Research - Sleep
The music that helps people sleep and the reasons they believe it works: A mixed methods analysis of online survey reports
Sleep loss is a widespread problem with serious physical and economic consequences. Music can impact upon physical, psychological and emotional states, which may explain anecdotal reports of its success as an everyday sleep aid. However, there is a lack of systematic data on how widely it is used, why people opt for music as a sleep aid, or what music works; hence the underlying drivers to music-sleep effects remain unclear. We investigated music as a sleep aid within the general public via a mixed methods data online survey (n = 651) that scored musicality, sleep habits, and open text responses on what music helps sleep and why. In total, 62% of respondents stated that they used music to help them sleep. They reported fourteen musical genres comprising 545 artists. Linear modelling found stress, age, and music use as significant predictors of sleep quality (PSQI) scores. Regression tree modelling revealed that younger people with higher musical engagement were significantly more likely to use music to aid sleep. Thematic analysis of the open text responses generated four themes that described why people believe music helps sleep: music offers unique properties that stimulate sleep (Provide), music is part of a normal sleep routine (Habit), music induces a physical or mental state conducive to sleep (State), and music blocks an internal or external stimulus that would otherwise disrupt sleep (Distract). This survey provides new evidence into the relationship between music and sleep in a population that ranged widely in age, musicality, sleep habits and stress levels. In particular, the results highlight the varied pathways of effect between music and sleep. Diversity was observed both in music choices, which reflected idiosyncratic preferences rather than any consistent musical structure, and in the reasons why music supports good sleep, which went far beyond simple physical/mental relaxation.
Source : PLOSOne
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Melatonin May Help Sleep Problems in People With High Blood Pressure Who Take Beta-Blockers
Melatonin supplements may help improve sleep in people with high blood pressure (hypertension) who take beta-blockers, according to a recent randomized controlled study. Beta-blockers are prescribed to treat a number of health problems and are the most commonly prescribed class of drugs for hypertension. However, frequent side effects of these drugs are difficulty sleeping and daytime fatigue, which may result from their suppression of melatonin, a hormone that promotes sleep. The intent of this study was to determine whether melatonin supplements for 3 weeks would improve sleep in hypertensive patients who were chronically treated with beta-blockers. Findings from this clinical trial, co-funded by NCCAM, were published in the journal Sleep.
The 16 participants enrolled in the study were adults (45 to 64 years of age) who had been diagnosed with uncomplicated essential hypertension, but were otherwise healthy. They had taken beta-blockers for at least 6 months, and some also took other antihypertensive drugs. Participants were not required to have sleep problems. Researchers randomly assigned participants to take either a 2.5 mg capsule of melatonin or a matching placebo by mouth 1 hour before bedtime, for approximately 3 weeks (20 to 28 days, depending upon laboratory and scheduling factors). An inpatient laboratory stay of 4 days in a private suite occurred at the beginning and at the end of this period, where patients were monitored for changes in sleep and daytime activities. The laboratory schedule consisted of 16 hours of scheduled wakefulness per day and 8 hours of scheduled bed rest per night at the same times as patients had maintained during the out-patient portions in the week prior to both admissions. Outside the lab, sleep and activity patterns were measured through several means, including a sensor worn on the wrist.
The researchers found that, compared with placebo, taking melatonin supplements significantly increased the participants’ total sleep time by 36 minutes; increased sleep efficiency by almost 8 percent; decreased sleep onset latency (by 14 minutes) to stage 2 sleep; and increased the length of sleep by 41 minutes in stage 2 (though not in other stages). In addition, a number of negative effects that can occur with chronic use of prescription sleep aids did not occur with melatonin. Patients did not experience tolerance (lowering of effectiveness following chronic use) or rebound sleep disturbance (sleep problems that develop after stopping a sleep aid), nor did the researchers find a decrease in slow-wave and/or REM sleep. Since beta-blockers must typically be taken for life, these benefits would be significant advantages.
