Seasonal Affective Disorder

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By Nikita Katz, MD, PhD

Seasonal affective disorder (SAD), also known as winter depression and winter blues, is a type of mood disorder that is typically caused by low light levels. SAD generally begins in the fall and worsens during the winter months.  The rarer, reverse seasonal affective disorder (summer blues, summer depression) begins in the spring and worsens in the in the summer.

SAD is generally found more frequently in people who live in latitudes far north or south of the equator (for example, one percent in Florida; four percent in Washington, D.C.; 10 percent in Alaska).  Some patients experience a serious mood change when the seasons change. They may sleep too much, have little energy, and crave sweets and starchy foods. They may also feel depressed. Although symptoms may be severe, they generally resolve over several months.

SAD can be a serious disorder that may require hospitalization. There is a potential risk of suicide among some individuals experiencing SAD. The symptoms of SAD mimic those of clinical depression or dysthymia. The prevalence of SAD in the adult American population has been estimated at between 1.5 percent in Florida and about nine percent in the northern US.  Overall, 6.1 percent of the US population is affected by SAD. Subsyndromal seasonal affective disorder is a milder form of SAD estimated to affect 14.3 percent of the American population.

Seasonal affective disorder is more common in women than men and in people between the ages of 15 and 55 years. The risk of developing SAD for the first time decreases with age. People who have a close relative with SAD are also at greater risk.

CAUSES

There is strong evidence that SAD is caused by a lack of available sunlight. Decreased exposure to sunlight may have an effect on the body’s biological clock, which regulates mood, sleep, and hormone production. Exposure to light may reset the biological clock. Melatonin and serotonin synthesis may be altered in individuals with SAD. Exposure to light appears to correct both neurotransmitter deficits and changes in the biological clock.

SYMPTOMS

Symptoms of SAD include difficulty waking up in the morning, a tendency to oversleep, to overeat, and to crave carbohydrate-rich foods, often leading to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. Individuals with SAD are characterized by depression, pessimism, and a lack of pleasure in usual activities. Symptoms of SAD can include heightened anxiety as well as depression. For most people with SAD, symptoms start in September or October and end in April or May  and tend to occur at the same time every year.

TREATMENT

There are several treatment options for classic SAD. Bright-light treatment uses a specially designed lamp (or light box) — with an intense “full spectrum” or blue light at doses of 2,500 to 10,000 lux. The patient sits at a prescribed distance, usually 30 to 60 cm, in front of the box with eyes open but not staring at the light source for 30 to 60 minutes. Many individuals use the light box in the morning, and there is evidence that morning light is superior to evening light  although people may respond to evening light as well. One study found that up to 69 percent of patients find the treatment inconvenient, and as many as 19 percent stop use because of this.

There is evidence that dawn simulation is effective as well. In some studies, this has been found to be 83 percent more effective than other bright-light therapies. Most studies have found light therapies to work well — for several weeks — as seasonal treatment until greater amounts of natural light are available.

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Childhood Nightmares

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

fantasy-1152677_640Sleep disorders occur in 35 to 45 percent of children ages 2 to 18 years,  with peak incidence in children ages 3 to 6 years.

Nightmares occur sporadically in many children and are frightening events for the entire family. Nightmare disorder is characterized by repeated episodes of a frightening or unpleasant dream that disrupts the child’s sleep. The child’s reaction often interrupts the parents’ sleep as well. On awakening from a nightmare, a child is alert and aware of the present surroundings, but the sleep disturbance causes distress and impairment in everyday functioning.

Nightmares are often confused with the parasomnia known as night terrors, which, as noted earlier, are episodes of extreme panic and confusion associated with vocalization, movement, and autonomic discharge. Children with night terrors are difficult to arouse and console and do not remember a dream or nightmare.

Other considerations include:

  • Nightmares are not associated with specific physical findings.
  • Heart rate and respiratory rate may increase or show increased variability before the child awakens from a nightmare. Mild autonomic arousal, including tachycardia, tachypnea, and sweating, may occur transiently upon awakening.
  • Approximately seven percent of individuals who have frequent nightmares have a family history of nightmares.
  • Nightmares are more common in children with mental retardation, depression, and CNS (central nervous system). An association also has been reported with febrile illnesses.
  • Medications may induce frightening dreams, either during treatment or following withdrawal. Withdrawal of medications that suppress REM (rapid eye movement) sleep can lead to an REM rebound effect that is accompanied by nightmares.
  • Nightmares may result from a severe traumatic event and may indicate post-traumatic stress disorder.

