Today's #Sleeptember FACT --- Cancer and its treatments can cause enduring sleep problems

#SLEEPTEMBER

If you or a loved one has cancer, you probably already know this first hand: Cancer can lead to all sorts of problems with sleep.

The cancer itself can wreak havoc on the body in such a way that it either leads to extreme daytime somnolence and fatigue, nightmare syndrome or the curse of insomnia. Anxiety about cancer can lead to poor sleep. The pain that cancer causes can also make sleeping nearly impossible due to comfort issues. Add to the mix a variety of cancer treatments (and their delivery systems) as additional challenges to achieving quality sleep while fighting to overcome cancer. Good sleep helps the body heal, but it's just so hard to get good sleep as a cancer patient.

According to the National Institutes of Health National Cancer Institute,

Sleep disorders are more common in people with cancer... as many as half of patients with cancer have problems sleeping.

Their website offers a wealth information about the relationship between sleep and cancer at their website. They discuss the impact of hospital stays, tumors, stress, drugs and other conditions on both cancer and sleep quality. They also discuss sleep health assessments and solutions for sleep problems that could offer many cancer patients relief and even aid in their healing.

• Learn more about identifying and treating sleep disorders in cancer patients at the National Cancer Institute
• Read about poor sleep and its potential to increase your cancer risk from the National Sleep Foundation
• Discover how poor sleep can impact a cancer patient's recovery rate from the American Academy of Sleep Medicine

Guest Post: Insights into the recent ASV device recall

CURATOR'S NOTE: Recent news of studies calling into question the safety of using the ASV/BiPAP Auto SV technologies have many patients concerned about their apnea therapies. Here's an overview of these technologies by registered sleep technologist Rui de Sousa, who has guest posted here at SHC in the past. 

Following his post below are further updates I was able to gather from this week's special session on this topic held at the Association of Professional Sleep Societies meeting held in Seattle. 


Rui de Sousa is a Canadian sleep technologist with over 20 years experience helping patients sleep better in and around the greater Toronto area. Rui is also heavily involved in educating new sleep technologists and the public, for whom he has presented educational forums. Rui has published several chapters in a medical textbook, articles in local newspapers, and has been interviewed on TV and on the radio. He also keeps abreast of the latest knowledge, techniques and technologies attending local and international conferences. He was recently in attendance at the Seattle SLEEP2015 event where the subject of the ASV/BiPAP device restrictions was discussed in special session. _____________________________________
Insights into the recent ASV device recall

