Sleep Deprivation – Most Night Shift Workers Don’t Adapt To The Hours


Most Night Shift Workers Don’t Adapt To The Hours Says Sleep Experts and Studies By NASA

NPR recently featured a in depth report on the topic of Night Shift Workers Don’t Adapt To The Hours Says Sleep. According to the report, numerous air traffic controllers who work the overnight shift have been caught sleeping on the job. Mary Louise Kelly talks to Dr. Charles Czeisler about the effects of sleep deprivation. Czeisler is the director of the Division of Sleep Medicine at Harvard Medical School and has studied the problem of fatigue on the job.

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We’ve been following the numerous reports about air traffic controllers caught sleeping on the job. Controllers often work overnight shifts or rotate among many different shifts. The Federal Aviation Administration is now changing staff scheduling practices to address fatigue among controllers.

Charles Czeisler is the director of the Division of Sleep Medicine at Harvard Medical School, and he told me why workers like air traffic controllers have a hard time adjusting to night shifts.

Dr. CHARLES?CZEISLER (Harvard Medical School): People can become completely adapted to overnight work, but most do not, even if they work permanent night shifts. And the reason for that is that on their days off they typically flip back into trying to function during the daytime and sleeping at night. And…

KELLY: On the weekends and that type thing.

Dr. CZEISLER: Exactly. Moreover, they’re living in a world in which the sun is up during the daytime and it’s dark at night. And the light/dark cycle is the most powerful synchronizer of our internal biological clock. Now, it’s possible to increase light intensity during nightshift work and use shorter wavelengths of light to help facilitate adaptation to working at night.

But nonetheless, most nightshift workers never fully adapt to their schedules, and hence it is more difficult for them to sustain alertness and performance when they’re working at night.

KELLY: You know, it’s curious, because people in all kinds of professions face sleep deprivation, many of the people working essential jobs: police, firefighters, overnight doctors and nurses in the ER. Have other professions figured out a better way to do this, a better way to schedule people to work the night shift?

Dr. CZEISLER: Well, that varies by profession. Certainly, the medical profession has not done so. They currently still schedule resident physicians to work 30-hour shifts twice a week. But change comes slowly in these areas, mainly because the environment has changed dramatically over the last 50 years, requiring people to stay continuously awake in jobs that they often were able to sleep at in times gone by, but the scheduling practices have not kept pace.

In addition, we are a sleep-deprived nation. Every week, nearly two million Americans nod off or fall asleep while driving their cars on the highways. And, you know, it’s part of our 24/7 culture that we think that we should be able to burn the candle at both ends without suffering any consequences, and at some point, the brain seizes control and we involuntarily make the transition from wakefulness to sleep, even at very inappropriate circumstances.

KELLY: One of the things that appears to have been ruled out in trying to tackle this is naps. Transportation Secretary Ray LaHood said this week, and I’m quoting him: “On my watch, controllers will not be paid to take naps.” Is that a good approach? Could naps be helpful, in your view?

Dr. CZEISLER: It’s a very common approach, although it’s kind of ironic. Controllers are allowed to eat while they’re being paid. They are allowed to smoke cigarettes while they’re being paid, during a break. But they’re not allowed to do the one thing that would help prepare them for work when they’re on break, which would be to take a brief nap.

KELLY: And in your view, would that help?

Dr. CZEISLER: Studies done by NASA for the FAA in relationship to pilots have shown that a brief, 20-minute nap greatly increases the ability to sustain alertness during the remainder of a flight. And yet, FAA regulations do not allow pilots to nap in the cockpit. So on one out of 10 trans-Atlantic flights, the pilots are nodding off in the cockpit, but it’s not scheduled or controlled in any way. It would be far better to recognize that it’s going to happen, to schedule it and to ensure that it doesn’t happen at unscheduled times than to simply ban it and pretend that it’s going to go away.

KELLY: Charles Czeisler is director of the Division of Sleep Medicine at Harvard Medical School.

Dr. Czeisler, thanks very much.

Dr. CZEISLER: Thank you.

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Obstructive sleep apnea linked to cancer growth in mice


Obstructive sleep apnea linked to cancer growth in mice says new study

A new study links the intermittent interruption of breathing that occurs in
patients with obstructive sleep apnea (OSA) to enhanced proliferation of melanoma cancer cells
and increased tumor growth in mice, according to researchers in Spain. The study also found
tumor cells of OSA mouse models tended to contain more dead cells, indicating a more
aggressive type of cancer.

The results of the study were presented at the ATS 2011 International Conference in Denver.

“To our knowledge, this study is the first one providing experimental evidence that a high-rate
intermittent lack of oxygen, or hypoxia, mimicking the one experienced by OSA patients
enhances tumor growth,” said Ramon Farre, PhD, professor of physiology at the University of
Barcelona School of Medicine Biophysics and Bioengineering Lab.

Recurrent hypoxia is one of the hallmarks of OSA, which may affect around 5 percent of
Americans. OSA has been associated with an increased risk of cardiovascular disease, including
high blood pressure, as well as daytime sleepiness and a lower quality of life.

