Antipsychotic Drugs Linked to Sudden Cardiac Death

http://edition.cnn.com/2009/HEALTH/01/15/healthmag.antipsychotic.sudden.death/
By Anne Harding
Susan Craig's brother Roger died of a pulmonary embolism in 2007, at age 38. Diagnosed with bipolar disorder in high school, he had been on antipsychotic drugs for years. At the time of his death, he was carrying 280 pounds on his 6-foot-4-inch frame.
Craig, a public relations specialist who works at Columbia University in New York City, knew that Roger's medications could cause weight gain. But she had never been told that the drugs he was taking might be harming his heart.

"We were never counseled by his psychiatrist or his primary care provider to watch for symptoms of heart disease or any risk of sudden death at all," Craig says. There's no evidence that Roger's medications caused his death, but his family might have been able to get him help sooner if they had known about the risks, Craig explains.

New research published Wednesday in the New England Journal of Medicine shows that antipsychotic drugs are not risk free, and the study's authors are urging much more caution in their use. The drugs are associated with a risk of sudden cardiac death, particularly at higher doses. Health.com 10 best foods for your heart

Craig's brother was taking haloperidol, which belongs to an older class of drugs called typical antipsychotics, which have long been known to increase the risk of sudden death due to cardiac causes. He was also on risperidone, a member of a newer class of drugs called atypical antipsychotics, which had been considered safer.

Doctors prescribe these newer medications, originally developed to treat schizophrenia, for a wide variety of problems -- from conduct disorder in kids to aggressive behavior in Alzheimer's patients. In fact, they've become so popular that three of them -- olanzapine, risperidone, and quetiapine -- are among the 10 top-selling drugs worldwide, with $14.5 billion in sales in 2007.

The new study suggests that among patients taking high doses of atypical antipsychotics, there are about 3.3 cases of sudden cardiac death per 1,000 patients per year, which an editorial characterizes as a risk that's "between 'moderate' and 'low,' but not 'rare.'" Health.com: Heart drug may be a cancer fighter

About 325,000 people in the United States each year die of sudden cardiac death, which has an incidence of 0.1 to 0.2 percent per year in adults.

"[The drugs] have potentially very serious side effects," says Wayne A. Ray, Ph.D., the director of the division of pharmacoepidemiology at Vanderbilt University School of Medicine, in Nashville. "So whenever a decision is made to use one, consideration of potential side effects needs to be made." Ray and his colleagues found that atypical antipsychotics doubled the risk of sudden death from heart-related causes, most likely by causing disturbances in heart rhythms.

First introduced in the mid-nineties, atypical antipsychotics were praised for having none of the troublesome side effects of their predecessors, including frequent, involuntary movements of the face and mouth that were in some cases irreversible.

But the new study shows that the increased risk of sudden cardiac death seen with the older drugs is nearly identical to that of the newer medications. There had been suspicions that the drugs were risky, especially when used in older patients, but the current study is the first to systematically investigate their association with sudden cardiac death.

Ray and his colleagues reviewed data on Tennessee Medicaid patients, comparing 44,218 people using older typical antipsychotics and 46,089 taking the newer atypical antipsychotics to 186,600 people who had never used the drugs. People with schizophrenia may have a higher rate of cardiac problems, due to smoking and other factors. To account for this, researchers also compared antipsychotic drug users without schizophrenia to non-drug users who had characteristics (in most cases, mood disorders) that made them likely candidates for the drugs.

Overall, people taking typical antipsychotics were at 1.99-times greater risk of sudden cardiac death, while the risk for those on atypical antipsychotics was increased 2.26 times. The increased risk was greater for people on higher doses of the drugs. People who had used the drugs in the past but stopped weren't at greater risk of sudden cardiac death.

"The drugs are still very effective for conditions that there's proven evidence for," says Jeffrey A. Lieberman, M.D., a professor and chair of psychiatry at Columbia University, in New York City, and the director of the New York State Psychiatric Institute, who was not involved with Ray's research. "They clearly need to still be able to be used. I think this [study] really underscores the need to be very judicious about how these medications are used and whom they're given to."

While atypical antipsychotics have been used to ease aggressive behavior for patients with Alzheimer's disease, for example, they are not approved for this purpose by the U.S. Food and Drug Administration; in fact, in 2005, the FDA issued a warning that these drugs increased the risk of death among elderly people, extending the warning to all antipsychotic drugs last year, notes Sebastian Schneeweiss, M.D., Sc.D., an associate professor of medicine at Harvard Medical School, in Boston, who coauthored an editorial accompanying the current study. Health.com: How is depression in the elderly different from dementia?

Given the lack of better alternatives, these drugs are still widely used in patients with dementia despite the warnings, he adds. But while there's anecdotal evidence that they will "cool these patients down" and reduce their aggressive behaviors, there's no scientific evidence that they really help patients or their caregivers, Dr. Schneeweiss says.

In his editorial, Dr. Schneeweiss and coauthor Jerry Avorn, M.D., also of Harvard, call for patients to undergo an electrocardiogram before and shortly after being placed on atypical antipsychotics, to determine if the drugs are causing any heart rhythm disturbances.

For people who must be on these medications, Ray says, it's essential for their doctors to treat any other conditions, such as high blood pressure, that can harm the heart. "Sudden cardiac death usually occurs when multiple risk factors are present," he explains. "When you add one, it's kind of like the straw that broke the camel's back."

"Absolutely the lowest dose that works should be used, because we found a strong dose response," Ray says.

Jamaison Schuler, a spokesperson for Eli Lilly and Company, the maker of Zyprexa, says, "Although the study appears to have important limitations, it provides additional information for practicing physicians to consider as they decide how to treat very complex diseases such as schizophrenia and bipolar disorder."

The FDA has approved atypical antipsychotics for treating bipolar disorder, Ray adds. But the researcher recommends that physicians first try safer alternatives, such as the mood stabilizer lithium. "That's a very serious illness, and it has important consequences for patients' quality of life and relationships," Ray notes. "If the mood stabilizer doesn't work, I think it's very reasonable to consider an antipsychotic, but...other drugs should be considered first."

Finally, he says, a patient should never stop taking any drug without consulting his or her physician. Nevertheless, anyone taking an atypical antipsychotic for a non-FDA-approved use should consult his physician. "I think off-label use should be undertaken very cautiously, and its frequency should be much less than it is currently," Ray says. Health.com: Superfoods that can save your health

For Susan Craig, the new research makes it clear that treating serious mental illness must go far beyond just prescribing pills. "We need to be supporting these people in a better, more systematic way," she says. "There's no magic pill. It's treating the whole person."

Insomnia can be long lasting

March 10th, 2009 - 5:18 pm ICT by ANI
Washington, Mar 10 (ANI): Insomnia can be a chronic problem lasting more than a year, a new study has found.

Insomnia is a symptom of a sleeping disorder characterized by persistent difficulty falling asleep or staying asleep despite the opportunity.

Several factors such as being female, increasing age, having anxiety or depression and experiencing pain from medical conditions have been associated with insomnia.

The condition has been linked to higher health care costs, work absenteeism, disability and higher risk of hypertension and depression.

For the study, Charles M. Morin, Ph.D., of Universite Laval and Centre de recherche Universite LavalRobert Giffard, Quebec, Canada, and colleagues evaluated insomnia persistence, remission and relapse in 388 adults (average age 44.8) over a course of three years.

Individuals with an insomnia syndrome (insomnia symptoms at least three nights per week for at least one month causing substantial distress or daytime impairment) at the beginning of the study were compared to those with insomnia symptoms to examine the course of initial severe sleep difficulties.

“Of the study sample, 74 percent reported insomnia for at least one year and 46 percent reported insomnia persisting over the entire three-year study,” the authors write.

The group with initial insomnia syndrome had a higher persistence rate than the group with symptoms of insomnia (66.1 percent vs. 37.2 percent), respectively.

About fifty-four percent of participants went into insomnia remission; however, 26.7 percent of them eventually experienced relapse.

“Individuals with subsyndromal insomnia [insomnia symptoms] at baseline were three times more likely to remit than worsen to syndrome status, although persistence was the most frequent course in that group as well,” the authors said.

Of the 269 individuals with baseline symptoms of insomnia, after one year 38.4 percent were classified as good sleepers, 48.7 percent still had insomnia symptoms and 12.9 percent had insomnia syndrome.

Results were similar after the second and third year of follow-up. Of the 119 participants with insomnia syndrome at the beginning of the study, 17 percent were good sleepers after one year, while 37 percent had symptoms of insomnia and 46 percent remained in the insomnia syndrome group.

