When it comes to executing items on tomorrow’s to-do list, it’s best to think it over, then “sleep on it,” say psychologists at Washington University in St. Louis.

People who sleep after processing and storing a memory carry out their intentions much better than people who try to execute their plan before getting to sleep. The researchers have shown that sleep enhances our ability to remember to do something in the future, a skill known as prospective memory.

Moreover, researchers studying the relationship between memory and sleep say that our ability to carry out our intentions is not so much a function of how firmly that intention has been embedded in our memories. Rather, the trigger that helps carry out our intentions is usually a place, situation or circumstance – some context encountered the next day – that sparks the recall of an intended action.

These are the key findings from a study published online this month in Psychological Science of the relationship between memory and sleep. Researchers Michael Scullin, doctoral candidate in psychology, and his adviser, Mark McDaniel, PhD, professor of psychology in Arts & Sciences, are focusing on “prospective memory” — things we intend to do – as opposed to “retrospective memory” — things that have happened in the past.

Prospective memory includes such things as remembering to take a medication, buying a Mother’s Day card or bringing home the ice cream for a birthday party. While the vast majority of sleep literature in psychology is devoted to retrospective memory, this study is the first foray into the relationship between sleep and prospective memory, the kind of memory we put to work every day. The findings, researchers say, offer important contributions to the understanding of the role sleep plays in cognition as well as memory.

Let’s say that you intend to give a colleague a message tomorrow, McDaniel explains. Seeing the colleague the next day will be a strong cue for remembering to give the message. But, during the time your brain encoded the intention, you’re also vaguely thinking of a meeting the two of you will attend the next afternoon. The context of the conference room is weakly associated with your intention to give the message even though you haven’t really thought explicitly about associating the room with the message.

The Scullin/McDaniel study shows that sleep strengthens the weak association between the conference room (the context) and the delivery of the message (the intention). But sleep does little or nothing with the stronger association between the person and the message.

“We found that sleep benefits prospective memory by strengthening the weak associations in the brain, and that hasn’t been shown before,” Scullin says.

“One of the more provocative findings we have is that sleep didn’t strengthen the link between the explicit cue, which is the person, and the intention, rather it strengthened the weak association and the intention,” McDaniel says.

Here’s how they showed it:

The researchers tested four different groups each of 24 Washington University students. Two were control groups – one tested in the morning, the other in the evening – to eliminate the notion that the biological clock might play any role in memory function. Another group was prepped for tests in the morning then tested twelve hours later in the evening before getting to sleep. The fourth group learned the test routine in the evening, went home and slept, then were tested 12 hours later in the morning.

Participants were given instructions for three tests in this order and the tests later were given in blocks of 150 items in the same order: a living/non-living test, in which they decided if a word (cat, for instance, or skate) indicated a living or non-living entity; a lexical decision test, in which participants decided if a string of letters was a word or nonsense; and a semantic category test, in which a word was classified by participants into a category, baseball, for instance, in the category of sport.

After learning the last test, participants were told that in the midst of these ongoing tests – given to represent such everyday activities as driving, watching TV, listening to a teacher – the words table or horse would pop up on a screen, and when they saw them, they were to press the “Q” button. This represented the prospective memory intention.

The researchers found that participants who tested in the morning following sleep overwhelmingly performed the prospective memory task better in the semantic category test, or context, than in the other two, and they found no such correlation in the group who tested sleepless.

The crux of the finding rests on the fact that the prospective memory instruction was given right after the semantic category practice. In this context, those who slept remembered the prospective memory intention better than in the other categories.

“Sleep promoted the remembering to do the prospective memory task when that one context was present, but not when some other context was present,” McDaniel says. “That’s because of temporal contiguity — the fact that the participants were told to hit that ‘Q’ button right after they were exposed to the semantic category context.

“The idea is that the semantic category test is weakly associated with the prospective memory intention — it’s weakly floating around in the mind and becomes weakly associated with the prospective memory test,” McDaniel says.

To return to the colleague and message analogy, because before sleeping you remembered you had a message to deliver to your colleague and you would see him in the conference room tomorrow, sleep enhances the likelihood that you will tell him in the conference room, but not in some other context, the office, elevator, the mail room, for example.

The researchers believe that the prospective memory process occurs during slow wave sleep — an early pattern in the sleep cycle — involving communication between the hippocampus and cortical regions. The hippocampus is very important in memory formation and reactivation and the cortical regions are keys to storing memories.

