Optimistic people sleep better, longer

August 7, 2019

Science Daily/University of Illinois at Urbana-Champaign, News Bureau

People who are the most optimistic tend to be better sleepers, a study of young and middle-aged adults found.

More than 3,500 people ages 32-51 were included in the study sample. The participants included people in Birmingham, Alabama; Oakland, California; Chicago; and Minneapolis.

The research was led by Rosalba Hernandez, a professor of social work at the University of Illinois.

"Results from this study revealed significant associations between optimism and various characteristics of self-reported sleep after adjusting for a wide array of variables, including socio-demographic characteristics, health conditions and depressive symptoms," Hernandez said.

Participants' levels of optimism were measured using a 10-item survey, which asked them to rate on a five-point scale how much they agreed with positive statements such as "I'm always optimistic about my future" and with negatively worded sentences such as "I hardly expect things to go my way."

Scores on the survey ranged from six (least optimistic) to 30 (most optimistic).

Participants reported on their sleep twice, five years apart, rating their overall sleep quality and duration during the prior month. The survey also assessed their symptoms of insomnia, difficulty falling asleep and the number of hours of actual sleep they obtained each night.

A subset of the participants was part of an ancillary sleep study based in Chicago and wore activity monitors for three consecutive days -- including two weeknights and one weekend night. Participants wore the monitors on two occasions a year apart.

The monitors collected data on their sleep duration, percent of time asleep and restlessness while sleeping.

Hernandez and her co-authors found that with each standard deviation increase -- the typical distance across data points -- in participants' optimism score they had 78% higher odds of reporting very good sleep quality.

Likewise, individuals with greater levels of optimism were more likely to report that they got adequate sleep, slumbering six to nine hours nightly. And they were 74% more likely to have no symptoms of insomnia and reported less daytime sleepiness.

According to a 2016 report by the Centers for Disease Control and Prevention, about 1 in 3 U.S. adults fails to get adequate sleep, escalating their risks of many chronic diseases.

"The lack of healthy sleep is a public health concern, as poor sleep quality is associated with multiple health problems, including higher risks of obesity, hypertension and all-cause mortality," Hernandez said. "Dispositional optimism -- the belief that positive things will occur in the future -- has emerged as a psychological asset of particular salience for disease-free survival and superior health."

Although a significant and positive association was found between optimism and better-quality sleep, Hernandez suggested that the findings should be interpreted cautiously.

While the scientists aren't sure of the exact mechanism through which optimism influences sleep patterns, they hypothesize that positivity may buffer the effects of stress by promoting adaptive coping, which enables optimists to rest peacefully.

"Optimists are more likely to engage in active problem-focused coping and to interpret stressful events in more positive ways, reducing worry and ruminative thoughts when they're falling asleep and throughout their sleep cycle," Hernandez said.

The findings, published recently in the journal Behavioral Medicine, bolster those of a prior study, in which Hernandez and her co-authors found that optimists ages 45-84 were twice as likely to have ideal heart health.

Kiarri N. Kershaw, Juned Siddique, Honghan Ning and Donald M. Lloyd-Jones, all of Northwestern University; Julia K. Boehm of Chapman University; Laura D. Kubzansky of Harvard University; and Ana Diez-Roux of Drexel University co-wrote that study. That paper was published in the journal Health Behavior and Policy Review in 2015.

The sample for the current study was drawn from the Coronary Artery Risk Development in Young Adults study, which explored the development and progression of cardiovascular disease risk factors in a U.S. sample of non-Hispanic white and African American adults.

https://www.sciencedaily.com/releases/2019/08/190807112941.htm

Sleep interrupted: What's keeping us up at night?

August 6, 2019

Science Daily/Florida Atlantic University

One of the largest longitudinal studies to date examined evening consumption of alcohol, caffeine and nicotine among an African-American cohort and objectively measured sleep outcomes in their natural environments instead of laboratory or observatory settings. The study involved 785 participants and totaled 5,164 days of concurrent actigraphy and daily sleep diaries that recorded how much alcohol, caffeine or nicotine they consumed within four hours of bedtime. Results may be good news for coffee lovers, bad news for smokers.

Between 50 to 70 million Americans have a sleep disorder. Sleepless nights are associated with a number of adverse health outcomes including heart disease, high blood pressure, diabetes, and certain cancers. Evening use of alcohol, caffeine and nicotine are believed to sabotage sleep. Yet, studies examining their effects on sleep are limited by small sample sizes that don't represent racial and ethnic diversity or objective measures of sleep. Furthermore, these investigations have been conducted in laboratory or observatory settings.