“Although earlier studies in animals have shown that lack of oxygen, or hypoxia, plays an
important role in regulating the various stages of tumor formation and progression, the results
obtained from human studies including large groups of OSA patients are not easy to interpret
because there are other contributing conditions, most notably obesity,” Dr. Farre added. “This
well-controlled mouse model study allowed us to ensure that the only variable under study was
intermittent hypoxia.”

In this study, mice injected with melanoma tumor cells were divided among two groups. In the
first group, mice were exposed to intermittent hypoxia, where oxygen was restricted for 20-
second periods at a rate of 60 periods per hour for six hours per day, and normal oxygen levels
for the remainder of the day. In the second group, mice received normal levels of oxygen
(normoxia). Tumor volume was measured throughout the study and at the end of the study
period. At the end of the 14-day study period, tumors from all mice were removed and weighed
and tumor necrosis (indicated by the numbers of dead cells present) was measured to determine
the aggressiveness of the tumors.

The authors found that while tumor volume progressively increased with time in both the
intermittent hypoxia and control groups, the increase was higher in the mice subjected to
intermittent hypoxia. Tumor weight and necrosis in the intermittent hypoxia group were almost
two times that of the tumors in the control group.

“With the limitations of any animal model study, these results suggest that the intermittent
hypoxia characterizing obstructive sleep apnea could enhance the growth of tumors,” Dr. Farre
said, adding that although the results were not entirely unexpected based on earlier studies
connecting hypoxia with tumor growth, a link between breathing abnormalities specific to OSA
and tumor progression had not previously been demonstrated.

“It was well known that continuous hypoxia promotes the growth of cancer cells and tumors,” he
said. “However, there were no data concerning the effects of the fast rate changes of oxygenation
in sleep apnea on cancer.”

Dr. Farre said the results of this study could have future clinical implications if the results are
confirmed in large-scale human studies. “There are still several questions that need to be
answered, both at the basic science and clinical levels,” he said.

Future studies would need to evaluate whether intermittent hypoxia also triggers the initial
formation of tumors and whether it promotes metastasis, or spread of tumors from one organ to
another. Because this study focused on melanoma, Dr. Farre said additional studies should also
explore whether intermittent hypoxia affects other types of cancer.
Extended population studies should also determine if there is a relationship between the
incidence of cancer and the severity of OSA, as well as addressing the issue of obesity, which
has been linked with OSA.
“Intermittent hypoxia is not the sole cancer-promoting challenge experienced by OSA patients,”
Dr. Farre said. “Obesity is also known to enhance cancer morbidity and mortality, and it is not
clear to what extent intermittent hypoxia and obesity could interact to increase cancer growth in
OSA patients.
Clarifying these questionscertainly will require additional studies,” he said. “If the current results
in an animal model are confirmed by further clinical research, the public health impact of
obstructive sleep apnea would be greater than currently known.”
“Intermittent Hypoxia Enhances Cancer Progression In A Mouse Model Of Sleep Apnea”
(Session C98, Tuesday, May 17, 2:00-4:30 p.m., Room 405-406-407 (Street Level), Colorado
Convention Center; Abstract 15455)
* Please note that numbers in this release may differ slightly from those in the abstract. Many of
these investigations are ongoing; the release represents the most up-to-date data available at
press time.
Abstract 15455
Intermittent Hypoxia Enhances Cancer Progression In A Mouse Model Of Sleep Apnea
Type: Scientific Abstract
Category: 08.06 – Intermittent Hypoxia and Animal Models of Sleep Apnea (SRN)
Authors: R. Farre1, I. Almendros2, J. Montserrat2, J. Ramírez3, M. Torres2, D. Navajas1; 1Universitat of
Barcelona/IDIBAPS-CIBERES – Barcelona/ES, 2Hospital Clinic-IDIBAPS-CIBERES –
Barcelona/ES, 3Hospital Clinic-Universitat Barcelona – Barcelona/ES
Abstract Body
RATIONALE: A hypoxic environment enhances the proliferation of cancer cells and tumor progression.
However, whether the intermittent hypoxia experienced by patients with the obstructive sleep apnea (OSA)
syndrome promotes cancer progression is unknown. AIM: To test the hypothesis that a pattern of intermittent
hypoxia mimicking the one found in OSA patients enhances tumor growth in an experimental mouse
model.METHODS: A melanoma tumor was induced in 22 male C57BL/6J mice by subcutaneous injection of
B16F10 cells in their left flank region. Seven mice with induced melanoma were subjected to intermittent
hypoxia with a pattern mimicking OSA: 20 s of 5%O2 and 40 s of room air and the time course of oxygen partial
pressure (PtO2) within the tumor tissue was measured by a fast-response micrometrically-controlled oxygen
micro-electrode pipette inserted ~3 mm from the tumor surface. Another group of 7 mice was chronically
subjected to the same pattern of intermittent hypoxia (20 s of 5%O2 and 40 s of 21%O2) for 6 h/day along 14
days. A control group of 8 animals was kept under normoxia. Tumor progression was assessed by estimating
its volume at days 8, 11 and 14. At day 14 the tumors were excised and weighted. Tumor necrosis was
assessed from hematoxilyn-eosin tumor preparations. RESULTS: On average, tumor tissue PtO2 varied from 6
mmHg at nadir to 45 mmHg after recovery of each hypoxic event. Tumor volume progressively increased with
time for both groups (p < 0.001) and the increase was higher in the intermittent hypoxia group. Tumor weight at day 14 was almost 2-fold greater (p = 0.012) in the intermittent hypoxia group (3.10 ± 0.42 g) compared to the normoxia group (1.66 ± 0.29 g). Tumor necrosis was 2-fold greater in the animals subjected to intermittent hypoxia than to normoxia (29.1±6.2% and 14.5±4.7%, respectively; p = 0.08). CONCLUSION: These data suggest that intermittent hypoxia could contribute to cancer progression in OSA.