“We think that during slow wave sleep the hippocampus is reactivating these recently learned memories, taking them up and placing them in long-term storage regions in the brain,” Scullin says. “The physiology of slow wave sleep seems very conducive to this kind of memory strengthening.”

Source: Tony Fitzpatrick, Washington University in St. Louis

In their new study appearing in Biological Psychiatry, Dr. Richard Bryant and colleagues assessed whether serotonin transporter genotype predicted a change in patients’ PTSD severity following treatment. Specifically, patients with PTSD were classified according to their genotype, and they received eight weeks of cognitive behavior therapy. Approximately one-third of patients do not respond to this treatment, and this study has now demonstrated that there may be a genetic basis for not responding to this therapy.

Dr. Bryant explained: “Patients with PTSD who carried the short allele of the serotonin transporter gene promoter responded more poorly to treatment than other PTSD patients. This study highlights that the serotonin system is implicated in responding to cognitive behavior therapy.”

The recent focus on personalized medicine has emphasized the impact of variation in genes that influence the responses to medications. This study supports the reasoning that genetic variation would also influence the response to psychotherapeutic or rehabilitative treatments.

Dr. John Krystal, Editor of Biological Psychiatry, noted, “While this study identifies a potential predictor of poor treatment response, it also may help to identify groups of individuals who respond relatively favorably to treatment. It is interesting this ‘good outcome’ group is a group that is also more resilient, i.e., less likely to develop PTSD or depression, after stress.”

Although further research is necessary, this initial finding indicates that PTSD treatments may need to be modified to accommodate patients’ genetic profiles.

Source: Maureen Hunter, Elsevier , via EurekAlert

A new study on a large group of youths with ASDs confirms these reports and will support the development of treatments for sleep disturbances as a way to improve behavior, according to researchers from Autism Speaks’ Autism Treatment Network (ATN).

Results of the study, and three others conducted by the ATN, were presented May 2 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

An estimated one in 110 US children has autism, a group of complex developmental brain disorders that affect behavior, social skills, and communication.

The ATN, which includes 14 treatment and research centers in the United States and Canada, enrolls patients ages 2-18 years with a diagnosis of autism, Asperger’s syndrome, or pervasive developmental disorder-not otherwise specified (PDD-NOS).

Parents of children participating in the ATN completed the Children’s Sleep Habits Questionnaire and the Child Behavior Checklist. An analysis of 1,056 children found an association between sleep problems and problematic daytime behaviors, especially emotional problems and anxiety. Children who got less sleep had more emotional problems, and children who had parasomnias, including nightmares, night terrors, and sleepwalking, had more behavior problems overall.

“This study contributes to our understanding of sleep issues and helps us to plan future work addressing more specific symptoms and treatments,” said Daniel Coury, MD, medical director of the ATN and professor of pediatrics and psychiatry at The Ohio State University. “A better understanding of the relationship between sleep problems and daytime behavior could lead to more effective treatments for both.”

Source: Sleep Review

VANCOUVER, BRITISH COLUMBIA – Adolescents who don’t get enough sleep may gain more than some extra time to play video games or text their friends. They also may gain weight, according to research being presented Tuesday, May 4 at the Pediatric Academic Societies (PAS) annual meeting in Vancouver, British Columbia, Canada.

Other studies have shown a relationship between sleep and weight issues, particularly in young children. However, this is one of the first studies to document an association between sleep duration and weight in adolescents, even after controlling for calorie intake, activity level and depressive symptoms.

In research led by Leslie A. Lytle, PhD, from the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, study investigators collected data on 723 adolescents (mean age 14.7 years) about how long they slept on weeknights and weekends, and how frequently they experienced sleep problems. On three separate occasions, researchers also asked the youths about the foods and beverages they had consumed the prior day to determine how many calories they consumed.

To measure activity, participants wore accelerometers on their belts for seven days. Unlike pedometers, which count the number steps walked, these highly specialized devices measure movement on three different planes. In addition, the wearer cannot see any data on how active they are.

“The use of accelerometers and 24-hour (dietary) recalls was unique in the study of sleep and weight in youth and is a real strength of the study,” Dr. Lytle said.

Researchers also measured participants’ weight, body mass index (BMI) and percentage of body fat.

Results showed that shorter sleep duration was related to higher BMI. The relationship was especially strong for boys and for middle school students compared to those in high school. In girls, only less sleep on weekends was related to higher BMI.

