Wednesday, December 10, 2014

New studies link poor sleep, OSA in the elderly to increased Dementia risks

A new study by the Pacific Health Research and Education Institute in Honolulu has found that elderly patients who spend less time in deep ‘slow wave’ sleep are significantly more likely to lose brain cells than those who sleep more deeply. The research also showed that the lack of oxygen caused by obstructive sleep apnea, a common condition marked by snoring, increases the risk of the small areas of brain damage linked to the development of conditions such as Alzheimer’s. Researchers say that it is not yet clear whether the early stages of dementia are causing poor sleep quality, or if the lack of deep wave sleep is exacerbating the disease process.

The study, published in the online edition of the journal Neurology, involved 167 Japanese American men from Hawaii with an average age of 84 who had sleep tests conducted at their homes. After death, post mortem examinations were conducted on their brains to look for changes such as loss of neurons and ‘micro infarcts’ - areas of dead tissue caused by oxygen starvation. These can be triggered by obstructive sleep apnea (OSA); a condition in which the airway repeatedly becomes blocked, often waking sufferers as they struggle for breath.

The men who had the worst oxygen levels during sleep were four times more likely to have brain damage caused by micro infarcts. Of the 37 men who spent the least time in slow wave sleep, 17 had brain cell loss compared with only seven of the 38 who spent the most time in slow wave sleep. The results remained the same after accounting for factors such as smoking and body weight, and excluding those who died early in the follow-up period. However, the study found no association between poor sleep and the brain plaques  that are a hallmark of Alzheimer’s disease.

Researchers say that the findings suggest that low blood oxygen levels and reduced slow wave sleep may contribute to the processes that lead to cognitive decline and dementia. More research is needed to determine how slow wave sleep may play a restorative role in brain function and whether preventing low blood oxygen levels may reduce the risk of dementia.

A separate study earlier this week showed that brains of healthy people who were sleepy during the day contained higher levels of a toxic protein called beta-amyloid, which is also linked to Alzheimer’s: some of those having scans were as young as 50 and none had memory problems.

A good night’s sleep is important for proper brain function in the short term. For more information on the treatment of OSA and snoring, visit us online at

Saturday, November 15, 2014

Firefighters may Have an Elevated Risk of Sleep Disorders

Two of the leading causes of death for firefighters in the United States are heart attacks and motor vehicle crashes, both of which share independent risk factors in sleep disorders.
In a recent national sample of almost 7,000 firefighters, researchers at Brigham and Women’s Hospital examined the prevalence of common sleep disorders and their association with adverse health and safety outcomes. The study found that sleep disorders are highly prevalent, and associated with substantially increased risk of motor vehicle crashes and cardio-metabolic diseases among firefighters.

Based on specific criteria, 66 US fire departments were selected to participate in a workplace based sleep disorders screening and educational program. Approximately 7,000 participants were assessed for common sleep disorders and surveyed about health and safety. Documentation was also collected for reported motor vehicle crashes. Participants reported current health status, previous diagnoses of sleep and other medical disorders, the likelihood of falling asleep while driving, motor vehicle crashes, near crashes, and injuries.

Researchers found that a total of 37.2 percent of firefighters screened positive for sleep disorders including obstructive sleep apnea, insomnia, shift work disorder and restless leg syndrome.  Firefighters with a sleep disorder were more likely to report a motor vehicle crash and were more likely to report falling asleep while driving than those who did not screen positive.  Additionally, firefighters with sleep disorders were more likely to report having cardiovascular disease, diabetes, depression and anxiety, and to report poorer health status, compared with those who did not screen positive.
More than 80 percent of firefighters who screened positive for a common sleep disorder were undiagnosed and untreated. 

Findings of the study, published in the Journal of Clinical Sleep Medicine, demonstrate the impact of common sleep disorders on firefighter health and safety, and their connection to the two leading causes of death among firefighters.

Excessive daytime sleepiness (EDS) is a common problem in today's society; it is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road, and the cost to society is estimated in billions of dollars per year.
There are several common causes for increased daytime sleepiness, including OSA, PLMS and RLS: these problems are all treatable, but unfortunately many physicians are still not familiar with  the diagnosis of these conditions.
If you have a problem with daytime sleepiness and have tried to increase your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem.

Further Reading:
Sleep Disorders That Raise Heart Disease And Depression Risk More Prevalent In Firefighters

Monday, November 10, 2014

Results from new Sleep Survey shows many Americans have problems falling and staying asleep.

From October 20 - 22 2014, the popular NBC television show "Today" conducted a survey among a nationally representative sample of 1,092 U.S. adults aged 18 and older, using a questionnaire focused on self-reported behavior and attitudes toward sleep. The study was fielded by Survey Sampling International, an independent research company based in Connecticut.
The study found that  61 percent of the survey participants reporting problems falling and staying asleep, and eighty percent of people who don’t get adequate sleep report experiencing more stress about finances with 74 percent becoming more worried about their health.

Among other issues, the study found that 32 percent of 18-to-34-year-olds say work makes them fret throughout the night, with 31 percent reporting that their children cause sleepless nights. Overall, 42 percent of people with a child under 18 reported inadequate sleep.

Modern electronic devices can have a serious impact on sleep quality, for multiple reasons. Physically, the blue light emitted by the screens of devices such as mobile phones and tablets mimics daylight and can interrupt our circadian rhythms; it's also known to suppress production of a brain chemical called melatonin, which helps us sleep. But more importantly, using the internet or texting before trying to sleep overstimulates the brain. Nonetheless, the survey reported that people still regularly watch TV and keep their phones at hand when they should be trying to fall asleep:
  • 51 percent of people have TV remote within reach
  • 50 percent of people have their smartphones within reach
  • 23 percent of people have a computer within reach
  • 21 percent of people have a tablet within reach
Seventy-seven percent of participants 35-49 said they watched TV right before bed, with almost two-thirds of 18-34-year-olds using their smartphones before sleep: only 1 in 5 adults claimed to sleep without any of these devices within reach.

The reported issues related to sleep problems included:
  • Overall 29 percent had difficulty concentrating; among 18 to 34-year-olds that number increased to 39 percent
  • 23 percent had difficulty performing daily chores
  • 19 percent had lost interest in hobbies or leisure activities
  • 16 percent reported falling asleep at inappropriate times during the day
  • 16 percent experienced short tempers or inappropriate behavior with children or partners, with 13 percent reporting short tempers or inappropriate behavior at work.
Healthy sleep is vital to our well-being. For more information on how you can get a better night's rest, see our sleep hygiene recommendations or contact us if you're having serious problems with sleep.

Why can't we sleep? TODAY 'Snooze or Lose' survey results may surprise you; Meghan Holohan, November 09 2014

Sunday, October 26, 2014

How the Daylight Savings Time Change Affects Sleep.

On Sunday, November 2, 2014 Daylight Savings Time ends for most Americans, a few days after Europe sets its clocks back an hour.
The modern idea of "daylight saving" was first proposed in 1895 by George Vernon Hudson of New Zealand, with Germany and Austria-Hungary organizing the first national implementation in 1916. Since then the concept has garnered its share of both advocates and critics from around the world; changing our clocks benefits retailing, sports, and other activities that are happy to exploit the extra hours of sunlight. Of course it can also disrupt meetings, travel and record keeping and cause multiple other scheduling issues.