CPAP Decreases Cardiovascular Mortality in Elderly Patients


Continuous Positive Airway Pressure (CPAP) Decreases Cardiovascular Mortality in Elderly Patients Says New Study

Continuous positive airway pressure (CPAP) effectively decreases the
risk of cardiovascular death in elderly patients who suffer from obstructive sleep apnea (OSA),
according to a study conducted by researchers in Spain. The study is the first large-scale study to
assess the impact of OSA and the effectiveness of CPAP treatment in cardiovascular mortality in
the elderly.

The findings were presented at the ATS 2011 International Conference in Denver.

“Our study offers two key conclusions,” said Miguel Angel Martinez-Garcia, MD, study lead
author pneumonologist at the Hospital General de Requena in Valencia, Spain.“First, with
younger patients, elderly patients with severe, untreated sleep apnea have a higher cardiovascular
mortality than those with mild to moderate disease or those without sleep apnea; and second,
treatment with CPAP can reduce cardiovascular mortality in elderly OSA patients to levels
similar to those found in patients without disease or with mild to moderate sleep apnea.”
Millions of people worldwide suffer from sleep apnea, which has been associated with
cardiovascular health risks and poorer quality of life. Most studies, however, have been
conducted in younger populations, Dr. Martínez-García noted.
“CPAP has been shown to be a very effective treatment for severe and symptomatic forms of
sleep apnea,” he said. “However, virtually all studies on the effectiveness of CPAP to date have
been conducted in middle-aged individuals, despite the fact that a growing percentage of the
patients we see in our sleep units are elderly and are treated with CPAP.
“This is a very important issue considering the gradual increase in longevity worldwide,” he
Patients with severe OSA typically experience regular interruptions in their sleep when breathing
temporarily stops. In these patients, normal airflow is blocked as the soft tissue of the airway
collapse and sag into the throat, preventing normal respiration. In CPAP, pressurized air is
delivered continuously through a mask worn over the nose or nose and mouth to help keep the
soft tissues of the airway from collapsing.
For their study, Dr. Martínez-García and colleagues enrolled 939 elderly patients referred with
suspected sleep apnea between 1999 and 2007, and followed these patients through 2009.
Patients were divided into four groups: a control group without OSA; mild to moderate OSA
patients without CPAP treatment; patients with severe OSA without CPAP treatment; and
patients with any degree of OSA who received CPAP treatment. Complete health histories,
including cardiovascular and respiratory data, were obtained from all patients at enrolment and
mortality causes were obtained from death certificates. Fatal cardiovascular events included
sudden death, stroke, heart failure (HF), cardiac arrhythmias and ischemic heart disease (IHD).
Median follow-up time was 69 months.
The researchers found that untreated severe OSA (but not untreated mild-moderate OSA) was
independently associated with all-cause and cardiovascular mortality, as well as stroke and HF
mortality, but not with IHD mortality. In addition, they found that CPAP treatment reduced these
increased risks of mortality in OSA patients.
Dr. Martínez-García said the results were not entirely unexpected, since anecdotal evidence and
several smaller studies have indicated CPAP offers improved outcomes in certain patients,
notably patients at risk for stroke.
“Our study provides an excellent scientific basisfor further studies in this area given a lack of
scientific evidence on the impact of sleep apnea and the role of CPAP treatment in elderly
patients,” Dr. Martínez-García said. “These findings clearly support the fact that treatment with
CPAP is effective in elderly people and therefore, within logical limits, it must be a treatment
that is offered to patients with severe or symptomatic OSA regardless of their age.
“The next step is to assess the effect of CPAP treatment in elderly OSA patients in large,
randomized clinical trials,” he added. “These studies should explore not only cardiovascular
outcomes, but other outcomes such as neurocognitive dysfunction.”

Sleep Problems More Prevalent than Expected in Urban Minority Children


Sleep Problems More Prevalent than Expected in Urban Minority Children Says New Study

Sleep problems among urban minority children, including resistance to
going to bed, shortened sleep duration, and daytime sleepiness are much more common than
previously thought, according to a study conducted by researchers in New York.

The results of the study were presented at the ATS 2011 International Conference in Denver.

“Although studies have shown that children from minority populations take more daytime naps
and have shorter nighttime sleep durations than their non-minority peers, no studies to date have
focused on sleep patterns and objectively measured sleep duration in early school-aged African-
American and Latino children living in urban, economically disadvantaged communities,” said
study author Beverley J. Sheares, MD, associate professor of clinical pediatrics at Columbia
University. “We studied this high-risk population because at age 5 and 6 years, children are
starting school and thus may have less time available for sleep at night or for daytime naps,
thereby reducing the amount of sleep at a time when the effect of shortened sleep on learning,
behavior and health is critically important.

