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

July 17, 2017

Are night owls better off changing their sleep patterns to be healthier?

Filed under: Blog — Tags: , , — Erika Mateus @ 4:27 am

A recent article published in the Wall Street Journal has sparked much debate for-and-against the need for people to change their sleep patterns in order to be healthier. Some experts say yes because ‘night owls’ tend to be vulnerable to health problems. Others say trying to overcome your natural tendencies can do more harm than good.

People who self-categorize as ‘night owls’ are often diagnosed with delayed sleep phase disorder (DSPD), a condition in which their internal clocks are out of sync with society’s external ones. Their 24-hour sleep-wake cycle is delayed, making them energetic long after most people have fallen asleep. Going to bed late has its disadvantages: most people with DSPD are forced to wake up before their bodies tell them to in order to make it to work or school on time, leading not only to insomnia early in the night, but also to fatigue during the day.

The aforementioned article showcases the opinions of Nathaniel F. Watson, a professor of neurology at the University of Washington in Seattle, who says some ‘night owls’ would benefit by trying to change their sleep patterns. On the other hand, Katherine Sharkey, an associate professor and the Assistant Dean for Women in Medicine and Science at Brown University’s Alpert Medical School, says going against your natural tendencies can do more harm than good.

The summary arguments are as follows:

YES

NO

·         Early to bed and early to rise makes a man healthy, wealthy and wise”

·         Evening type is bad for your health. Evening types have poorer diets, reduced quality of life and more depression, and they consume more alcohol than morning types. They also take longer to fall asleep and, perhaps most important, they sleep less.

·         The harsh reality is that modern society is hard on evening types. The end result is that evening types often end up chronically sleep-deprived, which is perilous to their health.

·         Chronic insufficient sleep is associated with cardiovascular disease, diabetes, obesity, impaired immunity, reduced performance, motor-vehicle accidents, poor mental health, pain and increased mortality. Clearly, we should strive to avoid these complications by prioritizing sleep in our lives, but simply ambling off to bed earlier isn’t an easy solution for evening types.

·         The most practical solution for evening types is to pursue careers with flexible hours.

·         Control the Light

·         Morning exercise, as is a regular bedtime routine that signals to the body that sleep is imminent.

·         Sleep patterns are determined mainly by core biological factors, and attempting to oppose the internal clock can increase health risks.

·         Sleep habits contribute less toward an individual’s predisposition to being a night owl. Unfortunately, resetting our internal clocks isn’t as easy as changing the time on a watch or the clock on a wall. And when sleep patterns and other light-dark cues don’t occur at predictable/expected times, this leads to desynchronization of the body clocks.

·         Desynchronized rhythms are associated with negative health consequences, including disrupted and shortened sleep, problems with mood regulation, metabolic abnormalities that increase the risk of obesity and diabetes, cognitive dysfunction and even increased cancer risk.

·         Solutions include the adoption of flexible schedules that allow people to work during their individual circadian daytime if possible. Education policy should acknowledge the strong preponderance of night owls among teens and young adults and schedule school start times to align with this known biology to reduce the number of young adults living in a perpetual state of circadian misalignment.

References:

 

 

Making healthy choices: Soluble Fibre can control Asthma

Filed under: Blog — Tags: , — Erika Mateus @ 4:05 am

Australian researchers have carried out an investigation which has found proof that soluble fibre can benefit people with asthma. According to researchers, these fibre supplements could be used as a complementary non-pharmacological treatment for people with poorly managed asthma.

 

In the study, the researchers gave a number of stable asthmatics daily supplements with inulin, a soluble fibre supplement, and monitored changes in asthma control, lung function and gut microbiota.  The trial duration was 9 weeks, including 6 visits to the clinical trials assessment facility. During the trial, participants were asked to consume a pre biotic (soluble fibre) supplement, a probiotic supplement and placebo and modify their diet by consuming two serves of fruit or vegetables and eat All-Bran each day.

