LANSING, Mich., July 12, 2010 – Drinking tart cherry juice daily could help reduce the severity of insomnia and time spent awake after going to sleep, according to a new study published in the Journal of Medicinal Food1.

A team of University of Pennsylvania, University of Rochester and VA Center of Canandaigua researchers conducted a pilot study on the sleep habits of 15 older adults. The adults drank 8 ounces of tart cherry juice beverage (CheriBundi www.cheribundi.com) in the morning and evening for 2 weeks, and a comparable matched juice drink, with no tart cherry juice, for another 2 week period. There were significant reductions in reported insomnia severity and the adults saved about 17 minutes of wake time after going to sleep, on average, when drinking cherry juice daily, compared to when they were drinking the juice drink.

Ongoing sleep issues plague more than 40 million adults and another 20 million experience occasional sleep disruptions, putting their health and wellbeing at risk, and leaving many Americans on a quest for sleep solutions, according to the National Institutes of Health. Americans spend more than $84 million on over-the-counter sleep aids each year2.

The researchers suspect tart cherries’ natural benefits could be due in part to their relatively high content of melatonin – a natural antioxidant in cherries with established ability to help moderate the body’s sleep-wake cycle. Produced naturally by the body in small amounts, melatonin plays a role in inducing sleepiness at night and wakefulness during the day.

Russel J. Reiter, Ph.D, a biomedical scientist at the University of Texas Health Science Center and one of the world’s leading authorities on melatonin, says while melatonin supplement pills have been heavily promoted as a sleep aid, foods such as cherries – available year-round as dried, frozen and juice – may be a better alternative for boosting the body’s own supply of melatonin. “When consumed regularly, tart cherries may help regulate the body’s natural sleep cycle and increase sleep efficiency, including decreasing the time it takes to fall asleep,” says Reiter. “And, because cherries are so rich in other antioxidants, such as anthocyanins, you get other important health benefits.”

The Power of Red

Not only is melatonin linked to sleep, but research suggests melatonin can be a powerful antioxidant, helping reduce age-related inflammation and fighting free radicals in the body. Beyond melatonin, cherries are packed with other powerful antioxidant compounds, including anthocyanins – the compounds responsible for cherries’ bright red color. A growing body of science indicates that cherries may help reduce inflammation, aid muscle recovery and reduce risk factors of age-related conditions.

Source: Caitlin Solway, Weber Shandwick Worldwide via EurekAlert

Phase III trials studying the efficacy and safety of MK-4305 in elderly and non-elderly insomnia patients are ongoing. Merck anticipates filing regulatory applications for MK-4305 in 2012.

"Since the discovery and characterization of orexin over the past decade as an important component of the sleep-wake system, Merck has been actively committed to discovering and developing potential interventions for sleep disorders that target the orexin receptors. We are encouraged by these phase II results showing positive effects of MK-4305 in patients with primary insomnia,” said David Michelson, M.D., vice president of Neuroscience Clinical Research, Merck. “Phase III research will provide further insight into the safety and efficacy profile of MK-4305, which, if approved, would provide a new class of insomnia treatments.”

About MK-4305

MK-4305 is an investigational dual orexin receptor antagonist (DORA) compound that is thought to inhibit the actions of the neuropeptides orexin A and orexin B, which bind with the OX1R and OX2R receptors. These neuropeptides are produced by neurons, located within the hypothalamus region of the brain, and play a key role in regulation of the brain’s sleep-wake process. Orexin antagonists are thought to block the stimulation of the brain’s arousal system.

Source: Merck

1. My sleep is getting worse and no one can help.

Insomnia can be treated with a very high rate of success. There are doctors near you who specialize in helping people who have sleep problems. A sleep specialist can decide which treatment option will work best for you.

2. Insomnia seriously affects health.

Insomnia is unlikely to cause severe health problems. But it may be related to other medical problems that can affect your health. Many people with insomnia also suffer from depression.

3. I am better off taking sleeping pills.

Sleeping pills can provide short-term relief for a sleep problem. But they may cause side effects. Other treatment options may be safer and more effective for you. You should discuss all your options with a doctor.

4. Insomnia prevents me from enjoying life.

Most people with insomnia have normal, enjoyable lives. Insomnia is a challenge for you to overcome. But it is not a barrier that keeps you from enjoying life.

5. I have no control over my racing mind.

You can learn how to relax your mind and your body when you are in bed. Part of this process involves setting aside time to reflect on the day’s events and plan for what lies ahead.

6. A bad night of sleep always follows a good night of sleep.

A good night of sleep usually helps you sleep well again the next night. You will feel better and more relaxed. You also will be less worried about your sleep.

