 7,000 flavours available in e-cigarettes are FDA approved, though that approval process was based on data generated for oral consumption, not inhalation.

To study what effects e-cigarettes have on genes that help our upper airways fight off potentially harmful pathogens, Jaspers’ lab recruited 13 non-smokers, 14 smokers, and 12 e-cigarette users. Each participant kept a journal documenting their cigarette or e-cigarette use, and in collaboration with researchers from the University of California at San Francisco, Jaspers’ team analysed participant urine and blood samples to confirm nicotine levels and biomarkers relevant to tobacco exposure.

After about three weeks, researchers took samples from the nasal passages of each participant to analyse the expression of genes important for immune responses.

Visually and functionally, the epithelial layers of our nasal passages are very similar to the epithelial layers in our lungs. All epithelial cells along our airways – from our noses to the tiny bronchioles deep in our lungs – need to function properly to trap and dispatch particles and pathogens so we don’t get sick. These epithelial cells are critical for normal immune defence. Certain genes in these cells must give rise to proper amounts of proteins, which orchestrate the overall immune response. It has long been known that cigarette smoking modifies this gene expression, which is one reason researchers think smokers are more sensitive to upper respiratory problems.

Using the non-smokers as the baseline comparison group, Jaspers’ team found that smoking cigarettes decreased the gene expression of 53 genes important for the immune response of epithelial cells. Using e-cigarettes decreased the gene expression of 358 genes important for immune defence – including all 53 genes implicated in the smoking group.

Jaspers said her lab’s findings do not mean that smoking e-cigarettes is as bad as or worse than smoking regular cigarettes.

She said that inhaling burnt tobacco and inhaling vaporized flavoured liquids are fundamentally different, and it’s more likely that e-cigarettes could induce different biological changes and play different roles in other respiratory problems.

Next, Jaspers will study how epithelial cells in e-cigarette users respond to a flu vaccine. This, she said, could help her team measure the immune response of epithelial cells in smokers, non-smokers, and e-cigarette users.

Story Source:

University of North Carolina Health Care. “E-cigarette use can alter hundreds of genes involved in airway immune defense: The long-term health effects of e-cigarettes remain unknown, but toxicologists at UNC are now uncovering how use of e-cigarettes affect genes involved in upper airway immune defense..” ScienceDaily. ScienceDaily, 20 June 2016.

Part 1

Does your partner ever wake up in the morning looking tired and cranky? If the answer is yes they probably spent the night listening to a strange cacophony of sounds that either kept them awake or woke them up during the night. Snoring would have to be the number one complaint of what will keep a partner awake and disturb their sleep. No one likes to be told that they snore, yet nearly everyone will snore at some stage in their life. Snoring occurs when the air going into your nose and throat during sleep doesn’t move freely and causes the surrounding tissues to vibrate, producing the snoring sound. Sometimes the position of the tongue during sleep can obstruct breathing and cause you to snore. If you would like to stop snoring we must first find the cause. It is important to identify how and why you snore so that solutions to the problem can be found. You will need the assistance of someone who can observe your sleep, whether it is your partner or a family member to monitor you snoring. The following different ways you sleep and snore can reveal why you snore;

• Open-mouth snoring – relates to tissues in your throat
• Closed-mouth snoring – could indicate a problem with your tongue
• Snoring on your back – mild snoring
• Snoring in all sleep positions – severe snoring

Why do we snore?

Being overweight or out of shape, your age, structure of your nasal and air passages, nasal and sinus issues, alcohol, smoking, medications and sleeping posture are all common causes of snoring. There are currently a plethora of devices available to stop snoring. However, most of them don’t work and have no research based evidence to prove their effectiveness. What you can trial are some lifestyle changes and bedtime remedies to help you stop snoring.

Lifestyle changes – proven techniques to cure and eliminate snoring include;

• Losing weight
• Exercise
• Quitting smoking
• Avoiding alcohol, sleeping pills and sedatives
• Establish regular sleeping patterns

Bedroom environment remedies that can stop snoring include;

• Clear nasal passage – nasal strips or a decongestant
• Humidify your bedroom air – dry air can irritate
• Sleep position – elevate your head by using a specially designed pillow can ease breathing and encourage your jaw and tongue to move forward
• Positional sleep – sleep on your side instead of your back

In part 2 we will cover how snoring relates to serious sleep related disorders such as obstructive sleep apnoea and suggest medical assistance to help stop snoring.  

A host of research suggests that sleep loss impairs glucose metabolism, the process in which sugars from food intake is processed and stored or used to produce energy. Studies have consistently found short-term sleep loss decreases glucose tolerance and insulin sensitivity in healthy, young, lean adults.