Most of you have heard of Obstructive Sleep Apnea (OSA). You know, when you stop breathing in your sleep because the airway becomes obstructed. The best way to treat this condition, at this time, is the Positive Airway Pressure, or PAP machine. Continuous Positive Airway Pressure, or CPAP, is the most common form of this therapy. It is the machine that connects to a mask which blows air at one steady pressure into your airway to keep it from collapsing. Another variant of PAP is the BiLevel PAP (BiPAP), which blows air at two different pressures, one when you inhale, and a lower pressure when you exhale. What many of you haven't heard of is Central Sleep Apnea (CSA). What exactly is it? With CSA, the airway is wide open, but your brain fails to signal to your lungs and diaphragm to breathe while you are asleep. The drive to breathe is gone; in essence, you are just holding your breath. The reasons why people may suffer from CSA are varied, but basically they fall into two camps: Neurological (the brain is the cause) and cardiological (the heart is the cause).
Both CPAP nor BiPAP are very effective in treating OSA, but not with CSA, because the openness of the airway is not at issue for CSA. But fear not, people much smarter than I have come up with ingenious machines to help that much smaller population who struggle with CSA. These devices, introduced in 2005, may look like regular CPAP machines and masks, but they work much differently. Known as the Adaptive Servo-Ventilator (ASV – by ResMed) or the BiPAP AutoSV (or BiPAP AutoSV Advanced) by Respironics, these machines use complex algorithms that adapt to the way you normally breathe, and try to mimic that when you are asleep, even when your body falters in sending or receiving the signals to breathe. 
Does it work? Surprisingly, it works rather well. These machines are indeed a huge step forward in the way we treat more complicated cases of sleep apnea not caused by obstructions. Even better, technologists have adjusted the algorithms for these therapies to target different diseases where CSA is a symptom, such as ALS (aka Lou Gehrig's Disease) and Chronic Obstructive Pulmonary Disease (COPD).  
OK! Great News... so what's the problem?
One of the target populations for this new generation of PAP therapy includes patients with heart failure. Heart disease can be a cause of CSA, and the ASV/BiPAP AutoSV technologies have been widely used in these patients to treat, reduce and even eliminate their apneas. 
However, in early May 2015, the SERVE-HF--a multinational, multicenter, randomized controlled Phase IV study (fancy words for a large and important study)--showed that for a specific sub-population of people who are in heart failure, ASV/BiPAP AutoSV therapies are actually doing more harm than good. Specifically, they identified those people with symptomatic chronic heart failure (LVEF* of less than or equal to 45%) as being at higher risk for death while using these therapies, even though their apneas may actually be eliminated or controlled.
Right now, the researchers are unclear why this is happening. Many smart researchers and doctors are working hard to understand whether the machine itself is causing the problem, or whether the actual apneas are somehow a protective mechanism within these patients, or whether it is something else entirely. 
As soon as word of the study results reached the manufacturers of these devices, both international companies recalled their use in those cases where patients using them belong to this very specific population: of people with symptomatic chronic heart failure. By no means does this suggest that all PAP therapies are dangerous, because the others are completely safe and effective and they have not been recalled for anybody. It is specifically the ASV/BiPAP AutoSV therapy model and the chronic heart disease patient who are affected by this change. Please continue to use your CPAP or BiPAP machine as prescribed, and if you are using an ASV/BiPAP AutoSV device, please contact your doctor immediately to confirm you should still be using it. Chances are, if you are an active user who belongs to the at-risk group, you have already been contacted by your physician. But if you haven't, and you are the least bit concerned, don't hesitate to make the phone call to confirm your prescription protocol. The best protection against fear is knowledge and facts. The CPAP is still the “gold standard” in treating OSA. The ASV/BiPAP AutoSV are still extremely valuable tools in treating CSA. If you have any concerns, please have them answered by a knowledgeable and competent professional. *Left Ventricular Ejection Fraction: Left ventricular ejection fraction (LVEF) is the measurement of how much blood is being pumped out of the left ventricle of the heart (the main pumping chamber) with each contraction. -- Definition from the Cleveland Clinic
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UPDATES FROM THE CURATOR At this week's SLEEP 2015 meeting in Seattle, which hosts three separate organizations (Sleep Research Society, American Academy of Sleep Medicine, and the American Association of Sleep Technologists), a special session devoted to this discussion, "ASV Therapy for CSA Patients with Heart Failure: SERVE-HF Results," took place on Monday June 8 and featured sleep activist and physician Dr. Timothy Morgenthaler of the Mayo Clinic and Dr. Glenn Richard, Chief Medical Officer for ResMed. Here are some additional details I was able to cull from that conversation.

1. The SERVE-HF study itself is not published; therefore, there are actually no conclusive results to share publicly about this latest finding. Many outstanding questions remain and the researchers involved are going over every detail to try to understand these recent (and unexpected) outcomes. They will put together their findings as soon as they are able.
   
   Some history: It was deemed by mid-April that the study should be closed due to proven risk factors encountered in overviews of the study's raw data.  The plan initially was for the results of SERVE-HF to be released formally in September. However, in mid-May, the American Academy of Sleep Medicine and the American Thoracic Society, in cooperation with ResMed, acted promptly by supporting the Field Safety Notice released by ResMed, as described above.
   Patient safety is a concern for all involved and expands to include Respironics, ResMed's technological competitor, who will also actively engage in review of the data from the SERVE-HF study to determine why the ASV/BiPAP AutoSV devices may be putting a very specific population group at risk. 
   
2. It is important to note that the people for whom this technology is most risky comprise a very small, specific population.
   