“The results of this study will be of significance to healthcare providers, researchers, parents and
educational professionals, and will have significant public health implications for a highly
vulnerable population of early school-aged children,” she said.
Researchers randomly enrolled 160 parents of healthy 5- and 6-year-old children. Data were
obtained using parental sleep log records and through face-to-face interviews using the
Children’s Sleep Habits Questionnaire (CSHQ), a validated tool commonly used to screen for
childhood sleep problems. CHSQ data were used to identify and characterize the nature of the
sleep disturbances. In addition, researchers were able to obtain data from 30 children who
underwent sleep monitoring at home for five to seven days using actigraphy, an objective
method of continuous, direct-motion monitoring used to measure sleep and awake time. The
monitors were worn 24-hours a day during the monitoring period.

“To our knowledge, neither the CHSQ nor actigraphy has been used extensively in this
population of early school-aged children to examine sleep,” Dr. Sheares noted.
Evaluating the results of the sleep questionnaire, researchers found that 147 of the 160 children,
or 92 percent, had scores indicating the presence of a sleep problem. In addition, parents reported
the following behaviors were the specific sleep problems for their children: parasomnias, a group
of sleep events that includes nightmares, sleepwalking and other events (51 percent); bedtime
resistance (50 percent); shortened sleep duration (50 percent); daytime sleepiness (47 percent);
night waking (41 percent); sleep-onset delay (27 percent); sleep anxiety (19 percent); and sleepdisordered
breathing (11 percent).

All children who completed actigraphy monitoring had shortened sleep duration, with a mean
sleep duration of seven hours 45 minutes per night on average, significantly less than the 10 to
11 hours recommended by the National Sleep Foundation for children in this age group.
“We expected to find behavioral sleep problems in this population, but we did not expect over 90
percent of the children in this community sample to have a behavioral sleep problem as indicated
by the CSHQ,” Dr. Sheares said. “While studies consistently show that 20 percent to 43 percent
of school-aged children experience a range of sleep problems, there is mounting evidence, and
our study supports this, suggesting that children from minority groups have significantly shorter
sleep durations and increased sleep disruptions.”
“Our study also demonstrates the need to use objective measures of sleep in urban populations of
young children,” she said. “While parental reports of children’s sleep behaviors have been
widely used in both clinical practice and in pediatric sleep research, our findings suggest that
parental reports of sleep duration are not reliable because parents in our study consistently
overestimated sleep duration.”
“Although previous studies have shown that parental reports are closely correlated with sleep
schedule variables such as bedtime, wake time and sleep duration, they are less sensitive in
assessing sleep quality variables such as sleep fragmentation as a result of night awakening,” she
explained. “Parents may not have been aware of time spent awake during the night which could
have led to an overestimation of sleep duration.”
Dr. Sheares said future studies will focus on developing intervention programs aimed at
improving children’s sleep disorders.
“The study’s results may have significant implications for this group of children because while
pediatric sleep problems are universal and exist across all cultures, the impact of poor sleep is
magnified in vulnerable children,” she said.
“Inadequate sleep is a major health problem of childhood that often fails to receive attention until
significant health problems are noted, such as inattentiveness, memory loss and impaired
learning,” Dr. Sheares added. “The next step of this research is to carry out and evaluate the
efficacy of a tailored, interactive, educational and behavioral intervention that utilizes trained
sleep counselors to assist parents in improving their children’s sleep hygiene and reducing risk
factors for poor sleep, thereby increasing sleep duration over a 12-month period in a randomized
controlled trial of children identified with sleep problems.”
“Sleep Problems in Urban Minority Children May Be More Prevalent Than Previously
Recognized” (Session B73, Monday, May 16, 8:15 a.m.-4:30 p.m., Area C, Hall B (Upper
Level), Colorado Convention Center; Abstract 21627)
* Please note that numbers in this release may differ slightly from those in the abstract. Many of
these investigations are ongoing; the release represents the most up-to-date data available at
press time.
Abstract 21627
Sleep Problems In Urban Minority Children May Be More Prevalent Than Previously Recognized
Type: Scientific Abstract
Category: 14.04 – Pediatric Sleep and Control of Breathing (PEDS/SRN)
Authors: B.J. Sheares1, K.B. Dorsey2, C.I. Lamm1, Y. Wei3, M. Kattan1,R.B. Mellins1, D. Evans1; 1Columbia
University College of Physicians and Surgeons – New York, NY/US, 2Yale University – New Haven,
CT/US, 3Columbia University, Joseph L. Mailman School of Public Health – New York, NY/US
Abstract Body
RATIONALE: Although studies consistently show that 20-43% of young children experience a range of sleep
problems, there is limited information on the sleep patterns of early school aged children living in low income,
urban, minority communities. Given the numerous exposures that could lead to inadequate sleep in this
vulnerable population, this is an important group to study. We utilized the Children’s Sleep Habits Questionnaire
(CSHQ), a validated screening instrument, to identify children with sleep problems in our population. Sleep
disturbances detected by the CSHQ have been linked to neurobehavioral and other health problems.
Additionally, actigraphy, an objective method of continuous, direct motion monitoring, was used to measure
sleep duration. Our goal was to determine the extent of sleep disorders in a group of 5-6 year old African
American and Latino children living in urban, economically disadvantaged communities. METHODS: Thirtythree
parents with healthy 5-6 year old children were randomly approached in 2 separate pediatric practices. All
parents who were approached for recruitment consented to participate in the study. Data were obtained via
face-to-face interviews using the CSHQ, sleep log records, and home actigraphy monitoring on a subset of the
group. RESULTS: Twenty-seven met eligibility requirements and completed the CSHQ. Twenty-four (89%)
scored greater than or equal to 41 on the CSHQ, indicating the presence of a sleep problem. Ten families
participated in actigraphy monitoring. Nine children yielded complete 7-night monitoring data. All children who
completed actigraphy monitoring had shortened sleep duration. Mean sleep duration was 8 hours/night on
average (SD = 0.81, Range 6.8-9) significantly less than the 10-11 hours recommended by the National Sleep
Foundation for children in this age group. Based on results from the CSHQ, parents of 62% of children reported
parasomnias, bedtime resistance (44%), daytime sleepiness (44%), shortened sleep duration (41%), night
waking (41%), sleep disordered breathing (26%), sleep anxiety (19%), and sleep onset delay (11%).
CONCLUSIONS: The results of this study suggest that sleep problems may be more prevalent than previously
recognized in urban, early school aged, minority children with CSHQ scores for 89% of children indicating the
presence of a sleep disturbance. Shortened sleep duration, parasomnias, bedtime resistance, daytime
sleepiness, sleep fragmentation as indicated by night waking, and sleep disordered breathing are the
predominant sleep problems detected in this study. These findings indicate the need for further study and
interventions that are tailored for use in this high risk population.