 

Lead researcher Professor Lisa Wood says that the improvements were greatest in the 12 subjects who had poorly controlled asthma at baseline despite currently using inhaled corticosteroids. All had an improvement in asthma control to levels deemed clinically significant.

 

Furthermore, the investigators argue that “these studies show both how diets high in fat can worsen asthma, and how – conversely – a diet high in soluble fibre can help manage it. It illustrates just how vitally important it is that Australians eat a healthily and how fundamental healthy gut bacteria are to our well-being,” Lisa Wood said.

 

The results of this short term study provide proof that making healthy dietary choices, in this specific case, the use of soluble fibre could be an effective approach for help people to get their asthma under control.

 

References:

July 13, 2017

What is Exercise-induced Bronchoconstriction (EIB)?

Filed under: Blog — Mark Russell-Pavier @ 11:15 pm

For most people, maintaining a fitness regime is complicated enough as it is. After all, life does tend to get in the way. But for patients who suffer from exercise-induced bronchoconstriction (EIB), there are added difficulties.

EIB: What is it?

EIB occurs when the airways that bring air into and out of your lungs narrow during exercise, and it typically affects patients with asthma. People who don’t have asthma may suffer from it too.

EIB is also known as exercise-induced asthma (EIA). The preferred term is EIB, though, as EIA wrongly suggests that exercise causes asthma. Instead, exercise is often an asthma trigger. In the case of teens and young adults, EIB might be the most common cause of asthma symptoms.

Symptoms

EIB causes symptoms of asthma, which may include:

  • Coughing
  • Wheezing
  • Chest tightness
  • Shortness of breath

More often than not, symptoms won’t occur immediately at the beginning of an exercise session. Rather, they may start during the session and can become progressively worse five to 10 minutes after stopping.

Symptoms typically resolve within 30 minutes. Some sufferers may even feel a second wave, or “late-phase” of symptoms 4 to 12 hours after exercising. These are typically less severe, though, and can take up to 24 hours to settle.

Causes

Ever noticed that you normally inhale through your mouth when you exercise? Well, you do because your body needs to work harder, meaning it needs more oxygen to keep it going. Inhaling through your mouth allows you to breathe faster and deeper.

The trouble with mouth breathing is that it causes the air to be dryer and cooler than when you breathe through your nose. Dry and cold air trigger your airway to narrow, so exposure to it during exercise is more likely to cause asthma symptoms than exercising in warm, humid conditions.

These triggers can also make EIB symptoms worse:

  • Pollution levels
  • High pollen counts
  • Exposure to irritants such as smoke and strong fumes

 

Controlling EIB

When looking to treat a medical condition, it’s always wise to consult a medical practitioner. But for EIB sufferers, here are a few standard remedies.

Medication

You can manage EIB by using various types of medication. Talk to a medical practitioner about the benefits linked with them.

Exercise

It may be wise to exercise less when you have a viral infection, pollen or air pollution levels are high, or when temperatures are low. It’s also a good idea to do warm-ups and cool-downs as they may help lessen EIB symptoms.

Low endurance exercise like swimming in a warm, humid environment or walking, as well as activities that require short bursts of exercise (like volleyball or gymnastics) are good options for EIB sufferers. Sports that require constant activity (like soccer) may not be.

Children with EIB

With children back at school, cricket, swimming and future summer sporting activities will be back on the agenda. In addition to seeking advice from a medical practitioner, tell teachers and coaches if your child suffers from EIB. And remember, with the proper care, your child can thoroughly enjoy summer, sports and life in general.

www.cipla.co.za

Electronic CPAP data management – Implications for management, privacy and medico-legal issues.

Filed under: Blog — Tags: , , , , , — Trent Segal @ 5:47 am

Technology has seen improvements in the amount and types of data CPAP machines record and more recently manufacturers have utilised wi-fi or modems to transmit data to cloud based databases so it is readily available without necessarily going into the clinic for review.