   • Patients have severe ventricular dysfunction. • Patients had measurable LVEF of less than or equal to 45%. • Patients belonged to a category of cardiac disease severity: NYHA class III or IV
3. Discontinuing use of ASV is ultimately a decision best left up to the patient and their doctor. Some patients who fit this very specific criteria are still continuing to use ASV because they have seen notable improvements in their health and feel it is worth the risk to continue. ASV has been delisted as a "standard" protocol for treatment for this particular population of patients and is now being listed as a "guideline" "in the absence of more reliable data" (Morganthaler). It is important for doctors to disclose to patients their potential for harm by using this device and to discuss further use of this therapy. Patients will likely need to sign additional documents verifying they fully understand their risks before continuing to use ASV/BiPAP AutoSV.
4. Initial safety of these devices was approved based on short-term primary outcome measures at a time when long-term outcome data were not yet available. The SERVE-HF represents one of the first long-term studies. 
5. The main question that was spawned from this study, "Why this result?" has, currently, the following as possible answers: a. There could be occult confounding variables. In layman's terms, that means there might be other factors not measured during the study, such as patient medication use compliance or something else yet to be discovered, that could have contributed to this outcome. b. ASV may not be a good therapy for these patients specifically because it could dampen signals connecting cardiac activity to the brain and the respiratory system. Only further research will be able to determine whether this is true. c. Maybe the abnormal respiratory patterns associated with CSA--Cheyne-Stokes Respiration--are actually positive mechanisms for these patients.
6. Other options for patients in this category who are currently on ASV can include the following: a. CPAP + oxygen therapy b. Stand-alone Oxygen therapy
7. The final takeaway: As with all medications, all therapies, including mechanical one likes ASV/BiPAP AutoSV, are NEVER risk-free. It is up to the patient, ultimately, to ask the doctor to clarify the risk-benefit ratio first in order to decide whether to start, to continue or to discontinue any kind of therapy, including this one. Be an informed patient; ask your doctor for all the details and make your medical decisions based on all the information available to you.

News from the curator, literally

Readers of this website will find a few things shifting in terms of content over the next few months. This is due to the fact that the curator is currently writing a book on sleep hygiene and needs to shift priorities in order to keep the manuscript on track for a January 2016 launch. It all takes time and we all get just 24 hours in a day.

The content posting schedule will shift to a frequency of 3-4 times weekly. You will still receive tons of great, up-to-date information, and guest bloggers have signed on to share their expertise, too, but content delivery will just happen less than the 5-6 times weekly that has been the norm these last nine months.

Also, readers have probably already noticed that the newsletter feature with its monthly giveaway has been suspended for the time being, mostly because it was taking a lot of extra work and time away from both the maintenance of the website and the writing of the book.

However, the loss of the newsletter is the website follower's gain! The newsletter's prime value--the news beat, itself!--will be added in a new feature here at SHC every Friday as a review of the week's sleep health news. Also, the quarterly clinical studies opportunities list which was included in the newsletter will also be reported on here at the website as well.

Note also that June, in particular, will be a non-themed month. This is partly due to the shift in behind-the-scenes efforts here.

But June also bring good fortune: the annual national conference on sleep medicine, SLEEP 2015, hosted by the Associated Professional Sleep Societies (the American Academy of Sleep Medicine, the American Association of Sleep Technologists, and the Sleep Research Society), takes place the second week of June in the region where SHC is located: Seattle.

You can be sure that SHC will be there with bells on for 12-15 hour days of symposia and networking, but that means a quiet website here during and immediately afterward, so all the latest sleep health information can be gathered and processed for eventual sharing on SHC. We can't wait to report back on new developments in sleep medicine!

July and August will be non-themed months as well, but themes will return in September with a Back to School focus that includes lots of information about the growing Start School Later campaign, as well as all kinds of other sleep-related topics related to kids.

Thanks for reading our content here at SleepyHeadCENTRAL and for supporting our efforts to improve sleep health through consumer education. As always, you can write to us directly with questions, suggestions and concerns.

INSOMNIA: What is CBTi? A quick guide to non-drug therapy for insomnia

Many people believe the only treatments available for chronic insomnia require drugs. The truth is, there is a non-drug therapy for insomnia which has been around for a while that can be very effective in treating insomnia. CBTi stands for Cognitive Behavioral Therapy for Insomnia, and it is often used by psychotherapists who have training in sleep medicine to treat insomnia disorders. Sometimes it is used in conjunction with sleep aids, but it can also be used with patients who are trying to wean themselves off of hypnotic drugs in an effort to try to sleep better naturally. 

Essentially, CBTi is a structured behavioral training approach which helps insomniacs to identify and replace thinking and actions which lead to or aggravate preexisting insomnia. This practical therapeutic training can help insomniacs discover, then overcome the root causes of their sleeplessness. 

