Number of sleep-disorder facilities growing as Kentuckians admit they're tired

The number of sleep-disorder facilities in Kentucky doubled from 25 to 52 in the past 10 years, part of a nationwide trend to help the 70 million Americans who have trouble getting some shuteye.

"Demand growth is a result of more physicians being better educated to recognize sleep deprivation symptoms as well as the public having more and better access to information and advertising that focuses on it," reports Anne Charles Doolin in an in-depth piece for The Lane Report. "Changes in insurance reimbursement also is playing a major part in the accredited facility surge."

Estimates show Americans suffer from more than 80 kinds of sleep disorders, though 85 percent of people are undiagnosed. "When we look at the most common sleep disorder, sleep apnea, we have evidence that demonstrates 25 percent of men are at risk and 9 percent of women are at risk," said Kathryn Hansen, executive director of the Kentucky Sleep Society.

In general, people don't think sleep problems can be fixed. "A typical patient is a male, in his 50s, slightly overweight," said Dr. Pam Combs, a cardiologist who has been studying sleep issues since the 1990s. "They don't think about sleep problems as the problem. They just think they're getting old and tired."

But not getting a good night's rest "is associated with a myriad of health conditions, and mental health conditions, and it undoubtedly affects productivity," said Dr. Ryan Wetzler, a clinical psychologist at Louisville's Sleep Medicine Specialists. "When you get a patient who has taken two hours to go to sleep for years or even decades, getting maybe four hours of sleep a night, and then with treatment they fall asleep quickly and get seven hours a night, it's a huge difference."

"Addressing the problem means less illness, less missed work and more productivity," said neurologist James M. Thompson. It's also less costly. Sleep disorders, sleep deprivation and sleepiness add up to about $15.9 billion to the national health care bill, the National Center on Sleep Disorders Research has found. "Other costs to society for related health problems, lost worker productivity and accidents can't be calculated, but educated guesses begin at 10 times NCSDR's health care cost tally," Doolin reports.

The assessment of sleep disorders has become more widely accepted as a field of study, with a recognized board exam, formal training programs and journals, said Dr. Barbara Phillips, director of the Sleep Center at the University of Kentucky Good Samaritan Hospital. But not all changes have been positive, with some fly-by-night "apnea mills" popping up "where the focus is on lucrative testing, and actual patient care and follow-up get shortchanged," Phillips said. (Read more)

Rising Star of Brain Found to Regulate Circadian Rhythms

Apr 14 2011

BOSTON (April 14, 2011, noon ET) — The circadian system that controls normal sleep patterns is regulated by a group of glial brain cells called astrocytes, according to a study published online on April 14th in Current Biology, a Cell Press publication. Neuroscientists from Tufts University School of Medicine found that disruption of astrocyte function in fruit flies (Drosophila) led to altered daily rhythms, an indication that these star-shaped glial cells contribute to the control of circadian behavior. These results provide, for the first time, a tractable genetic model to study the role of astrocytes in circadian rhythms and sleep disorders.

According to the National Institute of Neurological Disorders and Stroke, more than 40 million Americans suffer from sleep disorders. Some sleep disorders arise from changes to the internal clock that is modulated by environmental signals, including light. Biologically, the internal clock is known to be composed of a network of neurons that controls rhythmic behaviors. Rob Jackson and his team previously had found that normal circadian rhythms require a glial-specific protein. In the new study, the team demonstrates that glia, and particularly astrocytes, are active cellular elements of the neural circuit that controls circadian rhythms in the adult brain.

“This is significant because glia have been traditionally viewed as support cells rather than independent elements that can regulate neurons and behavior. Neurons have had center stage for some time but current research is establishing the role of glial cells in brain function,” said Rob Jackson, PhD, professor of neuroscience at Tufts University School of Medicine (TUSM) and member of the genetics and neuroscience program faculties at the Sackler School of Graduate Biomedical Sciences at Tufts. Jackson is also the director of the Center for Neuroscience Research (CNR) at TUSM.

“We used cellular and molecular genetic techniques to manipulate glial cells in the adult brain of fruit flies and found that such cells regulate neurons of the circadian network and behavior,” said first author Fanny Ng, PhD, a postdoctoral associate in the Jackson lab. Ng added, “this is the first study to show that glia can modulate the release of a neuronal factor that is essential for normal circadian behavior.”

Jackson’s team observed altered rhythms in locomotor activity with glial manipulations, an indication the circadian clock had been disrupted, which in humans can contribute to jet lag or serious sleep disorders.

“In order to develop treatments for these disorders, we need to understand their cellular and molecular bases. Our work suggests that Drosophila can serve as a model system for genetic and molecular approaches to understand astrocyte function and astrocyte-neuron interactions. This undoubtedly will contribute to a better understanding of sleep and other neurological disorders that result from circadian dysfunction,” said Jackson.

An additional author on this paper is Michelle Tangredi, PhD, a graduate of the Sackler program in neuroscience and a postdoctoral associate in Jackson’s lab.

This research was funded by grants from the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke (NINDS) and a training grant from the National Institute of Child Health and Human Development, all of the National Institutes of Health, and an award from the Russo Family Charitable Foundation Trust through TUSM. The Center for Neuroscience Research is funded by NINDS and Tufts University.

Ng FS, Tangredi MM, and Jackson FR. Current Biology. “Glial cells physiologically modulate clock neurons and circadian behavior in a calcium-dependent manner.” DOI 10.1016/j.cub.2011.03.027

About Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences

Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, biomedical sciences, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level. Ranked among the top in the nation, the School of Medicine is affiliated with six major teaching hospitals and more than 30 health care facilities. Tufts University School of Medicine and the Sackler School undertake research that is consistently rated among the highest in the nation for its effect on the advancement of medical science.