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

June 30, 2017

Pollution keeping you up a night?

Filed under: Blog — Tags: , , , , — Erika Mateus @ 6:46 am

While most of Australia has nice, clean air, Smog hanging over major cities can still be a problem. People can experience health impacts from polluted air including respiratory irritation and/or breathing difficulties. The risk of adverse effects depends on their present health status, the pollutant type and concentration, and the length of their exposure to the polluted air. Some of the associated diseases caused by this air contamination are stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma.

Nowadays, it has been discovered that this environmental issue may also have a big impact in individual’s sleep quality.

Research presented at the ATS 2017 International Conference has found that there is a relationship between sleep fragmentation and long-term exposure to derived traffic-related air pollution. The researchers analysed data from 1,863 participants (average age 68) in the Multi-Ethnic Study of Atherosclerosis (MESA) who also enrolled in both MESA’s Sleep and Air Pollution studies. The researchers looked at two of the most common air pollutants: NO2 (traffic-related pollutant gas) and PM2.5, or fine-particle pollution. Using air pollution measurements, the research team was able to estimate air pollution exposures at each participant’s home at two time points:  one year and five years.

The sleep patterns were measured using wrist actigraphy over seven consecutive days and the researchers found that the sleep efficiency of the worst 25 percent of participants was 88 percent or less. The research team studied if pollution exposures differed among those in this low sleep efficiency group. This population was divided into “fourths” according to levels of pollution. The quarter of those who experienced the highest levels of pollution was compared to the quarter with the lowest levels.

The study found:

  • The group with the highest levels of NO2 over five years had an almost 60 percent increased likelihood of having low sleep efficiency compared to those with the lowest NO2
  • The group with the highest exposures to small particulates (PM5) had a nearly 50 percent increased likelihood of having low sleep efficiency.

The air contamination that we are suffering involves every area of our existence, including the effect on the quality of our sleep and subsequent general well-being.  However, in our society sleep is considered as a luxury rather than a necessity. We have no problem spending long hours at work and then adding other activities on top of it, a poor choice, especially when the quality of our sleep is being reduced. Perhaps it should become another reason for us to think what can be done to address this. The participation of nations, governments, industries, companies, and individuals may be the principal action leading incentives to pollute less and then to sleep well.

References:

Insomnia treatment… A position statement from the ASA.

Filed under: Blog — Tags: , , , , — Phil Teuwen @ 4:35 am

Insomnia can be both chronic and acute. Insomnia is thought to be the most common sleep disorder, with most of us experiencing acute insomnia at some point in our lives (exams, crisis, jet lag etc). However for those of us with chronic insomnia, treatment options can vary widely. The Australasian Sleep Association (ASA) has published a position statement regarding the use of psychological/behavioural treatments to manage this chronic condition.

Highlights:

  • Cognitive Behaviour Therapy for Insomnia (CBT-I) as a first line treatment in the management of Insomnia.
  • there is emerging evidence for the use of Mindfulness Based Therapy for Insomnia when used in combination with behavioural techniques (MBT-I)
  • Medications should be limited to the lowest necessary dose and shortest necessary duration.

Original article can be found here:

http://www.sleep-journal.com/article/S1389-9457(17)30153-3/pdf

June 28, 2017

Drink coffee or sleep in?

Filed under: Blog — Tags: , , — Trent Segal @ 6:56 am

Caffeine is the world’s most widely used psychoactive stimulant, a natural drug occurring in tea, coffee and chocolate.   It works to promote wakefulness by blocking adenosine receptors in the brain.  The adenosine receptors when activated normally act to slow down neural transmissions and promote sleep, thus blocking their action has the opposite effect and prevents sleep.  There is a wide variety of new caffeine containing products available these days but are they safe for everyone and what are your kids getting their hands on?

Children aged 2-19 have steadily increased their consumption from the 70s through the 90s with a similar decrease in dairy and increase in soda.  Since the 90s the rise of the energy drink has taken on some with very high caffeine contents.

Maximum safe intake levels appears to be around 400mg / day in healthy adults, 100mg/day in adolescents and 2.5mg/kg/day in children (less than 12 years old).  One standard sized can of energy drink provides 77mg of caffeine.   The safe levels are much lower for people with cardio vascular issues or pregnant women.  Certain energy drinks have been measured with up to 500mg of caffeine which is higher than the adult safe intake let alone an adolescent.

A recent study on 309 children ages 8-12 years showed 41% drink tea or coffee and 40 % drink caffeinated sodas making up an average intake of 10.2+- 17.4 mg/day.  Caffeine consumption was significantly associated with sleep routine, morning tiredness, restless sleep and internalising behavioural problems.  Although the overall intake was low compared to normal adult consumption, there was an effect on sleep problems and related behaviour.

Remember that caffeine is a drug even if it is sold on every street corner of the city.  Recommendations are to not consume caffeine 6 hrs prior to going to bed.  If you have trouble sleeping or getting the jitters after too many cups of coffee, consider curbing your intake and sleep in for the extra rest.

