“These new criteria recognize that fibromyalgia is more than just body pain,” said Robert S. Katz, one of the authors of the new criteria and a rheumatologist at Rush University Medical Center. “This is a big deal for patients who suffer symptoms but have had no diagnosis. A definite diagnosis can lead to more focused and successful treatment and reducing the stress of the unknown.”

Routine lab tests can not detect fibromyalgia, a condition that is characterized by unexplained pain from head to toe and exhaustion. Instead, the diagnosis has been made by a tender point test, a physical exam that focuses on 18 points throughout the body. When light pressure is applied to these points, clustered around the neck, shoulder, chest, hip, knee, and elbow regions, patients with fibromyalgia feel tenderness or pain.

To meet the previous diagnostic criteria, which were established in 1990, patients must have widespread pain in all four quadrants of their body for a minimum duration of three months and experience moderate pain and tenderness at a minimum of 11 of the 18 specified tender points.

“There are numerous shortcomings with the previous criteria, which didn’t take into account the importance of common symptoms including significant fatigue, a lack of mental clarity and forgetfulness, sleep problems and an impaired ability to function doing normal activities,” said Katz.

According to Katz, fibromyalgia pain may fluctuate, which can affect the number of tender points, and the tender point test did not adequately measure symptom severity or the effectiveness of new treatments.

“The tender point test also has a gender bias because men may report widespread pain, but they generally aren’t as tender as women. Fibromyalgia may be under-diagnosed in both men and women because of the reliance on 11 tender points, and also due to failing to account for the other central features of the illness,” said Katz.

Additionally, due to the confusion regarding the tender point test, the authors note that most primary care doctors don’t bother to check tender points or they aren’t checking them correctly. Consequently, fibromyalgia diagnosis in practice has often been a symptom-based diagnosis. The new criteria will standardize a symptom-based diagnosis so that all doctors are using the same process.

The tender point test is being replaced with a widespread pain index and a symptom severity scale. The widespread pain index score is determined by counting the number of areas on the body where the patient has felt pain in the last week. The checklist includes 19 specified areas.

The symptom severity score is determined by rating on a scale of zero to three, three being the most pervasive, the severity of three common symptoms: fatigue, waking unrefreshed and cognitive symptoms. An additional three points can be added to account for the extent of additional symptoms such as numbness, dizziness, nausea, irritable bowel syndrome or depression. The final score is between 0 and 12.

To meet the criteria for a diagnosis of fibromyalgia a patient would have seven or more pain areas and a symptom severity score of five or more; or three to six pain areas and a symptom severity score of nine or more.

Some criteria will remain unchanged. The symptoms must have been present for at least three months, and the patient does not have a disorder that would otherwise explain the pain.

To develop and test the new criteria, researchers performed a multicenter study of 829 previously diagnosed fibromyalgia patients and a control group of rheumatic patients with non-inflammatory disorders using physician physical and interview examinations. The data were processed by the National Data Bank for Rheumatic Diseases.

The authors note the study has a number of limitations. They recommend a follow-up test in the primary care setting that includes patients with other rheumatic conditions to determine the rate of misclassification that may occur.

The study was funded by Lilly Research Laboratories. Lilly Research Laboratories did not participate in the design of the study, see the results of the study, or review the manuscript or submitted abstracts.

Source: Kimberly Waterman, Rush University Medical Center via EurekAlert

The third annual Swedish Sleep Medicine Congress, organised by the Swedish Sleep Research and Sleep Medicine Society (SFSS), was recently held in Gothenburg, Sweden. Around 250 researchers, doctors and invited guests from around the world took part in the congress, which run from 21 to 23 April. A number of new research findings which could lead to improved treatment and diagnosis of various sleep disorders were presented at the congress, as well as new knowledge about sleep mechanisms, our biological clock and the impact of sleep disorders on society in general.