The study has been published in the March 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals (ANI)

‘Brain music’ may help treat insomnia, fatigue

April 25th, 2009 - 11:55 am ICT by ANI
Washington, Apr 25 (ANI): Every brain composes a soundtrack. Its tempo and tone differ, depending on mood and frame of mind. Now, researchers at the US Department of Homeland Security (DHS) believe that the cerebral music can help in dealing with insomnia and fatigue in the aftermath of a stressful experience.

The Dept of Homeland Security’s Science & Technology Directorate (S&T) has begun a study into a form of neurotraining called “Brain Music” that uses music created in advance from listeners’ own brain waves to help them deal with common ailments that stem from stressful environments.

The concept of Brain Music is to use the frequency, amplitude, and duration of musical sounds to move the brain from an anxious state to a more relaxed state.

“Strain comes with an emergency response job, so we are interested in finding ways to help these workers remain at the top of their game when working and get quality rest when they go off a shift,” said S&T Program Manager Robert Burns.

“Our goal is to find new ways to help first responders perform at the highest level possible, without increasing tasks, training, or stress levels,” the expert added.

If the brain “composes” the music, the first job of scientists is to take down the notes, and that is exactly what Human Bionics LLC of Purcellville, VA does. Each recording is converted into two unique musical compositions designed to trigger the body’s natural responses, for example, by improving productivity while at work, or helping adjust to constantly changing work hours.

The compositions are clinically shown to promote one of two mental states in each individual: relaxation - for reduced stress and improved sleep; and alertness - for improved concentration and decision-making. Each 2-6 minute track is a composition performed on a single instrument, usually a piano.

The relaxation track may sound like a “melodic, subdued Chopin sonata,” while the alertness track may have “more of a Mozart sound,” says Burns. (It seems there’s a classical genius-or maybe two genii-in all of us.

After their brain waves are set to music, each person is given a specific listening schedule, personalized to their work environment and needs. If used properly, the music can boost productivity and energy levels, or trigger a body’s natural responses to stress.

The music created by Human Bionics LLC is being tested as part of the S&T Readiness Optimization Program (ROP), a wellness program that combines nutrition education and neurotraining to evaluate a cross population of first responders, including federal agents, police, and firefighters. (ANI)

Time to 'reclaim the night' for sleep

VIEWPOINT
By Neil Stanley
Sleep researcher, University of East Anglia
We all know the health risks of smoking, drinking and eating too much. But sleep expert Neil Stanley says we don't pay attention to the risks of having too little sleep.

In this week's Scrubbing Up health column, he warns it is time to "reclaim the night".

Good sleep is vital for good physical mental and emotional health - but unfortunately we seem to live in a society that has forgotten this fact.

In terms of healthy living, sleep is as important as good diet and exercise.
Poor or inadequate sleep can have serious consequences on overall health and wellbeing and has been shown to lead to lower immunity, poor performance and mood changes.

In the longer term, inadequate sleep is associated with a greater risk of a number of diseases, such as heart disease, depression and diabetes.

There are also important consequences of poor or inadequate sleep which negatively affect the way we feel and perform during the day.

Round the clock

We are living in an increasingly "tired" society. Think about how you feel at the moment with one as very tired and 10 as feeling wide awake.

I reckon very few of you are a seven, let alone a 10. Why do we go through life feeling this tired?

One reason is the increasing extension of the daytime activities into the night.
When I was growing up in the 1970s, Tomorrow's World each week promised us a future where, due to advances in technology, there would be so much leisure time that we would have to come up with new ways of amusing ourselves.

Unfortunately what was created by all this new technology was the 24/7 society.

Technology never sleeps, and thus people can work around the clock - whether they are in the office or at home.

The long hours, information overload and stresses associated with 21st Century living negatively affect our sleep which, in turn, is detrimental to our health, work performance and even our relationships.

Convenience brings risks

As a society we need to give much more serious consideration to our work/life balance particularly with regards to sleep.

For example it has been estimated that in future a third of the workforce will be working shifts, mainly in the service sector.

However there is a large body of evidence which shows that working shifts is bad for health and increases accidents at work.

So, whilst it is of course important for some workers to work around the clock, does the convenience of paying a bill at 2am really outweigh the health risks of having so many people doing shifts?

It has been reported that tired drivers now cause more deaths on European roads than drunk drivers, and yet whilst it has become socially unacceptable to be drunk behind the wheel or in the workplace it is almost a matter of pride that we believe we can function properly when tired.

Yet you would not want a drunken surgeon operating on you or a drunken train driver taking you to work, so why would you accept a tired one?

The problem of poor sleep is perhaps even more important in children as it has been linked with increased risk of - amongst other things - obesity, diabetes, poor academic performance and behavioural problems.

You only have to watch an episode of Supernanny to see how profound the positive effect of a good night's sleep can be on the behaviour of children.

Over the past decade there has been an increasing body of evidence that shows that sleep plays an important role in regulating weight and controlling appetite, and so I find it surprising that when earlier this year the government started its Change 4 Life healthy living campaign there is no mention of the importance of good sleep.

Isn't it about time we reclaimed the night for sleep?

http://news.bbc.co.uk/1/hi/health/7880583.stm

Want to lose weight? Go to bed and get some sleep

Millions of Britons struggling with their weight are failing to recognise that getting a good night's sleep is crucial to staying slim, says leading sleep researcher Dr Neil Stanley.
He claims that not enough of us are aware that lack of sleep causes the 'hunger hormones' to malfunction.

This leads to an increase in appetite - and an inability to recognise when we've had enough - as well as sugar cravings
These cravings cause an initial sugar rush, then a sugar low, leading to poor quality sleep which further dents our resolve to eat healthily.

Dr Stanley's comments come as a new Populus survey commissioned by Horlicks reveals that nearly 80 per cent of those questioned wanted to lose weight, but 74 per cent didn't view getting a good night's sleep as a priority.

Indeed, two-thirds said they even cut back on sleep to fit more into their day. This is despite the fact that there is now compelling evidence linking lack of sleep with weight gain.

This link was first revealed in a groundbreaking study five years ago. Eve Van Cauter, an endocrinologist from the University of Chicago, found that sleeplessness caused the two hormones associated with appetite to go haywire.

In her study, healthy young men were allowed to sleep for only four hours a night. After just two nights, their hormones were malfunctioning.

Levels of ghrelin, which stimulates appetite, fat production and body growth, had increased by 28 per cent, making the men hungrier than normal.

And levels of leptin, which regulates food intake and signals that the body has had enough to eat, dropped by 18 per cent, making it harder for the men to tell when they were satisfied.

The men's cravings for calorific, high-carbohydrate foods - such as sweets, biscuits, crisps, bread and pasta - increased dramatically.

Since then, there have been other studies confirming the link between lack of sleep and weight gain.
One showed that the increase in appetite caused by not sleeping enough can cause people to consume an extra 1,000 a calories a day.

Another study has shown that those who get a good amount of sleep - seven to eight hours a night - have the lowest body mass index.

While Dr Van Cauter's initial study and follow-up research have received wide coverage, the new survey suggests that people still don't appreciate the role sleep has in weight gain, says Dr Stanley, who runs the clinical trials and research unit at the Norwich and Norfolk University Hospital.

'Tired people eat more sugar - there is the physiological need for a sugar rush,' he explains.

'And, psychologically, you want a treat if you're feeling sorry for yourself. What are you going to have at 11am - an apple or a Mars bar?

'We're all aware of the five portions of fruit and veg a day message and the 10,000 steps per day message, even if we don't follow them,' says Dr Stanley.

'But where is the good sleep message? The Government isn't preaching it. And bed manufacturers sell beds, not sleep.

'Sleep is as important as diet and exercise - and easier and cheaper to do.'

For Dr Stanley's latest sleep report and tips on getting a good night's sleep go to www.horlicks.co.uk.

Time to wake up to sleep disorders

Millions in the UK have conditions that affect their sleeping – and waking – lives. Why is it so hard for them to get diagnosed?
Anne Wollenberg
guardian.co.uk, Monday 28 July 2008 14.30 BST
Article history
How have you been sleeping? Not very well, if you're among the 25% of people in the UK who suffer from one of the 80 or more known sleep disorders.

These include insomnia, sleep apnoea (pauses in breathing during sleep), narcolepsy (which causes daytime sleep attacks, among many other symptoms), idiopathic hypersomnia (which is very similar to narcolepsy and which I suffer from) and Klein-Levin syndrome (characterised by a need for excessive amounts of sleep and an abnormally uninhibited sex drive).

It seems logical to assume that disturbed sleep may be caused by a sleep disorder. But visit your GP to discuss problems relating to sleep – difficulty staying awake during the day, for example – and you're likely to find these disorders are at the bottom of the list of possible causes after diabetes, thyroid problems, drug abuse, depression, laziness and poor sleep hygiene. Take the lorry driver suffering from sleep apnoea who caused a pile-up which killed one man. He'd been tested for diabetes, but sleep apnoea hadn't been considered. Most of the narcolepsy and idiopathic hypersomnia sufferers I have spoken to report spending between five and 15 years trying to obtain a diagnosis (in my case, it was around seven).