On a personal level, moving our clocks in either direction changes our principal time cue -morning sunlight- which controls our 24-hour circadian rhythm track. This means that our internal clock falls out of sync with our current day-night cycle. Our ability to adapt to this depends on several things.

 Generally, "losing" an hour in the spring is more difficult to adjust to than "gaining" an hour in the fall. This is similar to the "flight lag" experienced in airplane travel; an earlier bedtime may cause difficulty falling asleep and increased wakefulness during the early part of the night. Conversely, setting the clocks back means we may fall asleep easily but can have a difficult time waking.

Our external time cues are called "zeitgeibers", and they include light, temperature, exercise and food/drink intake. It can take several days for our internal biological clock to re-synchronize with any new schedule, whether it's a clock change or a timezone difference. For some people, this can lead to disrupted sleep and feeling tired during the day (EDS).
Even if the actual time change doesn't affect your sleep, the change in seasons can; the lack of sunlight affects many people's moods despite a one hour change in time not being particularly important. For those who do feel affected, either physically or emotionally,  this misalignment between external cues and our internal body clock can also have more serious consequences.

For example, statistics have long shown that the risk of heart attacks spikes on Monday mornings. This is thought to be due to a combination of stress brought on through the anticipation of a new working week, and the sudden changes in our sleep-wake cycle. A recent study published in the AAC journal Open Heart looked at the rates of heart attacks before and after our clock changes over 4 years, and found a 25% increase on the Monday following the shift to daylight saving time; conversely, there was a 21% decrease in heart attacks when the clocks were rolled back in the Autumn.

One of the best sleep practices for the winter months is avoiding bright light exposure at night, which can delay the body's internal clock. This includes computers, tv's, cellphones and tablets - so they shouldn't be in the bedroom.
Routine is key for maintaining a consistent drive to sleep each evening. In the winter, with fewer hours of daylight overall, it’s important to seek out exposure to morning light if you can. Light is a strong cue for your  internal clock, and daylight ensures it remains synchronized to a 24-hour day even when your schedule changes slightly. Lack of light exposure during the day can result in a drift of the internal body clock to a longer than 24-hour rhythm, making it harder to get up in the morning in the winter. Here are some tips on how to make a smooth transition to the winter months:

  •  Start getting in sync early; try to eat, sleep, wake to the new time so that your circadian rhythm has a chance to adjust.
  • Exercise earlier in the day to keep your energy levels high and to ensure you’re tired enough to get to sleep ‘earlier’, but be sure to avoid the over-stimulation effect of evening exercise.
  • Get as much natural sunlight as possible: this will help adjust the body’s circadian rhythm. Dim lights in evening can help to induce sleepiness.
  •  Avoid alcohol and caffeine in the evenings and go for sleep-inducing foods and drinks.
  • Nap wisely: avoid taking naps after 4pm and try to keep naps to no more than 10 - 20 minutes.

For more information on healthy sleep habits or to get help for a sleep related problem, visit our website at

Sunday, October 19, 2014

Treating sleep problems improves conditions not typically considered by most physicians.

Over the past decade many Sleep Testing centers have opened throughout the country; most focus on evaluating patients with snoring complaints to determine if they have Obstructive Sleep Apnea (OSA). Once diagnosed these patients are typically placed on CPAP for treatment. Typically a second sleep study is performed to determine the best settings for the CPAP machine, with most centers taking the basic approach  rooted in standards developed when less was known about sleep abnormalities.

As a result, many patients who have abnormalities during sleep are not accurately diagnosed and patients are left without an effective treatment plan. Many patients may have a subtle breathing problem during sleep known as Upper Airway Resistance Syndrome (UARS). Patients with UARS have normal oxygen levels throughout the night and do not stop breathing, but they work harder to breathe and the increased effort causes brief disruptions called micro arousals. Recently accepted minimum standards in the field miss out on the identification of abnormalities such as UARS.

Some centers differentiate themselves in their ability to properly diagnose and treat patients with sleep disturbances by using refined approaches and assessing more sensitive parameters during sleep. Additionally, many conditions not typically thought to be rooted in abnormalities of sleep are now recognized and treated more effectively. In Houston, Jerald H. Simmons, MD, a Triple Board-Certified Neurologist specializing in sleep disorders, directs several sleep centers that clearly stand out from the crowd. His centers use methods beyond what is required by sleep centers for accreditation.

Dr. Simmons points out that "Every path has a starting point and we learn new things along the way. It is great that the field of Sleep Medicine is developing standards but unfortunately the current standards fall short of being able to properly diagnose and treat patients with complicated conditions. By identifying the more subtle abnormalities, we have been successful in providing care to patients who were previously left struggling by the health care system."

In example, a common cause for recurrent morning headaches is OSA or UARS. Many of these patients also have bruxism during sleep (clenching or grinding the teeth at night) and this can lead to TMJ Disorder. Research conducted by Dr. Simmons has shown that bruxism during sleep actually helps keep the airway open by moving the tongue and jaw forward; this is the body's attempt to prevent OSA or UARS. By treating the airway problems during sleep Dr. Simmons and Dental Sleep Specialist Dr.Ron Prehn have demonstrated improvement in both bruxing and TMJ pain.
When appropriate Dr. Simmons treats patients with OSA or UARS by using dental appliances as an alternative to the CPAP machine, and is performing pioneering research on the use of combined treatment approaches using both CPAP with dental appliances.

Additionally, most patients with fibromyalgia have poor sleep. Proper treatment of their sleep problems frequently improves the symptoms of Fibromyalgia. Signals from pain nerve fibers throughout the body constantly send a low level of signals to the brain, but the brain normally filters these out. If the brain is not properly rested it loses the ability to filter these signals which results in common fibromyalgia pain.
Treatments geared to improving sleep continuity restore the brain's pain filter mechanism, and the pain symptoms resolve.

The underlying sleep disturbances causing these symptoms is not always identified by sleep centers, and the treatment opportunities are missed. In many of these patients UARS can be at the root of the problem. Once the sleep disturbance is properly treated, fatigue resolves.

The sleep centers directed by Jerald H. Simmons, MD utilize advanced methods to properly diagnose and treat patients with conditions, such as those described above. Dr.Simmons concludes that "In the future we will look back and see how much we didn't understand, but unless we embrace the knowledge of our experience we will never reach that future perspective."

For more information on sleep disorders and the sleep centers of Dr. Simmons, visit and gain the knowledge you need to obtain a better night's sleep.

Wednesday, October 1, 2014

TMJ (TMD) and sleep Bruxism associated with OSA. Diagnosis and Treatment...