The Australasian Sleep Association (ASA) have reviewed the current literature on CPAP monitoring systems to provide guidance on their use in the Australasian context.

CPAP monitoring systems

Three leading CPAP manufacturers were compared and all were found to measure and record data in slightly different ways due to their patented algorithms.  For example, the machines algorithms all calculate the residual apnoea-hypopnoea index (AHI) and mask leakage from the flow sensors in the machine.  However all the compared manufacturers did this in a different way based off different criteria of changes in the flow signals.  Additionally during sleep study polysomnography (PSG), many other sensors are used such as respiratory effort, blood oxygen and EEG changes to ultimately determine the AHI, so can this be directly compared to the AHI of a CPAP data system?

Studies have found discrepancies between CPAP AHI and PSG AHI particularly the hypopnoea index.   It was only found to be clinically useful when the CPAP AHI is very low <10 or high >20 however treatment should always be assessed with clinical expertise.  It is also unknown how the long term CPAP AHI values mean clinically in terms of improving cardiovascular, cognitive and daytime function.

Privacy and security policies

The three major manufactures offer cloud based databases for storage of therapy data and patient information which has improved access and patient management.  How secure is this data though?  All have created privacy policies to comply with the relevant legislation and have measures in place to protect it.  However they do need to be reviewed and updated regularly to prevent data breaches and should be checked to ensure they comply with any legislation changes.  Patients should also be explained how their data is hosted and managed and they should carefully read the privacy policies before they consent to their use.

Legal implications

With the ability to now manage CPAP data remotely the question arises, what are the legal implications for providers of therapy?  For example, if a CPAP user has not been adherent or therapy is sub-optimal, then falls asleep driving and causes an accident, what are the legal implications for the treating physician or CPAP providers?  The ASA recognised that some liability does fall on the treating medical professionals and their practices should have good risk management and insurance practices in place.  The frequency of follow up using the new technology and optimal treatment guidelines need to be legally reviewed and no guidelines exist at present however the ASA recommends that CPAP data be reviewed in accordance with the ‘Best Practice Guidelines for CPAP Therapy’.

CPAP data for improving adherence

The modems and wireless transmission means have enabled better tracking of patients therapy however no guidelines have been published on how this data should be used, particularly the frequency in which they should be checked.  Some studies have shown improved adherence to therapy when using this technology in a way so that struggling patients are quickly followed up via telephone compared to standard routinely set follow ups.  The rapid delivery of data makes this information more available for providers to more easily identify struggling patients and follow them up.  New apps and websites allowing patients to view their own data and usage has also been shown to yield an improved adherence in patients who made use of these features compared to those who did not.

Take home messages

  • Standardisation is needed for the algorithms for detecting AHI, leak by CPAP machines.
  • A new name for CPAP AHI (AHIflow) should be adopted as it is not the same measure as PSG AHI.
  • CPAP AHI should not replace comprehensive clinical assessment and follow up. CPAP AHI is clinically useful if the AHI is very low <10 or high >20.
  • Patients should be encouraged to read privacy policies to follow understand how their data is securely stored and used.
  • CPAP data should be reviewed at 7, 30, 60 days then at 12 months and yearly thereafter. CPAP data should not be assessed in isolation and should occur within the context of an overall clinical review by a medical practitioner.
  • Data should be used to help stratify access to review for those that need it most to improve adherence and treatment.
  • Patients should be encouraged to engage in their own CPAP data to improve their usage.

 

http://www.sleep-journal.com/article/S1389-9457(17)30154-5/pdf

July 7, 2017

Environmental control of Asthma

Filed under: Blog — Tags: , , — Erika Mateus @ 6:51 am

Facts

 There is a strong link between asthma and allergies and it has been observed that the majority of people with asthma have allergies. In individuals with asthma, exposure to relevant allergens can exacerbate asthma symptoms and trigger flare-ups, including severe acute asthma.