The same stories come up again and again. Sufferers say their GPs have misinterpreted their symptoms (for example, disturbed night-time sleep is an established symptom of narcolepsy, but is often seen as a sign that the patient simply needs to improve his or her sleep routine) or informed them that tiredness is a fact of life. One girl suffering from daytime sleep attacks was kicked off the waiting list for treatment – because she fell asleep and missed her appointment. "I know I am lucky to have such severe symptoms", narcoleptic Katie Antoniou wrote last year. "Those with mild narcolepsy ... can go their whole lives being labelled lazy, forgetful, clumsy or stupid."

In March 2006, the British journal of hospital medicine reported that, by international standards, the UK has been slow to adapt its healthcare systems to deal with sleep disorders, and detects and treats far fewer cases than other countries. "We have a recurring problem with GPs refusing to refer people", a consultant at one sleep clinic told me. But why? Doctors aren't out to get their patients. They want them to get better. How is it, then, that people who present symptoms of sleep disorders find it so difficult to obtain the correct diagnosis and treatment?

"It's common for diagnosis to be greatly delayed", says Andrew Cummin, director of the Imperial College healthcare sleep centre. "Narcolepsy is relatively rare but common conditions causing sleepiness such as sleep apnoea are also not being diagnosed promptly. One problem is that there has been relatively little training in sleep medicine in this country – certainly there is no structured training for sleep physicians."

There are thousands of medical conditions jostling for GPs' attention. But with so many sufferers in the UK, surely it's time for the medical profession to wake up to sleep disorders.

Any dream will do

Is the boss on your back because you can't seem to stay awake? It could be that you have chronic sleep problems. Virginia Matthews learns how to beat the insomniac blues
The Guardian, Monday 21 April 2008
Article history
Most of us have experienced the odd interminably dull afternoon at work when we wouldn't have minded a quick 40 winks. And - whisper it quietly in case the boss hears - some of us might even have had one. Yet, for about 15% of the UK's workers, it's not so funny. Because that's how many of us are estimated to have chronic sleep problems - meaning difficulty in sleeping at least three nights a week for a month or more. And that can seriously affect our ability to get through the working day.

But while many workers might see a clear link between disturbed sleep patterns and modern-day working life - rising levels of stress stopping us dropping off at night, or non-stop attachment to PC screens adding to daytime drowsiness - employers still seem unsympathetic to the sleep problems of their workforce.

When party-loving neighbours moved in above Rosemary, a 27-year-old legal secretary, her typical 11pm to 7am sleep patterns were disturbed and she became sleepy and woolly headed at work.

"When I told my boss what the problem was he suggested it was down to me doing too much clubbing and refused to believe that most nights I turned in after the 10 o'clock news," she says.

"Whenever he saw me yawn over my computer screen, or on one or two occasions, burst into tears with sheer exhaustion, he would make some remark about 'burning the candle at both ends' and suggest that it was all my own fault.

"Yet when one of the wives of a partner had a baby, he couldn't do enough for the guy, even suggesting that he started later in the morning or worked from home on a regular basis."

Grouchiness, irritability, a lack of concentration and growing anxiety are all by-products of insomnia or acutely disturbed sleep. And while for most of us, the lack of zeds isn't likely to cause immediate problems at work, sleep deprivation is taken increasingly seriously by companies like airlines and haulage firms, and continues to be a burning issue for doctors.

Marianne Downey, director and co-founder of the British Snoring and Sleep Apnoea Association (BSSAA), says insomnia can be as hard to diagnose as it is to cure. "With more than 80 known sleep disorders, from restless legs syndrome and sleep apnoea to sleep walking or narcolepsy - where people can literally fall asleep while driving or playing sport - many employers find it easier to dismiss sleep problems as skiving rather than examine what's going on," she says.

"I would recommend that people with acute sleeping problems explain to their HR department or to their manager why they are so tired at work and, if necessary, get a letter from a GP to prove that they are trying to sort out the problem.

"If a colleague's sleepiness is a health and safety issue because of the work you do, I'd argue that whistleblowing is far preferable to worrying about whether your friend's insomnia is going to do real damage," she adds.

While sleep apnoea is most often associated with overweight, middle-aged men, Downey notes that it can strike anyone at any time.

Lorraine, 35, runs her own health food mail order business and started getting complaints about her loud snoring from her partner. At first she attributed it to spending too long in a wine bar one night, but the problem has persisted for six months and has, she says, made her very "on edge" during the day. "I've tried over-the-counter sleep remedies, and I've even tried wearing a horrendous-looking mask which maintains regular breathing, but I still snore three or four nights out of seven and feel really groggy and indecisive for much of the day," she says. "I go to sleep exhausted most of the time, but I still wake up as if I'm half-drugged."

While Lorraine's partner thinks she should see a doctor, she says she's "embarrassed by how gross and unsexy it sounds" and still can't bring herself to make an appointment.

Sleep scientists debate whether it is our sleep patterns or our waking lives that lead to disrupted sleep. Professor Jim Horne, director of the Sleep Research Centre at Loughborough University, says fretting about the number of hours of kip we get, and reading about Margaret Thatcher's legendary ability to run the country on four hours a night, doesn't help.

"If you are constantly sleepy during the day and you haven't got narcolepsy, then you need to urgently address your lack of sleep with either hypnosis, behavioural therapy, herbal remedies or as a last resort, sleeping pills," he says.

"But for most people, the problem isn't so much feeling sleepy at work - aside from late afternoon when all of us feel a little more tired - but going to bed at night and switching into full-on worry mode; about everything from our bank balance to a birthday we have forgotten.

"We need to work on the gnawing, day-time anxiety that comes to the surface as soon as we lie down, and until we do that, the blissful night's sleep we all like to fantasise about will continue to elude us."

Although most of us have been brought up on the notion that the average body needs eight hours' sleep a night in order to repair cells and refresh creative juices, Horne believes this is too prescriptive.

"We allow our bodies to tell us when we are hungry and the same should be true of sleepiness. If you are functioning OK during the day and aren't yawning all over the place, then you are genuinely getting enough sleep, even if you and your alarm clock don't recognise it as such," he says.

Doze and don'ts of how to beat office fatigue

· Fresh air and caffeine will help combat tiredness, but if you really need of sleep, the benefits will only be short-term.

· Tired workers can perform monotonous tasks on "remote control", but complex jobs and decision-making may be a chore.

· Get through any demanding tasks early - you'll feel a lot worse by 2pm.

· Don't arrange difficult personal meetings on a day when you feel starved of sleep - you may be irrational and argumentative without realising it.

· Keep to the same bedtime and waking-up time regime as far as possible through the week. The latter is more important in regularising sleep.

· The average adult needs about seven hours' sleep a night; a regular eight-to-nine hours or more can be counter-productive.

· Power napping for 15 minutes can provide an energy boost, but if it's any longer, we drift into deeper sleep and may wake feeling groggy.

· When we wake briefly in the night, the time spent awake can feel endless, but this may be due to a condition called "sleep onset misperception".

· Napping on the job is perfectly acceptable in Japan and Germany, but in the UK, nap rooms are rare.

I haven't slept for 37 years

Neil Epstein
The Guardian, Saturday 25 October 2008
Article history
When someone tells me they've had a bad night's sleep, I find it hard to sympathise. I can't believe anyone sleeps as badly as me. On a good night I get three hours of restless catnapping, waking every 15 minutes and then dropping off again. I regularly go for two or three nights with no sleep at all.

I can't remember any one night when I lost that ability to drift off, but by the age of seven I would regularly be pacing my room until dawn. I wasn't a particularly anxious child - there's no history of insomnia in my family and my mother said I slept well as a baby - so there was no obvious explanation. And no obvious solution: my mother tried everything, but nothing worked.

At school I was short-tempered with exhaustion and would bang my fists on my desk and kick walls. By eight, I was so frustrated and desperate to sleep that I hit my head against the wall in the middle of the night; if I couldn't fall asleep, I thought, I'd knock myself out. The years went by with no improvement - I could barely cope and grew into an irritable teenager, a loner always on the periphery of groups. Yet it felt normal to me because I was so used to being by myself at night.

I have never been able to lead a conventional life and can't imagine working in an office - I can barely function in the mornings. Fortunately I have been able to build a successful career as a ring designer, deciding what hours I work.

Before I met my wife, Julia, insomnia wrecked several relationships. Girlfriends would say, "I'll make sure you get some sleep," but my tossing and turning drove them away. Julia and I have accepted we need separate bedrooms. We tried two mattresses zipped together, separate duvets - but I need the radio on to drop off, and it keeps her awake.