In long-term (chronic) sleep loss, changes to glucose metabolism can increase the risk of obesity and type 2 diabetes. Combine this with the tendency when sleep-deprived to eat comforting foods, which are higher in fat and sugar, and it’s no wonder people who are sleep-deprived find it harder to lose weight than those who are well rested.

What’s more, both total and partial sleep deprivation have also been found to modify the normal daily rhythms of appetite-regulating hormones. Leptin, a hormone that suppresses appetite, and ghrelin, a stomach-derived peptide that stimulates appetite. When you do not get enough sleep, changes in these appetite-regulating hormones and an increase in food consumption can lead to weight gain and obesity.

These results have been found in a large population-based longitudinal study of sleep patterns known as the Wisconsin Sleep Cohort. In this study, participants reported their sleep habits through questionnaires and sleep diaries and provided a blood sample on one morning, prior to eating, to evaluate leptin and ghrelin levels. People sleeping less than eight hours a night (74.4% of the sample) had an increased body mass index (BMI).

Habitual short sleep was also associated with low leptin and high ghrelin. Since reduced leptin and elevated ghrelin are likely to increase appetite, this may explain the increased BMI observed and how insufficient sleep could contribute to developing obesity.

And when I say sleep like a log, it is not in reference to how heavily you sleep but what position you sleep in….. Now, if we are talking about sleep positions, than what on earth is the freefall style???

Apparently, there are six distinctive styles of sleeping that can explain your personality…So what is your sleeping style/s saying about you?

Log:                     Sleeping on your side with both arms down.

People who have a preference for this position are classed as very sociable and trusting, but unfortunately this can sometimes be to the point of gullibility. To sum it up, easy-going, trustworthy and naive. Approximately 15 % of people sleep like a log.

Foetal:                Sleeping on your side with your back slightly curved and legs curled up.

Believe it or not, about 41% of people sleep in this position and are considered to be tough on the outside but sensitive at heart; shy, over thinking, a worrier, but quick to warm up. It appears to be the common favourite position for women who are twice as likely to curl up to go to sleep then men.

Freefall:             Sleeping on your belly with arms under or wrapped around a pillow with head turned to the side.

It appears if you sleep like this you could be considered brash and outgoing but find it difficult to cope with personal criticism; often anxious and sensitive, however you like to be in control. It’s reported only 7% of people sleep style it in freefall!

Starfish:            Sleeping on your back with arms up near your head or pillow.

Friendly, generous, a good listener who likes to help whenever needed describes the starfish sleepers. Surprisingly, this is the least favourite sleep position, representing only 5% of sleepers. Due to mainly being on ones back, this position may lead to snoring, guaranteed not to be popular with your bed partner.

Yearner:            Sleeping on your side with both arms stretched out in front of you.

A suspicious person with a very rational approach to life, about 13% of people are Yearner sleepers. Open minded but cynical and stubborn about discussions they have made. To sum it up, slow decision maker, suspicious, cynical.

Soldier:              Sleeping on your back with both arms down and close to the body.

A close call to Starfishing, 8% of people prefer to sleep like a Soldier. Quiet and reserved but loathes noisy social scenes and thus can be prickly. This position may also lead to snoring.

Police officers “serve and protect us”, and we are certainly thankful for all the hard work they do. It’s a tough job, they work long and varied hours of shift work. In addition to these challenging shift work hours, sadly they often see a lot of us when we are at our lowest or less than ideal of moments. All too often we forget about the stress the job and its hours of work has on our officers wellbeing, but what about their sleep quality? We in the sleep unit know all too well how poor sleep can affect cognitive performance, mood and motor skills (eg driving).

In 2011, Dr. Charles Czeisler (director of the sleep medicine division at Brigham and Women’s Hospital in Boston) et al. screened nearly 5000 officers in the USA and Canada for sleep disorders. What they found was that up to 40% of them had a sleep disorder. Of those with a sleep disorder, they found that 58% had an increased risk of falling asleep while driving, a 23 percent greater risk of occupational injury and a 76% increase in safety violations. Also, an officer with a sleep disorder had a 21% increased risk of expressing uncontrolled anger towards a suspect or member of the public and had a 24% risk of receiving a citizen complaint against them. They were also 24% more likely to experience absenteeism, and were 39% more likely to make a major administrative error while on duty.

While this study is a few years old, we do know how shift work and sleep disorders can impact on the quality of ones sleep and reduce all the good benefits that a good night sleep can give us. Our brave officers have a hard enough job as it is, we can only hope that if officers have or suspect they have a sleep disorder to seek and comply with therapy. It’s certainly in the best interest of the police department, the general public and most importantly; the officers themselves and their families.