Temporal Mandibular Joint Dysfuntion (TMJ) causes pain and headaches in millions of people each year. This common problem is caused by clenching and grinding the teeth, typically while asleep.
 Research conducted by Dr. Jerald Simmons and Dr. Ronald Prehn has demonstrated that bruxism during sleep is the body's attempt to open up the airway and improve breathing, particularly for people who suffer from Obstructive Sleep Apnea. When Dr. Simmons has implemented treatments for OSA, such as CPAP or dental appliances (TAP or other mandibular advancing devices), their TMJ symptoms usually resolve.

Many of these patients can not be placed on a mandibular advancing dental appliance initially because of inflammation from the TMJ; once this improves through the use of other methods such as CPAP, then a mandibular advancing appliance can be used successfully. The physiology of this has been demonstrated and is explained by Dr. Simmons in this video.
Visit our web site for more information at

Monday, September 15, 2014

New Studies on Confusional Arousals

Parasomnias are a group of disorders that include behaviors that occur around sleep. Confusional arousals are a common parasomnia affecting children; generally mild episodes in which a person wakes up or arouses from sleep and remains in a confused state, they are characterized by the affected person briefly seeming to wake up, sit up, and even look around. The episodes last from seconds to minutes, and they may not be responsive to stimuli.

But according to a new study published in the journal Neurology, as many as 1 in 7 adults may have this disorder. Popularly referred to as "sleep drunkeness",  the episodes usually happen when a person wakes suddenly, and people may have no memory of these incidents. In the study, the researchers interviewed a random sample of more than 19,000 American adults about their sleep habits and history of confusional arousal, as well as any mental illness and any medications they were taking.

Approximately 15 percent of those surveyed said they had experienced at least one episode in the previous year, more than half claiming that they suffered at least one episode per week. Slightly fewer than 10 percent of those who had had an episode couldn't remember part or all of the experience, and 15 percent of them also had sleepwalking episodes.

Confusional arousal is different from the normal sleepiness that most people feel when they wake up; most people with sleep inertia, the feeling of grogginess most people experience after awakening, will remember the experience. But people suffering from confusional arousal are not aware of their actions, and attempts to fully wake them usually fail.

 The researchers found that among those who'd had a confusional arousal episode, 70 percent also had a sleep disorder and 37 percent had a mental illness. Only 31 percent were taking medication for these disorders, and these were mostly antidepressants. People suffering from depression, bipolar disorder, alcoholism, panic or post-traumatic stress disorder and anxiety seemed more susceptible to the disorder, as did those with sleep apnea.

Confusional arousal can result from getting too little or too much sleep; about 20 percent of people who reported getting less than 6 hours of sleep per night reported having an episode, and 15 percent of those who got at least 9 hours per night said the same, the researchers said.

The prevalence of these parasomnias may be cause for concern, and the disorder could have major consequences if it affects people with responsibility for the safety and security of others, such as pilots or emergency-room doctors. CSMA's sleep centers throughout Greater Houston provide treatment to patients suffering from parasomnias and confusional arousals. For more information visit the or call us today at (281) 407-6222.


Monday, August 25, 2014

Later School Times Suggested by American Academy of Pediatrics

Dr. Judith Owens, director of sleep medicine at Children's National Medical Center in Washington has recently submitted a policy statement requesting that school districts delay starting times for morning classes.
Recent research has shown that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life. Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need.

Many school districts are debating the change; the Long Beach, California, school board voted last year to delay the start of middle school until 9 a.m. But it’s a complex issue with school boards, educators and parents struggling to balance bus schedules, after-school activities and work schedules for older students. 

Nonetheless, Owens says biology should trump convenience. She notes that when teenagers go into puberty, there are changes in their circadian rhythm, the body's natural clock that regulates sleep and wake patterns. At the beginning of adolescence there is a natural delay in sleep and wake times, so that the average teenager doesn't fall asleep until around 11 pm.
 However, they also need between eight and nine hours of sleep per night so they are biologically programmed to wake at around 8am, when they're already in first period class. Teens often sleep in over the weekend, and many teen habits make it even harder to fall asleep which makes matters worse. But parents can help: it's especially important to set limits on the nighttime use of electronics. Studies have shown that the light from an tablet or cell phone can keep the brain in a waking, excited state. Quick naps late in the afternoon for 20 minutes or so can take the edge off and temporarily restore alertness.

A separate study published this month in the Journal of Pediatrics found that teenagers who don’t get enough sleep are more likely to become obese. Shakira Suglia of the Mailman School of Public Health at Columbia University and colleagues found that about a fifth of the 16-year-olds reported getting less than six hours of sleep a night, in a survey of 10,000 teens and young adults. Those with less sleep were 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep

 “Lack of sleep in your teenage years can stack the deck against you for obesity later in life,” Suglia said in a statement. “Once you’re an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer.”

Read more:
Teen Sleeplessness Piles on Risk for Obesity

Wednesday, August 20, 2014


THE SLEEP EDUCATION CONSORTIUM (S.E.C.) is Excited to Announce the Start of the A.W.A.K.E. GREATER HOUSTON Monthly Patient Advocacy Group for Individuals Suffering from Obstructive Sleep Apnea and Other Sleep Disorders.

A.W.A.K.E. is a national patient advocacy group sponsored by the American Sleep Apnea Association. Its mission is to increase awareness and education about Obstructive Sleep Apnea.
The A.W.A.K.E. GREATER HOUSTON chapter will meet monthly on a rotating cycle of three locations: the Houston Medical Center, The Woodlands, and Sugar Land. Meetings will start with patient discussion, followed by a brief interactive lecture about varying sleep disorders. These lectures will be given by local sleep specialists and will encourage patient Sleep Disorders. and education about Obstructive Sleep Apnea. involvement in the topics discussed.

The first meeting will be on Tuesday, August 26, 2014
At Comprehensive Sleep Medicine Associates
15423 Creek Bend Drive, Sugar Land, TX 77478

Patient Discussion Begins – 6:30 P.M.
Physician presentations:
Overview of Obstructive Sleep Apnea – 7:00 P.M.
Dental Appliances as an alternative treatment to CPAP – 7:20 P.M.
Discussion will follow the conclusion of the lectures.

RSVP by calling 281-269-7881 or by sending an email to

Tuesday, July 29, 2014

Sleep deprivation isn't always obvious.

"Sleep debt" (or sleep deficit) is the difference between the amount of sleep you should be getting and the amount you actually get. This difference represents a deficit which increases every time we skim some extra minutes off our nightly sleep.
"People accumulate sleep debt surreptitiously," says psychiatrist William C. Dement, founder of the Stanford University Sleep Clinic. In fact, studies have shown that such short-term sleep deprivation leads to a "foggy brain", worsened vision, impaired driving and problems in short-term memory. Long-term effects include obesity, insulin resistance, and heart disease.
And most Americans suffer from chronic deprivation. A 2005 survey by the National Sleep Foundation reports that, on average, Americans sleep 6.9 hours per night -6.8 hours during the week and 7.4 hours on the weekends: experts recommend eight hours of sleep per night.
The problem is that after a long period of sleep deprivation, you stop realizing how tired you actually are.