It is also true that allergens are present in workplaces and they are considered as a common cause of occupational asthma.

Although atopic sensitization increases the risk of developing asthma, most people who are allergic to inhalant allergens or food allergens do not have asthma. Among people with food allergies, asthma may be a risk factor for fatal anaphylaxis due to food allergens.  However, foods are rarely a trigger for asthma symptoms.

Neither asthma nor allergy is a single disease – each has multiple phenotypes and is a complex of several different diseases with different aetiologies, genetic risk factors and environmental risk factors. Asthma morbidity may be increased with exposure to indoor and outdoor environmental allergens.

 

Important indoor allergens may include:

  • house dust mites
  • pets
  • mould
  • cockroaches
  • mice
  • environmental tobacco smoke
  • indoor air pollution
  • poorly ventilated gas stoves

Allergens in the workplace may include

  • dust
  • chemicals
  • work site temperature
  • vapours, gas, fumes

Outdoor allergens or triggers may include

  • air pollution
  • weather changes or exposure to cold air

 

National Heart, Lung, and Blood Institute (NHLBI) recommendations include

General Recommendations

  • Reduce allergen exposure to relevant indoor and outdoor allergens to which the patient is sensitive.
  • Consider measures to control indoor mould
  • Consider air conditioning during warm weather, if possible, to reduce exposure to outdoor allergens.
  • Patients with asthma should not smoke or be exposed to environmental tobacco smoke
  • Consider referring adults who smoke and have young children with asthma to smoking cessation programs.
  • Suggest patients avoid, if possible:
  • Exertion or exercise outside when levels of air pollution are high
  • Exposure to gas stoves and appliances that are not vented to the outside
  • Fumes from wood-burning appliances or fireplaces
  • Sprays or strong odours

 

Exposure to house dust mite (mainly Dermatophagoides pteronyssinus) is a major asthma trigger in Australia. Strategies that have been proposed for reducing exposure to house dust mites include:

  • encasing bedding (pillows, mattresses and doonas) in mite-impermeable covers
  • Weekly washing bed linen (pillowcases, sheets, doona covers) in a hot wash (> 55°C)
  • using pillows manufactured with anti-microbial treatments that suppress fungal growth and dust mites
  • removing unnecessary bedding such as extra pillows and cushions where dust mites might live and breed
  • removing soft toys, or washing them in a hot wash (> 55°C) every week
  • vacuuming rugs and carpets weekly using a vacuum with a high-efficiency particulate air (HEPA) filter, while the allergic person is absent
  • cleaning hard floors weekly with a damp or antistatic cloth, mop or a steam mop and dusting weekly using a damp or antistatic cloth
  • Regularly washing curtains or replacing curtains with cleanable blinds
  • Spraying the area with chemicals that kill mites (acaricides), such as benzyl benzoate spray or liquid nitrogen. Acaricide sprays are not commonly used in Australia

 

Pet Allergen Control Measures

 If patient is sensitive to animal, treatment of choice is removal of animal from the home

If removal of animal unacceptable:

  • Keep pet out of patient’s bedroom
  • Keep patient’s bedroom door closed
  • washing hands and clothes after handling pets
  • washing clothes and pet bedding in hot water (> 55°C)
  • Frequent vacuuming of the home using a vacuum with a HEPA filter
  • cleaning hard floors with a damp/antistatic cloth or a steam mop, and cleaning air-conditioning or heating ducts
  • Grooming pets regularly (where possible, the patient should be absent while this occurs), and washing pets regularly, but no more than the vet recommends. 