When we did sleep together, I couldn't bear it if Julia woke me up when she snored. "How can you wake me up?" I'd rage. "It's taken me four hours to get to sleep."

We don't share a bed any more and I yearn for the day when we can. Instead, when Julia goes to bed at 11pm, I pad around the house, or work until 2am or 3am. It's pointless trying to sleep any earlier. I take sleeping tablets only once a week because they are addictive - three times the recommended dose (with my GP's blessing) to ensure three to four hours' solid sleep.

When my children were babies, I'd hold them in my arms and watch them drift off peacefully - it was like watching a miracle. I'd hold them close to try to absorb some of the blissful sleep that I craved. We have four children now and they've grown up understanding that Daddy is awake at night. It meant I could do the nightshift when they were babies.

It's still such a mystery to me, the act of falling asleep. People say, let your mind go blank, but how? Thoughts whirr round in my head. I don't have that ability to switch off.

I once gave a colleague a lift and he told me casually he was going to have a power nap. Thirty seconds later, I heard snoring and nearly crashed the car. I wasn't jealous - I'd never want to deprive anyone of their sleep - but I was definitely envious. How on earth did he do it?

Over the years, I've taken part in numerous sleep studies and therapies: cognitive behavioural therapy, allergy tests, diets, yogacise, aromatherapy, acupuncture, melatonin. Each new specialist would treat me as a challenge, determined that they'd be the one to crack my insomnia. But I grew to recognise the signs of defeat in their eyes, and with it any hope of a cure. They could never find any cause.

Sleep deprivation is a form of torture and, before I met my wife, I could easily have contemplated suicide. My salvation has been psychotherapy, being able to talk about how angry I've been all these years, and gaining a new perspective. It hasn't cured my insomnia, but at least it has given me a coping strategy - acceptance. Hours of talking has led to understanding. It doesn't sound much, but it's a huge source of comfort to be able to manage my frustration. So when the night comes now, the dread doesn't descend as deeply as it did before. I don't have that extreme sense of frustration. I settle down in front of my computer, tapping out emails of support to fellow insomniacs, while the quiet hum of the radio keeps me company into the small hours. I feel not quite content but resigned.

Is anxiety about sleep keeping us all awake?

Britain is suffering from an epidemic of insomnia. Sleep - or lack of it - has become a modern obsession. A vast industry exists to try and cure this malaise, with a mix of pills, potions and psychology. But what is it about our lives that is keeping us awake? Have our high-tech, high-speed lives made us lose contact with our bodies' natural rhythms - or is it all in the mind?
Kate Kellaway
The Observer, Sunday 27 April 2008
Article history
Insomnia is a modern curse. It is, according to every other headline, an 'epidemic'. Are you getting enough? is a question far more likely these days to apply to sleep than sex. It is a national obsession. Every other person I asked about insomnia for this article - colleagues, friends, acquaintances - seemed to have difficulty sleeping, or to be married to someone who did, or to have an insomniac child. Some of the people I spoke to would ask, with a glint in their eye: was I an insomniac too? - as if it were some sort of secret society. No, I'd say, and their interest would flag. But my interest in them was just waking up.

Insomnia is complicated, idiosyncratic, personal. One friend told me he felt like 'a ghost' in his own life. Another said there was no worse 'agony' than her sleeplessness, which filled her with 'the adrenaline of terror'. A third described the way her worries are distorted in the small hours as in a seaside mirror. She found it hard to listen to people grumbling about how tired they were on six hours' sleep ('For me, that would be a sleepfest'). A fourth was desperate about her sleepless daughter. I was beginning to get a glimpse of a most terrible scene, a scattered crowd of insomniacs, trying to manage the waking nightmare of their nights.

The Clinical Sleep Research Unit, at Loughborough University, describes sleep problems as 'the most commonly reported psychological symptoms in Britain' and maintains that '30 per cent of adults have significant sleep difficulties.' Insomnia is constantly in the news, with Heath Ledger (the actor who died from an overdose of prescription drugs, including sleeping pills) its most recent casualty. I keep remembering the haunting image of him (in a final interview) drifting from one bed to another, an itinerant in his own house, trying to get some rest. And there is no shortage of other sleepless celebrities, from Madonna to Margaret Thatcher. Insomniacs conspicuously abound. Yet is it really an epidemic? And if so, why? What is it about our lives that is keeping us awake?

If you read media reports, they all boil down to the same argument. We lead a '24/7 lifestyle'. We are hyperactively high-tech: we spend too much time on computers. We talk on mobiles late at night (mobile phone radiation, according to a recent study - sponsored, ironically, by a mobile phone company - can interfere with sleep). Our computers and mobiles may know how to 'sleep' but we have lost the knack. We don't know how to switch off. And we self-medicate (too much caffeine, too much booze). It all sounds plausible enough: an over-stimulated, brave new world.

But at a recent symposium devoted to insomnia at London's Wellcome Collection, little time was given to such explanations. And, most surprisingly of all, sleep experts offered no evidence of an 'epidemic' (except that the older you are, the more likely you are to suffer from insomnia - and we have an ageing population). Instead, what emerged is something more subtly dismaying: a change in our attitude to sleep itself. It seems that what we are suffering is an anxiety epidemic. Our levels of anxiety about sleep have gone through the bedroom ceiling.

Dr Chris Idzikowski, director of the Edinburgh Sleep Centre, has an appropriately reassuring bedside manner. And he is at pains to differentiate insomnia ('the chronic inability to sleep when one wants to') from sleeplessness ('being kept awake for a reason'). Women, he says (especially after the menopause), are 20 per cent more likely to suffer from insomnia than men. Idzikowski is an expert on the physiology of sleep - all the ways in which our inner clocks can get muddled. He can tell you about larks and owls (insomniacs, presumably, are nightingales) and explain what makes our body clocks tick. He can even explain how to reset the clock, using light. But a body clock disorder does not, on its own, he reveals, qualify as insomnia. Insomnia is primarily psychological. Insomniacs are 40 times more likely to be depressed than ordinary sleepers. It is a viciously circular relationship. Does insomnia cause depression? Or the other way round?

And where does the anxiety about sleep begin? I remember, as a child, lying awake after my grandmother's death, tormented by the reality of my own death to the extent that it seemed imperative for survival to keep my eyes open. Giving in to sleep would have been a way of acknowledging my own extinction. Sleep can, after all, be seen as a rehearsal for death (the affinity between sleep and death is a literary commonplace). Could it be that insomnia is a protest against mortality?

Eluned Summers-Bremner is a sparky English professor, a New Zealander, a part-time insomniac and the author of a fascinating new book, Insomnia: A Cultural History, which could not be less morbid. If anything, her attitude to insomnia is cautiously celebratory. She sees insomnia as akin to falling in love - a state you can't control. (Love and sleeplessness are, after all, linked. And lovelorn insomniacs have an exhausted glamour.)

Summers-Bremner believes that we worry about sleep partly because we have false expectations of it. The ancients, she explains, did not suffer from anxiety about insomnia because they never took sleep for granted in the first place. We, on the other hand, tend to see sleep as our due. We see it as 'the necessary evil required for a productive and happy life'. Mistakenly, we imagine the night to be a dimensionless, featureless stretch. She coins a wonderful phrase to describe what we are missing: 'nocturnal literacy'. By this she means 'all things dark and unconscious that we have largely lost the ability to talk and think about with agility in everyday ways (especially in the more consumerist parts of the world)'.

She believes we have lost the ancient world's respect for the night. And she has a bracing line, too, on the 18th-century attitude to sleep. Far from fretting about sleeplessness, 18th-century metropolitans were nervous about indolence - ashamed if they slept too long. (Queen Anne Wing chairs, apparently, acquired their wings to hide sleepers from view.)

But to alter and really shake up our expectations - as one might renew a flattened eiderdown - we need the historian A Roger Ekirch to come to our aid. He explains (in At Day's Close: A History of Nighttime) that before the industrial revolution, it was the norm for people to sleep in two parts (a sort of sleep sandwich). In the middle - the filling - all manner of things went on. 'Families rose to urinate, smoke tobacco, and even visit close neighbours. Many others made love, prayed, and, most important, historically, reflected on their dreams, a significant source of solace and self-awareness.' It is an upbeat idea: the night as opportunity. But it is easier to imagine than to achieve.