7. I can’t predict how I’m going to sleep.

Your body tends to sleep in a cycle. This makes sleep fairly predictable. Your body sleeps best when you go to bed and wake up at the same times every day.

8. I need 8 hours of sleep to function during the day.

Most adults do need an average of 7 to 8 hours of sleep each night. But a poor night of sleep does not have to ruin your day. Most people with insomnia continue to function well after a sleepless night.

9. I should try harder when having sleep problems.

Many people with insomnia try too hard to sleep. It is important to help your mind and body relax at bedtime. Take a warm bath, eat a light snack or read for a few minutes before going to bed.

10. I should spend more time in bed to get more sleep.

You should go to bed only when you are sleepy. If you are not asleep in 20 minutes, then you should get back out of bed. Leave the bedroom and do something relaxing. Once you are sleepy, return to bed and go to sleep.

Discuss your sleep problems with your primary care doctor. Let him or her know if your sleep problem is causing you distress or affecting you during the day. Your doctor may refer you to a sleep specialist for more help.

Some sleep specialists are certified in behavioral sleep medicine (BSM). They specialize in treatment methods that help you change habits or thoughts that keep you from sleeping well.

In a study of young children, researchers showed that insomnia symptoms were consistently associated with impaired heart variability measures. They also found a significant but less consistent pattern with shortened sleep duration and decreased heart rate variability.

Heart rate variability is the beat-to-beat variations of heart rate. In a healthy person, beat-to-beat intervals change slightly in response to automatic functions like breathing.

The study included 612 elementary school children in the first to fifth grades. The children were average age 9, and 25 percent were non-white and 49 percent were boys. All were generally in good health. Their parents completed the Pediatric Behavior Scale, including two questions that focused on symptoms of insomnia.

Researchers examined the children overnight in a sleep laboratory with polysomnography (PSG), a standardized method for measuring sleep disorders. The researchers measured sleep duration, trouble falling asleep, the number of wake-ups and problems going back to sleep if awakened. They also measured cardiac autonomic modulation (CAM), the balance of the sympathetic and the parasympathetic control of the heart rate rhythm.

A balance is needed between the sympathetic modulation that “excites” the heart and the parasympathetic modulation that “calms” the heart, said Mr. Fan He, the lead-author of the study and a graduate student at Penn State University College of Medicine in Hershey, Pa. “The balance between the sympathetic and the parasympathetic provides a favorable profile for the heart.”

The study showed:

• Children with reported insomnia had impaired CAM with a shift towards more sympathetic or excitable activation of the heart rhythm. There was a 3 percent to 5 percent reduction in the parasympathetic modulation of heart rhythm in children with insomnia.
• Children with longer sleep duration had a slower heart rate indicative of a balance of heart rhythm, with a shift towards more parasympathetic modulation. The heart rate of children who slept eight hours was two beats per minute slower than that of kids who slept only seven hours.
• Insomnia and short sleep duration, even in young children, resulted in a physiological activation of the sympathetic modulation.

“Kids who sleep a longer duration have a healthier heart regulation profile compared to kids who sleep shorter durations,” said Duanping Liao, M.D., Ph.D., co-author of the study and professor of epidemiology at Penn State University College of Medicine in Hershey, Pa. “Their hearts are more excitable if they have insomnia. If the heart is too excited, that means it is beating too fast and usually that isn’t good. These data indicate that among young children with insomnia symptoms reported by their parents, there already is an impairment of cardiovascular autonomic regulation, long before they reach the traditional high-risk period for cardiovascular disease.”

Parents should encourage their children to have healthy bedtime habits that encourage sleep, Liao said. “Watching television before going to bed and waking up to return text messages are examples of activities that could have a harmful affect on healthy sleep patterns in children.”

Liao called for further studies in children to determine the impact of sleep deprivation and stress and the possible long-term risk of cardiovascular disease and obesity. “Previous studies have shown a strong association of heart rhythm regulation and heart risk in adults. It’s quite possible that this kind of stress can have a long-term impact even at a young age.”

The study was funded by the National Heart, Lung, and Blood Institute.

Other co-authors are: Xian Li, M.D., M.S.; Sol Rodriguez-Colon, M.S.; Alexandros N. Vgontzas, M.D.; Chuntao Wu, M.D., Ph.D.; and Edward O. Bixler, Ph.D. Author disclosures are on the abstract.

Source: Karen Astle, American Heart Association

The study, published online by the journal Sleep Medicine, demonstrates that a behavioral intervention can help patients who already are taking medications for pain and might be reluctant or unable to take additional drugs to treat sleep disturbance.