Among the speakers were scientists from the Sahlgrenska Academy reporting on their latest research results, including Mahssa Karimi, a doctoral student from the Center for Sleep and Vigilance Disorders. Her research project looked at the incidence of sleep disorders in 116 bus and tram drivers in Gothenburg. The study found that 23% have problems with pronounced daytime sleepiness, 28% have trouble getting to sleep, 29% suffer from restless legs, and 19% have sleep apnoea (pauses in breathing while asleep which can result in tiredness and difficulty concentrating during the day).

“We looked more closely at the drivers with sleep apnoea because previous studies have shown that these patients run a clearly increased risk of accidents due to drowsiness,” says Karimi.

The drivers with sleep apnoea were treated with a CPAP machine, where a breathing mask is used to maintain a positive pressure in the airways, keeping them open and so preventing snoring and apnoea while asleep.

“The study showed that these drivers stopped having apnoea episodes during the night and also had significantly lower blood pressure and, above all, greatly reduced daytime sleepiness,” says Karimi.

The researchers had to actively look for sleep disorders in the group of professional drivers who had not already sought medical assistance for their problems. They found a large number of sleep disorders in these drivers which in many cases significantly affected their alertness and concentration. When the drivers received treatment for these disorders, there was a clear improvement.

“Our findings suggest that it’s important to systematically examine professional drivers and other professional groups entrusted with the safety of others in order to be able to treat any sleep disorders, as their work demands alertness and concentration at all times,” says Karimi.

Source: Mahssa Karimi, University of Gothenburg via EurekAlert

Not surprisingly, the problem of daytime sleepiness usually starts at night. Even missing just a few nights’ sleep, or not getting enough uninterrupted sleep, can slow you down and sour your mood.

Poor sleep habits are often the cause of daytime sleepiness. Before you go through any more groggy and crabby days, try these 12 ways to improve nighttime sleep and avoid daytime sleepiness.

1. Get adequate nighttime sleep.

That may sound obvious, but many of us succumb to shaving an hour or two off our sleep time in the morning or at night to do other things. Most adults need seven to nine hours a night, and teenagers usually need a full nine hours. Block out eight or nine hours for sleep every night.

2. Keep distractions out of bed.

“Reserve your bed for sleep and sex,” says Avelino Verceles, MD, assistant professor at the University of Maryland School of Medicine and director of the school’s sleep medicine fellowship. “You shouldn’t read, watch TV, play video games, or use laptop computers in bed.” Don’t do your bills or have heated discussions in bed either. They may leave you sleepless.

3. Set a consistent wake-up time.

People who have problem sleepiness are often advised to go to bed and get up at the same time every day, including on weekends. But randomly setting an ideal bedtime can lead to more frustration if you suffer from insomnia and already have trouble falling asleep, says Barry Krakow, MD, medical director of Maimonides Sleep Arts and Sciences Ltd. in Albuquerque, N.M., and author of Sound Sleep, Sound Mind: 7 Keys to Sleeping Through the Night.

Instead, Krakow suggests starting out by setting a wake-up time only. “Stick by that for the first few weeks or even months to establish a rhythm,” he says. “That process of always getting up at the same time helps to anchor the circadian rhythm. And if you do that and have a bad night, you’ll also to be sleepier the next bedtime.”

4. Gradually move to an earlier bedtime.

Another approach to getting into a consistent schedule is to try going to bed 15 minutes earlier each night for four nights. Then stick with the last bedtime. Gradually adjusting your schedule like this usually works better than suddenly trying to go to sleep an hour earlier.

5. Set consistent, healthy mealtimes.

Regular mealtimes, not just regular sleep times, help regulate our circadian rhythms. Eating a healthy breakfast and lunch on time — rather than grabbing a doughnut and coffee in the morning or a late sandwich on the run — also prevents energy deficits during the day that will aggravate your sleepiness. Plan to finish eating meals two to three hours before bedtime.