The full review can be read at http://journal.frontiersin.org/article/10.3389/fpsyt.2017.00080/full#h13

https://www.ncbi.nlm.nih.gov/pubmed/28162144

June 27, 2017

June 26, 2017

June 22, 2017

Connection between sleep disorders and polycystic ovary syndrome

Filed under: Uncategorized — Tags: , — Erika Mateus @ 6:54 am

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. PCOS affects 5%-10% women ages 18 to 44 1-2. 30% of these women have some PCOS symptoms which include menstrual irregularity, hyperandrogenism and ovarian cysts, which lead to fertility problems, including oligo-anovulation, and infertility.

This condition leads to metabolic disorders and psychosocial problems. The metabolic disorders may include obesity, insulin resistance, gestational diabetes mellitus, diabetes, and cardiovascular diseases. The psychosocial PCOS may bring anxiety disorders, depression and it may markedly reduce the quality of life in the women who suffer this condition.

Studies have shown women with PCOS have increased sleep disturbances and abnormal sleep architecture. Furthermore, the same investigations have demonstrated that obstructive sleep apnoea (OSA) is higher in women with PCOS in comparison to the general population. OSA in women with PCOS also exacerbates insulin resistance.

One study developed by Nianjun et al3, aimed to investigate the sleep status before polycystic ovary syndrome (PCOS) and analyse the relationship between sleeping and PCOS. The study design was a retrospective cohort study, which recruited 129 PCOS patients and 156 non-PCOS infertile women according to Rotterdam criteria. All patients filled in Pittsburgh Sleep Quality Index (PSQI). PSQI score (>5), daytime dysfunction and snoring were risk factors for PCOS.

Another investigation4 suggests that the screening assessment of sleep disturbances should be a part of medical diagnostics in women with PCOS, claiming that sleep disturbances such as insomnia occurs significantly more often in women with PCOS than in women without PCOS. Their research was based on two validated questionnaires which evaluated clinically insomnia and daytime somnolence.

The prevalence of sleep-disordered breathing (SDB) in women with PCOS and the association with the free testosterone levels5 has been studied by Suria et al. They conclude that free testosterone levels positively correlated with the respiratory distress index and the waist circumference values and that obesity is the final common pathway for development of SDB in PCOS. Their findings suggested that increased testosterone levels acted by promoting central obesity, leading to SDB. Hence, it is recommended that all PCOS patients with central obesity should be screened for SDB, preferably with a whole night PSG as snoring is commonly underreported in these women.

 References:

  1. Trivax, B., & Azziz, R. (2007). Diagnosis of polycystic ovary syndrome. Clinical Obstetrics and Gynecology, 50, 168–177.
  2. NICHD, NIH, DHHS. (2008). Beyond Infertility: Polycystic ovary syndrome (PCOS) (08-5863). Washington, DC: U.S. Government Printing Office
  3. Nianjun Su, Chongyang Du, Yuemei Zhang, et al. Retrospective investigation and analysis of sleep disorders on occurrence of polycystic ovary syndrome. Biomedical Research 2017; 28 (2): 583-587
  4. Franik, G., Krysta, K.,  Madej, P., et al.  Sleep disturbances in women with polycystic ovary syndrome. Gynecological Endocrinology Volume 32, Issue 12, 1 December 2016, Pages 1014-1017.
  5. Jyotsna Suria, Jagdish Chander Surib, Bidisha Chatterjee. Et al. Obesity may be the common pathway for sleep-disordered breathing in women with polycystic ovary syndrome. Sleep Medicine. Volume 24, August 2016, Pages 32–39.

June 21, 2017

Here’s why swimming is good for asthmatic kids

Filed under: Blog — Tags: , , , — Mark Russell-Pavier @ 11:16 pm

For some, an asthma attack feels as though an elephant is sitting on their chest, while for others breathing becomes so laboured that it’s like trying to suck peanut butter through a straw.

Dilemma for many families

Asthma is the most common chronic childhood disease, and entails struggling to breathe due to constricted airways.

Because of these adverse effects, children are often discouraged from taking part in sport, but new research now suggests that when it comes to cardio activities that are well-tolerated, swimming, specifically, is highly recommended, particularly in indoor swimming pools.

Staying active can be a challenge for the more than six million children with asthma in the United States, noted Dr Tod Olin, a paediatric pulmonologist at National Jewish Health.

“It can be a dilemma for many families. All it takes is one asthma attack, and suddenly patients can become very tentative about overdoing it,” he said in a hospital news release.

Symptoms of asthma in kids

Common symptoms of asthma among kids include:

  • Coughing usually at night or with activity. Coughing usually starts late at night or in the early hours of the morning. It can be dry or wet and is persistent.
  • Complaints of chest pain
  • Avoidance and a refusal to participate in active sports and games
  • Asthma wheeze (whistle)

How is asthma treated?