“This therapy made a major difference to these patients,” said Carla R. Jungquist, F.N.P., Ph.D., of the Medical Center’s Sleep and Neurophysiology Research Laboratory, who is the lead author of the Sleep Medicine article. “We saw very good treatment effects.”

For the study, a nurse therapist delivered the eight weeks of cognitive behavioral therapy, which included sleep restriction, stimulus control, sleep hygiene, and one session devoted to discussion of catastrophic thoughts about the consequences of insomnia.

“This study really shows that this therapy can be delivered successfully and very effectively by advance practice nurses,” Jungquist said. “Training nurses in the delivery of this type of therapy will result in better access for patients. Currently, access to this therapy is limited as there are few trained therapists and most are psychologists.”

Patients with chronic pain often use sleep as an escape. They seek sleep when not sleepy, sleep in places other than the bedroom, and engage in non-sleep behaviors, such as watching television and resting a painful back, in the bedroom, the researchers report.

Using behavioral therapy instead of adding to their list of medications is a healthier and safer method of treating sleep disturbance, Jungquist said.

“We establish a structure for the times or hours spent in bed,” Jungquist explained. “We focus on a patient’s negative thoughts about sleep and address unhealthy sleep behavior. We address habits, including use of caffeine or alcohol. We tell people to do nothing in bed except sleep or sex.”

Twenty-eight patients took part in the study. They were tracked through detailed sleep diaries. Their pain and mood were measured using several standard methods throughout the study period. The patients were followed for six months after treatment. Researchers expect to report soon on the duration of the effects of the treatment.

The researchers believe that cognitive behavioral therapy is as effective as other tested treatments for insomnia and chronic pain and, in some cases, is more effective than other therapies.

The researchers have developed a unique, user-friendly manual that described each step of every treatment session. It can be used to train more therapists.

The study, published online this month, was funded by the National Institute of Nursing Research.

In addition to Jungquist, the authors of the study include: Chris O’Brien, R.N., of the University of Rochester School of Nursing; Sara Matteson-Rusby, Psy.D., research assistant professor of Psychiatry; Michael T. Smith, Ph.D., associate professor of Psychiatry and Behavioral Medicine at Johns Hopkins University; Wilfred R. Pigeon, Ph.D., assistant professor of Psychiatry and director of the Medical Center’s Sleep and Neurophysiology Research Laboratory, Yinglin Xia, Ph.D., and Naiji Lu, Ph.D., of the Medical Center’s Department of Biostatistics, and Michael L. Perlis, Ph.D., of the University of Pennsylvania, Department of Psychiatry.

Source: University of Rochester Medical Center

Two other therapies — light therapy and melatonin — have been used to treat insomnia with varying degrees of success. As of 2005, neither has been found as effective as changing your habits or taking medications.

Light therapy

Some experts recommend exposure to bright light to reset an insomniac’s internal clock. Researchers from Flinders University in Adelaide, South Australia, successfully used bright light therapy to improve the sleep of nine insomniacs prone to waking between 3 a.m. and 5 a.m. After two evenings of exposure to bright light, the participants slept more than an hour longer. A comparison group of insomniacs exposed to dim lighting showed no improvement. However, light therapy is not commonly used to treat insomnia at most sleep centers because other treatments such as behavior modification are usually more effective.

Melatonin

In the mid-1980s, researchers began to investigate whether oral doses of melatonin, a hormone secreted by the pineal gland might help reset the biological clocks of travelers, shift workers, and people with insomnia. It seems to be most helpful for people with low levels of naturally occurring melatonin. So far, however, there are insufficient data for the FDA to approve this supplement as a treatment for insomnia.

In one small study, researchers in Israel tested melatonin as a sleep aid in 12 men and women, with an average age 76, who had insomnia. People who took melatonin before going to bed fell asleep faster and slept about 10% longer than those who received a placebo. There were no adverse reactions. Other studies, however, found that melatonin did not have any effect on sleep.

A synthetic form of melatonin is sold in health food stores and pharmacies. In the United States, this product – which is not regulated by the FDA – is considered a nutritional supplement, so there is no guarantee of its purity or efficacy. In Great Britain and Canada, melatonin is now classified as a medicine and is no longer available over the counter. To date, there is no reliable information available about its effects during pregnancy or its interactions with other drugs.

Source: everyday Health

Can’t sleep at night? A new study published in the journal Sleep has found that people who suffer from insomnia have heightened nighttime blood pressure, which can lead to cardiac problems. The investigation, which measured the 24-hour blood pressure of insomniacs compared to sound sleepers, was conducted by researchers from the Université de Montréal, its affiliated Hôpital du Sacré-Cœur de Montréal Sleep Disorders Centre and the Université Laval.