Management of nightmares is based on reassurance. Although all stressors cannot be removed from a child’s life, parents can attempt to make bedtime a safe and comfortable time. Parents should be encouraged to spend time in the evening reading, relaxing, and talking with the child.

If the child has a recurring nightmare, it may help to have parents encourage the child to imagine a good ending. Psychological evaluation is indicated when nightmares occur more than twice a week over several months. Medications are neither helpful nor indicated.

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Can Loss Of Sleep Make Us Fat?

Posted on Posted in Continuing Education, Homestudy, Psychology, Webinars

buddha-85673_640Laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of diabetes and obesity. The relationship among sleep restriction, weight gain, and diabetes risk may involve alterations in glucose metabolism, upregulation  of appetite, and decreased energy expenditure. Shorter periods of sleep are associated with decreased glucose tolerance and increased concentrations of blood cortisol. Research has suggested that long-term sleep restriction (less than 6.5 hours per night) may cause a 40 percent fall in glucose tolerance.

An association between short, habitual sleep time and increased BMI  has been reported in large populations. Short sleep was associated with changes in hormones that control hunger. Specifically, leptin levels were low  while ghrelin levels were high. These effects were seen when sleep duration fell below eight hours. This suggests that sleep deprivation is a risk factor for obesity. One controlled study with healthy males found that a sleep time of around four hours was associated with significantly greater craving for calorie-dense foods with high carbohydrate content (sweets, salty foods, and starchy foods). Reported hunger was also higher.

One could also argue that less time spent sleeping would allow for more time for eating and drinking. This could certainly be a contributor to a general obesogenic environment. On the other side of the energy equation, sleep-deprived people are less likely to be physically active, resulting in lower energy expenditure. Taken together, the increases in appetite and food craving and decreases in activity create a compelling argument for understanding  the role of sleep deprivation in weight management.

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Sleep: Crucial for Good Health

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

baby-22194_640By Michael Howard, PhD

Regular and restful sleep helps keep immune systems strong.  Such sleep also helps keep blood pressure and blood sugar at low levels.

This kind of sleep can help resist weight gain and obesity, assist in emotional stability and forming new memories, and reduce pain perception.

Many older people in their 70s and 80s get only about six hours of sleep per night. Centenarians typically have regular sleep patterns and get plenty of restful, restorative sleep—usually seven to eight hours.

One of the major characteristics of 100-year-olds in an area of Costa Rica is sleeping about eight hours per day on a regular basis. While sleep times can vary from person to person, getting regular rest is the key.  Centenarians have established sleep routines, tending to go to bed and wake up at the same time each day. In general, they go to sleep when the sun goes down and wake up when it comes up. In the Japanese Centenarian Study, spontaneously waking up at regular times in the morning was a major characteristic of those who were living independently.

Taking a nap during the day may be a healthy sleeping pattern for older people. While sleeping continuously throughout the night is often touted as the most recommended way to sleep, midday napping appears to be a common characteristic of the healthiest older people. In the MEDIS study of long-lived people in the Mediterranean islands, all of the people in the study older than 90 years were found to engage in naps around noontime.

Unfortunately, as many as 40 percent of the elderly have some type of sleep disorder that can result in physical and cognitive problems. “Short-sleepers” getting less than six hours of sleep a night have been found to have poor insulin control of blood sugar, more diabetes and obesity, stronger appetites, more heart attacks, and shorter life spans. These risks are even more pronounced for those getting five or fewer hours of sleep per night.  Obesity and sleep deprivation are strongly connected. Studies show that, compared with those getting about eight hours of sleep per night, those who sleep only five hours have a 50 percent higher chance of becoming obese. Those who sleep only four hours have a 73 percent higher chance of obesity. It also appears that getting too much sleep—hypersomnia—of nine or more hours nightly may be even worse for health and longevity than sleep deprivation.

Increasing age increases the chance of developing several sleep disorders. Sleep disorders are associated with many health problems and are major risk factors for heart disease, stroke, depression, and even Alzheimer’s disease.

Common age-related sleep disorders include insomnia, obstructive sleep disorder, restless legs, periodic limb movement disorder, and REM (rapid eye movement) behavior disorder. Insomnia is the biggest culprit, because it is the most common sleep disorder. Other less-common sleep disorders may be even more dangerous. Obstructive sleep apnea, for example, dramatically raises the risk of heart attack and stroke. According to a study in the American Journal of Respiratory and Critical Care, even mild obstructive sleep apnea raises cardiovascular disease risk because of increased arterial stiffness. It seems clear that getting a good night’s sleep is crucial to health and longevity.