Sleep and High School Students


According to news report on PBS, Most high school students are chronically tired.

They juggle school, sports, homework, chores, friends and family says experts interviewed in the report.

To meet all of these demands, surveys show, high schoolers usually stay up close to midnight on school nights. And then they have to get up early the next morning, typically around 6 or 6:30 a.m., to get to school on time, as most high schools start classes around 7:30 a.m.

By Friday, most teens are very tired, says Dr. Helene Emsellem, a sleep researcher with George Washington University in Washington, D.C. And then comes the weekend.

“Every parent of a teenager knows that if you try to get them up in the morning on the weekends, they’re tired, grouchy, irritable and not the charming individuals that they’re capable of being, because they’re so exhausted,” says Emsellem, a neurologist who also runs the Center for Sleep and Wake Disorders in Chevy Chase, Md.

She says the typical high school senior gets less than seven hours of sleep on school nights. But they need a great deal more.

Growth Spurts Call For Sleep

“Most studies show a fairly consistent 9 1/4 hours sleep requirement,” says Emsellem. “So there’s a huge gap between what they’re getting on an average school night and what they require.”

An adolescent’s biology bears some of the blame for this sleep problem. As teens progress through puberty, unprecedented growth occurs in body and brain that requires a lot of sleep.

In addition, something else is changing: The very brain chemical that makes one feel sleepy — a hormone called melatonin — is released later and later in the evening as teens get older.

Because of this shift in the onset of melatonin, teenagers don’t feel sleepy until later at night, says Stephanie Crowley, a sleep researcher at Rush University Medical Center in Chicago.

“A 16- or 17-year-old might be able to stay awake later compared to a 10-year-old who will likely fall asleep on the couch watching TV,” Crowley explains.

Accruing A ‘Sleep Debt’

Most studies show a fairly consistent 9 1/4 hours sleep requirement. So there’s a huge gap between what they’re getting on an average school night and what they require.

– Helene Emsellem, neurologist at George Washington University and medical director of the Center for Sleep and Wake Disorders

When a teen’s propensity to fall asleep later is coupled with the early-to-rise school start times, most high school students end up accruing a “sleep debt” of five to 10 hours by the end of a school week.

And teenagers’ typical habits on the weekend create even more chaos in their sleep-wake cycle.

“What the majority of adolescents do is they will try to recover their sleep on the weekends,” Crowley observes. “And what usually will happen is they’ll stay up late to socialize with friends and then sleep in in the morning.”

But this sleep-wake pattern makes things worse for the teen, not better, Emsellem says.

“Even if you catch up by sleeping in late on your weekend mornings,” she says, “by doing so, it makes it harder for you to fall asleep by 10 or 10:30 on Sunday night. And you start all over again, sleep restricted.”

But Emsellem offers some suggestions for the weekends, based on her sleep research in the lab — and her personal experience of raising three daughters.

“As a parent myself, I feel like a criminal if I ask them to get up at 7:30 or 8 in the morning. But I do try to get them up by 9. And I encourage them to get some activity and some light exposure in the morning,” she says.

Let There Be Not Much Light At Night

Light, Emsellem says, is a “drug that promotes wakefulness” in the morning, in the same way that darkness can promote sleep at night. In the evening, she recommends dimming and even turning off some lights in the house to minimize light exposure.