Some techniques for CBTi can include (this list is not exhaustive): 

• Biofeedback. Observing your biological signs (heart rate, respiration, muscle tension, etc.) so you can see what needs to be adjusted, using a take-home device.
• Relaxation training. Mind and body helps, such as meditation, self-hypnosis, yogic breathing, muscle relaxation, etc. 
• Sleep hygiene. What we talk about all the time in SHC: better lifestyle habits lead to better sleep habits! 
• Sleep restriction. This is the strategic decrease of time in bed which helps to reset the sleep drive. Usually requires sticking to an odd schedule for a while.
• Sleep space improvement. It's not silly to rethink sensory comforts like bedding, lighting, even aromatherapy.
• Stimulus control therapy. This helps break down thought processes ("racing thoughts") that encourage resistance to sleep. 
• Relapse prevention. Behaviors can return; a good CBTi therapist can offer tools to prevent this from happening.

CBTi may not work immediately as it requires behavioral modification, unlike a sleep aid like Ambien, which you just take at night and (with any luck) fall asleep. For people who are impatient to find sleep again, these are therapies that require time and earnest effort. If you are resistant to the notion of using therapy to fix your insomnia problems, consider this: 

However, the problem with the vast majority of drugs used to facilitate sleep is that they have unsafe side effects, can negatively interact with other maintenance drugs and are often only meant for short-term use as they can be addicting or easily habituated to. For many insomniacs, drugs simply do not work because they are at best a temporary, Band-Aid solution, whereas the value in CBTi lies in the fact that this therapy can help address and conquer the underlying reasons for not sleeping.

CBTi also works for other kinds of sleep problems, such as adult acclimation to CPAP therapy, pediatric difficulties with falling or staying asleep and anyone suffering from recurrent nightmares.

Below is a quick list of excellent, in-depth resources on CBTi. If you have insomnia and have had no luck with prescription or over-the-counter sleep aids and your friends' home remedies aren't working either, please consider giving CBTi a try. Most insurance will cover it, and you can often meet with more than one practitioner in a free consult to determine if they are a good match for you. Ask them what kinds of therapies they support and get patient testimonials, whenever possible.

NATIONAL SLEEP FOUNDATION || Cognitive Behavior Therapy for Insomnia

SLEEPDEX || Cognitive Behavioral Therapy for Insomnia

STANFORD HEALTH CARE || Cognitive Behavioral Therapy for Insomnia (CBTi)

MAYO CLINIC || Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

AMERICAN ACADEMY OF SLEEP MEDICINE || "Cognitive behavioral therapy is an effective treatment for chronic insomnia." Published June 9, 2009; accessed March 28, 2015.

“New Developments in Cognitive Behavioral Therapy as the First-Line Treatment of Insomnia.” Siebern, Allison T, and Rachel Manber. Psychology research and behavior management 4 (2011): 21–28. PMC. Web. 28 Mar. 2015. [PDF]

NPR: SHOTS || Working With A Therapist Can Help When Sleeping Pills Don't

INSOMNIA: The AASM gets more patient-centered on treatments for insomnia

On March 13, the American Academy of Sleep Medicine (AASM) announced new efforts to more actively unite sleep physicians and their insomnia patients toward a more successful partnership. This new process-outcome effort could be a boost for hundreds of thousands of insomniacs who have struggled for years with sleeplessness or potential misdiagnoses or cycled through numerous failed drug and behavioral treatments. It could also create a more standard, nationwide healthcare approach to diagnosing and treating insomnia in the years ahead.

The Affordable Care Act (ACA), which focuses largely on patient-centered outcomes and more cost-effective healthcare, prompted the AASM to pull together specific ways for sleep physicians to measure diagnoses and therapies on a broad scale in order to answer the critical question,

“What insomnia assessment and treatment processes lead
to the best outcomes at the least cost per average patient?” 

It's an answer demanded not only by the ACA, but by thousands of insomnia patients and sleep physicians. Insomnia is considered a high prevalence sleep disorder with significant health and cost impacts for both patients and healthcare providers. However, insomnia and its various treatments have not been studied closely enough on a large scale to show conclusive evidence of positive outcomes for specific therapies. Insomnia is a complex sleep disorder that involves medical, behavioral and pharmacological review, but without standardized protocol for researching, diagnosing or treating it, both physicians and patients are often left on their own to look for solutions. These new efforts hope to change this.