“Over many years, chronic insomnia can have negative effects on the hearts of otherwise healthy individuals,” says lead author Paola A. Lanfranchi, a professor in the Université de Montréal Faculty of Medicine and researcher at the Hôpital du Sacré-Cœur de Montréal Sleep Disorders Centre. “Whereas blood pressure decreases in regular sleepers and gives their heart a rest, insomnia provokes higher nighttime blood pressure that can cause long-term cardiovascular risks and damage the heart.”

The findings are important given that insomnia, which is a chronic difficulty falling or staying asleep, affects up to 48 percent of the population at some point in their lives. As part of the study, the scientific team recruited 13 otherwise healthy chronic insomniacs and 13 good sleepers. Subjects spent 40 hours in the sleep laboratory: two nights for adaptation and one for monitoring followed by the intervening day.

“Blood pressure cycles are mainly linked to the sleep-wake cycle,” says co author Jacques Montplaisir, a professor in the Université de Montréal Department of Psychiatry and director of Hôpital du Sacré-Cœur de Montréal Disorders Center. “Since blood pressure is heightened among insomniacs, those with overt cardiac disease are particularly at risk for progression of the disease.”

About the Study:

The article “Nighttime Blood Pressure in Normotensive Subjects With Chronic Insomnia: Implications for Cardiovascular Risk,” published in Sleep was authored by Paola A. Lanfranchi, Marie-Hélène Pennestri, Lorraine Fradette, Marie Dumont and Jacques Montplaisir of the Université de Montréal and its affiliated Hôpital du Sacré-Cœur de Montréal, as well as Charles M. Morin of the Université Laval.

Partners in Research:

This study was funded by the Cana¬dian Institutes of Health Research, the Heart and Stroke Foundation of Québec and the Fonds de Recherche en Santé du Québec.

Source: Sylvain-Jacques Desjardins, University of Montreal

Results showed that treatment improves both immediate and long-term self-reported sleep and pain in older patients with osteoarthritis and comorbid insomnia without directly addressing pain control. Participants who received CBT-I reported significantly decreased sleep latency (initially decreased by an average of 16.9 minutes and 11 minutes a year after treatment) and wake after sleep onset (initially decreased by an average of 37 minutes and 19.9 minutes a year after treatment), significantly reduced pain (initially improved by 9.7 points and 4.7 points a year after treatment) and increased sleep efficiency (initially increased by 13 percent and 8 percent a year after treatment). These improvements persisted in CBT-I patients (19 of 23) who were further assessed for sleep quality and perceived pain at a one-year follow-up visit.

According to lead author Michael V. Vitiello, PhD, professor at the University of Washington in Seattle, Wash., results indicate that insomnia is not merely a symptom of osteoarthritis but rather a co-existing illness. Vitiello said improving sleep can result in an improvement in osteoarthritis, which is particularly important because, at least in older adults, insomnia rarely exits by itself, rather it typically coexists with other illnesses, pain conditions and depression.

“The particular strength of CBT-I is that once an individual learns how to improve their sleep, study after study has shown that the improvement persists for a year or more,” said

Vitiello. “What we and others are showing is that CBT-I can not only improve sleep but that improvement of sleep may lead to improvement in co-existing medical or psychiatric illnesses, such as osteoarthritis or depression, and in the case of our study, that these additional benefits can be seen in the long term.”

A total of 23 patients with a mean age of 69 years were randomly assigned to CBT-I, while 28 patients with a mean age of 66.5 years were assigned to a stress management and wellness control group. Participants in the control group reported no significant improvements in any measure.

CBT-I intervention consisted of eight weekly, two-hour classes ranging in size from four to eight participants. All classes were conducted in an academic medical center in downtown Chicago and were spread out over the calendar year. Participants received polysomnographic assessment in their home in order to exclude individuals with sleep apnea. Sleep and pain were assessed by self-report at baseline, after treatment, and (for CBT-I only) at one year follow-up. Sleep logs were recorded prior to and after treatment and at the one year follow-up and included information about sleep latency, wake after sleep onset and sleep efficiency. Subjects were required to be over the age of 55, have insomnia symptoms that have persisted for at least six months and have been diagnosed with osteoarthritis. A majority of the sample was female. Volunteers were recruited from placements of brochures, memos and flyers in places where medical patients who qualified for the study might see them.

According to the study, sleep quality is a major concern for people with osteoarthritis, with 60 percent of people who have the disease reporting pain during the night. Chronic pain initiates and exacerbates sleep disturbance; disturbed sleep in turn maintains and exacerbates chronic pain and related dysfunction.