Considering the public health importance of getting a good night's sleep and the widespread use of these substances, relatively few studies have thoroughly investigated the association between evening use of alcohol, caffeine and nicotine and sleep parameters.

A study led by a researcher at Florida Atlantic University with collaborators from Brigham and Women's Hospital, Harvard T. H Chan School of Public Health, Harvard Medical School, Emory University the National Institutes of Health, and the University of Mississippi Medical Center, is one of the largest longitudinal investigations to date to examine evening consumption of alcohol, caffeine and nicotine among an African-American cohort with objectively measured sleep outcomes in their natural environments.

Using actigraphy (wrist-watch-like sensor) and concurrent daily sleep diaries, the researchers examined the night-to-night associations of evening use of alcohol, caffeine and nicotine on sleep duration, sleep efficiency and wake after sleep onset. The study involved 785 participants and totaled 5,164 days of concurrent actigraphy and daily sleep diaries that recorded how much alcohol, caffeine or nicotine they consumed within four hours of bedtime.

Results of the study, published in the journal Sleep, may be good news for coffee lovers. The researchers did not find an association between consumption of caffeine within four hours of bedtime with any of the sleep parameters. However, the researchers warn that caffeine dosing, and individual variations in caffeine sensitivity and tolerance, were not able to be measured and can play an important role in the association between caffeine use and sleep.

For smokers and those who enjoy "Happy Hour" or an alcoholic beverage with dinner, the study shows that a night with use of nicotine and/or alcohol within four hours of bedtime demonstrated worse sleep continuity than a night without these substances, even after controlling for age, gender, obesity, level of education, having work/school the next day, and depressive symptoms, anxiety, and stress.

Nicotine was the substance most strongly associated with sleep disruption and yet another reason to quit smoking. There was a statistically significant interaction between evening nicotine use and insomnia in relation to sleep duration. Among participants with insomnia, nightly nicotine use was associated with an average 42.47-minute reduction in sleep duration. The effects of nicotine may be particularly significant among individuals with insomnia.

The results from this study are especially meaningful as they were observed in individuals unselected for sleep problems and who generally had high sleep efficiency. Moreover, they were based on longitudinal data so that the associations can take account of not only between-person differences but also within-person variations in exposures and covariates such as age, obesity, educational attainment, having work/school the next day, and mental health symptomatology.

"African Americans have been underrepresented in studies examining the associations of nicotine, alcohol, and caffeine use on sleep," said Christine E. Spadola, Ph.D., lead author and an assistant professor in FAU's Phyllis and Harvey Sandler School of Social Work within the College for Design and Social Inquiry. "This is especially significant because African Americans are more likely to experience short sleep duration and fragmented sleep compared to non-Hispanic Whites, as well as more deleterious health consequences associated with inadequate sleep than other racial or ethnic groups."

These findings support the importance of sleep health recommendations that promote the restriction of evening alcohol and nicotine use to improve sleep continuity.

https://www.sciencedaily.com/releases/2019/08/190806101604.htm

1 in 300 thrives on very-early-to-bed, very-early-to-rise routine

Many extreme early birds share genetic trait with family members

August 6, 2019

Science Daily/University of California - San Francisco

A quirk of the body clock that lures some people to sleep at 8 p.m., enabling them to greet the new day as early as 4 a.m., may be significantly more common than previously believed.

So-called advanced sleep phase -- previously believed to be very rare -- may affect at least one in 300 adults, according to a study led by UC San Francisco and publishing in the journal SLEEP on Aug. 6, 2019.

Advanced sleep phase means that the body's clock, or circadian rhythm, operates on a schedule hours earlier than most people's, with a premature release of the sleep hormone melatonin and shift in body temperature. The condition is distinct from the early rising that develops with normal aging, as well as the waking in the wee hours experienced by people with depression.

"While most people struggle with getting out of bed at 4 or 5 a.m., people with advanced sleep phase wake up naturally at this time, rested and ready to take on the day," said the study's senior author, Louis Ptacek, MD, professor of neurology at the UCSF School of Medicine. "These extreme early birds tend to function well in the daytime but may have trouble staying awake for social commitments in the evening."

Advanced Sleepers 'Up and at 'Em' on Weekends too

Additionally, "advanced sleepers" rouse more easily than others, he said, and are satisfied with an average of an extra five-to-10 minutes of sleep on non-work days, versus the 30-to-38 minutes' more sleep of their non-advanced sleeper family members.