The researchers acknowledged limitations in the study, particularly the small size and the unavailability of pre-study measurements (prior to beta-blocker therapy). However, investigators suggested that melatonin may have profound potential benefits in improving sleep, not only for the more than 20 million people taking beta-blockers, but also for patients with other health conditions and risks associated with sleep disturbances.
Reference
- Scheer FA, Morris CJ, Garcia JI, et al. Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial. Sleep. 2012;35(10):1395-1402.
Source : NNCAM
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Effects of a Homeopathic Combination Remedy on the Acute Stress Response, Well-Being, and Sleep: A Double-Blind, Randomized Clinical Trial
Juliane Hellhammer, MSc, and Melanie Schubert, PhD
DAaCRO – Diagnostic Research and Clinical Research Organization, Science Park of Trier, Trier, Germany.
Abstract
Objectives: Stress impacts on health, causing stress-related illness. The aim of this study was to investigate stress dampening effects of the homeopathic combination remedy dysto-loges® S on physiological and psychological measures during acute stress. Additionally, effects of the substance on sleep and life quality were investigated.
Design: This randomized, double-blind, placebo-controlled single center study had a total duration of 15 days for each participant.
Setting/location: The study was performed by Daacro, Trier, Germany.
Subjects: We included 40 women aged 30–50 years that regularly experienced impaired well-being when feeling stressed.
Intervention: Participants took three tablets daily for 14 days. On the final study day, participants took three pills in the morning and upon arrival at the study site. Thereafter, the Trier Social Stress Test (TSST) was performed.
Outcome measures: Primary endpoints were saliva cortisol responses to the stress test. Secondary biological endpoints were plasma cortisol, adrenocorticotrophic hormone, epinephrine, and norepinephrine (NE) and heart rates. Psychological secondary endpoints were well-being, anxiety, stress, and insecurity during the stress test as well as sleep and quality of life.
Results: Stress-induced cortisol levels did not differ between groups, but verum-treated participants were characterized by lower NE levels. Two weeks of treatment with the homeopathic substance resulted in a better sleep quality. Sleep improvement was associated with a higher hormonal response to the TSST in both groups. In addition, individuals with impaired sleep in the placebo group had higher unstimulated NE levels.
Conclusions: This study provides preliminary evidence for beneficial effects of dysto-loges S on sleep quality. Improvement of sleep quality was positively associated with a normalized neuroendocrine stress response during acute stress, whereas an altered hormonal response was observed in participants with impaired sleep. We hypothesize that the test product may possibly reduce NE release.
Source : The Journal of Alternative and Complementary Medicine
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Forget All-Night Studying, a Good Night’s Sleep Is Key to Doing Well on Exams
As fall semesters wind down at the country’s colleges and universities, students will be pulling all-night study sessions to prepare for final exams. Ironically, the loss of sleep during these all-nighters could actually work against them performing well, says a Harris Health System sleep specialist.Dr. Philip Alapat, medical director, Harris Health Sleep Disorders Center, and assistant professor, Baylor College of Medicine, recommends students instead study throughout the semester, set up study sessions in the evening (the optimal time of alertness and concentration) and get at least 8 hours of sleep the night before exams.
“Memory recall and ability to maintain concentration are much improved when an individual is rested,” he says. “By preparing early and being able to better recall what you have studied, your ability to perform well on exams is increased.”
As head of the Harris Health Sleep Disorders Center, a nationally certified facility by the American Academy of Sleep Medicine, Alapat and his staff perform about 1,200 sleep studies a year to evaluate patients for a variety of sleep disorders, including apnea, insomnia, restless legs syndrome, narcolepsy and chronic fatigue syndrome.
College-aged students ideally should get 8-9 hours of sleep a night. Truth is, most students generally get much less.
“Any prolonged sleep deprivation will affect your mood, energy level and ability to focus, concentrate and learn, which directly affects your academic performance,” Alapat adds.
Throw in the occasional all-nighter, consumption of caffeinated beverages like coffee, tea or energy drinks, and students are at risk for developing insomnia, as well as increased risks for alcohol abuse and motor vehicle accidents.