The teen should also try to make the transition to sleep time by taking a warm shower or doing some gentle stretching. Emsellem suggests that there be a lights-out time in the teen’s bedroom during the school week and that they try to stick with it.

But if the teenager gets into bed and turns out the lights but cannot sleep, Emsellem says, just lying there in bed doing nothing is just as frustrating for the teen as it is for an adult. In that case, electronics can be helpful if used carefully — for example, soothing music or an audio book. But she suggests limiting such sleep aids to 30 minutes.

Making The Case For Sleep

Emsellem wants teenagers to understand what sleep does for them every night.

“I think it’s important for teens to recognize that during the day, they’re gathering information,” she says. “But they’re really not learning it till they sleep on it.”

Another tip for teens: no caffeine — including chocolate — after midafternoon. Emsellem says caffeine stays in a teen’s system for at least six hours.

Experts also recommend naps. Over the weekend, an hour or so can help a teen catch up on sleep. During the school week, naps should be short — 20 to 30 minutes — and are best taken during study hall or a break before midafternoon. Otherwise, they could interfere with nighttime sleep.

Naps can be particularly helpful when teens have a test in the afternoon. “Studies have shown they’ll do better on their test with a nap midday,” Emsellem says.

There’s another advantage to an early afternoon nap: Teens will then have more energy and concentration to power through homework later in the evening.

Shift Work Disorder News


Cephalon Presents Positive Results with NUVIGIL in Largest Shift Work Disorder Trial Ever Conducted

Study Shows Efficacy of NUVIGIL Late in Shift, Including Commute Home

At the Society of General Internal Medicine’s 34th Annual Meeting in Phoenix, Ariz. today, Cephalon, Inc. (Nasdaq:CEPH – News) presented positive results from a phase IV trial of nearly 400 people with excessive sleepiness associated with shift work disorder. In the trial, NUVIGIL® (armodafinil) Tablets [C-IV] improved shift-workers’ overall clinical condition late in their shifts (i.e., 4:00 a.m. to 8:00 a.m.), including the commute home, compared to placebo. The key secondary endpoint of the study was to assess global function, as measured by the Global Assessment of Functioning (GAF), and patients taking NUVIGIL experienced a greater improvement in GAF score compared to those patients taking placebo. Shift work disorder occurs when the body’s internal sleep-wake clock is out of sync with the individual’s work schedule – their bodies tell them to go to sleep when their work schedule needs them to stay awake. The primary symptoms of shift work disorder are excessive sleepiness and insomnia.