6. Exercise.

Regular exercise (30 minutes a day on most days) offers multiple benefits for sleep. Exercise, especially aerobic exercise, generally makes it easier to fall asleep and sleep more soundly.

Exercise also gives you more daytime energy and keeps your thinking sharp. And if you exercise outside in daylight, you get still more benefits. Sleep experts recommend 30 minutes of exposure to sunlight a day because daylight helps regulate our sleep patterns. Avoid exercising within three hours of bedtime.

7. De-clutter your schedule.

“If you don’t think you can allow seven or eight hours for sleep, then you need to look at your schedule and make some adjustments,” says Verceles. “Move some activities from nighttime to early evening or from early to late morning.” Try to eliminate tasks that aren’t really important. Getting enough sleep at night will help you function better during your remaining activities.

8. Don’t go to bed until you’re sleepy.

If you go to bed when you’re just tired, you probably won’t be able to fall asleep, Krakow says. “Distinguish between the feeling of sleepiness and being tired. Get into bed when you’re sleepy — eyes droopy, you’re drowsy, you feel like you’re nodding off. It’s a very different kind of feeling.”

9. Don’t nap late in the day.

Late afternoon napping can make daytime sleepiness worse if because it can interfere with nighttime sleep.

10. Create a relaxing bedtime ritual.

A relaxation routine before bedtime can help you separate from the day — especially from activities that are over-stimulating or stressful, making it difficult to sleep. Try meditation, soaking in a hot bath, listening to soothing music, or reading a book. A cup of herbal tea or warm milk can also be soothing, but skip those if they cause you to wake at night to go to the bathroom.

11. Avoid “nightcaps.”

People often think that alcohol helps sleep, but it actually robs you of deep sleep, which is essential for feeling well rested. When the effects of alcohol wear off during the night, you’ll probably be wide awake again.

12. See a sleep specialist.

Daytime sleepiness can be caused by sleep disorders. If you are excessively sleepy consistently during the day even when you sleep well or if you fall asleep without warning during daily activities, you may have a sleep disorder such as narcolepsy or sleep apnea, a breathing problem that occurs during sleep. According to Krakow, undiagnosed and untreated sleep disorders are probably the greatest cause of daytime fatigue and sleepiness.

Problem sleepiness can also be caused by certain illnesses and medications. And mental conditions such as depression, posttraumatic stress disorder, and anxiety are very commonly linked to sleep problems.

A sleep specialist can design a treatment program for you that treats the underlying sleep disorder and helps you develop better sleep habits and attitudes though cognitive behavioral therapy. Sometimes it takes a combination of medication and behavioral therapy to eliminate daytime sleepiness, but it can be done.

Source: Camille Peri, WebMD

Fibromyalgia is a widely misunderstood condition that causes widespread pain and fatigue. If you’ve been diagnosed with fibromyalgia and are trying to learn all you can about the condition, you may come across some of the many common myths and misconceptions about fibromyalgia. Don’t let these myths confuse you or discourage you from seeking help for your fibromyalgia symptoms. Here’s a look at nine common myths about fibromyalgia and why each is wrong.

Myth: Most doctors don’t believe fibromyalgia is a real condition.

Truth: This myth may come from a misunderstanding. Since fibromyalgia is defined by a list of symptoms, claiming that fibromyalgia isn’t real is essentially saying that your symptoms aren’t real. That doesn’t make sense. Most doctors believe your symptoms are real.

The controversy comes when deciding whether fibromyalgia is a disease process that can be reversed or cured. Most doctors believe fibromyalgia is a set of symptoms that aren’t caused by an underlying disease. Most doctors believe that fibromyalgia symptoms can be managed, but there is no underlying disease to “cure.”

In some cases, a doctor may not be familiar with fibromyalgia. He or she can refer you to someone who knows more about the condition.

Finding a compassionate doctor can be a frustrating part of living with fibromyalgia. But don’t give up if you haven’t found the perfect doctor. Focus on finding a doctor who is willing to listen to you and take you seriously.