As an adult, the closest I have come to insomnia was when my children were babies. Being woken repeatedly was torture, yet - unlike the insomniac proper - I had company. And sometimes being with a baby, indifferent to the hour, felt precious - an oasis for two. What could be more natural, after all, than being kept awake by a baby? Yet I often felt desperate. It was not the broken nights I dreaded. It was the days. I panicked about sleep deprivation, about not being able to cope. I remember the exhaustion as an out-of-body experience. I hated the feeling of sleepwalking through my own life, of being an automaton, the sense that my pilot light was about to go out. And I fantasised about sleep. I longed for its temporary oblivion more than anything in the world and was, eventually, lucky. I perfected the art of diving into it, whenever I could, like an opportunistic swimmer into deep water. The two lessons of that time were that it is possible to survive on little sleep. And that sleep is a blessing. And those nights gave me a small insight into what it must be like to be chronically sleep-deprived. But sleepless parents have this advantage over insomniacs: we are awake for the best of reasons.

Looking back at that time, I am not sure why I was so anxious. Why couldn't I relax - and accept sleeplessness? It is the key question for insomniacs: what is behind the anxiety about sleep? And there are no neat answers. But if you want to take a psychoanalytic route, Darian Leader makes a perfect chaperone. In his most recent book, The New Black: Mourning, Melancholia and Depression, he argues that psychologically, we are unravelling. We don't know how to mourn. Depression is rampant. Our understanding of emotions and relationships is awry. No wonder our sleep is disturbed. If we were better able to process emotions by day, the implication is, we might sleep better at night. For insomnia, in Leader's view, seldom exists in isolation: 'I have never met someone with insomnia as a unique symptom,' he says. As an analyst he, unsurprisingly, believes that insomnia should not be dismissed with sleeping pills, but interpreted.

For those reluctant to be analysed, it may be anxiety-reducing to reflect that not everyone needs the same amount of sleep. In America, the National Sleep Foundation recommends eight hours (70 per cent of the population get less than this). Here, experts say that anything between five-and-a-half and nine-and-a-half hours is normal. One insomniac told me he keeps a waking diary (instead of the commonly recommended sleep diary) to see how he fares on almost no sleep. The results are surprisingly cheering. Leonardo da Vinci declared sleep a waste of time - he maintained you needed 15 minutes every four hours - one-and-a-half hours in every 24.

It would be easy to write about insomnia as an affliction without ever acknowledging that sleeplessness can be positive. Yet most insomniacs I spoke to were able to describe a passing elation at being awake: a thrill of splendid isolation. (The gloomy singer Leonard Cohen put it like this: 'The last refuge of the insomniac is a sense of superiority to the waking world.') And, at best, creativity can be wrested out of restlessness. The Queen of Insomnia (if she will permit the title) is the 96-year-old French artist Louise Bourgeois. Hers is a heartening case. She has been an insomniac since 1939 and, even in old age, has fierce things to say about it: 'I am insomniac, so the state of being asleep is paradise. It is a paradise I can never reach.' Yet, between November 1994 and June 1995, she produced a remarkable body of work, The Insomnia Drawings. Some are soothing abstracts - Bourgeois described working on them as 'a kind of rocking and stroking and an attempt at finding a kind of peace'. Others are sharper, more figurative (of water, houses, the figure of a woman). These are a way of dealing with traumatic experience (she had an abusive father, a traitor of a stepmother and, in her youth, tried to drown herself).

Curator Ann Coxon of Tate Modern believes insomnia is crucial to Bourgeois: 'She has to keep herself in that traumatised place to keep creating such amazing work.' What I find most interesting is that for Bourgeois art is an alternative to sleep: her drawings process trauma as dreams are supposed to do.

But it would be misleading to push this positive argument too far. At the Wellcome insomnia symposium, I learned that the sleep-deprived brain is, cognitively, feeble - a rotten multi-tasker. So when people report that they have felt an unusual, single-minded, creative clarity in the middle of the night, the physiological explanation may be that the brain has slowed down to focus on one thing at a time. But that is if you are lucky. The bleak truth for most insomniacs is that they are too tired, or feel too stupid, to use their nights creatively.

And if people go without sleep for long enough, they are likely to go mad - or die. Peter Tripp, the New York disc-jockey who stayed awake for 201 hours without sleeping, became aggressive, had hallucinations and developed paranoia. His later problems, personal and professional, were thought to be a result of his experiment. And most extreme and ghastly of all, as with the rare genetic disorder fatal familial insomnia, a patient who cannot sleep at all will die.

There is no easy cure for insomnia. Sleep is something money cannot buy - though not for want of trying. In the US, a $20bn industry turns over on sleeplessness. Here, sleeping pills (often inappropriately prescribed) cost the NHS millions every year. Research shows that 60 per cent of users suffer adverse effects or withdrawal from sleeping pills after two to three weeks, due to tolerance or addiction. That's why non-pharmaceutical intervention, cognitive behavioural therapy (CBT), is widely recommended (though not always widely available): the attempt to replace negative thought patterns with positive thinking.

Not only is it important to think optimistically, it is also (as one insomniac shrewdly pointed out to me) crucial to change the language we use to think about sleep. We describe sleep as if it was something that came from outside, like a train pulling into a station to pick us up. Whereas actually, sleep is 'contained within us. And we need to acknowledge its root causes'. The best antidote to a sleepless night during the day is power napping. To prove the point, Dr Chris Idzikowski cites an experiment involving three groups: the first napped for half an hour, the second merely rested, the third soldiered on without a break. In cognitive tests, the nappers did best, the rested came second, the sloggers last. (So put your feet up now.)

And then there are the wind-down routines. I am always struck by how insipid these sound on paper: read a book, listen to relaxing music, solve a jigsaw puzzle in another room (I find sleep expert Jim Horne's insistence that insomniacs juggle through the night with pieces of blue cardboard sky surreal). A friend told me that her husband, a chronic insomniac, still gets asked by well intentioned GPs whether he has ever tried a hot drink of milk before bed time. 'They just don't get it!' she says, rolling her eyes.

There is a DIY nature to many remedies for insomnia - and not all of them are harmless. At the Wellcome symposium, it was argued that insomnia has become a public health issue because it is self-diagnosed and because insomniacs try to cure themselves - often in a most irregular way. One insomniac told me that, in desperation, often feeling quite 'barmy' in the middle of the night, she would dose herself with anti-histamine pills and other 'weird stuff'. Groucho Marx's solution was to ring people up in the middle of the night and shout at them. Some people settle for the more peaceable option of ringing friends on the other side of the Atlantic for a chat. But perhaps emailing is best of all. One insomniac told me her friendship with another insomniac was cemented when she spotted that the emails she was receiving had been sent at an ungodly hour of the night. (Might an online community of insomniacs be devised?)

It was not until I read Nicholson Baker's novel The Mezzanine, that I suddenly realised why insomniacs struggle with tame remedies. Baker's sleepless narrator attempts the time-honoured strategy of counting sheep. But he quickly decides that faceless animals won't work for him - and decides to give each sheep a name. Then he goes further: 'I needed to pierce through the cartoon, and create a procession of truly differentiable sheep for myself. So I homed in on each one in its approach to the hurdle and looked for individuating features - some thistle prominently caught, or a bit of dried mud on a shank. If I wasn't off by then, I backed up and reconstructed the sheep's entire day.'

Suddenly, I realised what this man's problem was - and it is one shared by most insomniacs. They are far too lively minded. They are the opposite of passive. They do not want to be bored. But boredom is, actually, exactly what they need. And, I'd tentatively add, acceptance. Chris Idzikowski says that to 'try' and sleep is worst of all. Sleep dislikes scrutiny. It is shy - like a nocturnal animal. Perhaps the clue to surviving a long night's journey into day is not to try at all.

Sleep - our new obsession

The new Western obsession is sleep - or a lack of it. Jo Revill, health editor, reveals new research that lifts the lid on how much we really need. Tell us how you're sleeping on the Observer blog
Jo Revill
The Observer, Sunday 9 April 2006
Article history
Sleep, or rather our frustration at not having enough of it, is the new health obsession. Worries about diet, pollution and exercise have given way to new anxieties about insomnia. We are told that the nation is building up a 'chronic sleep debt' because our modern lifestyles don't allow us to spend enough time in bed after a long day.

It is a new sort of epidemic, with millions being spent on sleeping pills to 'cure' those who can't drop off at night. Interrupted sleep is now one of the most common complaints aired in the GP's surgery. Everything from parenting problems to diabetes and career setbacks are blamed on a 'sleep disorder pattern' which is fuelling an industry of therapists, drugs and devices.

Now a new book by Britain's leading expert on the subject sets out our real relationship with sleep. It argues that most of us get quite enough, and that the present generation enjoys a better-quality night-time than our ancestors ever had. Instead of obsessing about sleep debt, we should realise that the key to feeling energetic and focused in the morning is what we do in the waking hours, not whether we are getting enough time with our heads on a pillow. Even those who wake up frequently at night are probably getting sufficient sleep.