“Sleep has long been recognized as an important health behavior,” Dr. Lytle said. “We are just beginning to recognize its relationship to overweight and obesity in children and adults alike.”

Source: Susan Martin, American Academy of Pediatrics via EurekAlert

Results indicate that physical health-related quality of life in African-Americans who snored frequently, had insomnia symptoms or reported excessive daytime sleepiness was significantly worse than in Caucasians. African-Americans with insomnia also had significantly more physical limitations than Hispanics. However, when mental health-related quality of life was evaluated, it was Hispanics with frequent snoring, insomnia symptoms or excessive daytime sleepiness who had significantly greater mental distress than Caucasians. African-Americans with insomnia also had significantly worse mental health than Caucasians.

“The study highlights the increased disparities among African- and Latino-Americans compared with Caucasians even in the sleep and health-related quality of life domain,” said lead author Carol M. Baldwin, PhD, RN, FAAN, Southwest Borderlands Scholar and director of the Center for World Health Promotion and Disease Prevention in the College of Nursing and Health Innovation at Arizona State University in Phoenix, Ariz.

The study involved a secondary analysis of data from the Sleep Heart Health Study, a multi-center study that recruited participants from seven regions of the U.S. Eighty-six percent of the 5,237 people in the current study were Caucasian, nine percent were African-American and five percent were Hispanic. The Hispanic participants were predominantly of Mexican heritage residing in Arizona, with a smaller number of Puerto-Rican participants from the New York cohort. All participants were 40 years of age or older, and their mean age was 63.5 years.

The presence of obstructive sleep apnea was detected by overnight, in-home polysomnography. Snoring and insomnia – defined as trouble falling asleep, staying asleep or waking too early – were assessed using the Sleep Habits Questionnaire. The Epworth Sleepiness Scale was used to evaluate daytime sleepiness.

Health-related quality of life was assessed with the physical and mental composite scales of the Medical Outcomes Study 36-item short form survey. According to the authors, low scores on the physical scale suggest limitations in self-care and physical activities, severe bodily pain and frequent tiredness. A low score on the mental scale indicates frequent psychological distress, as well as social and role disability due to emotional problems.

The study found that sleep disturbances were common, with 46 percent of people having at least mild sleep apnea, 34 percent reporting frequent snoring, 30 percent having insomnia symptoms and 25 percent reporting excessive daytime sleepiness. Frequent snoring was significantly more common among Hispanics (41 percent), and excessive daytime sleepiness was significantly more common among African-Americans (32 percent). There were no statistically significant differences in the distribution of obstructive sleep apnea or insomnia symptoms by race.

According to Baldwin, the study could help reduce health disparities and improve outcomes by advancing “tailored care” in sleep medicine.

“These findings support the need for sleep clinicians to use culturally-responsive sleep education, assessment and intervention approaches, as well as depression, anxiety and other relevant mood and socioeconomic-status measures,” she said.

The authors cautioned that the correlational nature of the study did not allow for an analysis of causality. Baldwin added that the causes of differences in health-related quality of life can be complex and may include such factors as lifestyle and activity patterns, diet, sleep architecture and access to health care.

However, the study suggests that the impact of sleep disorders on daily living and general well-being may be similar to that of other chronic conditions. The mean score profiles for health-related quality of life in people with sleep apnea and other sleep symptoms were similar to those that have been previously reported for patients with hypertension and type 2 diabetes.

Source: Kathleen McCann, American Academy of Sleep Medicine

Results show that after playing a stimulating video game it took adolescents a median of 7.5 minutes to fall asleep, which was only slightly longer than the three minutes it took them to fall asleep after passively watching a documentary on DVD. Although no participants fell asleep while playing the video game, almost one-third of them fell asleep while watching the DVD. Subjective sleepiness after playing the video game was only slightly lower than after watching the DVD, and playing the video game was associated with a small increase in cognitive alertness. However, no significant differences in physiologic arousal or sleep architecture were found between testing conditions.

“Initially we were surprised that playing the violent video game did not lead to a much longer time taken to fall asleep,” said research supervisor Michael Gradisar, PhD, senior lecturer in clinical child psychology at Flinders University in Adelaide, South Australia. “Although the scientific literature is sparse when it comes to measuring sleep latency associated with playing video games, anecdotally a lot of people report difficulty falling asleep after playing video games at night.”