Finding a doctor who’s an expert on fibromyalgia may not be practical, for instance, if there aren’t many specialists in your area. But a doctor who’s willing to learn more about fibromyalgia and listen to your concerns can be an invaluable ally.

Myth: Fibromyalgia damages your joints.

Truth: Though fibromyalgia pain can be severe at times, it doesn’t damage your bones, joints or muscles. Some people worry that when pain worsens, it means that fibromyalgia is progressing. But that isn’t the case. While increasing fibromyalgia pain can make it difficult to go about your daily activities, it isn’t damaging your body.

Myth: You look fine, so there’s nothing wrong with you.

Truth: You know this is a myth, but friends, family and co-workers who don’t understand fibromyalgia may sometimes hold this belief. It can cause tension when others wonder if you’re faking your pain because they think you don’t look sick. Resist the urge to get angry and withdraw rather than explain how you’re feeling.

Open and honest communication can help others better understand fibromyalgia. Be honest about how you feel and let others know that if they have questions, you’re willing to listen and explain.

Myth: You were diagnosed with fibromyalgia because your doctor couldn’t find anything wrong with you.

Truth: Fibromyalgia is a specific diagnosis based on your symptoms, not a diagnosis you’re given when there’s nothing wrong with you. The American College of Rheumatology developed a set of criteria to help doctors diagnose fibromyalgia.

Diagnosing fibromyalgia often takes time. Since there’s no single test that can confirm you have fibromyalgia, your doctor will often run tests and procedures to rule out other conditions. Enduring repeated tests can be frustrating, but it’s an important part of determining whether your symptoms are caused by fibromyalgia or something else. The results will guide your treatment.

Myth: Fibromyalgia causes pain. Those other symptoms you’re experiencing must be caused by something else.

Truth: Fibromyalgia can cause symptoms in addition to pain. Many people with fibromyalgia also experience fatigue and difficulty sleeping. Other fibromyalgia symptoms may include headaches, sensitivity to light, dizziness, memory problems, and numbness and tingling in your arms and legs. A number of other conditions commonly accompany fibromyalgia, including irritable bowel syndrome, bladder control problems and mood disorders, such as depression and anxiety.

Myth: No treatments for fibromyalgia exist, so it’s no use going to the doctor.

Truth: There’s no standard treatment for fibromyalgia, and the Food and Drug Administration has approved just one drug for treating fibromyalgia. But you have many options for controlling fibromyalgia pain, including medications, lifestyle changes, and complementary and alternative treatments. Often you’ll need to try a few treatments in different combinations to determine what works best.

Myth: On days when you’re feeling good, you should try to do as much as you can since you may be unable to accomplish everything you want on other days.

Truth: Overdoing it on the good days may catch up with you. You may feel exhausted the next day and your fibromyalgia symptoms could worsen. But that doesn’t mean you should keep your activity to a minimum. Doing very little could weaken your muscles and increase your pain.

Cope with the good days and the not-so-good days by finding a balance. Pace yourself. Set goals for each day. Your goals should be reasonable. And they should include daily exercise and time for yourself, such as time to relax or listen to music.

Myth: Fibromyalgia is a life-threatening disease.

Truth: Fibromyalgia isn’t fatal and it doesn’t damage your body. Fibromyalgia symptoms fluctuate over time, sometimes getting worse and sometimes becoming milder. Fibromyalgia pain rarely disappears completely, but you can learn to gain some control over it.

Myth: You can’t have a productive life with fibromyalgia.

Truth: Learning to control your fibromyalgia pain takes time. It’s likely that the pain will never completely go away and you’ll have to accept that your life might never be the same. But that doesn’t mean your life can’t be satisfying and productive.