The following processes will be implemented in the future by AASM-accredited healthcare providers in an effort to better answer this question:

1. Assessment of sleep quality
   This means that staff at sleep clinics and centers may be tasked with doing more to determine an insomnia patient's overall sleep quality (including efficiency of sleep). Patients may be required to answer more questions about their sleep habits.
2. Delivery of evidence-based treatment
   This means that staff at sleep clinics and centers will be tasked with doing more to deliver (and keep better records of) evidence-based treatment. Providers may be required to follow more specific treatment protocols based on evidence-backed scientific data.
3. Assessment of daytime functioning
   This means that staff at sleep clinics and centers may be tasked with doing more to determine the level of an insomnia patient's daytime functioning (memory, problem solving, job performance, physical performance, etc.). Patients may be required to answer questions about their daytime activities, job performance, and/or cognitive functioning.
4. Assessment of side effects of treatments
   This means that staff at sleep clinics and centers may be tasked with keeping better records of treatments and their side effects. More careful collection of data accessible to larger electronic record databases could help researchers crunch more accurate numbers related to real-world insomnia diagnoses and therapies than can otherwise be found in a small-range study. 

Meanwhile, the following patient outcomes have been defined as goals for achieving answers to the same fundamental question cited above:

1. Provision of accurate insomnia diagnosis
   This means that staff at sleep clinics and centers may be tasked with doing more to prove a conclusive and accurate diagnosis. This can mean working harder to achieve a differential diagnosis to make sure a patient with insomnia isn't experiencing their symptoms due to another hidden disorder.
2. Improvement of sleep satisfaction or quality
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient achieve measurably better sleep quality. There could be much more communication between the patient and the clinic during treatment to ensure patients are committed and adherent to their therapies, for instance.
3. Improve of daytime functioning
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient achieve measurably improved daytime function. This may mean more communication between the patient and the clinic to see if job performance, memory or cognitive function has improved.
4. Minimization of treatment-related adverse effects 
   This means that staff at sleep clinics and centers may be tasked with working harder to help the insomnia patient better manage their medications and side effects. Patient may be asked to report side effects regularly and may have their entire drug list reviewed to ensure no drug interactions or improper dosing has occurred.

While these are efforts that physicians' clinics make (or should be making) already, these new directives could mean more proof of their implementation in a way that can help show more reliable evidence when treatments succeed or fail, as patient outcomes will depend on both patient cooperation and more standardized approaches to diagnosis and treatment. These proposed measures are complex and require the earnest participation of not only the patient and their physician, but all of the core healthcare workers involved in any single appointment.

The AASM hopes these new efforts will constitute a fresh starting point for discovering new and better technologies for diagnosis insomnia and therapies for its treatment, plus more comprehensive record keeping and improvements to healthcare settings that benefit both patients and their providers. Once patients cycle through this new system, outcomes should be more effectively measured, lighting the way for more accurate diagnoses, improved insomnia management and the facilitation of important, conclusive process-outcome research needed to get to the bottom of one of America's most common sleep disorders.

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Source

"Quality measures for the care of patients with insomnia." Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Journal of Clinical Sleep Medicine 2015;11(3):311–334.

ABCs of Sleep---D is for DME

DME: Durable Medical Equipment, defined as any equipment used for repeated medical therapy, especially at home. DME is acquired by prescription through an MD. DME for sleep includes PAP machines, oxygen supplementation equipment, invasive mechanical ventilators for home use, portable pulse oximeters and respiratory assist devices. What's important to note is that DME used for home health services may be reimbursable under Medicare's Part A and Part B plans.

There are also nonMedicare DME suppliers in the field of sleep medicine; their products ideally (but voluntarily) undergo an accreditation process through the American Association of Sleep Medicine (AASM) in order to show a commitment to quality control and patient support.

Sleep patients with a need for daily therapeutic equipment such as CPAP have an ongoing relationship with a DME provider either directly or through their connection with a local hospital or free-standing sleep lab or clinic. Some are more vigilant than others about servicing patient equipment and helping with general compliance, fit and replacements. When it comes to DME, sleep patients should demand the highest level of customer service and quality assurance if they are to extract benefits from their particular mechanical therapies. 