     

     

     

    REFERENCES

    1. AUSTRALIAN AND NEW ZEALAND GUIDELINES:

    National Asthma Council Australia (NACA) guideline on allergies and asthma can be found at NACA 2016 Oct PDF. Available: https://www.asthmahandbook.org.au/uploads/58041f9d4f999.pdf. Please note the content of this PDF reflects the Australian Asthma Handbook at the publication of Version 1.2 (October 2016). For the most up-to-date content, please visit asthmahandbook.org.au

    1. National Library of Medicine, or “Vancouver style” (International Committee of Medical Journal Editors): DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Record No. 116833, Environmental control of asthma; [updated 2015 Apr 20, Australia]; [about 12 screens]. Available from  http://search.ebscohost.com.ezproxy.unal.edu.co/login.aspx?direct=true&db=dnh&AN=116833&site=dynamed-live&scope=site

July 3, 2017

Sinus infection (sinusitis) related to asthma

Filed under: Blog — Mark Russell-Pavier @ 6:36 am

Sinus infection (sinusitis) is related to asthma. The sinuses are located in the cheekbones, around the eyes and behind the nose in hollow cavities. The sinuses help keep the air that is inhaled warm, moist and filtered by being lined with mucus. If something blocks the mucus from draining normally, an infection can occur.

The asthma and sinusitis relationship – also known as rhinosinusitis – exists because the conditions are quite similar and both affect airways. In fact, there are high rates of allergic rhinosinusitis in those with asthma. Sinusitis symptoms include sneezing, congestion and inflammation of the nasal passages. In asthmatics, the same things that trigger asthma can also trigger the nasal passages to become inflamed, thus contributing to sinusitis.

Presence of sinusitis in asthma patients

Numerous studies show a relationship between asthma and sinusitis. One study in particular compared the two respiratory conditions and found asthma symptoms worsen for asthmatics with sinusitis, asthma flares become more severe and their sleep is more disturbed.

Other research found that developing sinusitis in asthma patients is more common in women than men. Acid reflux and smoking can also increase the risk of developing sinusitis in asthma patients. Furthermore, the more debilitating a person’s asthma is, the more severe sinusitis will be.

In an alternative study of 78 asthma patients, 50.7 percent of them also showed evidence of sinusitis. Those asthmatics had lower forced expiratory volume within one second compared to asthmatics without sinusitis. The study revealed that although sinusitis can reduce lung function at baseline, it does not contribute to long-term lung impairment after a three-year follow-up.

Asthma related chronic sinusitis vs. allergic rhinitis

Asthma related chronic sinusitis vs. allergic rhinitisAllergic rhinitis is when you inhale something you are allergic to that causes the nose to become inflamed and swollen.

Both chronic sinusitis and allergic rhinitis share many symptoms, so the two are often confused with one another. However, there are some distinct differences between the two. For example, symptoms of allergic rhinitis are a blocked nose, runny nose, watery and itchy eyes, sneezing and itchy mouth, nose and ears.

Symptoms of chronic sinusitis include throbbing pain in the cheek area, forehead and eyes, yellowish or greenish nasal discharge, loss of smell, aches and pain in the face or jaw and even fever or nausea.

A fever is a sign of infection and is related to sinusitis; therefore, a fever will not be experienced in allergic rhinitis.

Additionally, there are differences in treatment. Treatment for allergic rhinitis consists of preventing an allergic attack and avoiding allergens, and sinusitis treatment involves antibiotics and nasal decongestions.

Tips to prevent sinusitis from triggering asthma

Sinusitis is an infection, so in order to prevent it you must take the necessary steps to protect yourself from getting infected. Tips to prevent sinusitis include:

  • Practice good hygiene – wash your hands, use hand sanitizers, avoid people who are sick.
  • Get the flu shot.
  • If you have asthma, speak to your doctor as symptoms of asthma can worsen if you contract sinusitis.
  • Keep breathing equipment clean, i.e., asthma inhalers or mouthpieces.
  • Keep your nose moist.
  • Avoid dry indoor air – use a humidifier.
  • Avoid products that give off fumes.
  • Get yourself tested for allergies.
  • Avoid swimming for long hours in chlorinated pools.