Work with your doctor to adapt your daily activities so that you can have time and energy for what’s important to you. Your strategy may include a number of approaches, such as setting goals, for instance, making time for relaxation exercises every day, or making lifestyle changes, such as walking most days of the week.

Maria Giraki, from Heinrich-Heine-University, Düsseldorf, Germany, worked with a team of researchers to study the condition in 69 people, of whom 48 were ‘bruxers’. She said, “Bruxing can lead to abrasive tooth wear, looseness and sensitivity of teeth, and growth and pain in the muscles responsible for chewing. Its causes are still relatively unknown, but stress has been implicated. We aimed to investigate whether different stress-factors, and different coping strategies, were more or less associated with these bruxism symptoms”.

Tooth grinding was measured by thin plates that were placed in trial participants mouths’ overnight, while stress and coping techniques were assessed by three questionnaires. Bruxing was not associated with age, sex or education level, but was more common in people who claimed to experience daily stress and trouble at work. Giraki adds, “Our data support the assumption that people with the most problematic grinding do not seem to be able to deal with stress in an adequate way. They seem to prefer negative coping strategies like ‘escape’. This, in general, increases the feeling of stress, instead of looking at the stressor in a positive way”.

Source: Graeme Baldwin, BioMed Central, viaEurekAlert.

Learn more about common alternative and complementary methods, vitamins, minerals, herbs and foods used to treat sleep disorders, including insomnia. Most of the treatments help your body make serotonin (an important substance for normal nerve and brain function), relax, reduce anxiety and become calm or sedated.

5-HTP

5-HTP is used by the human body to make serotonin, which appears to play significant roles in sleep, emotional moods, pain control, inflammation, intestinal peristalsis, and other body functions.

Avena sativa (oats)

Oat alkaloids are believed to account for the relaxing action of oats, but it should be noted this continues to be debated in Europe.

Catnip

The volatile oil in catnip contains the monoterpene, nepetalactone, which is similar to the valepotriates found in valerian, a more commonly used herbal sedative. Human trials are lacking to prove the effectiveness of catnip for treating insomnia.

Chamomile

Chamomile is an herb commonly drunk as tea, and it is often used to treat sleeping problems because of its relaxing effects.

Hops (Humulus Lupulus)

Hops have been shown to have mild sedative properties, although the mechanism is unclear. Some herbal preparations for insomnia combine hops with more potent sedative herbs, such as valerian.

Kava

The kava-lactones, sometimes referred to as kava-pyrones, are the most important active constituents in kava extracts. High-quality kava rhizome contains 5.5 to 8.3 percent kava-lactones. Medicinal extracts used in Europe contain 30 to 70 percent kava-lactones. Kava-lactones are thought to have anti-anxiety, mild analgesic (pain-relieving), muscle-relaxing, and anti-convulsant effects. *Beware of potential liver toxicity.

Lavender

The essential oil of lavender contains many constituents, including perillyl alcohol and linalool. The oil is thought to be calming and thus can be helpful in some cases of insomnia. One study of elderly people with sleeping troubles found that inhaling lavender oil was as effective as some commonly prescribed sleep medications. Similar results were seen in another trial that included young and middle-aged people with insomnia.

Lemon balm

The terpenes, part of the pleasant smelling volatile oil from lemon balm, are thought to produce this herb’s relaxing and gas-relieving effects. One small preliminary trial studying sleep quality compared the effect of a combination product containing an extract of lemon balm and an extract of valerian root with that of the sleeping drug triazolam (Halcion). The effectiveness of the herbal combination was similar to that of Halcion, as determined by the ability to fall asleep and the quality of sleep. Another trial also found that the same combination of valerian and lemon balm, taken over a two-week period, is effective in improving quality of sleep.

Melatonin

Melatonin is a natural hormone that regulates the human biological clock. Melatonin is produced by the pineal gland, located within the brain. Levels of melatonin in the body fluctuate with the cycles of night and day. The highest melatonin levels are found at night. Melatonin is present in foods only in trace amounts.