The study involved thirteen male students between 14 and 18 years of age who were good sleepers, normally falling asleep in less than 15 minutes. They were “evening types” who did not have excessive daytime sleepiness and had no identifiable sleep disorders. Participants completed a seven-day sleep diary for the week prior to their initial testing night. This information was used for the testing conditions so that participants attempted to sleep at their usual bedtime.

The study was conducted at the Flinders University Sleep Laboratory, where participants sat in bed beneath the covers with electrodes attached and lights dimmed for both testing conditions. During the 50-minute experimental session the teens played the Sony PlayStation 3 video game “Call of Duty 4: Modern Warfare,” which was the top-selling game of 2007. During the control condition on a separate night they spent an equal amount of time watching “March of the Penguins,” which won the 2006 Academy Award for Best Documentary Feature. The two visits to the sleep lab were separated by exactly one week.

“We purposefully chose a very tranquil movie to contrast against the very stimulating effect of playing a violent video game in the hope of producing the greatest effect on sleep.” noted Gradisar.

Sleep-onset latency and sleep architecture were measured by electroencephalography (EEG), electromyography (EMG) and electro-oculography (EOG). Cognitive alertness also was measured by EEG, with a higher maximum alpha-power reading indicating reduced cognitive alertness. Participants wore an oximeter probe on their right index finger to measure heart rate, the most common index of physiologic arousal. Subjective sleepiness was assessed using the Stanford Sleepiness Scale.

Eleven adolescents took longer to fall asleep after playing the video game than after watching the documentary, while two of them fell asleep faster. Seven teens reported that they felt less sleepy after playing the video game than after watching the DVD, four indicated the same level of sleepiness and two felt less sleepy after watching the movie. No significant differences were found between conditions in the percentage of total sleep time comprised of rapid eye movement (REM) sleep or slow-wave sleep.

According to the authors, the extent to which the results reflect genuine sleep impairment is questionable. The increase in sleep-onset latency was small and may have few perceptible ramifications for adolescent sleep. However, the observed reduction in subjective sleepiness may be enough to cause teens to postpone going to bed until later at night. Gradisar also noted that the 50-minute experimental session may not reflect the reality of teens’ gaming experience at home.

“Very few teens would limit their playing time to a single night of 50 minutes,” said Gradisar. “With greater time invested there could be a greater emotional investment in the game. What happens to the teen’s virtual character could begin to evoke feelings of anxiety and/or frustration that could have quite larger effects on their sleep.”

The authors also pointed out that the participants were older teens with a mean age of 16 years and seven months, so it is possible that playing a video game before bedtime has a more severe effect on the sleep of younger adolescents. The teens in the study also were good sleepers, so playing a video game might have a greater impact on adolescents who normally take a long time to fall asleep. Frequent gaming also could desensitize adolescents to its stimulating effects, in which case teens who play only occasionally would experience greater sleep impairments.

Gradisar also suspects that sleeplessness could occur when the video games that teens play before bedtime require high levels of physical activity.

“When you add the effect of physical movement to the game-playing experience, such as playing “Guitar Hero” or Nintendo Wii, you’re sure to increase alertness even further,” he said. “Such movement would increase one’s body temperature, and with increased body temperature comes increased alertness.”

The authors concluded that the adage “everything in moderation” should guide parents as they set limits on bedtime video-game playing for adolescents.

The Journal of Clinical Sleep Medicine is published bimonthly and is the official publication of the American Academy of Sleep Medicine, a professional membership society that is the leader in setting standards and promoting excellence in sleep medicine health care, education and research.

Source: Kathleen McCann, American Academy of Sleep Medicine

This list is divided into two categories, one for adult sleep issues and another for infants through teens. In the latter category you may see issues that you worry about with your children, or you even may see yourself and how your current sleep patterns developed over time. Each graphic is linked to the article that will reveal more information about each study, so click on the images to learn more.

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The 2010 Sleep in America poll released today by the National Sleep Foundation (NSF) reveals significant differences in the sleep habits and attitudes of Asians, Blacks/African-Americans, Hispanics and Whites. It is the first poll to examine sleep among these four ethnic groups.

NSF’s Sleep in America poll found that more than three-fourths of respondents from each ethnic group agree that poor sleep is associated with health problems (76-83%). These new findings echo lessons learned by former President Bill Clinton who recently admitted that he has adopted a new lifestyle regimen to sleep seven or more hours on the advice of his doctors.

