Sleep apnea common in adults with pacemakers

Nearly two thirds of heart patients with implanted pacemakers have undiagnosed sleep apnea, a significantly higher prevalence than found in the general population, a study shows.

"Because of the excessive prevalence of undiagnosed sleep apnea we found, it could be recommended that all patients referred for a pacemaker should first be screened for sleep apnea," Dr. Patrick Lévy, at Grenoble University in France advises in a written statement.

Even patients with pacemakers should be screened for sleep apnea, Lévy and colleagues advise, because untreated sleep apnea may further contribute to cardiovascular deterioration.

The authors report their findings in the rapid access issue of Circulation: Journal of the American Heart Association, scheduled for print publication.

Sleep apnea is a breathing disorder characterized by frequent, short periods during sleep when breathing stops. An implantable pacemaker is a small device that uses electrical impulses to help regulate the beating of the heart.

Overnight sleep studies in 98 individuals with cardiac pacemakers revealed sleep apnea in 59 percent of patients. The condition was severe in about 21 percent of patients.

Lévy's team notes that more than 70 percent of sleep respiratory events involved abnormally shallow breathing or slow respiratory rate (also called hypopneas). More than 75 percent of these events were classified as obstructive apneas in which soft tissue in the throat temporarily collapses during sleep causing a blockage.

The investigators also found that none of the patients had symptoms traditionally reported by patients with sleep apnea. As noted, they advise pacemaker patients be routinely checked for sleep apnea.

Article Source: Medical Health Care Information

10 Tips to Get Better Sleep

Set yourself up to get a good night's sleep.

Want to know how to sleep better? We all have trouble sleeping from time to time. But you can make it easier to get a good night's sleep every night with these simple steps. Here are 10 tips for better sleep:We all have trouble sleeping from time to time. But you can make it easier to get a good night's sleep every night with these simple steps:

Cut caffeine. Simply put, caffeine can keep you awake. It can stay in your body longer than you might think -- up to about 14 hours. So if you drink a cup of coffee at noon and are still awake at midnight, caffeine might be the reason. Cutting out caffeine at least four to six hours before bedtime can help you fall asleep easier. If you have already had too much caffeine, try eating some carbohydrates like bread or crackers to help reduce the effects.

Avoid alcohol as a sleep aid. Alcohol may initially help you fall asleep, but it also causes disturbances in sleep resulting in less restful sleep.

Relax before bedtime. Stress not only makes you miserable, it wreaks havoc on your sleep. Develop some kind of pre-sleep ritual to break the connection between all the day's stress and bedtime. These rituals can be as short as 10 minutes or as long as an hour.Some people find relief in making a list of all the stressors of the day, along with a plan to deal with them — this can act as "closure" to the day. Combining this with a period of relaxation — perhaps by reading something light, meditating, aromatherapy, light stretching, or taking a hot bath — can also help you get better sleep. And don't look at the clock! That "tick-tock" will just tick you off.

Exercise at the right time for you. Regular exercise can help you get a good night's sleep. The timing and intensity of exercise seems to play a key role in its effects on sleep. If you are the type of person who gets energized or becomes more alert after exercise, it may be best not to exercise in the evening. Regular exercise in the morning even can help relieve insomnia, according to a recent study.

Keep your bedroom quiet, dark, and comfortable. For many people, even the slightest noise or light can disturb sleep — like the purring of a cat or the light from your laptop or TV. Use earplugs, window blinds or curtains, and an electric blanket or air conditioner — everything possible to create an ideal sleep environment. And don't use the overhead light if you need to get up at night; use a small night-light instead. Ideal room temperatures for sleeping are between 68 and 72 degrees Fahrenheit. Temperatures above 75 or below about 54 can disrupt sleep.

Eat right, sleep tight. Try not to go to bed hungry, but avoid heavy meals before bedtime. An over-full belly can keep you up. Some foods can help, though. Milk contains tryptophan, which is a sleep-promoting substance. Other foods that help promote sleep include tuna, halibut, pumpkin, artichokes, avocados, almonds, eggs, bok choy, peaches, walnuts, apricots, oats, asparagus, potatoes, buckwheat, and bananas. Also, try not to drink anything after 8 p.m. This can keep you from having to get up to use the bathroom during the night.

Restrict nicotine. Having a smoke before bed -- although it feels relaxing — actually puts a stimulant into your bloodstream. The effects of nicotine are similar to those of caffeine. Nicotine can keep you up and awaken you at night. It should be avoided particularly near bedtime and if you wake up in the middle of the night.