In a study by the University of Pennsylvania School of Medicine, researchers followed three groups of subjects for 14 days; one group slept for eight hours a night, the second group slept for six hours a night, and the third group slept just four hours a night. Cognitive tests after the two-week period showed that the people with only six hours of sleep a night showed similar reaction times as people with a blood alcohol content of 0.1 percent; a level which is considered legally impaired.

Other studies have indicated that a consistent lack of sleep may cause permanent damage to your brain
One in particular, also conducted by the University of Pennsylvania School of Medicine and published in The Journal of Neuroscience looked at lab mice that were kept awake to replicate the kind of sleep loss common in modern life, through night shifts or long hours in the office.
The team studied certain brain cells which are involved in keeping the brain alert. After several days of sleep patterns similar to those followed by night workers - three days of night shifts with only four to five hours sleep in 24 hours - the mice lost 25% of the brain cells in vital parts of the brain stem.

After only a night or two of sleep deficit, a few nights of adequate sleep are usually enough to reverse the effects and "recharge" your system. But chronic sleep deprivation may be harder to recover from.
For information on how to increase your sleep drive and improve your waking hours, take a look at our  sleep hygiene recommendations. If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem.

Sleep-Deprived People Can’t Tell They’re Sleep-Deprived; Melissa Dahl,
Lost sleep leads to loss of brain cells, study suggests; Helen Briggs, BBC News

Sunday, July 13, 2014

Fragmented sleep could be as physically harmful as a total lack of sleep.

It will come as no surprise to new parents struggling after a night of feeds or doctors on call, but being woken up in the night is as detrimental as getting just four hours of sleep. Just one night of interrupted sleep may negatively affect mood, attention span and cognitive ability according to a new study from Tel Aviv University, published in the journal Sleep Medicine.

In the last 50 years, sleep research has focused on sleep deprivation, and practically ignored the impact of night-wakings, which is a pervasive phenomenon for people from many walks of life. Directors of the study hope that their work will bring this to the attention of scientists and clinicians, who should recognize the price paid by individuals who have to endure frequent night-wakings.

Researchers studied the sleep patterns of 61 healthy adults, 40 of which were females between the ages of 20 and 29 years old, were traced at their homes using actigraphy and sleep diaries. Subjects slept a full eight-hours one night, followed by a night of interrupted sleep in which they received four phone calls directing them to complete a brief computer exercise before returning to bed. The interruptions were designed to keep participants awake for a period of 10 to 15 minutes. The morning after both nights, the volunteers completed tasks to measure their attention span and emotional state: results proved that just one night of interrupted sleep had negative effects on mood, attention span and cognitive ability.

While they found few significant differences between interrupted sleep and sleep deprivation, the differences between the aforementioned conditions and a normal night's sleep were vast. Results indicate an increase in depression, fatigue and confusion in addition to diminished vigor and motivation when sleep is interrupted or restricted.

This means that even when people get a total of seven hours sleep a night, being forced to wake up for regular 15 minute feeds, or consultations, will leave them feeling like they had just four hours rest. “The sleep of many parents is often disrupted by external sources such as a crying baby demanding care during the night,” said Professor Avi Sadeh and a team of researchers from Tel Aviv University's School of Psychological Sciences. Doctors on call, who may receive several phone calls a night, also experience disruptions. These night wakings could be relatively short - only five to ten minutes - but they disrupt the natural sleep rhythm.

These effects accumulate and therefore the functional price new parents-who awaken three to ten times a night for months on end-pay for common infant sleep disturbance is enormous.
Besides the physical effects of interrupted sleep, parents often develop feelings of anger toward their infants and then feel guilty about these negative feelings. The findings bear relevance to substantial portions of the population whose sleep is regularly fragmented including medical students, shift workers, military personnel and parents.
Professionals as well as the general public should be aware of the detrimental effects of the various kinds of disruption in sleep on daily functioning and mood and consider countermeasures to minimise their consequences.

For more information on how you can get a good night's sleep visit our website at

Study: Interrupted Sleep May Be as Harmful as No Sleep at All- Melissa Hellmann, TIME Magazine July 9, 2014

Tuesday, June 24, 2014

Commercial Drivers Still at High Risk From "Drowsy Driving"

The issue of sleep-deprived or "drowsy" driving has made the news again following the tragic June 7 accident involving the comedian Tracy Morgan. Prosecutors say that the Walmart truck driver whose tractor-trailer slammed into a van, critically injuring Mr. Morgan and killing another passenger, had not slept in over 24 hours.
Drowsy driving is a leading cause of crashes and highway fatalities, according to federal officials: more than 30,000 people die on highways annually in the United States and crashes involving large trucks are responsible for one in seven of those deaths.
Federal rules introduced last year reduced the maximum workweek for truckers from 82 to 70 hours, after which drivers have a mandatory 34-hour resting period. This “restart” must include two periods between 1 a.m. and 5 a.m. to allow drivers to rest at least two nights a week: they cannot drive for more than 11 hours a day and must have a 30-minute break in their schedule.

But the trucking industry has been battling to get the new nighttime-break regulations repealed. On June 6, Senator Susan Collins, Republican of Maine, pushed an amendment through the Senate Appropriations Committee that would freeze the rules, pending further studies. Ms. Collins said the administration had failed to take into account that the new rules would put more trucks on the roads during peak traffic hours. Trucking officials and executives also said that drivers needed to be afforded maximum flexibility in their work and should not be told when to rest.

Safety investigators said that sleepy or drowsy driving is a far more common problem than most people realize, but how extensive the problem is remains a matter of debate, partly because it is difficult to obtain evidence that drivers fell asleep. In 1990, a National Transportation Safety Board study of 182 heavy-truck accidents in which the truck driver died concluded that fatigue played a role in 31 percent of the cases, more than alcohol or drugs.
But the American Trucking Associations said that a federal database of fatal crashes cited fatigue in less than 2 percent of police reports about accidents involving trucks; a more accurate estimate, they claim, is that driver fatigue plays a role in about 7 percent of truck crashes. “Until we have a blood test for determining fatigue, all estimates are likely going to under-report fatigue, because the dead don’t speak and the living often plead the Fifth, especially if they are facing criminal charges,” said Deborah A. P. Hersman, former chairwoman of the N.T.S.B. and now the president and chief executive of the National Safety Council.

The Transportation Department has proposed that all interstate commercial truck and bus companies be required to use electronic logging devices to increase compliance with driving-hour rules. Paper logs are easier to manipulate and more difficult for law enforcement officials to verify. The comment period for the rule is scheduled to end this month. Some commercial truck fleets already such devices. For instance, Walmart’s trucks have GPS and electronic logging systems, which track where the vehicles are and what they are doing. A Walmart spokeswoman said the truck involved in the accident that injured Mr. Morgan, who remains in a New Jersey hospital, was also outfitted with anti-collision technology, which is supposed to alert drivers if there is a car in a neighboring lane when they activate their turn signal, for example. It is also supposed to slow the truck down automatically if it is approaching slow-moving or stopped traffic. Citing the incomplete investigation, Walmart declined to provide specifics on the accident or the driver’s schedule in the days leading up to the crash.

Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep. The average person requires 7 to 8 hours of sleep per night. If a person routinely gets less than this, it will most likely cause excessive daytime sleepiness. Another common problem can be sleeping in a noisy environment. This can cause many short awakenings, so brief that a person doesn't remember them the next morning. This results in non-restful sleep with resulting excessive daytime sleepiness. If a person gets 8 hours of sleep a night and still feels sleepy during the day, one should consider that they may have a medical problem which hinders their ability to obtain restful sleep.
For more information on the causes of "drowsy driving" and how you can get treatment for the sleep-related issues involved, visit Dr.Simmon's website at

Truckers Resist Rules on Sleep, Despite Risks of Drowsy Driving (NYT, June 16, 2014

Monday, June 9, 2014

Good Sleep Helps Consolidate and Strengthen New Memories

In a recent article published in Science Magazine, researchers from NYU Langone Medical Center have shown that sleep after learning encourages the growth of dendritic spines, tiny protrusions that connect brain cells and facilitate the passage of information across synapses. The laboratory  research, conducted on mice, concludes that the activity of brain cells during deep or slow-wave sleep after learning is critical for such growth.

These findings provide important physical evidence to support a hypothesis that sleep helps consolidate and strengthen new memories, and they show how learning and sleep can cause physical changes in the motor cortex, a brain region responsible for voluntary movements. 
It is well known that sleep plays an important role in learning and memory, but the underlying physical mechanism responsible weren't understood until now. On the cellular level, brain cells that spark as we digest new information during waking hours "replay" during slow-wave sleep, when the brain waves slow down and rapid-eye movement and dreaming stop. Scientists have long believed that this nocturnal replay helps us form and recall new memories, yet the structural changes of this process have remained poorly understood.

The scientists employed mice which had been genetically engineered with a fluorescent protein in their neurons. Using a special laser-scanning microscope that illuminates the fluorescent proteins in the motor cortex, they were then able to track and image the growth of dendritic spines along individual branches of dendrites both before and after the mice learned to balance on a spinning rod.
They trained two sets of mice: one set spent an hour on the spinning rod and then slept for 7 hours: the second trained for the same period of time but was kept awake for 7 hours. The sleep-deprived mice experienced significantly less dendritic spine growth than the well-rested mice.

The scientists also showed that brain cells in the motor cortex that activate when mice learn a task reactivate during slow-wave deep sleep. Disrupting this process prevents dendritic spine growth. Their findings offer an important insight into the functional role of neuronal replay -the process by which the sleeping brain rehearses tasks learned during the day- observed in the motor cortex.

Wednesday, May 21, 2014

Study Ties Children’s Sleep Quality To Obesity Rates

A new study published in the journal Pediatrics suggests that infants and young children who regularly get insufficient sleep may face a greater risk of obesity by age 7.

Researchers from Massachusetts General Hospital for Children analyzed data from 1,046 children and gathered information from the children's mothers at 6 months, 3 years and 7 years. They also compiled information from questionnaires completed by the children when they were ages 1, 2, 4, 5 and 6.
The interviews with the mothers included questions about their children's sleep duration at night and during nap time.

When the children were age 7, the researchers gathered information on their height and weight, as well as their lean body mass, waist and hip circumference, total body fat and abdominal fat. The researchers then assigned sleep scores to the children based on their levels of sleep throughout the entire study period, with 0 being the highest levels of insufficient sleep and 13 being the lowest levels of insufficient sleep (no reports of insufficient sleep).
The average sleep score among the children was 10.2; more than half of children in the study did not experience much sleep curtailment over the study period. A little more than 4 percent of the children received a score of 0 to 4, 12.3 percent received a score of 5 to 7, and 14.1 percent scored 8 to 9. However, 28.8 percent received a score of 10 to 11, and 40.3 percent received a score of 12 to 13.

Researchers found an association between sleep curtailment and obesity, with sleep curtailment at all ages being associated with higher levels of measurements indicative of obesity. Kids who received the lowest sleep scores had higher total and trunk fat mass index, as well as higher waist and hip circumferences, compared with kids who received the highest sleep scores. There was also an association between lower sleep scores and socioeconomic factors, such as household income and maternal education. However, even after adjusting for these factors, researchers still found the association between sleep curtailment and obesity.

While this is hardly the first study to show an association between inadequate sleep and obesity, this study is unique in that it looked at sleep curtailment over time. Another recent study in the journal Childhood Obesity showed that one of the three most significant obesity risk factors for preschoolers is insufficient sleep (the other two are having a parent who is overweight or obese, and having parents who restrict the preschooler's eating because of weight control). The Society of Behavioral Medicine has also released a study which showed that sleep seemed to be associated with weight especially among low-income kids, with normal-weight children sleeping about a half hour more than overweight or obese children.

The study can't tell whether the missed sleep actually caused the kids to put on fat; it's possible that some factor the authors didn't account for was the real culprit. But there are several theories that might tie curtailed sleep to obesity, including the ebb and flow of hormones that control hunger.
Much of the research on mechanisms depends on findings in adults, and additional factors may be at play in kids, according to a lead author of the study. For example, a poor sleep routine at home also means that eating and meal patterns are probably also disrupted in those homes.

Dr. Jerald Simmons is active in treating pediatric sleep disorders and has long stressed the importance of proper sleep habits and patterns for kids. Childhood sleep disorders have also been linked to ADD and ADHD. For more information visit our website at

Thursday, May 15, 2014

F.D.A. Recommends Lower Dose of Lunesta Sleeping Pill

As part of the agency’s continuing effort to reduce sleep aids’ risky side effects such as drowsiness while driving, the Food and Drug Administration has announced that people prescribed the sleeping pill Lunesta should be starting with half the current recommended dose of two milligrams.

The dosage change is based, in part, on findings from a study of 91 healthy adults ages 25 to 40. The study shows, compared to an inactive pill (placebo), Lunesta 3 mg was associated with severe next-morning psychomotor and memory impairment in both men and women 7.5 hours after taking the drug. The study found that recommended doses can cause impairment to driving skills, memory, and coordination as long as 11 hours after the drug is taken. Despite these long-lasting effects, patients were often unaware they were impaired.

Taken at bedtime, the recommended starting dose of Lunesta (eszopiclone) has been decreased from 2 milligrams to 1 mg for both men and women. The 1 mg dose can be increased to 2 mg or 3 mg if needed, but the higher doses are more likely to result in next-day impairment of driving and other activities that require full alertness. Using lower doses means less drug will remain in the body in the morning hours.
Patients currently taking the 2 mg and 3 mg doses of Lunesta should contact their health care professional to ask for instructions on how to continue to take their medicine safely at a dose that is best for them.

According to IMS Health, a health care services company, about 55 million prescriptions for sleep aids were dispensed in the United States in 2013. Lunesta represents a relatively small part of that market, with about three million pills prescribed.
It was not the first time the agency has reduced the recommended dose of sleeping pills. In January 2013, the FDA said that doses of Ambien and other sleeping pills that contain zolpidem should be halved for women. The agency also told manufacturers that labels should recommend that health care providers “consider” prescribing lower doses for men.