“A lot of college students graduate high school and leave the protective family environment where they have curfews or set bed times,” Alapat says. “In college, they don’t have these guidelines for sleep and recognize that they can stay up late. This likely contributes to the sleep deprivation seen commonly in college students.”
Alapat’s recommendations:
• Get 8-9 hours of sleep nightly (especially before final exams)
• Try to study during periods of optimal brain function (usually around 6-8 p.m.)
• Avoid studying in early afternoons, usually the time of least alertness
• Don’t overuse caffeinated drinks (caffeine remains in one’s system for 6-8 hours)
• Recognize that chronic sleep deprivation may contribute to development of long-term diseases like diabetes, high blood pressure and heart disease
Source : Newswise
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Sleeping Pill Death Toll May Top 500,000
By Charles Bankhead,
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania.
The use of hypnotic sleep aids was associated with a three- to five-fold higher mortality risk compared with the risk for nonusers, even when the prescription was for a small number of pills, investigators reported.
A prescription for 0.4 to 18 doses per year was associated with a mortality hazard ratio of 3.60 compared with patients who had no prescriptions for hypnotics.
The hazard jumped to 5.32 for patients prescribed more than 132 doses a year, investigators reported online in BMJ Open.
"Rough order-of-magnitude estimates ... suggest that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the U.S. alone," Daniel F. Kripke, MD, of the Scripps Clinic in La Jolla, Calif., and co-authors wrote. "From this nonrandomized study, we cannot be certain what portion of the mortality associated with hypnotics may have been attributable to these drugs, but the consistency of our estimates across a spectrum of health and disease suggests that the mortality effect of hypnotics was substantial."
Patients who used hypnotics most often also had an increased risk of cancer, with an overall cancer increase of 35% among those prescribed high doses.
More than 30 years ago, investigators in an American Cancer Society-supported study showed that both cigarette smoking and hypnotic use were associated with excess mortality (Arch Gen Psychiatry 1979; 36: 103-116). But the link to hypnotics was largely discounted because the study was not designed primarily to examine these drugs, Kripke and colleagues wrote.
Subsequently, at least two dozen studies examined the mortality risk associated with hypnotic use, and two-thirds of the studies demonstrated significant (P<0.05) associations. Lack of uniformity across the studies precluded a meta-analysis, but 22 of the reports showed a mortality hazard ratio that exceeded 1.0, the authors continued.
Previous studies had several notable limitations, including limited information on the specific types of drugs, confounding with tranquilizers, lack of monitoring of the quantities of drugs provided to patients, and limited data on newer short-acting hypnotics, such as zolpidem, zaleplon, and eszopiclone (Lunesta).
To address some of the limitations of previous work, Kripke and colleagues performed a matched-cohort study based on longitudinal data from a large U.S. health system.
A query of the database identified 10,531 adult patients who had at least one prescription for a hypnotic drug from Jan. 1, 2002 to Sept. 30, 2006. Using the same database, the authors matched the hypnotic-user group with 23,674 patients who did not have a prescription for a hypnotic during the period studied.
Three-fourths of patients prescribed a hypnotic had an explicitly stated sleep-related indication in their records.
Women (mean age 54) accounted for 63.9% of hypnotic users. Hypnotic users and the control group had been followed for about 2.5 years. The users had a mean morbidity score of 1.53. Zolpidem was the most commonly used hypnotic (4,338), followed by temazepam (2,076).
Overall, 6.1% of hypnotic users died during observation, compared with 1.2% of the nonusers. Hypnotic use was associated with a significantly increased mortality risk (P<0.001). The magnitude of the hazard ratio increased with the number of pills prescribed per year (P<0.001 for all comparisons versus nonusers):
- HR 3.60 for 0.4 to <18 pills
- HR 4.43 for 18 to 132 pills
- HR 5.32 for >132 pills
Patients with temazepam prescriptions totaling 1 mg/year to 240 mg/year had a mortality hazard of 3.71, increasing to 6.56 for >1,640 mg/year (P<0.001).