If there are problems sleeping, there are techniques you can try at home to help, called “sleep hygiene.”  Techniques of improving sleep with easily-implemented sleep hygiene strategies can be found on the internet, and many people can help themselves to a better night’s sleep by using them. Centenarians practice many of these techniques. If sleep hygiene techniques do not work and sleep problems continue, the best recommendation is to see a sleep disorders specialist or go to a sleep disorders clinic for thorough evaluation, diagnosis, and treatment.  Bottom line: to live long, sleep well.

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Chronic Insomnia

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sleeping-child-812181_640By Nikita Katz, M.D., Ph.D.

Chronic insomnia is associated with an increased risk of depression, anxiety, excess disability, reduced quality of life, and increased use of health care resources.

Insufficient sleep can result in industrial and motor vehicle accidents, somatic complaints, cognitive dysfunction, depression, and decrements in daytime work performance owing to fatigue or sleepiness. It is also associated with hypertension, heart disease, and greater risk of mortality.

Statistical evidence highlights the scope and gravity of the problem of sleep loss among Americans.

  • More than one-third of all Americans suffer from sleep disorders at some point in their lives.
  • Up to two-thirds of adults report difficulty sleeping at some point each year. Approximately 20 percent of adults consider the problem to be serious.
  • Twenty percent of adults (approximately 40 million) report having a chronic sleep disorder.
  • The prevalence of insomnia is about 1.4 times higher among women than among men.
  • Mature age predisposes one to sleep disorders. The rate increases from 5 percent in persons aged 30 to 50 to approximately 30 percent in those more than 50 years old. In the National Institute on Aging’s Established Populations for Epidemiologic Studies of the Elderly, 42 percent of senior citizens who participated in the survey had difficulty falling and staying asleep.
  • Twenty-three percent of adults report having difficulties concentrating because they do not get enough sleep: For this reason, 18 percent say they have trouble remembering things; 38 percent report unintentionally falling asleep during the day at least once in the preceding month; and 5 percent, while driving, report nodding off or falling asleep at least once in the prior month.
  • Up to one in four adults reports using a “sleep aid” at least a few nights a week.
  • According to the 2011 Sleep In America Poll, conducted by the National Sleep Foundation, the growing use of cell phones and electronic devices (for phone calls, texting, or emailing) — shortly before going to bed and being awakened after going to sleep by one of these forms of communication — is causing individuals to get less sleep at night, negatively affecting millions of Americans’ functioning the next day.

Although insomnia is very common, evidence suggests that only a small proportion of people who suffer from sleep disturbance report it to their physicians. Moreover, physicians may not detect or adequately assess or treat insomnia. Factors that contribute to under-diagnosis and under-treatment of insomnia include reluctance on the part of patients to discuss it; physicians’ limited training in this condition; time constraints in medical practice; misperceptions about the impact poor sleep can have on patients’ daytime functioning, health, and safety (such as putting insomnia sufferers at risk for serious accidents); and misconceptions about the benefits and risks associated with the use of hypnotic medications.

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The Importance of Sleep

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

sleeping-child-812181_640When you’re scrambling to meet the countless demands in life, cutting back on sleep might seem like the only answer. Although you realize that getting a good night’s sleep is important, you might not realize the vital role sleep plays in our physical and emotional health. Not getting enough shuteye can have serious and even devastating consequences.

Unfortunately, sleep problems are quite common, and over 60% of Americans report having trouble getting to sleep or staying asleep at least a few nights a week. More troubling is the fact that over 40% of American adults report daytime sleepiness severe enough, at least a few days each month, to interfere with their daily activities.

During sleep, the brain is preparing itself for the next day—and even forming new neural pathways that help with learning, memory, and problem-solving. For teenagers and children, deep sleep actually stimulates the production of growth hormone which supports normal growth and development.

Sleep is also important in maintaining a healthy functioning heart, blood vessels, kidneys, and immune system. Emotional well-being—especially during times of stress—is also tied to getting enough sleep. The ability to react to stress without mood swings and undue anger, as well as the ability to get along with others, is affected by whether or not one gets enough sleep.

Lack of sleep causes not only fatigue, but also a wide range of health problems and disease. Chronic sleep deficiency can causes immune system dysfunction, making it difficult to fight infections. Insomnia can also lead to problematic changes in the endocrine system, which may exacerbate diseases such as diabetes. And sleep problems can lead to abnormalities in the central nervous system and cardiovascular system. Children and adults who don’t get enough sleep, for instance, are at increased risk for a host of emotional ailments, including depression, mood swings, impulsivity, and anxiety.