Drowsiness is listed as a common side effect for all insomnia drugs, along with warnings that people may still feel drowsy the next day after taking one of these products. The FDA is continuing to evaluate the risk of impaired mental alertness with the entire class of sleep drugs, including over-the-counter drugs, and will update the public as new information becomes available.

Studies show that sleepiness can impair driving performance as much or more so than alcohol; the American Automobile Association (AAA) estimates that one out of every six (16.5%) deadly traffic accidents, and one out of eight (12.5%) crashes requiring hospitalization of car drivers or passengers is due to drowsy driving.  To learn more about the dangers of poor sleep habits and how you can get a better night's sleep, visit us at the HoustonSleepNet.

FDA News Release: May 15, 2014

Wednesday, April 23, 2014

Rapid-eye-movement sleep behavior disorder (REMBD) may be an indicator for Alzheimer's, Parkinson's Disease

Researchers at the University of Toronto say a sleep disorder that causes people to act out their dreams is the best current predictor of brain diseases like Parkinson's and Alzheimer's.
According to an article in Trends in Neurosciences, John Peever, MD, associate professor at the University of Toronto suggests the link occurs because brain degeneration attacks the brain circuits controlling REM sleep before it attacks those areas involved in Parkinson’s, Alzheimer’s, and other neurodegenerative conditions.

Sleep occurs in five distinct phases; the the fifth stage is REM, the the most active sleep phase in which you’re most likely to dream. The REM stage is also when you may find yourself twitching or tossing.
During normal REM sleep your brain temporarily paralyzes your muscles, but in people with REM sleep behavior disorder (REMBD) this paralysis ceases to occur; they may act out their dreams, resulting in injury to themselves and/or their bed partner.

The new research examines the idea that neurodegeneration might first affect areas of the brain that control sleep before attacking brain areas that cause more common brain diseases like Alzheimer’s. REMBD is most common in older men – 90 percent of people who develop it are male, and most are over the age of 50. Scientists already knew REMBD was associated with certain brain disorders including Parkinson’s: previous research has shown that approximately 30 percent of people diagnosed with REMBD will develop Parkinson’s within three years. However, the new study suggests that  80 to 90 percent of people who develop REM sleep behavior disorder will develop degenerative brain disease within the near future.

Medications are available for many of these conditions that can delay or slow progression of the disease when taken early enough, so REMBD could serve as an alert to do so. Once you’re diagnosed with REMBD the usual treatment is a muscle relaxant such as clonazepam (Clomid or Klonopin). However this new research suggests it’s a good idea for anyone diagnosed with REMBD to have a complete workup for Parkinson’s, Alzheimer’s, dementia, and other brain disorders.

Dr. Peever suggests that “...It’s important for clinicians to recognize RBD as a potential indication of brain disease in order to diagnose patients at an earlier stage. This is important because drugs that reduce neurodegeneration could be used in RBD patients to prevent (or protect) them from developing more severe degenerative disorders.”


Breakdown in REM sleep circuitry underlies REM sleep behavior disorder (Abstract; Trends in Neuroscience, 03/04/2014
Specific Sleep Disorder Associated with Brain Diseases: Psyche Central

Monday, April 7, 2014

Engineer in fatal Bronx train derailment had sleep apnea

The commuter train engineer at the center of last year's deadly derailment in the Bronx was found to have obstructive sleep apnea that went undiagnosed before the Dec. 1 derailment, a sleep medicine doctor said in the National Transportation Safety Board's investigation docket. Rockefeller told investigators that he felt fine that day, but experienced something like highway hypnosis as he stared straight ahead at the tracks. "I came up with that hypnotized feeling, dazed, that's what I was in," he said. "The only thing that shook me out of it was the feeling of the train. Something wasn't right with it.
" He activated the emergency brake, but it was too late. The train derailed as it headed around a sharp curve at 82 miles per hour, nearly three times the speed limit.

A report on Rockefeller's medical history revealed he had never been tested for a sleeping disorder by any of his doctors prior to the accident. He had a history of snoring but "not of choking or gasping" awake. His sleep was disrupted as much as 65 times per hour, the report stated.
Sleep apnea occurs when a person involuntarily stops breathing while asleep. Rockefeller's lawyer said that
"...He had absolutely no idea of this condition prior to the diagnosis. It was exacerbated by the change in shifts two weeks earlier."

 Excessive daytime drowsiness is a tendency to sleep at inappropriate times regardless of activity or circumstance. It can manifest itself in mild or severe forms.
Excessive daytime sleepiness is a common problem in today's society. It is so common that in some circles people almost consider it a normal aspect of a productive society. The fact is that daytime sleepiness and fatigue are leading causes of accidents, both on the job and on the road. The cost to society is estimated in billions of dollars per year. There are several common causes for increased daytime sleepiness. The simplest cause of daytime sleepiness that can be corrected results from insufficient sleep.

A common medical problem that can cause increased daytime sleepiness results from having a breathing problem during sleep. Snoring for example, is a form of obstructed breathing. Obstructive breathing can make it difficult to breathe properly during sleep and can even cause a complete blockage in the airway during which breathing stops. Breathing is re-established with a brief disruption of sleep and possibly a brief gasp or choking sound.

Another common medical problem causing frequent disruptions of sleep is called Periodic Limb Movements of Sleep. This occurs when a person has multiple brief leg movements every 20 to 60 seconds for long periods during the night. These leg movements can fragment sleep, resulting in increased daytime sleepiness. Frequently people with this problem also have what is called Restless Legs Syndrome (RLS). RLS occurs when a person is sitting still or lying in bed, which makes it difficult to keep their legs still. This frequently can keep people awake, causing insomnia. People with this problem feel that moving their legs relieves this restless sensation.

These problems are all treatable. Unfortunately, many physicians are not yet familiar with treating these conditions. Ask your doctor about treatment and feel free to have your doctor contact us for questions on diagnosis and treatment for these conditions.
If you have a problem with daytime sleepiness and you have increased your sleep length without improving your daytime sleepiness, then you should be evaluated by a Sleep Disorders Specialist. With proper care most people can obtain the treatment they need to improve this problem. Contact us today at 281-407-6222 or visit  for more information.

Thursday, March 27, 2014

Learn about how your sleeping habits affect your epilepsy and what you can do to improve your health

The Epilepsy Awareness Houston Support Group presents a program on 
"How your sleeping habits affect your epilepsy and what you can do to improve your health."

Tuesday, April 8, 2014 from 6:00 to 8:00 pm., 
at 2401 Fountain View Dr.,Suite 900, (9th Floor),
Houston, Texas 77057

With special guest speaker Dr. Jerald H. Simmons:
Triple board-certified in Neurology, Sleep Medicine and Epilepsy, Dr. Simmons’ main focus has always been the specialty of Sleep Disorders Medicine. He trained in Sleep Medicine at Stanford University, then co-directed the University of California Sleep Disorders Center in Los Angeles. He was recruited to Houston to develop and direct the Sadler Clinic Sleep Disorders Center, which he did for 13 years, while also founding his private practice, Comprehensive Sleep Medicine Associates. Always eager to teach, he is the founding director of the Sleep Education Consortium, a nationally recognized, non-profit organization that provides medical education seminars on sleep disorders to phy- sicians, dentists, health care professionals and the community. He continues to be published by many peer reviewed journals and conducts research studies to improve the field of sleep medicine

Friday, March 14, 2014

Sleep disorders may cause ADD/ADHD

For more than three decades, there has been a growing recognition that some people have difficulty focusing and maintaining attention; in various instances, they also may have difficulty sitting peacefully in a classroom
or calm setting. These individuals have been labeled with attention deficit disorder - with or without hyperactivity -known as ADD/ADHD.