Professor Jim Horne is the experts' expert when it comes to sleep research in Britain, and his views will annoy some people because he does not pander to the idea that we are all chronically deprived of sleep. But he celebrates the fact that we know so much more now about 'Nature's soft nurse' than in the past, and that it's there to enjoy: we should stop being so hung up on it. Sleep is now something, finally, we can understand. As mornings become lighter and Easter approaches, many of us find ourselves waking early. Long before the alarm clock goes off, you're opening your eyes, reacting to the combination of early sunlight and the April dawn chorus. But how is the body able to fine-tune itself so exactly to the seasons when we live in such a hectic, technology-driven world?

The last 10 days would suggest that we are hopelessly out of synch, given the plethora of stories warning of the dangers of sleeplessness. The New York Times said that insomnia was pushing thousands more people into taking prescribed drugs for the condition amid concern that younger people are finding it particularly hard to doze off. The British Association of Counselling is reported as saying that 12 million people have at least three bad nights of sleep a week. Then the RAC warned that sleepy drivers were responsible for 20,000 crashes last year.

Horne wants to change the tone of the debate, arguing that the human body adjusts to different sleep patterns with great agility. This is because our lives are governed by a body clock which affects not only the timing of sleep but also the different levels of alertness or lethargy. These 'circadian rhythms', which govern our moods and energy levels, are set by the body clock, which in turn is synchronised by sunset and sunrise, and also by more modern cues such as artificial light, the alarm clock, even the daily addiction to a particular TV soap.

But this timepiece, which in prehistoric times would allow us to rise early to have the best chances of survival and hunting, can be shifted by our own irregular lifestyles. For example, a very bad night's sleep will affect your level of alertness so that by 10am, when you would normally be awake and highly receptive to people around you, you will still be in a sleepy phase. Afternoon sleepiness is an entirely natural phase of the body clock, and is the human way of getting through the day. 'Some people think that because they feel tired in the afternoon something is wrong with them, but that is not at all the case,' said Horne. 'It's a natural dip in the day.'

The afternoon siesta is still common in hotter countries but is something that might benefit people in cold climes too. Winston Churchill was a proponent of the afternoon kip, and stuck to this routine during the Second World War. Later he wrote: 'You must sleep some time between lunch and dinner, and no half-way measures. Take off your clothes and get into bed. That's what I always do. Don't think you will be doing less work because you sleep during the day. That's a foolish notion held by people who have no imagination. When the war started, I had to sleep during the day because that was the only way I could cope with my responsibilities.'

Throughout the ages, humans have regulated their sleep according to their working lives. Five centuries ago Britons enjoyed something known as 'fyrste slepe', an early evening nap. Supper usually followed, then a period of prayer or talking. People would then stay awake until the early hours of the morning, then had a five to six-hour sleep.

'It seems to me that a night of between seven and eight hours' sleep is a fairly modern western development, which is clearly linked to industrialisation,' said Horne. 'Human beings are very adaptable, and we should keep that in mind because we tend to think of these hours as sacrosanct, when in fact we are far more flexible than we like to think.'

The reality is that we probably sleep more now than our ancestors did 100 years ago. 'Increasingly you hear people talking about us all having a chronic sleep debt, and that you have to catch up with it, but I'm not sure that is true,' said Horne.

'Think back to what life was like in Dickensian times. People were working 14-hour days, six days a week, and there was no lie-in on a Sunday as you were up for church. At night they would return to bedrooms they would share with children, to beds infested with bugs, in a noisy environment. The great majority of people were not getting eight hours of uninterrupted rest. But they didn't think about it in that way, or if they did feel tired they kept quiet.'

What exactly is sleep? The myths and beliefs that have surrounded the time we spend dead to the rest of the world have always mattered to successive civilisations. Aristotle thought it resulted from the warm vapours rising from the stomach after a good meal. But that was 2000 years ago, before we had EEGs (electroencephalograms) to measure the brainwaves we emit in sleeping hours.

Sleep is far more than an absence of body movement or a closing of the eyes: it is to do with the profound changes that take place in the cortex, the part of the brain that controls all the higher functions - the intellect, the imagination, social responsibility and love. By looking at the brainwaves that emerge from this region using an EEG, scientists can study the different stages of sleep. The process may seem continuous but is actually broken up into 90-minute spells. What tends to happen is that, soon after you nod off, you will go into a deep sleep. The brainwaves alter in their height and number, and move from becoming 'small ripples to large rollers', as Horne puts it. 'These deep waves, affecting your levels of consciousness, enable the body to block out external noises and movement and to maintain sleep, and will make up between 10 and 20 per cent of a night's sleep for a typical adult. It usually happens in the first half of the night.'

Much research has gone into the stage of sleep known as REM (rapid eye movement) first identified in 1955. The name is rather a misnomer, because during this time the eyes are mostly not moving at all. The rapid jerky movements under the eyelid first described by Professor GT Ladd in 1892 were associated with dreaming. In fact, the most vivid and intense dreams do occur during the REM period, but in the rest of sleep you also dream, although the images tend to be milder and more reflective.

Dreams are created in the cortex, but REM derives from a much deeper part of the brain which seems less connected with thought processing and more to do with memory storage and wakefulness. 'Some have compared this stage to a screen-saver on a computer - it's the mode into which the brain can retreat when it is in a state of non-wakefulness,' said Horne.

'We know that sleep looks after many, many processes which affect your personality, your memory, your thoughts, your feelings - really everything that makes you human and able to function. The many studies on sleep deprivation show us that these fragments of who you are start to break down once you take away essential rest.'

What is exciting new interest - and what few of us realise - is that the amount of deep, beneficial sleep you get really depends on the amount of time you have previously spent awake. It seems the deep waves are crucial for enabling the cortex to recover its powers, or 'recharge' before it can cope with the next day. A fairly new discovery is that there are very slow waves within this deep sleep that appear to be particularly important for the brain and affect the workload that the cortex can deal with during waking hours. But someone who regularly sleeps for just five hours can enjoy the same amount of deep sleep as the person who has nine hours a night - and there is no research to suggest that one is less alert or energetic than the other.

We think of insomnia as a modern condition, as a state created by the internet and constant news coverage and 24-hour cafes. The film Lost In Translation, starring Bill Murray as an exhausted actor unable to sleep in his Tokyo hotel, conveys the sense of weariness with modern pressures. His exhaustion is expressed by the boredom and frustration of his situation, and a desire to escape.

But is it really anything new? 'The hurry and excitement of modern life is held to be responsible for much of the insomnia of which we hear; and most of the articles and letters are full of good advice to live more quietly and of platitudes concerning the harmfulness of rush and worry. The pity of it is that so many people are obliged to lead a life of anxiety and high tension.' This statement comes from the British Medical Journal but was written in September 1894. It entirely conveys what most people feel is the truth now about life in Britain.

Everyone has had the experience of trying to go off to sleep, only to find that their mind is still buzzing and that the more they try, the harder it is to find rest. But Horne's research in Loughborough has shown that most people don't take that long to doze off. The period of time measured from the 'lights out' moment to nodding off is around 10 to 30 minutes, although in 25 per cent of cases it can take longer than that. There is an interesting difference between the sexes. After the age of 50, men report falling asleep much faster - averaging about 13 minutes compared with 22 for women. It appears to be older women who have most problems in getting off to sleep.

Most of us go to bed between 11pm and midnight, although women tend to go somewhat earlier than men. There are, however, people who survive well on five hours' sleep and also those who need nine hours. The average daily sleep over the past 40 years turns out to be between seven and seven and a half hours, across the West. What is more, the human being's ability to sleep in virtually any circumstances is well documented in history. The phrase 'hangover' does not come from some alcohol-related source but from the bedtime tradition in Victorian workhouses. Workers lined up along a bench and a rope was tied from one end to the other, allowing them to sleep by draping their arms over the rope which they 'hung over' as it supported them.

Horne, who has carried out research on thousands of volunteers at his sleep laboratory, believes that, although around one-quarter of the population may feel they get insufficient sleep, there is very little firm evidence to support this. Tests measuring cognitive performance show that when people have lost two hours a night, it does not affect ability to perform tasks. 'Much of the insomnia is self-diagnosed, and it's easier to take a patient's word for it and prescribe tablets than to sort out whether they are really sleep-deprived,' he said. 'When a whole society starts to think it has a chronic sleep debt, then you are going to increase the problems. A lot of sleepiness is more imagined than real.'