This six-week, double-blind, placebo-controlled study of 383 patients with excessive sleepiness associated with shift work disorder was conducted at 45 sites across the United States. Participants in the study spanned a wide range of occupations associated with shifts or non-traditional work hours, including transportation and material moving, healthcare support, protective services, management roles and office and administrative support. For the primary endpoint, physicians used the Clinical Global Impression of Change (CGI-C) scale to evaluate the change from baseline (beginning of the study) in overall clinical condition late in the shift – from 4:00 a.m. to 8:00 a.m. The observation period also included the participant’s commute home from work. Using the CGI-C rating, at the final visit, 77 percent of patients taking the recommended NUVIGIL dose of 150 mg (n=177) improved, compared to 57 percent of patients taking placebo (n=182) – a significantly greater improvement (p<0.0001). These clinical data build upon the findings from the pivotal phase III study of NUVIGIL in patients with excessive sleepiness associated with shift work disorder. The key secondary endpoint in this trial was the Global Assessment of Functioning or GAF, a well-recognized assessment of patient functioning found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, which evaluates an individual's social, occupational, and psychological functioning on a scale of 1 to 100. Scores above 70 on the Global Assessment of Functioning may be considered within the normal range of functioning. This study was the first to use the GAF to provide an assessment of functioning in patients with excessive sleepiness associated with shift work disorder. In this trial, physicians used the GAF to measure a patient's overall level of functioning at baseline and at the final visit. At baseline, patients in both the placebo and NUVIGIL groups were rated an average score of 63, which is indicative of functional impairment associated with shift work disorder. Patients treated with NUVIGIL experienced a 9.5 point improvement over baseline in the Global Assessment of Functioning, to mean scores of 72.6 at the final visit, compared to a 5.2 point improvement to means scores of 67.9 in those taking placebo at final visit (p< 0.0001). "This study is important because up to 25 percent of people who work nights, early mornings, or other nontraditional shifts may be affected by shift work disorder. This condition affects their ability to function at work and at home, but they still need to do their jobs. The results of this study show an improvement in condition as well as a reduction in the impairment of patients treated with NUVIGIL for excessive sleepiness associated with shift work disorder when compared to placebo," said Milton K. Erman, M.D., study lead investigator. Dr. Erman is a Clinical Professor of Psychiatry at the University of California San Diego and President, Pacific Sleep Medicine Services, San Diego, CA. "This study reinforces the need for healthcare professionals to learn more about this disorder and about how treatment options like NUVIGIL may be of help in managing excessive sleepiness due to shift work disorder." The most frequently reported adverse events in this study are similar to those described in the NUVIGIL prescribing information, and include headache, nausea, and insomnia. There were no serious adverse events observed in patients taking NUVIGIL in this study. This is the first presentation of these data at a medical meeting and additional results will be submitted for future publications and presentations. About Shift Work Disorder According to the U.S. Department of Labor, over 15 million Americans work odd hours or non-traditional shifts, and are "at risk" for shift work disorder. Approximately 10 – 25 percent of shift workers are estimated to have shift work disorder. People with shift work disorder often struggle to stay awake during their waking hours (excessive sleepiness), or have trouble sleeping during their sleeping hours (insomnia). About NUVIGIL NUVIGIL is indicated to improve wakefulness in patients with excessive sleepiness associated with shift work disorder (SWD), treated obstructive sleep apnea (OSA), or narcolepsy. In patients with OSA, NUVIGIL is used along with other medical treatments for this condition. The NUVIGIL (armodafinil) label includes a bolded warning for serious or life-threatening rash, including Stevens-Johnson Syndrome, requiring hospitalization and discontinuation of treatment, that has been reported in adults in association with the use of modafinil and armodafinil and in children in association with the use of modafinil, a racemic mixture of S and R modafinil (the latter is armodafinil, the active ingredient in NUVIGIL). NUVIGIL is not approved for use in pediatric patients for any indication. The most common adverse events in controlled clinical trials (five percent or greater) were headache, nausea, dizziness, and insomnia. Full prescribing information for NUVIGIL is available at About Cephalon, Inc. Cephalon is a global biopharmaceutical company dedicated to discovering, developing and bringing to market medications to improve the quality of life of individuals around the world. Since its inception in 1987, Cephalon has brought first-in-class and best-in-class medicines to patients in several therapeutic areas. Cephalon has the distinction of being one of the world's fastest-growing biopharmaceutical companies, now among the Fortune 1000 and a member of the S&P 500 Index, employing approximately 4,000 people worldwide. The company sells numerous branded and generic products around the world. In total, Cephalon sells more than 150 products in nearly 100 countries. More information on Cephalon and its products is available at In addition to historical facts or statements of current condition, this press release may contain forward-looking statements. Forward-looking statements provide the Cephalon current expectations or forecasts of future events. These may include statements regarding anticipated scientific progress on its research programs; development of potential pharmaceutical products; interpretation of clinical results; prospects for regulatory approval; manufacturing development and capabilities; market prospects for its products; and other statements regarding matters that are not historical facts. You may identify some of these forward-looking statements by the use of words in the statements such as "anticipate," "estimate," "expect," "project," "intend," "plan," "believe" or other words and terms of similar meaning. Cephalon performance and financial results could differ materially from those reflected in these forward-looking statements due to general financial, economic, regulatory and political conditions affecting the biotechnology and pharmaceutical industries as well as more specific risks and uncertainties facing Cephalon such as those set forth in its reports on Form 8-K, 10-Q and 10-K filed with the U.S. Securities and Exchange Commission. Given these risks and uncertainties, any or all of these forward-looking statements may prove to be incorrect. Therefore, you should not rely on any such factors or forward-looking statements. Furthermore, Cephalon does not intend to update publicly any forward-looking statement, except as required by law. The Private Securities Litigation Reform Act of 1995 permits this discussion.

25 Foods That Help You Sleep


25 Foods That Help You Sleep and Catch the ZZZ’s you Need

Andrea Carter

We all know that a cup of coffee can get you going in the morning, but for the millions who need some extra help getting to bed, is there a food that can help out? Surprisingly, the answer is: “yes, and there’s more than one.” Those who are looking to go the opposite way of coffee can find many natural choices foods for better sleep.

To help, below we have listed 25 foods that can help you sleep. They include fruits, veggies, meats, and a few others that may not be as commonly known. Don’t be afraid to combine them in all sorts of inventive ways to get the maximum benefits.

Produce That Help You Sleep

Whether grown over ground or underground, these fresh fruits and veggies can help you get a good night’s sleep and contain loads of other health benefits.

1. Tomatoes Grown on the vine, the tomato is a natural source of melatonin, a chemical produced by the body during sleep. Although it is recommended to get fresh sources, tomatoes can be found in sauces, paste, and even in ketchup. They are also full of antioxidants.

2. Cherries Far more than a sundae garnish, the cherry is also similar to the tomato. Also boasting high levels of melatonin, tart cherries where found to have loads of anti-oxidants and other nutrients. Be sure to steer clear of the sugary, canned variety which can actually detract from sleep.

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3. Radish Also a high source of fiber, there are many types of radishes that contain melatonin. One of the highest rating radishes was the Japanese radish. They can be prepared a number of different ways including radish butter.

4. Bananas Ever wake up in the middle of the night from a Charlie Horse? Than a banana has two ways in which it can help you sleep. A high source of potassium, it is a natural muscle relaxant. Bananas also contain tryptophan, which can help sleep.

5. Ginger The ginger root has a significant amount of melatonin. Whether in root form, ground up, or in a natural tea, they are all good sources of ginger and sleep. It can also be taken as a supplement.

6. Sweet Corn Although not available all season, sweet corn contains high levels of natural melatonin. You can eat it straight from the cob, make it into a cornbread, or even as a frozen food when out of season. Other health benefits include a high level of folate and Thiamin for the heart and mind, respectively.