Traditional treatment for ADD/ADHD has been with stimulant medications, such as Ritalin or Adderall, which provide improvement by stimulating a fatigued, unrested brain. It is now known that problems with sleep can result in difficulties with concentration and the ability to stay focused during the day. The increased physical activity -hyperactivity - displayed by many of those affected is a way of remaining stimulated, thus overcoming the sleepiness. This difficulty is most noted when sitting inactive and under-stimulated.

About 30 percent of these patients have a sleep disturbance as a fundamental cause according to Dr. Simmons, who has treated these types of patients for over 20 years. If a sleep disorder is present, there are other treatment options for improvement of the ADD/ADHD symptoms.
"If there is a concern that a child or adult has ADD/ADHD, then it is imperative to first make a few observations regarding the person's sleep in order to determine whether a sleep disorder center consultation is necessary, prior to starting stimulant drugs," Dr. Simmons continued. "In many cases, those who have been placed on stimulants can be successfully taken off them if a sleep problem has been properly diagnosed and treated. For years now, I have taken this approach and many patients labeled with ADD/ADHD in whom we have diagnosed with a sleep disturbance have demonstrated dramatic improvement after treating the sleep disorder. This treatment has minimized or eliminated their reliance on stimulant medications."

The main causes for the disturbed sleep in the ADD/ADHD population are lack of sleep due to domestic/environmental factors in the home, restless legs syndrome or obstructive sleep apnea, or an associated condition known as the Upper Airway Resistance Syndrome.

UARS is a subtle breathing disorder not properly diagnosed at most sleep centers; but by utilizing extra measures Dr. Simmons' team is able to recognize and treat this disorder properly. "We look at a whole battery of issues when someone complains of ADD/ ADHD, including both psychological and physiological factors," Simmons said. "I've seen many patients improve when we treat their sleep without the need for stimulants."

An example of one such patient is Trey Girlinghouse, a 9-year-old whose teachers became concerned with his difficulties in school. They encouraged his mother to find medical assistance for what they labeled as ADD; he was placed on stimulant medication treatment, but his mother was concerned about medication usage and looked for alternative treatments.
She had Trey evaluated by Dr. Simmons, and after a comprehensive sleep test he was found to have UARS. He then began treatment for this breathing disorder and is no longer on stimulants: he has also markedly improved his performance at school.
"Now that his sleep is better and he does better at school, the teachers agree that he no longer needs to be on medications," his mother said.

Dr. Simmons provides this partial list of signs which should raise concerns when considering whether ADD/ADHD may be associated with a sleep disturbance:
  •  Difficulty falling asleep 
  • Difficulty staying asleep 
  • Snoring or labored breathing 
  • Kicking repetitively during the night 
  • Excessively grinding or clenching teeth 
  • Difficulty awakening in the morning 
  • Sleep walking or sleep talking 
  •  Noticeable sleepiness during the day when not active

If someone has any of these indicators and appears to suffer with ADD/ADHD symptoms, then a proper sleep evaluation would be warranted. Patients can be evaluated by contacting CSMA's sleep centers throughout Greater Houston at 281-407-6222.
Visit for more information and fill out our questionnaire to initiate an evaluation.

Wednesday, March 5, 2014

"Infant sleep machines" could damage babies' hearing

Sleep machines are devices designed placed next to the baby's crib and designed to help babies sleep more soundly. They work by generating ambient or "white" noise, masking other noises from around the house or outside that could disturb the baby. Websites promoting these machines often suggest that parents and childminders should have the device on continually while a child is sleeping: a common recommendation is that the volume of the sounds played by the machine should be equal to or louder than the cry of an infant. Many parents say their babies become so used to the sounds of rainfall or birds that they will not nap without them.

But researchers at the University of Toronto evaluated 14 popular sleep machines at maximum volume and found they produced between 68.8 to 92.9 decibels at 30 centimeters, about the distance one might be placed from an infant’s head. Three exceeded 85 decibels, the workplace safety limit for adults on an eight-hour shift for accumulated exposure as determined by National Institute for Occupational Safety and Health. One machine was so loud that two hours of use would exceed workplace noise limits.

At 100 centimeters, all the machines tested were louder than the 50-decibel limit averaged over an hour set for hospital nurseries in 1999 by an expert panel concerned with improving newborn sleep and their speech intelligibility. 

As infants are still developing and have much smaller ear canals than adults, it is possible that babies are more susceptible to the adverse effects of noise levels than adults.

The researchers think that safe use of these devices could be possible, but only with policy recommendations that set appropriate limits on the manufacture and use of the devices.
They recommend that families using infant sleep machines should place the device as far away as possible from the baby, and never in the crib or on the rail of the crib, only play the sleep machine at a low volume and only play the sleep machine for a short duration of time.
The study authors also recommended that manufacturers limit the maximum noise level of infant sleep machines. 

Another concern briefly raised in the Pediatrics study is whether listening to white noise can be detrimental to auditory development. A 2003 study published in the journal Science found continuous white noise delayed development of the brain’s hearing center in newborn rats.
In humans, the brain of a newborn is learning to differentiate sounds at different pitches even during sleep, said Lisa L. Hunter, scientific director of research in the division of audiology at Cincinnati Children’s Hospital.
“If you’ve conditioned them to white noise, there’s every indication that they might not be as responsive as they otherwise should be to soft speech,” she said.

Infant Sleep Machines and Hazardous Sound Pressure Levels: PEDIATRICS ( journal of the American Academy of Pediatrics);

Thursday, February 13, 2014

Non-Restorative Sleep May Lead To Pain In Older Adults

New researcher indicates that "non-restorative sleep" is the biggest risk factor for the development of widespread pain in older adults.

Widespread pain that affects different parts of the body, a primary characteristic of fibromyalgia, affects 15 percent of women and 10 percent of men over age 50 according to previous studies.
The researchers collected data on pain, psychological and physical health, lifestyle and demographic information from 4,326 adults over the age of 50 who were free of widespread pain at the start of the study (1562 subjects reported no pain and 2764 had some pain). These participants were followed up three years later for the development of widespread pain.

The results, published Feb. 13 in Arthritis & Rheumatology, show that restless sleep as well as anxiety, memory problems and poor health play a role in the development of this type of pain. Specifically, The researchers found that pain status, anxiety, physical health-related quality of life, cognitive complaint and non-restorative sleep were all associated with increased risk of widespread pain development, after adjusting for osteoarthritis (OA).