The poll also shows that all groups report disturbingly similar experiences missing work or family functions because they were too sleepy (19-24%). Among married people or couples living together, all ethnic groups report being too tired for sex frequently (21- 26% of the time).

“As the leading voice of sleep health, we are committed to better understanding people’s sleep needs,” says David Cloud, CEO of the National Sleep Foundation. “By exploring ethnic and family sleep practices we have gained new insight into why we sleep the way we do.”

Blacks/African-Americans report the busiest bedtime routines.

Blacks/African-Americans are the most likely to report performing activities in the hour before going to bed every night or almost every night, specifically watching TV (75%) and/or praying or doing another religious practice (71%). Whether on weekdays/workdays or non-workdays/weekends, Blacks/African-Americans spend much more time in bed without sleeping than the other ethnic groups (54 minutes on weekdays/workdays and 71 minutes on non-workdays/weekends).

• Blacks/African-Americans and Hispanics (10% each) are ten times more likely to report having sex every night than Asians (1%) and 2.5 times more likely than Whites (4%).
• Most Blacks/African-Americans report praying every night (71%); more than four times the reported frequency of Asians (18%), twice the rate of Whites (32%) and 1.5 times the rate of Hispanics (45%).
• Blacks/African-Americans (17%) and Asians (16%) are more likely than Whites (9%) and Hispanics (13%) to report doing job-related work in the hour before bed, among those employed.
• Blacks/African-Americans report losing sleep every night over personal financial concerns (12%) and employment concerns (10%) at a higher rate than Whites (6% and 7%) or Asians (1% and 4%). Hispanics are almost equally concerned each night about these two issues (11% and 9%, respectively).

“The hour before bed is an important time to relax and wind-down before going to sleep,” says Thomas J. Balkin, Ph.D., Chairman of the National Sleep Foundation. “For those who are having problems sleeping, it’s a good idea to consider whether your bedtime routines may be too alerting.”

Asians report getting the best sleep, report the least amount of sleep problems and infrequent use of sleep aids.

Asians are the most likely ethnic group (84%) to say that they had a good night’s sleep at least a few nights or more a week. In addition, Asians are about half as likely (14%) to discuss their sleep issues with a healthcare professional, and are half as likely (10%) to report having been diagnosed with a sleep disorder. Asians are the least likely to report using sleep medication at least a few nights a week (5% versus 13% Whites, 9% Blacks/African-Americans and 8% Hispanics).

• Asians are the least likely (9%) to say that they “rarely” or “never” have a good night’s sleep, compared with 20% of Whites, 18% of Blacks/African-Americans and 14% of Hispanics.
• The poll shows that Asians are more than twice as likely to use the Internet every night in comparison to any other group (51% versus 22% Whites, 20% Blacks/African-Americans, 20% Hispanics). They are also the least likely to watch TV an hour before sleep (52% versus 64% Whites, 72% Hispanics and 75% Blacks/African-Americans).
• Asians report the use of herbal and alternative therapies at rates similar to Hispanics (2% each), but less than Whites (4%).
• Asians report the lowest rates of losing sleep due to personal financial concerns at least a few nights a week (9% versus 22% Hispanics, 20% Whites and 19% Blacks/African-Americans).

While Blacks/African-Americans report the least amount of sleep, they also say they need less sleep. Blacks/African-Americans report getting the least amount of sleep on workdays/weekdays (6 hours and 14 minutes). Interestingly, they also say that they need only 7 hours and 5 minutes of sleep each night to perform at their best during the day, which is significantly less sleep than Asians and Hispanics (7 hours and 29 minutes each).

• Blacks/African-Americans report getting an average of 34 minutes less sleep on a work night/weeknight than Asians and 38 minutes less than Whites.

“The finding that Blacks/African-Americans say they need less sleep and get less sleep is instructive for public health professionals,” says Jose S. Loredo, MD, MPH, Professor of Medicine at the University of California, San Diego. “Their total sleep time and attitudes regarding sleep may be associated with Blacks/African-Americans’ higher rates of sleep apnea, hypertension and diabetes and provide sleep-related insight into how to improve awareness and education programs and, very importantly, how to improve therapy compliance rates.”

Hispanics are the most likely to say they are kept awake by financial, employment, personal relationship and/or health-related concerns.

Overall, at least one-third of Hispanics (38%) and Blacks/African-Americans (33%) report that any of these concerns disturb their sleep at least a few nights a week, compared to about one-fourth of Whites (28%) and/or Asians (25%).