7. Grapes That glass of wine might be doing more for your sleep than previously thought. Researchers at the Institute of Vegetable Virology found that Nebbiolo grapes contained the most melatonin of all the grapes tested.

8. Spinach If you have dark circles under your eyes, lack of sleep is often thought of as the culprit. But as reported on by Nature’s Basin, it could be lack of Vitamin K. They recommend eating foods high in it, which include spinach.

Main Dish Foods That Help You Sleep

Whether as an entree, side, or even beverage, all of the below foods can help you get a good night’s sleep.

9. Milk Ever wonder why mothers give kids milk before bed time? It’s probably because it will help both of them get through the night. In fact, one of the doctors at WebMD took the time out to give the medical reasons why.


10. Goat Milk Because not all milk comes from cows, check out this tryptophan loaded substitute. Both sweeter and saltier than traditional milk, goat’s milk is commonly drank in other parts of the world. Also a good substitute for the lactose intolerant.

11. Poultry One of the reasons many people feel worn out after Thanksgiving is the turkey. A natural source of tryptophan, it is like many poultry dishes that are also high in it. Other choices include chicken and even duck. Baked is best, while fried can have the opposite effect.

12. Oats Quick and easy to prepare, oats are said to be an excellent breakfast. However, especially when combined with milk and/or honey, oats can also have a calming effect useful for sleep. They are also a good source of tryptophan.

13. Walnuts A good source of protein, walnuts make an excellent snack or vegan option. They also contain high levels of melatonin in addition to many heart benefits. A quick visit to Whole Foods shows the high level of omega fatty acids and other vitamins contained in walnuts.

14. Sardines There are many reasons to eat one of the world’s most natural super vitamins. Just a few ounces of sardines provide many nutrients including vitamin B12, selenium, and Vitamin D. Click here to get the amazing amount of tryptophan levels they contain (over 50 grams!).

15. Potatoes This starch is often used as the staple in many foods, including the American. Whether baked, roasted, or mashed, the potato is also a high source of tryptophan and fiber. If fried, the high fat content can actually have the opposite effect and disturb sleep.

Other Foods That Help You Sleep

Get the best of the rest in foods that help you sleep below.

16. Honey In a study, those who drank more honey improved the antioxidant levels in their blood, making it a useful cure for insomnia. Dark honey is thought to contain more and honey also has vitamins B1, B2, C, B6, B5, and B3.

17. Cheese and Crackers Although alone they have the carbs and tryptophan that can induce sleep, combining the two can help even more. Keeping both the cheese and crackers natural, with as few additives as possible is also a good choice for those seeking better sleep.


18. Yogurt and Cereal Like the above, this snack combines carbs and tryptophan in one easy snack. It is also small enough to not overdo the digestive system. Best when done with a low fat yogurt and low sugar cereal.

19. Barley Often used in baking and even some beers, barley is also a natural source of melatonin. It can be purchased in many specialty stores or even in the health aisle at many national chains. Although found in beer, the alcohol in it can actually deter sleep.

20. Rice Another world staple, rice is often the main or side dish in many countries. Although brown rice is higher in melatonin content, it can also be found in many natural white rice varieties. As with potatoes, eating rice just about any way but fried is the best way to get its sleep benefits.

21. Sunflower Seeds They may be annoying to open and discard, but sunflower seeds can be high in melatonin. Along with many other useful nutrients, these seeds can also be substituted for fennel seeds, green cardamom seeds, and others.

22. Hummus Made from the chick pea and other ingredients, this is more than a Mideast favorite. The dip is high in amino acids and tryptophan that can help sleep. Best when combined with whole grain pita bread.

23. Tahini Another Mideast food, this one is made from sesame seeds, which are similar to sunflower seeds. Other health benefits include anti-aging properties and digestion. Visit to get more on tahini and even a few authentic recipes.

24. Tea Although many teas contain caffeine and are stimulants, there are also others that are specifically designed for sleep. One of them is Valerian tea is made from an herb that has long been used for insomnia. Check out this entry from Cathy Wong, the alternative health expert at

25. Bedtime Snack Although eating right before bed can be a disaster, it can also be a good thing. Combining two or more of the above foods in small doses can actually help sleep. It can also keep a rumbling tummy from keeping you awake.

Although items such as melatonin and tryptophan can aid in sleep, simply changing a diet may not be enough. Because many sleep aids can be bought over the counter, it is important to consult a doctor before using any of them or if you are having consistent trouble sleeping.

Sleeping on the Job – Ohio Fires Teacher


Ohio Teacher Accused Of Sleeping On Job Is Fired

Press reports reflect that a northwestern Ohio school board is firing a longtime teacher after an investigation concluded she slept in class and repeatedly arrived late.

The firing of 72-year-old Carol Smith by Perkins district officials was recommended by a referee in the matter who said her actions were “totally unprofessional” and threatened the safety of her middle and high school students.

School board vice president Steve Schuster said Wednesday’s vote to terminate the 34-year veteran teacher followed lengthy deliberations.

The Sandusky Register reports students had testified class was “unruly” when Smith was late and that they played computer games when she slept.

Smith said she was late a handful of times and denied falling asleep. She testified a condition required her to rest her eyes.