Reference: Shantha M.W., Laura K. Barger, Steven W. Lockley, Steven A. Shea, Wei Wang, Christopher P. Landrigan, Conor S. O’Brien, Salim Qadri, Jason P. Sullivan, Brian E. Cade, Lawrence J. Epstein, David P. White, and Charles A. Czeisler, “Sleep Disorders, Health, and Safety in Police Officers” Exit Notice, JAMA 306 (2011): 2567-2578.

Snoring is known to cause sleep deprivation to snorers and those around them, often causing irritability as well as daytime drowsiness, lack of focus and even decreased libido. Although snoring is often considered a minor affliction, not only snorers but also their partners can sometimes suffer severe impairment of lifestyle.

Snoring is one of the most common symptoms associated with OSA and is caused by vibration of the soft tissues obstructing the pharynx during sleep. However, most people who snore do not have OSA. The prevalence of snoring in the general population varies widely (from 15 to 54 percent) mainly because most studies rely on self-reporting by patients. Although there is no real ‘standard’ treatment available for primary snoring, current treatments vary widely and include avoiding alcohol and sedatives, sleeping on one’s side instead of laying on your back, weight loss, palate and upper airway surgeries, treatment of nasal problems, and use of dental sleep devices.

Some of these surgical treatments are invasive and alongside dental sleep devices can be costly. While adjusting your sleep position and weight loss are more affordable options, they are not always applicable treatment options for everybody. But, there is hope for all snorers and potential reprieve for their sleepless bed partners in the form of some simple e in the form of some simple exercises. A recent study has found that in patients with primary snoring or mild OSA, mouth and tongue exercises significantly reduced the frequency of snoring by 36 percent and total power of snoring by 59 percent.

This study demonstrates a promising, non-invasive treatment for large populations suffering from snoring, and their bed partners.

If you are a snorer, try these exercises:

• Pushing the tip of the tongue against the roof of the mouth and sliding the tongue backward
• Sucking the tongue upward against the roof of the mouth, and pressing the entire tongue against the roof of the mouth
• Forcing the back of the tongue against the floor of the mouth while keeping the tip of the tongue in contact with the bottom, front teeth
• And elevating the back of the roof of the mouth and uvula while saying the vowel “A”
• Put a finger in your mouth on each side and press outward
• Alternate chewing on either side when you eat

You should see your health care provider if you are often feeling tired during the day, wake-up feeling unrefreshed, or wake up during the night gasping for breath.

Want more information on snoring?

Visit the Sleep Health Foundation website: http://www.sleephealthfoundation.org.au/pdfs/Snoring.pdf

Reference:

American College of Chest Physicians. “Snoring keeping you up at night?” ScienceDaily. ScienceDaily, 7 May 2015. <www.sciencedaily.com/releases/2015/05/150507122956.htm>.

Vanessa Ieto, Fabiane Kayamori, Maria I. Montes, Raquel P. Hirata, Marcelo G. Gregório, Adriano M. Alencar, Luciano F. Drager, Pedro R. Genta, Geraldo Lorenzi-Filho. Effects of oropharyngeal exercises on snoring. CHEST Journal, 2015; DOI: 10.1378/chest.14-2953

Are video games like “Bloodborne,” “Fallout” and “Call of Duty” worth losing sleep over? For plenty of gamers, the answer is yes. A new study has shown that gamers will push off obtaining adequate sleep in order to continue video gaming.

The study included online surveys from 963 gamers. Participants were U.S. gamers with an average age of 28.7 years, whom played video games at least once the previous week. The study shows that gamers delayed going to bed 36 percent of the nights they played video games. Participants averaged 4.6 nights per week game playing. The average delay in bedtime on the nights spent gaming was 101 minutes.

The lead author, Brandy M. Roane, said that these findings, “provide further insight into factors that influence individuals’ decision making when determining if they should get sufficient sleep. Our data shows that video gaming is quite an important factor that frequently leads to missed sleep for 67 percent of gamers. Additionally, the reasons provided by gamers for their choice to delay bedtime strongly supports the inclusion of video gaming as an addictive behaviour.” While the study can’t prove that playing games into the early hours of the morning means you’re hooked, it suggests a possible link between the two.

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Monday, June 13, in Denver at SLEEP 2016, the 30th Anniversary Meeting of the Associated Professional Sleep Societies LLC (APSS).

American Academy of Sleep Medicine. “Video game playing negatively influences adequate sleep and bedtimes: Over 67 percent of gamers reported missed sleep due to playing.” ScienceDaily. ScienceDaily, 13 June 2016. <www.sciencedaily.com/releases/2016/06/160613144656.htm>.