• Moreover, about two in ten Hispanics (19%) and Blacks/African-Americans (19%) say their sleep is disturbed every night or almost every night by at least one of these concerns.
• Hispanics (16%) are more likely than Blacks/African-Americans (12%), Asians (9%) and Whites (7%) to say that health-related concerns have disturbed their sleep at least a few nights a week.

“So many people are suffering because of economic uncertainty,” says Martica Hall, Ph.D., Associate Professor of Psychiatry at the University of Pittsburgh. “If you find yourself lying awake worrying, write a note to yourself to work on these issues the next day so you can dismiss those ideas at bed time. Consider using relaxation techniques and focus on calming activities and thoughts. If your problems persist, you may want to seek out a sleep professional.”

Whites are the most likely to report sleeping with their pets and/or their significant other/spouse. Among those married or partnered, Whites are much more likely (14%) than the other ethnic groups (2% each) to say they usually sleep with a pet.

• Among those married or partnered, 90% of Whites report that they sleep with their significant other compared to 84% of Blacks/African-Americans, 76% of Hispanics and 67% of Asians.
• Interestingly, among all respondents, Whites are the least likely to say they sleep alone (21% versus 41% Blacks/African-Americans, 37% Asians and 31% Hispanics.)

Among those married or partnered respondents with children, Asians (28%) and Hispanics (22%) are the most likely to report that they sleep in the same room with their children (compared to 15% of Blacks/African-Americans and 8% of Whites).*

“Other studies support the findings that co-sleeping with children is prevalent with Asians,” says Sonia Ancoli-Israel, Ph.D., chair of the National Sleep Foundation’s Sleep in America Poll Task Force. “If you are having trouble sleeping, and you sleep with your spouse, your child, your pet or all three, remember that may be contributing to sleep disturbances that prevent you from getting a good night’s sleep.”

• Bed sharing/co-sleeping is a complex and controversial practice. This study did not specifically examine the issue of sleeping with infants, nor does the National Sleep Foundation wish to have these results misconstrued to suggest a position on the practice. Parental counseling about infant sleep environments is strongly suggested.

Sleep disorder diagnosis is uneven among the four ethnic groups.

The 2010 poll found that sleep disorders continue to be very common among the adults surveyed, with specific disorders occurring at different frequency among the four groups.

• Whites report the highest rate of diagnosis for insomnia (10%), and Blacks/African-Americans have the highest rate of diagnosed sleep apnea (14%) among the four groups.
• Among those experiencing sleep problems, Whites are the most likely to report using over-the-counter sleep aids at least a few nights a week (7%). Blacks/African-Americans are almost twice as likely to report taking medications prescribed by a doctor (7%) rather than over-the-counter sleep aids (3%). Asians are the least likely to report using any form of sleep medication (5%).

“If you are experiencing problems sleeping,” says Balkin, “Take charge of your own sleep. You should critically examine your bedtime routines and pre-sleep activities and make time to ensure your bedroom is conducive to your sleep comfort. You will spend approximately a third of your life in bed, so it’s worth it to take time to make sure your bed and bedtime routine are right for you. If you continue having problems sleeping for more than a few weeks, it’s advisable to speak with your healthcare professional.”

Ethnic groups seek help for sleep problems differently.

When experiencing a specific sleep problem, Blacks/African-Americans say they are more likely to speak with their doctor (16%) or research online (10%) than to get recommendations from friends or family (4%).

• Asians (15%) are the most likely to say they get advice from family and friends.
• Respondents were also asked if their healthcare professional or doctor had ever asked them about their sleep during a routine visit. At least four in ten Whites (48%), Blacks/African-Americans (42%) and Hispanics (40%) say yes; however, only 28% of Asians had been asked about sleep by their doctor.

“We are making progress with physicians and patients discussing sleep issues in regular office visits,” says Cloud. “But we still have a lot of work to do to make sleep a routine part of every physician-patient interaction.”

Adds David G. Davila, MD, Medical Director of the Baptist Health Sleep Center in Little Rock, Arkansas, “Sleep is a vital sign for overall health, therefore, discussing sleep problems should be an important part of health check ups for doctors and patients, especially since sleep disorders can affect many other medical conditions.”