But there are many who argue against Horne when he questions the whole idea of a sleep debt. Professor Russell Foster, an expert in circadian rhythms at Imperial College London, said: 'A few days of not getting enough sleep won't harm you, but there is a cumulative effect that you see, and there is evidence that it can affect your cognitive performance. I think western societies are increasingly 24/7, increasingly sleep-deprived and increasingly reliant on stimulants. Why is it that the second most traded commodity after oil is coffee beans? Because we can keep ourselves awake for longer. The problem comes at weekends when we then want to relax but find it hard, so we use alcohol and sedatives to do so. Yet sleep is more important than ever to us, because in Britain we don't have a manufacturing base any more, we are reliant on our creative processes, and for individuals to come up with really novel ideas and decisions, they need to enjoy regular, good-quality sleep. There's no getting away from it.'

The struggle to get enough sleep is one of the most common complaints of modern life, and like everything else it therefore demands 'a quick fix'. More than £20m a year is spent in Britain on sleeping pills, but these are short-term therapies which usually stop working after four weeks and can be difficult to withdraw from. The older benzodiazepine drugs have left thousands of people dependent on them, although they carry side effects and do nothing to sort out the problems of insomnia.

Back in the Eighties, when doctors worked gruelling 90-hour weeks, there were many accounts of accidents and errors made by clinicians who were too tired to think properly. The results of such long hours without rest led to a big change in working patterns, and finally to the European Working Time Directive, which now means that no one must work more than a week without a break.

One doctor who remembers what it felt like to be so tired is Sarah Marwick, who now works as a GP in Birmingham. 'Like all junior [doctors], I had to work shifts in Accident and Emergency for six months, and I felt constantly drained, and a feeling of jet lag the whole time. I felt under par continuously, which made me very stressed and irritable. At the end of a 36-hour shift I felt I was drunk. I couldn't concentrate, felt like I had to work hard and really think to get words out.'

Marwick, who shared her experiences with other doctors on the online forum Doctorsnet.org.uk, found that on a number of occasions she would be asked the next morning about something she had done the previous night at the end of a long period on call, and she would have no recollection of it, or even having been to the ward, or giving intravenous drugs.

'But the scariest time was when I fell asleep while driving home after a weekend on call. I was sitting at a traffic light in the city centre and I must have dozed off. A man had to come and knock on the car window and wake me up, and he said he had been beeping his horn and I had not moved for a good three minutes. It could have been fatal.'

For doctors at least, those long working hours have been reduced, as they have in other professions with new European rules. The irony is that, as our working hours lessen, we feel more tired than ever, perhaps because of all the other tasks that we impose on ourselves in our spare time. In the desperate desire for more sleep, an entire industry has grown up around the problem - university departments, journals, academics and clinics as well as a 'National Sleep Awareness Week' are there to make us aware of the problem. And so are the breathing masks, the nose pillows, the aromatherapy solutions and sleep clinics.

Even the people who started the research in laboratories, such as Jim Horne, are aware of the dilemma. One of them is Dr William Dement, who runs the Sleep Disorders Clinic at Stanford University in California and founded the concept of sleep medicine decades ago in the US. 'Nutrition, fitness and now sleep,' he told the New York Times recently. 'Twenty-five years ago, everyone started jogging and worried about their fitness. Now sleep is having its moment.'

· Additional reporting by Murad Ahmed

Perchance to dream

Sleep is an altered state of consciousness, as opposed to an unconscious state. It allows the brain to undergo a complex recovery process, and as the brain 'winds down' into sleep mode, you physically become less aware of the surroundings.

Sleep is the regular state of natural rest observed in all mammals, birds and fish, and is characterised by a reduction in voluntary body movement.

The circadian rhythms which govern the body clock, and hormonal and environmental factors all affect your ability to sleep.

Sleep appears to perform a restorative function for the brain and body, and we know this because of the many symptoms of personality and behaviour change which are seen when humans and other animals are deprived of it.

Sleep is also a time for healing and growth. When you go into deep, or slow-wave sleep, growth hormone levels increase, and changes in immune function occur. In babies, sleep is essential for processing new information about the environment.

One process known to be highly dependent on sleep is memory. REM (rapid eye movement) sleep appears to help with the consolidation of spatial and procedural memory, which is the long-term memory of acquired skills essential for surviving in the modern world.

But another view is that sleep serves an evolutionary function in simply protecting people during the hours of night, at a time when roaming around would place the individual at greatest risk, according to some experts. Organisms don't require 24 hours to feed themselves and meet all other necessities, so they are safer asleep and out of harm's way.

They sleep, therefore, at times that maximise their safety, given their differing physical capacities and their various habitats.

Sleep may be the price you pay for brain to remain plastic the next day

August 26th, 2008 - 2:57 pm ICT by ANI
Washington, Aug 26 (ANI): While the importance of sleep is something that everyone agrees to, there are still many mysteries surrounding its function and how essential it is. Now, a group of scientists have tried to define the core function of the activity, which they say, might be the price one pays pay so that their brain can be plastic the next day.

The study has been published this week in PLoS Biology.

The study by Chiara Cirelli and Giulio Tononi rejects the hypothesis that sleep is merely a way to impose a quiet, immobile state (rest), and isn”t important by itself in mammals and birds.

The search for the core function of sleep can seem as elusive as the search for the mythological phoenix, says Cirelli, an associate professor of psychiatry at the University of Wisconsin School of Medicine and Public Health in Madison.

“We don”t understand the purpose of sleep, but it must be important because all animals do it,” Cirelli says.

There’’s no clear evidence of an animal species that doesn”t sleep, she says. Even the dolphinwhich is sometimes held up as an animal that doesn”t sleep because it moves continuouslywill show “unihemispheric sleep” with one eye closed and one half its brain showing the slow waves characteristic of deep sleep.

“The very fact that dolphins have developed the remarkable specialization . . ., rather than merely getting rid of sleep altogether, should count as evidence that sleep must serve some essential function and cannot be eliminated,” Cirelli says.

She also argues that sleep is strictly regulated by the brain, because sleep deprivation is followed by a rebound, in which the sleep-deprived animal either sleeps longer, or spends more time in the deeper sleep characterized by large slow brain waves.

Prolonged sleep deprivation has been shown to kill rats, flies and cockroaches. Humans who have a genetic insomnia can also die. In less extreme cases, sleep deprivation affects cognitive function in animals ranging from flies to rodents.

Rats kept awake will engage in “micro-sleep” episodes, and sleep-deprived humans tend to fall asleep even in the most dangerous circumstances.

Because it is universal, tightly regulated, and cannot be lost without serious harm, Cirelli argues that sleep must have an important core function.

“Sleep may be the price you pay so your brain can be plastic the next day,” Cirelli and Tononi say.

Their hypothesis is that sleep allows the brain to regroup after a hard day of learning by giving the synapses, which increase in strength during the day, a chance to damp down to baseline levels. This is important because the brain uses up to 80 percent of its energy to sustain synaptic activity.

Sleep may also be important for consolidating new memories, and to allow the brain to “forget” the random, unimportant impressions of the day, so there is room for more learning the next day. This could be why the brain waves are so active during certain periods of sleep. (ANI)

Sleep clears the brain for next day’s learning

April 5th, 2009 - 4:50 pm ICT by ANI
Washington, Apr 5 (ANI): Snoozing does more than help us recover from tensions and weariness - it helps the brain clear clutter accumulated after a long day’s work and make way for new learning.

Shutting down during the night helps the body to produce new synapses which connect brain cells.

Researchers at Washington University School of Medicine in St. Louis believe if synapses are not renewed they become saturated with knowledge which stops people absorbing new information.

“There are a number of reasons why the brain can’t indefinitely add synapses, including the finite spatial constraints of the skull,” says senior author Paul Shaw, Ph.D., assistant professor of neurobiology at Washington University School of Medicine in St. Louis.

“We were able to track the creation of new synapses in fruit flies during learning experiences, and to show that sleep pushed that number back down,” he added.

Many aspects of fly sleep are similar to human sleep; for example, flies and humans deprived of sleep one day will try to make up for the loss by sleeping more the next day. Because the human brain is much more complex, Shaw uses the flies as models for answering questions about sleep and memory.

Sleep is a recognized promoter of learning, but three years ago Shaw turned that association around and revealed that learning increases the need for sleep in the fruit fly. In a 2006 paper in Science, he and his colleagues found that two separate scenarios, each of which gave the fruit fly’s brain a workout, increased the need for sleep.

The first scenario was inspired by human research linking an enriched environment to improved memory and other brain functions. Scientists found that flies raised in an enhanced social environment-a test tube full of other flies-slept approximately 2-3 hours longer than flies raised in isolation.

Researchers also gave male fruit flies their first exposure to female fruit flies, but with a catch-the females were either already mated or were actually male flies altered to emit female pheromones. Either fly rebuffed the test fly’s attempts to mate.

The test flies were then kept in isolation for two days and exposed to receptive female flies. Test flies that remembered their prior failures didn’t try to mate again; they also slept more.

Researchers concluded that these flies had encoded memories of their prior experience, more directly proving the connection between sleep and new memories.