Because asthma is two conditions rolled into one, inflammation and bronchoconstriction of the airways, the most effective treatment consists of a two-pronged approach, treating both factors simultaneously. In most cases this involves treatment with puffers or inhalers which contain a bronchodilator to relieve bronchoconstriction and an inhaled corticosteroid to reduce airway inflammation.

Asthmatic kids should exercise

Children with asthma have often been told to limit exercise, Dr Olin noted. “More recently, we’ve changed our approach,” he said. “We now encourage kids to exercise, especially as the obesity epidemic has become more and more problematic.”

Starting with swimming and letting kids with asthma choose the sports they enjoy make it more likely they will stay active, he said.

“I generally recommend that they use their albuterol inhaler about 15 minutes before exercise, but if their asthma is well-controlled, there is no reason to limit any activity,” Dr Olin said. “If their heart is taking them toward a certain sport, they should be encouraged to pursue that.”

Just keep swimming

The high humidity in indoor swimming pools protects against asthma attacks by keeping airways open, Dr Olin said.

“We think that the way asthma attacks happen is that the airways dry out, and that sets off a cascade of reactions that ultimately squeezes down the airway,” Dr Olin explained. “If we can prevent that initial airway-drying step by staying in a humid environment, we prevent the asthma attack all together.”

 

Article source:

http://www.health24.com/Medical/Asthma/Asthma-and-exercise/heres-why-swimming-is-good-for-asthmatic-kids-20170221

The Sleepless, Hungry Brain

Filed under: Blog — Tags: , , , , , — Riley Forbes @ 5:23 am

Your brain is not static. It is an ever-changing web neuronal connections, like wires, called synapses. When we imagine the brain, we imagine this sleek, complex circuitry. What science understands, but rarely portrays, is that it is messy. Synapses are removed and created, dysfunctional neurons are often destroyed. The brain has a clean-up crew. Part of that involves the astrocytes. These cells prowl the brain, pruning unnecessary or damaged synapses.

A recent study has investigated the relationship between the activity of these cells, and sleep deprivation. The authors demonstrate that losing one night’s sleep will result in a further 2% astrocyte activity, and the chronically sleep deprived a further 7.5% activity. Furthermore, other maintenance and disposal cells are more active after chronic sleep deprivation.

Increased activity in such cells has been linked to neurodegenerative disorders, such as Alzheimer’s disease. This is another item in the long list of reasons to value sleep. Further research is needed to clarify the effects of sleep disrupting disorders like obstructive sleep apnoea, and periodic leg movement disorder, but the way the wind is blowing, it appears these could play a similar role to deprivation in terms of neurodegeneration.

Bellesi, M., de Vivo, L., Chini, M., Gilli, F., Tononi, G. and Cirelli, C. (2017). Sleep Loss Promotes Astrocytic Phagocytosis and Microglial Activation in Mouse Cerebral Cortex. The Journal of Neuroscience, 37(21), pp.5263-5273.

June 20, 2017

Humidification – Is it full of hot air?

Filed under: Blog — Tags: , , , — Trent Segal @ 6:18 am

With the recent release of smaller CPAP units, many people are looking at these alternatives for the CPAP treatment for travel purposes or even the primary machine at home.  One of the biggest things these smaller devices forgo is the conventional pass over heated humidifier system with heated tube in place for a heat exchange unit or even nothing at all.

There has been significant evidence showing heated humidifier systems increase adherence to CPAP1, particularly in patients who suffer upper airway or nasopharyngeal symptoms such as dry throat and mouth2.  As a result quality of life when using CPAP has been shown to improve when using humidification3.

Heated tubes were introduced to prevent condensation build up occurring at the mask particularly during the cooler seasons.  The humidifier air would cool as it travels through the tube away from the heater source of the humidifier.  Once it cools enough, the water vapour would turn back into a liquid and flood the mask.  Heated tubes allow the air temperature to remain high all the way from the humidifier to the mask, preventing this ‘rain out’ and ensuring warm, moist air is inhaled by the patient.  The addition of the heated tube has solved this problem however has not been shown to improve adherence of CPAP use overall4.

Humidification is particularly important for sufferers of chronic airways disease.  Disorders such as COPD and bronchiectasis are often associated with persistent airway inflammation with mucus retention.  These patients can suffer exacerbations which often require hospitalisation.  Long term daily humidification use in this group of patients has been shown to significantly reduce exacerbations, improve lung function and quality of life5.

While humidification is often seen as comfort feature in regular CPAP therapy it is important to speak with your doctor or healthcare provider to ensure your treatment is optimised to reduce your symptoms.

  1. https://www.ncbi.nlm.nih.gov/pubmed/10453869
  2. https://www.ncbi.nlm.nih.gov/pubmed/27220350
  3. https://www.ncbi.nlm.nih.gov/pubmed/25957615
  4. https://www.ncbi.nlm.nih.gov/pubmed/26727475
  5. https://www.ncbi.nlm.nih.gov/pubmed/20144858
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