Scullcap (American)

Few studies have been completed on the constituents of American scullcap. One of its constituents, scutellarian, has been reportedly shown to have mild sedative and antispasmodic actions in animal studies. Human trials have not yet been conducted to confirm the use of scullcap for anxiety or insomnia.

Valerian

Valerian root contains many different constituents, including essential oils that appear to contribute to the sedating properties of the herb. Central nervous system sedation is regulated by receptors in the brain known as GABA-A receptors. According to test tube studies, valerian may weakly bind to these receptors to exert a sedating action. This might explain why valerian may help some people deal with stress more effectively. Double-blind trials have found that valerian is an effective treatment for people with mild to moderately severe insomnia.

Generally, valerian makes sleep more restful as well as making the transition to sleep easier, but does not tend to increase total time slept, according to these studies. Two trials have also found that a combination with lemon balm is effective in improving quality of sleep and in treating insomnia.

Source: Prevention

The study, published Jan. 14, 2010, in The New England Journal of Medicine, examined medical records of the wives of active duty U.S. Army personnel, comparing those whose husbands were serving abroad with those whose husbands were not deployed.

“This study confirms what many people have long suspected,” said Alyssa Mansfield, Ph.D., the study’s lead author, who conducted the research as a doctoral student at the UNC Gillings School of Global Public Health and is now a research epidemiologist at RTI International. “It provides compelling evidence that Army spouses are feeling the impact of recent deployments to Iraq and Afghanistan. The result is more depression, more stress, more sleepless nights.”

Understanding the scope of the problem can help the U.S. military better plan mental health prevention and treatment programs for the families of active duty personnel, she said. The study also may provide insight into families’ long-term medical needs.

The researchers examined medical records of more than 250,000 female spouses of active duty Army personnel for outpatient care received between 2003 and 2006. About 31 percent of the wives’ husbands were not deployed during that period, while about 34 percent were overseas for between one and 11 months and 35 percent were deployed for longer.

Although the three groups were similar in size, the study found almost 3,500 more diagnoses of mental health conditions among wives of soldiers deployed for less than a year, compared to the group of wives of non-deployed soldiers. Also, there were more than 5,300 additional diagnoses among wives of soldiers deployed for a year or longer.

Depression, anxiety, sleep disorders and acute stress reaction and adjustment disorders were the most commonly diagnosed conditions among both groups.

Spouses of deployed military personal naturally fear for their loved ones’ safety, Mansfield said. But they also often face challenges maintaining a household, coping as a single parent and dealing with the marital strain that comes with being apart for an uncertain amount of time.

“The majority of active duty soldiers are married, so we need to pay attention to the needs of their families, both short and long term,” Mansfield said. “These findings should help the military medical system better plan mental health programs not only for treatment, but also for support and prevention.”

Other researchers who contributed to the study were Jay S. Kaufman, Ph.D., an associate epidemiology professor in the UNC Gillings School of Global Public Health at the time of the study who is now associate professor in the epidemiology, biostatistics and occupational health department at McGill University, Montreal, Canada; Stephen W. Marshall, Ph.D., associate professor of epidemiology, and Joseph P. Morrissey, Ph.D., professor of health policy and management, both in the UNC public health school; Bradley N. Gaynes, M.D., associate professor of psychiatry in the UNC School of Medicine; and Charles C. Engel, M.D., associate professor of psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md.

Source: University of North Carolina at Chapel Hill

A new study led by Julie Carrier, a Université de Montréal psychology professor and a researcher at the affiliated Hôpital du Sacré-Cœur Sleep Disorders Centre, has found the main byproduct of coffee, caffeine, interferes with sleep and this side-effect worsens as people age.

“Caffeine is the most widely used stimulant to counteract sleepiness, yet it has detrimental effects on the sleep of night-shift workers who must slumber during the day, just as their biological clock sends a strong wake-up signal,” says Carrier. “The older you get, the more affected your sleep will be by coffee.”