Scientists repeated these tests for the new study, but this time they used flies genetically altered to make it possible to track the development of new synapses, the junctures at which brain cells communicate.

“The biggest surprise was that out of 200,000 fly brain cells, only 16 were required for the formation of new memories, ” says first author Jeffrey Donlea, a graduate student.

“These sixteen are lateral ventral neurons, which are part of the circadian circuitry that let the fly brain perform certain behaviors at particular times of day,” he added.

When flies slept, the number of new synapses formed during social enrichment decreased. When researchers deprived them of their sleep, the decline did not occur.

Donlea identified three genes essential to the links between learning and increased need for sleep: rutabaga, period and blistered. Flies lacking any of those genes did not have increased need for sleep after social enrichment or the mating test.

Blistered is the fruit fly equivalent to a human gene known as serum response factor (SRF). Scientists have previously linked SRF to plasticity, a term for brain change that includes both learning and memory and the general ability of the brain to rewire itself to adapt to injury or changing needs. (ANI)

Cort: Coping With Insomnia

Cort's story
Cort's story reflects his experiences as told in an interview. The photograph is not of Cort, to protect his privacy.

Waking up at 4 a.m. every day is a way of life for Cort. He gets about 5 hours of sleep each night on average. He doesn't mind waking up early. But he does wish he had a few more hours of sleep at night.

“I'm a very light sleeper. So if someone opens a door, a dog barks, an owl calls, it'll wake me up. I've never been a deep sleeper. I've tried sleeping with earplugs and nothing makes a difference,” Cort says. He envies small children who can drop off to sleep anywhere. Cort has learned to cope with getting less sleep.

Cort has done a lot of reading and research about sleep problems. For him, anxiety is a big part of why he doesn't sleep well. “When I wake up at 2 or 3 in the morning, my mind starts processing stuff—things that I need to get done, that I forgot to do,” he says. "Trying to relieve that anxiety seems to me a very worthwhile sleep prescription.”

Cort’s research led him to this anxiety-reducing tip: Keep a pad of paper and a pen by your bed to write down those thoughts racing around in your head. This lets you get back to sleep without worrying about things you need to remember to do in the morning.

When it comes to sleeping pills, Cort has done his homework. While he does have a prescription, he uses the medicine only when he needs to be well rested the next day, such as when he has to give a presentation at work. Cort heeds his doctor’s warning about becoming dependent on sleeping pills. “I have a prescription for 5 mg tablets, and I never take a full one. I break them in half, and I never take them more than once in 2 weeks.”

Cort also uses the pills in another way. By having a pill on his bedside table, it relaxes him even if he doesn't actually take it. It’s a way of managing his anxiety about not getting enough sleep.
http://health.yahoo.com/other-other/cort-coping-with-insomnia/healthwise--uz2317.html;_ylt=AidPEzkMPxhZsdgTT6UZqFRLvs8F

Time to 'reclaim the night' for sleep

VIEWPOINT
By Neil Stanley
Sleep researcher, University of East Anglia
We all know the health risks of smoking, drinking and eating too much. But sleep expert Neil Stanley says we don't pay attention to the risks of having too little sleep.

In this week's Scrubbing Up health column, he warns it is time to "reclaim the night".

Good sleep is vital for good physical mental and emotional health - but unfortunately we seem to live in a society that has forgotten this fact.

In terms of healthy living, sleep is as important as good diet and exercise.
Poor or inadequate sleep can have serious consequences on overall health and wellbeing and has been shown to lead to lower immunity, poor performance and mood changes.

In the longer term, inadequate sleep is associated with a greater risk of a number of diseases, such as heart disease, depression and diabetes.

There are also important consequences of poor or inadequate sleep which negatively affect the way we feel and perform during the day.

Round the clock

We are living in an increasingly "tired" society. Think about how you feel at the moment with one as very tired and 10 as feeling wide awake.

I reckon very few of you are a seven, let alone a 10. Why do we go through life feeling this tired?

One reason is the increasing extension of the daytime activities into the night.
When I was growing up in the 1970s, Tomorrow's World each week promised us a future where, due to advances in technology, there would be so much leisure time that we would have to come up with new ways of amusing ourselves.

Unfortunately what was created by all this new technology was the 24/7 society.

Technology never sleeps, and thus people can work around the clock - whether they are in the office or at home.

The long hours, information overload and stresses associated with 21st Century living negatively affect our sleep which, in turn, is detrimental to our health, work performance and even our relationships.

Convenience brings risks

As a society we need to give much more serious consideration to our work/life balance particularly with regards to sleep.

For example it has been estimated that in future a third of the workforce will be working shifts, mainly in the service sector.

However there is a large body of evidence which shows that working shifts is bad for health and increases accidents at work.

So, whilst it is of course important for some workers to work around the clock, does the convenience of paying a bill at 2am really outweigh the health risks of having so many people doing shifts?
It has been reported that tired drivers now cause more deaths on European roads than drunk drivers, and yet whilst it has become socially unacceptable to be drunk behind the wheel or in the workplace it is almost a matter of pride that we believe we can function properly when tired.

Yet you would not want a drunken surgeon operating on you or a drunken train driver taking you to work, so why would you accept a tired one?

The problem of poor sleep is perhaps even more important in children as it has been linked with increased risk of - amongst other things - obesity, diabetes, poor academic performance and behavioural problems.

You only have to watch an episode of Supernanny to see how profound the positive effect of a good night's sleep can be on the behaviour of children.

Over the past decade there has been an increasing body of evidence that shows that sleep plays an important role in regulating weight and controlling appetite, and so I find it surprising that when earlier this year the government started its Change 4 Life healthy living campaign there is no mention of the importance of good sleep.

Isn't it about time we reclaimed the night for sleep?
http://news.bbc.co.uk/2/hi/health/7880583.stm

Child behaviour 'linked to sleep'

A good night's sleep could reduce hyperactivity and bad behaviour among children, a Finnish study reports.

It has been suggested that some children who lack sleep do not appear tired, but instead behave badly.

Of the 280 examined in the Pediatrics study, those who slept for fewer than eight hours were the most hyperactive.

Experts said adequate sleep could improve behaviour in healthy children and reduce symptoms of attention deficit hyperactivity disorder (ADHD).

It is recognised that chronic sleep deprivation is a problem for many adults in Western countries and that it can have consequences for their health and daily life.

The team behind this research said not enough was understood about the role of sleep in children's lives but it has been estimated that a third of US children do not get enough sleep.

Monitoring

In this research, the team from the University of Helsinki and Finland's National Institute of Health and Welfare studied 280 healthy children aged seven or eight.

They wanted to see if those healthy children who slept the least were the most likely to display the kind of symptoms associated with ADHD.
None of the children studied had the attention disorder.

Parents filled in questionnaires about their children's usual sleeping habits and then noted how long their children slept for over seven nights.

The children also wore devices called actigraphs, which measure movement, to monitor how long they actually rested for.

Parents' estimates of sleep duration were longer than the actigraph measurements, which the researchers say could be because they measured from bedtime or because they assumed their children were asleep when they were simply lying awake in bed or reading.

The parents were also asked about their children's behaviour, using measures normally used to diagnose ADHD.

The children whose average sleep duration as measured by actigraphs was shorter than 7.7 hours had a higher hyperactivity and impulsive behaviour score.

They also had a higher ADHD symptom score overall.

'Sleep needs differ'

Dr Juulia Paavonen, who led the study, said: "We were able to show that short sleep duration and sleeping difficulties are related to behavioural symptoms of ADHD.

"The findings suggest that maintaining adequate sleep schedules among children is likely to be important in preventing behavioural symptoms.

"It may well be that inadequate sleep is increasing some of the behavioural problems that have been seen in children with attention deficit disorders."

Dr Paavonen said further studies were needed to confirm the link.

And she advised parents that, even though the study suggested fewer than eight hours sleep could be problematic, it was not a figure everyone should aim for.

"Sleep needs differ between individuals. The only way to take care that a particular child has enough sleep is to see if they seem to have a problem with short sleep.

"But even [an extra] 30 minutes per night has been shown to give a major improvement in objective cognitive tests, improving reaction times, impulsivity and attention spans."

Sleep expert Neil Stanley, of the University of East Anglia, said: "It has been acknowledged for a while now that there is a lot of commonality between the symptoms of a tired child and the symptoms of a child with ADHD."

He said parents needed to recognise that sleep was important for children.

"These things have been lost at a time when ADHD is increasing.

"How much of what is diagnosed as ADHD is something that can be modified or improved, or even totally cured by a more rigid sleep pattern?

"Maybe parents should try and get sleep sorted out. If the child is still showing symptoms, then that's probably the time to look at pharmacological interventions."
http://news.bbc.co.uk/2/hi/health/8016531.stm