Links to learn more:

• DME Accreditation || American Association of Sleep Medicine
• New Medicare PAP Regulations || Sleep Health Centers
• One example of communications problems between patients, physicians and DME providers || Sleep Guide forum
• DME in the Sleep Lab || BinarySleep.com

____________________

*SOURCE for DEFINITIONS:
USLegal.com

ABCs of Sleep---C is for CPAP

A typical CPAP machine is small
enough to put on your nightstand
and includes a humidifier and
other simple adjustments.

CPAP

Continuous Positive Airway Pressure. A device for treating obstructive sleep apnea and other sleep-related breathing disorders.

____________________

CPAP is a common therapy which involves wearing a mask hooked to a machine delivering continuous air pressure in order to "splint open" the upper airway to prevent sleep obstruction. CPAP therapy is considered the gold standard for treating apneas.

This nasal mask is light enough to be
comfortable while still being an  effective
aid for improved breathing while asleep.

CPAP machines don't actually deliver oxygen to the patient airway via the mask, they just provide the right amount of pressure through the mask to keep the patient's airway "patent" or open. This kind of therapy helps keep the patient fully oxygenated while asleep, preventing a wide array of homeostatic problems such as hypoventilation, oxidative stress on the heart and hypertension. In fact, CPAP is considered a life-saving, life-altering device. Many patients have added years to their lives after using this therapy. Most patients, once adapted and compliant to CPAP therapy, report increased energy during the day and more restful sleep at night.

There are multiple versions of PAP therapies, including Bi-Pap and AutoPap, which regulate pressures through algorithms and preset programs to make the experience of breathing simpler and more comfortable for those with additional or multiple respiratory issues.

Today's CPAP therapy uses various kinds of masks to deliver the pressure, include oral nasal masks with or without chin straps, nasal pillows and full face masks. The technology has rapidly improved in recent years so that machines are far more quiet and deliver more comfortable pressure using built-in humidifiers; the masks today are also made of ultralight hospital grade silicone which is more light and flexible than previous masks.


Links to learn more:

What is CPAP? || National Heart, Lung and Blood Institute
How CPAP controls sleep apnea || Mayo Clinic (VIDEO)
Sleep and CPAP Adherence || National Sleep Foundation
AASM Recommendations for Treatment || SleepWell Solutions

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*SOURCE for DEFINITIONS:
Spriggs, WH. (2010.) Glossary. In Essentials of Polysomnography (pp585-606). Sudbury, MA: Jones and Bartlett Publishers

So you want to deprive yourself of sleep in order to go shopping today?

"Black Friday" (2013) by Powhusku. CC BY-SA 2.0

The following short list (for complete source: AASM.net) reveals the many ways in which sleep deprivation can legitimately impact your behavior.

SHC tries to imagine how sleep deprivation might affect someone who is shopping at Oh-Dark-Thirty on Black Friday, a post-Thanksgiving American event in the 21st century wherein "savvy" consumers forgo a night's rest in order to stand in line to shop in the wee hours while the rest of the world is asleep. Let's just see how savvy you might be if you're running on zero hours of sleep, shall we?

Irritability -- You easily participate in wrestling matches over sales tables that would embarrass your four-year-old twin boys

Anxiety -- You suffer panic attacks at empty shelves in the toy aisles and have to sit on the cold tile floor with your head between your knees to stop hyperventilating

Symptoms of depression -- You weep when you discover you left your coupons at home--WITH your shopping list

Lack of concentration -- What were you shopping for again?

Attention deficits -- What were you shopping for again?

Longer reaction times -- After your third shopping cart crash you just decide to play bumper cars with everyone else instead

Distractibility -- You ask a clerk: "Excuse me, can you help me find the... Squirrel?"

Lack of energy -- The checkout line is 20 deep and your arms can't hold your stuff any longer, but you are too bushed to go get a cart and then you would lose your not-so-great-already spot in line, so... you plant it all in a pile on the ground and push it forward with your equally exhausted feet every 10 minutes until you finally get to the counter... and then the clerk takes a break and you have to start all over again.

Fatigue -- You collapse on a bench with your receipts in hand, plastic bag handles knotted to your fingers, your wallet shoved down the front of your pants, to take "a short nap"

Restlessness -- You think: "Will they EVER open more checkout stands? EVER??? Did they NOT know we were COMING??? Let's-go-let's-go-let's-go-let's-go!"