Twenty-four men and women participated in the study: one group was aged 20 to 30, while a second group was aged 45 to 60. Everyone spent two sleepless nights in lab rooms before being allowed to sleep. “We all know someone who claims to sleep like a baby after drinking an espresso. Although they may not notice it, their sleep will not be as deep and will likely be more perturbed,” says Professor Carrier.

Both participant groups had to take a pill three hours before sleeping; either 200 milligrams of caffeine or a lactose-based placebo. All subjects who consumed caffeine pills had their sleep affected, especially older participants who slept 50 percent less than usual. In both age groups, caffeine decreased sleep efficiency, sleep duration, slow-wave sleep (SWS) and REM sleep.

The combined influence of age and caffeine made the sleep of middle-aged subjects particularly vulnerable to the circadian waking signal. Professor Carrier suggests that lower brain synchronization — caused by age and caffeine — produces greater difficulty in overriding circadian waking signals during daytime and that leads to fragmented sleep.

These results have implications for the high proportion of the population using caffeine to cope with night work and jetlag, particularly the middle-aged. Carrier recommends that everyone over 40 reduce their coffee consumption, especially if they work at night. Her study builds on recent findings that reducing coffee consumption is the best way to improve sleep for the middle-aged.

This study was supported by the Canadian Institutes of Health Research, the Fonds de Recherche en Santé du Québec and the Natural Sciences and Engineering Research Council of Canada.

Journal reference: Julie Carrier, Jean Paquet, Marta Fernandez-Bolanos, Laurence Girouard, Joanie Roy, Brahim Selmaoui and Daniel Filipini. Effects of caffeine on daytime recovery sleep: A double challenge to the sleep–wake cycle in aging. Sleep Medicine, 2009; 10 (9): 1016 DOI: 10.1016/j.sleep.2009.01.001

Source: University of Montreal

It is estimated that 8 percent of the general US population suffers from bruxism, a condition frequently associated with a preexisting dental or jaw disorders, as well as stress.

“The relationship between obstructive sleep apnea and sleep bruxism is usually related to an arousal response. The ending of an apneic event may be accompanied by a number of mouth phenomena, such as snoring, gasps, mumbles, and teeth grinding,” said Shyam Subramanian, MD, FCCP, Baylor College of Medicine, Houston, TX. “Men typically have more severe sleep apnea, and perhaps may have more arousal responses, which may explain the higher prevalence of teeth grinding in men. Besides, men characteristically tend to report more symptoms of sleep apnea than women, such as snoring, loud grunting, and witnessed apneas.”

Other factors that might help explain the relationship between sleep apnea and teeth grinding include anxiety and caffeine use.

“High levels of anxiety can lead to bruxism, and untreated sleep apnea is known to cause mood disturbances including depression and anxiety,” said Dr. Subramanian. “Daytime sleepiness from sleep apnea may cause a person to ingest caffeine, and this has also been associated with a high risk of bruxism.”

Through a retrospective chart review, Dr. Subramanian and his colleagues, from the Baylor College of Medicine, Houston, TX, assessed the prevalence of bruxism and gastroesophageal reflux (GERD) in 150 men and 150 women with OSA. Each group consisted of 50 Caucasians, 50 African-Americans, and 50 Hispanics. Results showed that 25.6 percent of patients suffered from teeth grinding, while 35 percent of all patients with OSA complained of nocturnal heartburn and GERD symptoms.

The researchers also examined the influence of gender and ethnicity on OSA, GERD, and bruxism. They found that bruxism was higher in men than in women — 43 percent vs. 31 percent. Caucasians had the highest rate of bruxism compared to other ethnic groups — 35 percent vs. 19 percent in Hispanics. African-Americans have the highest prevalence of GERD — 40 percent vs. 31 percent in the Hispanic population and 34 percent in Caucasians. Overall, no correlation was observed between the presence of self-reported GERD and bruxism.