For the most comprehensive source of information on sleep health, visit the National Sleep Foundation’s website, www.sleepfoundation.org. The website also provides a directory of sleep professionals and sleep centers in your community. You can also read the complete Summary of Findings and highlights from this year’s Sleep in America poll and polls from prior years.

Healthy Sleep Advice

The National Sleep Foundation suggests the following to improve your sleep:

• Go to sleep and wake at the same time every day, and avoid spending more time in bed than needed.
• Use bright light to help manage your “body clock.”Avoid bright light in the evening and expose yourself to sunlight in the morning.
• Use your bedroom only for sleep to strengthen the association between your bed and sleep. It may help to remove work materials, computers and televisions from your bedroom.
• Select a relaxing bedtime ritual, like a warm bath or listening to calming music.
• Create an environment that is conducive to sleep that is quiet, dark and cool with a comfortable mattress and pillows.
• Reduce or eliminate your intake of caffeine, nicotine and alcohol.
• Save your worries for the daytime. If concerns come to mind, write them in a “worry book” so you can address those issues the next day.
  If you can’t sleep, go into another room and do something relaxing until you feel tired.

• Exercise regularly, but avoid vigorous workouts close to bedtime.

Poll Methodology and Definitions

The National Sleep Foundation began surveying American sleep health and behaviors in 1991. The 2010 Sleep in America annual poll was conducted for the National Sleep Foundation by WB&A Market Research, using a random sample of 1,007 adults between the ages of 25-60 and identifying themselves as White, Black/African-American, Asian or Hispanic. This poll has adopted the group definition used by the Centers for Disease Control and Prevention (CDC), the U.S. Census Bureau, and related public health groups; while NSF also acknowledges that this is an imperfect description of race and ethnic groups. No effort was made to verify the accuracy of the respondent’s self-identification. Individuals from other ethnic groups were excluded from participating. The Sleep in America Poll Task Force did consider economic factors in analyzing the data. The margin of error is ±3.1 percentage points at the 95% confidence level.

Source: Jennifer Cowher Williams, National Sleep Foundation

A study in the March 1 issue of the journal SLEEP shows that African–American and Hispanic young adults with short or long sleep durations had greater increases in belly fat over a five-year period compared with those who reported sleeping six to seven hours a night.

Results show that in participants younger than 40 years of age, both short and long sleep durations were associated with significant increases in body mass index (BMI), as well as in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) fat accumulation. Compared with people who reported a nightly sleep duration of six to seven hours, those with a self-reported sleep duration of five hours or less per night had an average BMI increase over a five-year period that was 1.8 kg/m2 higher, and greater accumulations of SAT (42 cm2) and VAT (13 cm2); and those who reported sleeping eight hours or more had a BMI increase that was 0.8 kg/m2 higher, as well as greater accumulations of SAT (20cm2) and VAT (6 cm2). No significant relationship existed between sleep duration and abdominal fat change in participants older than 40 years of age.

Lead author Kristen G. Hairston, M.D., assistant professor of internal medicine at Wake Forest University School of Medicine in Winston-Salem, N.C., said that obtaining a sufficient amount of sleep is important for people of all races and ethnicities. However, ethnic minorities disproportionately report extremes in sleep duration, putting them at risk for negative metabolic outcomes such as obesity and type 2 diabetes.

“Appropriate amounts of sleep are important for maintenance of healthy weight,” said Hairston. “In a group of African-American and Hispanic participants, those who slept less than this had greater increases in belly fat over a five-year period.”

Information was obtained from 1,107 people in the IRAS Family Study, an extension of the Insulin Resistance Atherosclerosis Study (IRAS). Data were collected from 332 African-Americans and 775 Hispanics with a mean age of 41.7 years at baseline and an age range from 18 to 81 years. Sixty-two percent of participants were female. Mean sleep duration at baseline was 6.7 hours in response to the question, “On average, about how many hours of sleep do you get a night?” Seventeen percent of the sample reported sleeping five hours or less per night, 55 percent slept six to seven hours per night and 28 percent averaged eight or more hours of sleep per night.

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Abdominal computed tomography (CT) scans and BMI were obtained at a five-year interval. Dietary intake was assessed using a short, retrospective, one-year, semi-quantitative food-frequency interview. An estimate of usual frequency of participation in vigorous activities also was obtained. Generalized estimating equations using linear regression models assessed the association between sleep duration and five-year fat accumulation with adjustment for age, race, gender, study site, baseline fat measure, physical activity, total calorie intake, smoking status and education.