Below are just a few of the health problems that can result from lack of sleep:

  • Obesity
  • Kidney disease
  • Hypertension
  • Stroke
  • Depression
  • Chronic Pain

Many people think they can function well even with sleep deficits. But scientific research reveals that the opposite is true. After just several nights of not getting enough sleep—with a loss of 1 to 2 hours of sleep per night—your ability to function declines as much as if you hadn’t slept for a day or two.

Research has also shown that people who don’t get enough sleep take longer to finish tasks, have a slower reaction time, and are more likely to make mistakes. They also have difficulty making decisions, are less creative than those who get enough sleep, have a hard time controlling emotions and behavior, and suffer declines in their problem-solving abilities. So not only does lack of sleep compromise alertness and physical health, it can also reduce productivity at work and decrease one’s ability to weather life’s stresses.

When sleep is compromised, the body’s ability to heal, repair, and restore itself can be impaired. Blood pressure fluctuations, adrenaline production, and hormone synthesis are affected —and impede our ability to bounce back from the physical stresses of normal life. When sleep deficits persist for an extended length of time, these disruptions in normal bodily function can push a vulnerable organ system from health into disease.

The bottom line is that we live in a sleep deprived world. Sleep is good for your mind, body, and spirit. In the words of Homer — “There is a time for many words, and there is also a time for sleep.”

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The Power Of Sleep

Posted on Posted in Continuing Education, Homestudy

By Dr. Mary O’Brien MD

When you’re scrambling to meet the countless demands in life, cutting back on sleep might seem like the only answer. Although you realize that getting a good night’s sleep is important, you might not realize the vital role sleep plays in our physical and emotional health. Not getting enough shuteye can have serious and even devastating consequences.

baby-303068_640Unfortunately, sleep problems are quite common, and over 60% of Americans report having trouble getting to sleep or staying asleep at least a few nights a week. More troubling is the fact that over 40% of American adults report daytime sleepiness severe enough, at least a few days each month, to interfere with their daily activities.

During sleep, the brain is preparing itself for the next day—and even forming new neural pathways that help with learning, memory, and problem-solving. For teenagers and children, deep sleep actually stimulates the production of growth hormone which supports normal growth and development.

Sleep is also important in maintaining a healthy functioning heart, blood vessels, kidneys, and immune system. Emotional well-being—especially during times of stress—is also tied to getting enough sleep. The ability to react to stress without mood swings and undue anger, as well as the ability to get along with others, is affected by whether or not one gets enough sleep.

Lack of sleep causes not only fatigue, but also a wide range of health problems and disease. Chronic sleep deficiency can causes immune system dysfunction, making it difficult to fight infections. Insomnia can also lead to problematic changes in the endocrine system, which may exacerbate diseases such as diabetes. And sleep problems can lead to abnormalities in the central nervous system and cardiovascular system. Children and adults who don’t get enough sleep, for instance, are at increased risk for a host of emotional ailments, including depression, mood swings, impulsivity, and anxiety.

Below are just a few of the health problems that can result from lack of sleep:

  • Obesity
  • Kidney disease
  • Hypertension
  • Stroke
  • Depression
  • Chronic Pain

Many people think they can function well even with sleep deficits. But scientific research reveals that the opposite is true. After just several nights of not getting enough sleep—with a loss of 1 to 2 hours of sleep per night—your ability to function declines as much as if you hadn’t slept for a day or two.

Research has also shown that people who don’t get enough sleep take longer to finish tasks, have a slower reaction time, and are more likely to make mistakes. They also have difficulty making decisions, are less creative than those who get enough sleep, have a hard time controlling emotions and behavior, and suffer declines in their problem-solving abilities. So not only does lack of sleep compromise alertness and physical health, it can also reduce productivity at work and decrease one’s ability to weather life’s stresses.

When sleep is compromised, the body’s ability to heal, repair, and restore itself can be impaired. Blood pressure fluctuations, adrenaline production, and hormone synthesis are affected —and impede our ability to bounce back from the physical stresses of normal life. When sleep deficits persist for an extended length of time, these disruptions in normal bodily function can push a vulnerable organ system from health into disease.

The bottom line is that we live in a sleep deprived world. Sleep is good for your mind, body, and spirit. In the words of Homer — “There is a time for many words, and there is also a time for sleep.”

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