Avoid napping. Napping can only make matters worse if you usually have problems falling asleep. If you do nap, keep it short. A brief 15-20-minute snooze about eight hours after you get up in the morning can actually be rejuvenating.

Keep pets off the bed. Does your pet sleep with you? This, too, may cause you to awaken during the night, either from allergies or pet movements. Fido and Fluffy might be better off on the floor than on your sheets.

Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. If not, you can end up associating the bed with distracting activities that could make it difficult for you to fall asleep.

Article Source: Medical Health Care Information

Hormone responsible for teen tantrums

A new research has revealed that a hormone could be the cause behind teen tantrums.

Researchers report that a hormone the body produces in response to stress that normally calms adults and younger children instead increases anxiety in adolescents.

They conducted experiments with female mice focusing on the hormone THP to demonstrate this paradoxical effect, and described the brain mechanism that explains it.

If, as the scientists suspect, the same thing happens in people, the researchers say this phenomenon may help account for the mood swings and anxiety exhibited by many adolescents.

"Teenagers don't go around crazy all the time," says lead researcher Sheryl Smith, a professor of physiology and pharmacology at the State University of New York Downstate Medical Center.

"But it really is a mood swing where things seem fine and calm, and then the next thing is someone's crying or angry," she says.

"And I think that's why people have used the term 'raging hormones'."

"Responses to stressful events are amplified, and anxiety and panic disorder first emerge at this time, being twice as likely to occur in girls as in boys," the researchers write.

"In addition, suicide risk increases in adolescence, despite the use of adult-based medical strategies."

THP, also called allopregnanolone, generally serves as a natural tranquilliser and is produced several minutes after a stressful situation.

"It's not the immediate fight-or-flight response," Smith says.

It calms neural activity to reduce anxiety and help people adapt and function under stress.

"It's thought to be one way that we all can compensate for stress, so we just stay focused and don't go crazy, sort of focus on our task," she says.

Smith's team examined brain activity and behaviour in mice before puberty, during puberty and as adults. The researchers subjected the mice to a stressful event by suddenly placing them inside a container just slightly larger than a mouse's body, a sort of claustrophobic experience, and keeping them there for 45 minutes.

"Twenty minutes after stress, both the young mice and the adult mice showed less anxiety. But the pubertal mice showed more anxiety The parallel with humans is that in humans there are similar hormonal changes going on in puberty," Smith says.

"So the beginning of puberty is a time when a lot of emotions and responses to stress are increased. It's nothing new that teenagers go through a difficult time. Hopefully this will shed some new light on it," she added.

Article Source: Medical Health Care Information

Pain complicates depression treatment in elderly

By interfering with normal activities, chronic pain can impede recovery from depression in older adults, according to findings reported in the Journal of the American Geriatrics Society.

Dr. Shahrzad Mavandadi, of the University of Pennsylvania, Philadelphia, and colleagues examined the effects of pain on the response to depression treatment in 524 men, 60 years of age or older, who were seen at a VA medical center.

The men were randomly assigned to an integrated care group, in which patients saw a mental health professional at a primary care clinic, or to a specialty care group, in which the patient was referred to a mental health professional at another facility.

The researchers assessed the patients' pain severity, the degree to which pain interfered with work inside and outside the home, and depression symptoms at the beginning of the study and at 3, 6, and 12 months.

The results showed that depression symptoms decreased over time in both treatment groups. However, pain modified the reductions in symptoms.

Patients who reported higher levels of pain severity and more interference with work activity had less improvement in their depression symptoms. Pain that interfered with activities had a greater effect on depression symptoms, than did pain severity, the team reports.

These findings, and the fact that pain and depression often occur together in the elderly, suggest that older patients who are being treated for depression might benefit from routine assessment of pain as well as any other medical conditions that may complicate their treatment, Mavandadi said in an interview with Reuters Health.

"Better assessment and treatment of these conditions may improve depression...outcomes," she said. Also, when patients with pain are being assessed to confirm a depression diagnosis and determine the course of treatment, it may help to incorporation tests that address various aspects of the pain condition, rather than just pain severity.

Mavandadi also noted that these findings may be attributed to a number of factors. For example, she suggested that the mere experience of pain may contribute to greater distress and depressive symptoms both directly and indirectly through its impact on physical and psychosocial functioning.

Pain can also interfere with "the patients' and providers' ability to manage depression," Mavandadi said. "Dealing with severe pain may be distracting and hinder, both physically and psychologically, the patient's ability to concentrate on a treatment regimen or successfully engage in treatment visits," she explained. Furthermore, pain and depression each require time and attention.

Article Source: Medical Health Care Information