In those younger than 40 years old, a short sleep duration of five hours or less was most frequently reported by Hispanic men (30 percent), and a long sleep duration of eight or more hours was most frequently reported by Hispanic women (53 percent). Participants reporting five hours of sleep or less consumed more total calories (2,224 kcal) than those reporting six to seven hours (1,920 kcal) or eight or more hours (2,199 kcal).

The authors proposed that short sleep may impact fat accumulation by promoting increased caloric intake via increased hunger, or by reducing energy expenditure via altered thermoregulation and increased fatigue. Both increased caloric intake and decreased vigorous activity were observed in the short sleep group.

The authors also suggested that it is just as important for doctors to encourage patients to get adequate sleep as it is for them to promote a healthy diet and physical activity. This is particularly relevant when young adults make transitions involving college, marriage and childbearing, because these life stages often are associated with sleep deprivation.

Source: Kelly Wagner, American Academy of Sleep Medicine, EurekAlert

Results show that the prevalence of type 2 diabetes was 36 percent higher (adjusted odds ratio = 1.36) in participants who reported napping four to six times a week and 28 percent higher (OR = 1.28) in those who napped daily. Similar associations were found between napping and impaired fasting glucose. The observed associations were unaltered in statistical analyses that removed participants with potential ill health and daytime sleepiness, suggesting it is less likely that diabetes leads to daytime sleepiness and raising the possibility that napping may increase the risk of diabetes.

According to the authors, napping in China is a social norm, which is practiced by all ages primarily as a habit started in childhood. In Western countries, napping is less common and is often unplanned and prompted by sleepiness likely caused by aging, deteriorating health status or nighttime complaints.

Lead author Neil Thomas, PhD, reader in epidemiology at the University of Birmingham, U.K., said that additional research is needed to determine if napping itself plays a causative role in the development of type 2 diabetes, or if other factors are involved.

“In many non-Mediterranean, Western countries a large proportion of those that nap are generally older or have other conditions that cause tiredness and create an urge to nap,” said Thomas. “The napping can therefore be a marker of disease.”

This cross-sectional study analyzed baseline data from the Guangzhou Biobank Cohort Study, a collaboration between the Guangzhou Number 12 People’s Hospital and the Universities of Birmingham and Hong Kong. The community-based study took place in Guangzhou, China, where 19,567 participants between the ages of 50 and 93 years were recruited from 2003 to 2004 and 2005 to 2006. The sample comprised 13,972 women with a mean age of 61.4 years and 5,595 men with an average age of 64.2 years.

Participants underwent a half-day assessment, which included a structured interview on lifestyle and medical history, and a physical examination. Self-reported frequency of napping was obtained by questionnaire, and type 2 diabetes was assessed by a fasting blood glucose sample and/or self-reports of physician diagnosis or treatment. Participants were asked to describe their napping habits and daytime sleepiness.

Type 2 diabetes was identified in 13.5 percent of the sample and was more prevalent in people who reported napping daily (15.1 percent) and in those who napped four to six times per week (14.7 percent). Logistic regression models were constructed to assess the relationship between napping and diabetes and impaired fasting glucose, adjusting for demographics, lifestyle, sleep habits, health status, body fat and metabolic markers.

At least one nap per week was reported by 67.2 percent of participants, more commonly in males (76.4 percent) than in females (63.6 percent). About 59.4 percent of these people reported napping daily. Total sleep duration was longer and daytime sleepiness was reported less often in more frequent nappers than in people who never napped.

In a sub-sample of 3,822 participants who were re-contacted for additional information about sleep habits, there was a statistically significant trend of increasing risk of diabetes with longer nap duration. Compared with people who never took naps, the risk of diabetes was 41 percent higher (OR = 1.41) for people who took naps that lasted longer than 30 minutes and 35 percent higher (OR = 1.35) for people whose naps lasted 30 minutes or less.

The authors noted that the association between napping and diabetes was observed despite the fact that nappers had higher levels of physical activity, which has been shown to reduce the risk of diabetes. This suggests that the relationship between napping and diabetes might have been stronger had it not been offset by the protective effects of physical activity. The authors added that there will be profound public health implications in China if the relationship between napping and increased risk of type 2 diabetes is confirmed in longitudinal studies, as the nation is currently affected by an emerging diabetes epidemic.

Source: Kelly Wagner, American Academy of Sleep Medicine via EurekAlert