Treatments for asthma and sinusitis

Treatments for asthma and sinusitisIf you’re asthmatic, sinusitis can worsen your asthma. Treating both conditions can offer optimal relief. Treatment for asthma and sinusitis include:

  • Avoid upper respiratory infection – the prevention tips above can help you with that.
  • Treat all respiratory infections promptly.
  • Manage your allergies.
  • Avoid cigarette smoking, smoke in general and air pollution – pay attention to news reports or air pollutants.
  • Use an air filter or humidifier within your home and bedroom.
  • Use an air purifying system within your home.

Working closely with your doctor can provide you with more effective treatment tips in order to successfully treat both conditions.

7 myths about cough

Filed under: Blog — Tags: — Mark Russell-Pavier @ 5:51 am

A cough is the rapid expulsion of air from the lungs to clear the throat airways of mucus, foreign particles, fluids, microbes and various irritants.

People tend to get worried if a cough lasts more than a week to ten days, but a 2013 review found that the average cough actually lasts around 18 days. After more than eight weeks a cough can be regarded as chronic and it is advisable to seek medical advice.

Here are seven misconceptions about this common respiratory reflex:

1. All coughs are caused by infections

The occasional cough to clear one’s throat doesn’t indicate a health problem or condition. Frequent bouts of coughing, however, is a sign that there is something more serious irritating the throat. This may or may not be caused by infection.

Infectious causes of cough include the common cold, flu, laryngitis, sinus infections, bronchitis, pneumonia and whooping cough.

Non-infectious causes of cough include post-nasal drip, emphysema, asthma, GERD (gastroesophageal reflux disease) and allergies.

2. Antibiotics will cure a cough

Antibiotics kill bacteria, but do not have any effect on viruses. A cough is most commonly caused by a cold or flu, which are both viral infections, so the answer in most cases is no. Pneumonia may however be caused by bacteria, in which case antibiotics will be effective.

A good reason to avoid using antibiotics for colds and flu is the emergence of “superbugs” that are resistant to antibiotics. In South Africa antibiotic resistance is being driven by the incorrect use of antibiotics by people suffering from a cold.

3. Hot soup can cure a cough

People suffering from colds or flu tend to produce excess mucus (wet cough), which can get into the lungs and result in coughing. Warm liquids like soups are soothing to the throat and decrease irritation and may therefore ease coughing, but cannot cure the respiratory tract infection that – in most cases – caused the cough.

4. All coughs are contagious

A cough may or may not be contagious. A cough that is caused by a viral or bacterial infection will tend to be contagious, whereas coughs that are the result of allergies, asthma or airway irritation are in most cases not contagious at all.

5. Cough syrups are an effective remedy

Commercial cough syrups typically include cough suppressants like dextromethorphan, which block your cough reflex, and expectorants like guaifenesin, which are supposed to loosen up mucus in the airways. However, studies have found no good evidence that cough meds are any better than a placebo.

6, There are lots of different types of cough

The truth is that there are in fact only two types of cough, wet (productive) and dry (non-productive).

A dry cough will tickle your throat and is mostly caused by viral infections, smoke, dust or inflammation. A wet or “slimy” cough is caused by phlegm or mucus in the lungs.

7. Vaccination will prevent a cough

CDC cautions that pertussis (whooping cough) vaccines are effective, but not perfect. They typically offer good levels of protection within the first two years of getting vaccinated, but protection decreases over time.

The annual flu vaccine is the best way to avoid the seasonal flu, which will most likely involve coughing. Trivalent (three-component) and quadrivalent (four-component) flu vaccines are available, which means that your flu shot will offer protection against three or four of the most common flu strains. There are however many other flu strains around against which you will not be protected.

Vaccination will have no effect on non-infectious causes of cough (e.g. post-nasal drip, emphysema, asthma, GERD, allergies).

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

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