Untreated bruxism can lead to excessive tooth wear and decay, periodontal tissue damage, jaw pain and temporomandibular joint or TMJ pain, headaches, and sleep disturbances for patients and their bed partners.

“Bruxism can be both a daytime syndrome as well as a nighttime syndrome, but it is bruxism during sleep, including short naps, that causes the majority of health issues,” said Dr. Subramanian. “Studies do suggest that when sleep bruxism is related to OSA, certain therapies, including continuous positive airway pressure, may eliminate bruxism during sleep.”

“Sleep disorders such as sleep apnea can lead to many secondary health conditions,” said Kalpalatha Guntupalli, MD, FCCP, President of the American College of Chest Physicians. “When treating sleep apnea, clinicians must also recognize and address secondary health conditions, such as bruxism, in order to fully manage a patient’s sleep disorder.”

CHEST 2009 is the 75th annual international scientific assembly of the American College of Chest Physicians, held October 31-November 5 in San Diego, CA. The ACCP represents 17,400 members who provide patient care in the areas of pulmonary, critical care, and sleep medicine in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication.

Source: American College of Chest Physicians

Results show that the odds of having disturbed sleep in the seven years after retirement were 26 percent lower (adjusted odds ratio of 0.74) than in the seven years before retiring. Sleep disturbance prevalence rates among 14,714 participants fell from 24.2 percent in the last year before retirement to 17.8 percent in the first year after retiring. The greatest reduction in sleep disturbances was reported by participants with depression or mental fatigue prior to retirement. The postretirement improvement in sleep also was more pronounced in men, management-level workers, employees who reported high psychological job demands, and people who occasionally or consistently worked night shifts.

Lead author Jussi Vahtera, professor in the department of public health at the University of Turku in Finland, noted that the participants enjoyed employment benefits rarely seen today, including guaranteed job stability, a statutory retirement age between 55 and 60 years, and a company-paid pension that was 80 percent of their salary.

“We believe these findings are largely applicable in situations where financial incentives not to retire are relatively weak,” said Vahtera. “In countries and positions where there is no proper pension level to guarantee financial security beyond working age, however, retirement may be followed by severe stress disturbing sleep even more than before retirement.”

The study involved employees from the French national gas and electricity company, Electricité de France-Gaz de France, who retired between 1990 and 2006 at a mean age of 55 years. The study includes data from 11,581 male and 3,133 female workers who reported sleep disturbances at least once before and once after the year of retirement. Thirty-five percent of participants had worked night shifts, and 17 percent reported having depression.

Annual survey measurements ranging from seven years before to seven years after retirement (with a mean of 12 measurements) were collected throughout the study period. Participants completed questionnaires concerning health, lifestyle, individual, familial, social and occupational factors. The presence of sleep disturbances was indicated by an affirmative response to a single question from a systematic checklist of more than 50 medical conditions experienced during the previous 12 months. Information concerning occupational and health data also was collected from the company.

Results also show that there is a slowly increasing prevalence of sleep disturbances with increasing age, which can be observed both before and after retirement. From the first to the seventh year after retirement, the prevalence of sleep disturbances increased from 17.8 percent to 19.7 percent but remained significantly lower than at any time point prior to retirement.

The only exception to the general improvement in sleep after retirement was related to the four percent of participants whose retirement was based on health reasons. People who retired early because of a long-standing illness or disability had a 46 percent increased risk of sleep disturbances (adjusted odds ratio of 1.46) after retiring.

The authors conclude that in the present time when people are expected to live many years beyond the traditional age of retirement, consideration should be given to the restructuring of working life to enable older workers to remain economically active without compromising their future health.

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

The study: “Effect of Retirement on Sleep Disturbances: the GAZEL Prospective Cohort Study”

Source: Kelly Wagner, American Academy of Sleep Medicine