Overall, only patients whose hypnotic use fell into the top two categories (18 to 132 pills and >132 pills) had an increased cancer risk (HR 1.20, P=0.022; HR 1.35, P<0.001).
For individual drugs, only patients in the top category of zolpidem use had an increased cancer risk (HR 1.28, P=0.023), whereas the two top categories of temazepam use were associated with an increased mortality hazard (HR 1.44, P=0.024; HR 1.99, P<0.001).
The authors acknowledged limitations to this research, most notably that residual confounding could not be fully excluded "due to possible biases affecting which patients were prescribed hypnotics and due to possible imbalances in surveillance."
They also pointed out that cohort studies may demonstrate an association but do not necessarily imply causality. However, "the preferable randomized controlled trial method for assessing hypnotic risks may be impractical due to ethical and funding limitations," they said.
"The meager benefits of hypnotics, as critically reviewed by groups without financial interest, would not justify substantial risks," the authors wrote. "A consensus is developing that cognitive behavioral therapy of chronic insomnia may be more successful than hypnotics.
"Against meager benefits, it is prudent to weigh the evidence of mortality risks from the current study and 24 previous reports, in order to reconsider whether even short-term use of hypnotics, as given qualified approval in National Institute for Clinical Excellence guidance, is sufficiently safe," they added.
Kripke disclosed that he has a long history of criticism of hypnotics on a personal website.
He also disclosed a family interest in an investment organization that has a small percentage of assets in stock of drug companies.
Primary source: BMJ Open
Source reference:
Kripke DF, et al "Hypnotics' association with mortality or cancer: A matched cohort study" BMJ Open 2012; 2: e000850.
Source : Medpage Today
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Physical activity impacts overall quality of sleep
People sleep significantly better and feel more alert during the day if they get at least 150 minutes of exercise a week, a new study concludes. A nationally representative sample of more than 2,600 men and women, ages 18-85, found that 150 minutes of moderate to vigorous activity a week, which is the national guideline, provided a 65 percent improvement in sleep quality. People also said they felt less sleepy during the day, compared to those with less physical activity.
The study, out in the December issue of the journal Mental Health and Physical Activity, lends more evidence to mounting research showing the importance of exercise to a number of health factors. Among adults in the United States, about 35 to 40 percent of the population has problems with falling asleep or with daytime sleepiness.
"We were using the physical activity guidelines set forth for cardiovascular health, but it appears that those guidelines might have a spillover effect to other areas of health," said Brad Cardinal, a professor of exercise science at Oregon State University and one of the study's authors.
"Increasingly, the scientific evidence is encouraging as regular physical activity may serve as a non-pharmaceutical alternative to improve sleep."
After controlling for age, BMI (Body Mass Index), health status, smoking status, and depression, the relative risk of often feeling overly sleepy during the day compared to never feeling overly sleepy during the day decreased by 65 percent for participants meeting physical activity guidelines.
Similar results were also found for having leg cramps while sleeping (68 percent less likely) and having difficulty concentrating when tired (45 percent decrease).
Paul Loprinzi, an assistant professor at Bellarmine University is lead author of the study, which was conducted while he was a doctoral student in Cardinal's lab at OSU. He said it is the first study to examine the relationship between accelerometer-measured physical activity and sleep while utilizing a nationally representative sample of adults of all ages.
'Our findings demonstrate a link between regular physical activity and perceptions of sleepiness during the day, which suggests that participation in physical activity on a regular basis may positively influence an individual's productivity at work, or in the case of a student, influence their ability to pay attention in class," he said.
Cardinal said past studies linking physical activity and sleep used only self-reports of exercise. The danger with this is that many people tend to overestimate the amount of activity they do, he said.
He added that the take-away for consumers is to remember that exercise has a number of health benefits, and that can include helping feel alert and awake.
"Physical activity may not just be good for the waistline and heart, but it also can help you sleep," Cardinal said. "There are trade-offs. It may be easier when you are tired to skip the workout and go to sleep, but it may be beneficial for your long-term health to make the hard decision and get your exercise."
Source ; Science E News (November 2011)
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