The findings indicate that successful treatment of sleep disturbance may improve the quality of life for patients in this population. The authors recommend that CBT-I, which specifically targets sleep, be incorporated into behavioral interventions for pain management in osteoarthritis and possibly for other chronic pain conditions as well.

The study: “Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis”

Source: Kelly Wagner, American Academy of Sleep Medicine

Stress, worry, caffeine, alcohol and watching TV in bed — factors known as “poor sleep hygiene” — are the major reasons why people can’t shut down their bodies when it’s time for sleep, explained Dr. Sunil Mathews, medical director of the Sleep Center at Baylor Medical Center at Irving, Texas. Poor sleep hygiene can also lead to taking sleep-aid medications that could interfere with alertness the next day, he said.

A recent National Sleep Foundation poll found that 47 percent of people with sleep problems were likely to use caffeinated beverages to compensate for their daytime sleepiness, but these stimulants contribute to more difficulties sleeping.

“Insomnia can turn into a vicious cycle,” he said in a news release from the medical center.

To develop good sleep hygiene, Mathews recommends the following:

• Develop a calming bedtime routine. Relax body and mind through yoga, biofeedback and meditation, or take a cup of warm milk with nutmeg.
• Avoid workouts within four hours of bedtime. While regular exercise relieves stress, it also raises core body temperature, which can make falling asleep more difficult.
• Avoid caffeine, alcohol or sugary items within eight hours of bedtime.
• Keep your bedroom dark, cool, quiet and comfortable.
• Maintain a regular sleep schedule, even on weekends.
• Use your bedroom for sleep only. Find someplace else to watch TV, plan your day or fret so that your mind associates the room only with sleep.

Today, millions of Americans can attest to his insight. According to a poll from the National Sleep Foundation (NSF), 27 percent of Americans say personal finances, the economy or unemployment concerns are keeping them awake at night.

“Stress and anxiety can definitely impact sleep,” says Sunil Mathews, M.D., medical director of the Sleep Center at Baylor Medical Center at Irving. “And unfortunately, insomnia can turn into a vicious cycle.”

For example, according to the NSF poll, 47 percent of the sleepless are very likely to use caffeinated beverages like coffee, tea and sodas during the day to compensate for their sleepiness. But the use of artificial stimulants and insomnia are correlated. The majority of people who have difficulty sleeping report using those substances.

Dr. Mathews describes these habits as “poor sleep hygiene,” or behaviors that will delay sleep onset. Examples include going to bed at irregular times, watching TV late at night, exercising too close to bedtime, and of course consuming caffeine and alcohol.

Another aspect of poor sleep hygiene includes worrying while in bed.

“Some people can develop an unhealthy habit of using the bed to plan for the next day. The mind won’t shut down, which delays sleep onset.”

In desperation, these people may turn to sleep aids like pills. Unfortunately, these aids are short-term solutions at best and tend to cause next-day drowsiness and then prevent sleep the next night, unless another pill is taken, according to Dr. Mathews.

Besides affecting concentration, memory and mood, Dr. Mathews says sleep deprivation can “precipitate depression and sometimes make people think they’re suffering from other cognitive issues.”

One effect that can prove lethal: drowsy driving.

More than half of adults (54 percent) have driven when drowsy at least once in the past year. An alarming percentage of people (28 percent) say they’ve nodded off or fallen asleep at the wheel, according to an AAA study. The National Highway Traffic Safety Administration attributes an estimated 76,000 injuries and 1,500 deaths each year at least in part to drowsy driving.

What can you do to break the cycle of sleeplessness? Dr. Mathews recommends good sleep hygiene habits.

- Don’t just throw yourself into bed after a hectic day and expect to fall asleep. Implement a relaxing bedtime routine that allows you to gently segue from your day to bedtime. Yoga, biofeedback and meditation can help relax both body and mind prior to sleep. Even a small glass of warm milk with nutmeg can help ease the passage from daytime activities to bedtime.

- Exercise regularly, but finish working out at least four or five hours before bedtime. Exercising raises core body temperature, which can delay sleep onset.

- Avoid caffeinated and sugary foods, as well as alcohol, for the eight hours prior to bedtime.

- Keep your bedroom dark, cool and quiet to ease your passage into sleep. Make sure that your sleeping area is comfortable.

- Keep a regular sleep schedule during both the week and weekend.

- Use your bedroom for sleep so that you don’t associate other daily activities with going to bed.

And remember, the economy, just like sleep, is a cycle, so when it’s bedtime, try to go with the flow.

Source: Baylor Health Care System