Lack of coordination -- You have cell phone dropsies, then shopping list oopsies, and now you are secretly replacing the jewelry box that you fumbled and broke in aisle 9 on the shelf, hoping nobody, including the security camera staring at you right now, saw you. Then you take a perfect nonbroken one and walk away, trip, and break that one, too

Poor decisions -- You wanted the TV for $199 but it's gone, so just... just get the $399 one and be done with it! (Forget that you logically know you can still get it for $199 online and might even be able to order it by phone right there in that moment.)

Increased errors -- You keep asking the clerk to recount your change and discover you are the one counting it wrong as the numbers on the bills and coins swim before your bloodshot eyes

Forgetfulness -- What were you shopping for again?

New technologies: Blue light blocking shields for electronics

Perhaps you know, intellectually, that you need to turn off your laptop or your phone or tablet right before bed because you know that blue spectrum light emission may be part of the problem behind your insomnia. And yet... let's be perfectly honest here: the habit of checking email one more time, playing one more game of Words with Friends before going to bed, or even reading a book on your tablet at bedtime can be very hard to kick.

Finally there's a solution to help with this dilemma. SleepShield has developed a line of screen shields which are designed to block blue light emissions on everything from phones to tablets to game consoles to laptops.

These shields, which you apply directly to the screen, are composed of high-grade PET anti-blue light film which reduces the amount of blue spectrum light emitted from your personal electronics. These films have a 93 percent transparency rate and the manufacturer promises they won't alter the color of the screen being shielded.

SleepShield screen films are recommended by Dr. Michael J. Breus PhD, known on the Internet as "The Sleep Doctor." Breus is a clinical psychologist who works with the American Board of Sleep Medicine and the American Academy of Sleep Medicine to educate the public about sleep health.

If you have trouble with insomnia, and you regularly work on a backlit electronic screen up until bedtime, you may wish to try out this nonpharmaceutical solution to your sleep problems if you are unable to kick your electronics habit.

AASM News Headlines, Summer 2014 Edition: New insomnia pill; Pledge to "stop the snore;" Relaxis Pad for RLS; CDC shows striking rise in sleep related clinic visits

Here are some links to AASM news posted between June and mid-August 2014. For more news, visit the AASM here.

FDA approves new sleeping pill Belsomra (suvorexant) for insomnia
Suvorexant (Belsomra) tablets were approved by the FDA on August 13, 2014 for the treatment of insomnia. Suvorexant is a receptor antagonist for the neurotransmitter orexin; it functions by altering the brain's chemical signals responsible for regulating the sleep-wake cycle. Studies show that patients taking suvorexant tend to fall asleep faster and spend less time awake after sleep onset when compared to those taking placebo. Next-day drowsiness is the medication's most common side effect. More information

Stop the snore: AASM urges sleep apnea action for those at risk
Obstructive sleep apnea (OSA) is a potentially life-threatening disease that afflicts at least 25 million American adults. Untreated OSA can increase your risk for serious health problems like heart disease, stroke, diabetes and depression. Did you know that snoring is its most common warning sign? If you snore, or you know someone who snores, it's worth checking out, as OSA is fairly simple to treat. Interested in "stopping the snore?" Take the Pledge.

FDA clears the Relaxis Pad for treatment of restless legs syndrome
A new nonpharmaceutical treatment for Restless Legs Syndrome (RLS), a health condition that can significantly disrupt sleep patterns, is now available through Sensory Medical. The Relaxis Pad is a noninvasive device which emits vibratory counterstimulation to relieve pain and tension in the legs at bedtime. As many as 12 million Americans suffer from RLS, which can rob the body of deep, restorative sleep. Many sufferers go undiagnosed as the symptoms of RLS often resemble stress, arthritis, muscle cramps, or are often attributed to the “normal effects” of aging. Its nonpharmaceutical value makes the Relaxis Pad a breakthrough medical device for many. More information

CDC study examines national trends in office visits for sleep problems
The number and percentage of office visits for sleep related problems, and the number and percentage of office visits accompanied by a prescription for a sleep medication, have increased significantly since 1999. Most striking were increases in the number of office visits resulting in the acquisition of prescription sleep aids. Read the abstract here.

The American Academy of Sleep Medicine (AASM) is the only regulatory, professional organization dedicated exclusively to sleep health. It sets standards and promotes excellence in sleep-related healthcare, education and research and is comprised of nearly 12,000 accredited sleep labs and sleep professionals across the US.