Three years after the study began the researchers found that 19 percent of the participants had new widespread pain which was worse for those who had some pain at the beginning of the study; of those with some prior pain, 25 percent had new widespread pain. Meanwhile, 8 percent of those with no pain at the start of the study had widespread pain three years later.

Dr John McBeth from the Arthritis Research UK Primary Care Centre at Keele University in Staffordshire, said: "While OA is linked to new onset of widespread pain, our findings also found that poor sleep, cognition, and physical and psychological health may increase pain risk. Combined interventions that treat both site-specific and widespread pain are needed for older adults."
The results showed that non-restorative sleep – gauged by waking up feeling tired and worn out even after getting the usual amount of sleep – "was the strongest predictor of new onset widespread pain."
"We have previously shown that among persons with widespread pain, restorative sleep predicted symptom resolution," the paper said. "Together these data suggest that sleep may offer a modifiable target to improve outcome in this patient group."

Increasing age was linked to a lower chance of developing widespread pain: muscle, bone and nerve pain is more common among older people. Up to 80 percent of people 65 and older experience some form of pain on a daily basis, according to the news release.
While the study finds an association between poor sleep and widespread pain, it does not establish a direct cause-and-effect relationship.

The sleep centers directed by Jerald H. Simmons, MD utilize advanced methods to properly diagnose and treat patients suffering from non-restorative sleep and fibromyalgia.
Dr. Simmons concludes that "In the future we will look back and see how much we didn't understand, but unless we embrace the knowledge of our experience we will never reach that future perspective."
For more information on sleep disorders and the sleep centers of  Dr. Simmons visit

Thursday, January 30, 2014

"Fitness Trackers" may provide misleading information on your sleep quality.

As wearable fitness trackers have become en vogue, physicians are voicing growing concerns over their actual usefulness in a patient's health regime. These devices count your steps, measure your sleep and some even monitor your heart rate, however most of them rely on simple accelerometers and their methods of interpreting the data may not be as accurate as they lead you to believe.

Experts say that while most trackers can in theory tell when a person is awake versus asleep, they are prone to mistakes. And as far as distinguishing sleep stages, trackers that include only an accelerometer as their sensor, "can't do what they claim," said Hawley Montgomery-Downs, a sleep researcher and associate professor at West Virginia University, who has studied the accuracy of sleep trackers. A persons sleep is usually evaluated through a scientifically structured sleep lab test, known as polysomnography.
In 2011, Montgomery-Downs and colleagues compared data from  trackers to polysomnography tests, looking at adults who wore trackers while also undergoing an overnight sleep test. They found that the tracker overestimated the time participants were asleep by 67 minutes, on average.
"It says you are asleep more often than you accurately are," Montgomery-Downs said. The study also found that an actigraph, another device that also uses an accelerometer to monitor sleep and is sometimes used in sleep studies, overestimated sleep time by 43 minutes. Another study, presented at a sleep researchers' meeting in November 2013, found the opposite effect in children -the tracker underestimated how long the children were asleep by 109 minutes.

Although an accelerometer monitors your movement, "you move the same amount whether you're in deep sleep, or lighter stages of sleep," Montgomery-Downs said. Experts worry there may be a danger in consumers putting too much trust in these devices to accurately monitor sleep, especially users who have sleep disorders.
For people without sleep disorders, using a fitness monitor to track sleep isn't going to hurt or help them,
but if someone does present with a sleep disorder, tracking sleep with one of these monitors might give them a false reassurance. And sleep trackers with only an accelerometer cannot provide much insight into the quality of sleep. For instance, a person with sleep apnea may stop breathing 300 times a night, but this wouldn't be detected.

According To Dr. Jerald Simmons, a sleep study provides important information about what occurs during sleep and is designed to identify factors that cause sleep disruption. Typically, a study is done to identify breathing problems or limb movement problems during sleep. Once asleep, being hooked up to the wires does not prevent these types abnormal events from occurring. However, it is important that a person falls asleep during the test.It is important to mention that a sleep study is not designed to identify causes for difficulty falling asleep. If a person’s main sleep problem is difficulty falling asleep, treatment can be initiated without a sleep study, but does require a detailed assessment by a Medical Doctor, Nurse practitioner or Physician Assistant who understands the issues of Sleep Medicine.

CSMA's sleep centers throughout Greater Houston provide treatment to patients sufferering from snoring and obstructive sleep apnea disorders. For more information on how to stop snoring and obtain help for sleep apnea call us today at (281) 407-6222.

References: Fitness Trackers & Sleep: How Accurate Are They? -Rachael Rettner, January 20, 2014 fitness trackers and sleep

Sunday, January 12, 2014

TMJ (TMD) and Sleep Bruxism Associated with OSA

Teeth clenching or grinding - known as bruxism - is a common problem that may lead to headaches, facial pain and TMJ disorder.

 Bruxism has puzzled dentists and physicians for years, limiting the successful treatment of these disorders. Research conducted by neurologist and sleep disorder specialist Jerald H. Simmons, M.D. has demonstrated that a main cause of bruxism relates to breathing problems during sleep, such as snoring and obstructive sleep apnea. Years of observation and experience in treating patients with OSA and bruxism led him to recognized the relationship of these conditions; with the assistance of Ron Prehn, DDS, they began studies on more than 700 patients with OSA.
This is the first research in the world to conclusively demonstrate that bruxism during sleep is actually an attempt to bring the jaw and tongue forward. Nocturnal bruxism stops the back of the tongue from blocking the airway and, is the brain's way of preventing this blockage from occurring.

Dr. Simmons treats patients with a variety of methods including CPAP masks that fit over the nose to deliver positive pressure; special dental appliances that bring the jaw forward to open the back of the airway, and in some cases surgical procedures which remove crowded tissue in the back of the throat. In some patients a combination of all these treatments are needed. Dr. Prehn has assisted in designing customized CPAP masks for some patients which are held on the face using a special dental appliance, eliminating the need for straps on the head and chin.

One of Dr. Simmons' patients,  Diane F. states that "... I saw multiple doctors, and none of them were able to take care of my symptoms. As soon as Dr. Simmons' treatment opened up my airway, my clenching stopped... I think Dr. Simmons' research has found that missing link."

Other conditions treated at Dr. Simmons Sleep Center, Comprehensive Sleep Medicine Associates (CSMA) include:
ADHD, which is now recognized to frequently result from poor, non-restorative sleep;
Fibromyalgia and Chronic Fatigue, both of which are also recognized as a result of sleep problems; and
• Morning headaches, a condition usually resulting from disturbances in sleep that is not properly diagnosed in many patients.

Doctors Simmons and Prehn have presented their results to dentists and physicians at national medical and dental conferences. This new concept has created a wave of interest within the dental field, as most dentists are challenged by patients with bruxism. They have a new prospective and alternative approach in treating these patients.
"It is amazing how much improvement we can provide in patients by properly treating disturbances in their sleep," Dr. Simmons said.

CSMA's sleep centers, founded and directed by Dr. Simmons, are found throughout the greater Houston area. For more information about his work and the sleep center, visit