Ptacek and his colleagues at the University of Utah and the University of Wisconsin calculated the estimated prevalence of advanced sleepers by evaluating data from patients at a sleep disorder clinic over a nine-year period. In total, 2,422 patients were followed, of which 1,748 presented with symptoms of obstructive sleep apnea, a condition that the authors found was not related to sleep-cycle hours.

Among this group, 12 people met initial screening criteria for advanced sleep phase. Four of the 12 declined enrollment in the study and the remaining eight comprised the 0.03 percent of the total number of patients -- or one out of 300 -- that was extrapolated for the general population.

This is a conservative figure, the researchers noted, since it excluded the four patients who did not want to participate in the study and may have met the criteria for advanced sleep phase, as well as those advanced sleepers who had no need to visit a sleep clinic.

Night Owls More Likely to Struggle with Sleep Deficits

"Generally, we find that it's the people with delayed sleep phase -- those night owls that can't sleep until as late as 7 a.m. -- who are more likely to visit a sleep clinic. They have trouble getting up for work and frequently deal with chronic sleep deprivation," said Ptacek.

Criteria for advanced sleep phase include the ability to fall asleep before 8:30 p.m. and wake before 5:30 a.m. regardless of any occupational or social obligations, and having only one sleep period per day. Other criteria include the establishment of this sleep-wake pattern by the age of 30, no use of stimulants or sedatives, no bright lights to aid early rising and no medical conditions that may impact sleep.

All study participants were personally seen by Christopher R. Jones, MD, a former neurologist at the University of Utah and co-author of the paper. Patients were asked about their medical histories and both past and present sleep habits on work days and work-free days. Researchers also looked at sleep logs and level of melatonin in the participants' saliva, as well as sleep studies, or polysomnography, that record brainwaves, oxygen levels in the blood, heart rate and breathing.

Of note, all eight of the advanced sleepers claimed that they had at least one first-degree relative with the same sleep-wake schedule, indicating so-called familial advanced sleep phase. Of the eight relatives tested, three did not meet the full criteria for advanced sleep phase and the authors calculated that the remaining five represented 0.21 percent of the general population.

The authors believe that the percentage of advanced sleepers who have the familial variant may approach 100 percent. However, some participants may have de novo mutations that may be found in their children, but not in parents or siblings, and some may have family members with "nonpenetrant" carrier mutations. Two of the remaining five were found to have genetic mutations that have been identified with familial advanced sleep phase. Conditions associated with these genes include migraine and seasonal affective disorder.

"We hope the results of this study will not only raise awareness of advanced sleep phase and familial advanced sleep phase," said Ptacek, "but also help identify the circadian clock genes and any medical conditions that they may influence."

https://www.sciencedaily.com/releases/2019/08/190806101552.htm

People who eat dark chocolate less likely to be depressed

August 2, 2019

Science Daily/University College London

Eating dark chocolate may positively affect mood and relieve depressive symptoms, finds a new UCL-led study looking at whether different types of chocolate are associated with mood disorders.

The study, published in Depression and Anxiety, is the first to examine the association with depression according to the type of chocolate consumed.

Researchers from UCL worked in collaboration with scientists from the University of Calgary and Alberta Health Services Canada and assessed data from 13,626 adults from the US National Health and Nutrition Examination Survey. Participants' chocolate consumption was assessed against their scores on the Patient Health Questionnaire, which assesses depressive symptoms.

In the cross-sectional study, a range of other factors including height, weight, marital status, ethnicity, education, household income, physical activity, smoking and chronic health problems were also taken into account to ensure the study only measured chocolate's effect on depressive symptoms.

After adjusting for these factors, it was found that individuals who reported eating any dark chocolate in two 24-hour periods had 70 per cent lower odds of reporting clinically relevant depressive symptoms than those who reported not eating chocolate at all. The 25 per cent of chocolate consumers who ate the most chocolate (of any kind, not just dark) were also less likely to report depressive symptoms than those who didn't eat chocolate at all. However researchers found no significant link between any non‐dark chocolate consumption and clinically relevant depressive symptoms.

Depression affects more than 300 million people worldwide, according to the World Health Organisation, and is the leading global cause of disability.

Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: "This study provides some evidence that consumption of chocolate, particularly dark chocolate, may be associated with reduced odds of clinically relevant depressive symptoms.

"However further research is required to clarify the direction of causation -- it could be the case that depression causes people to lose their interest in eating chocolate, or there could be other factors that make people both less likely to eat dark chocolate and to be depressed.

"Should a causal relationship demonstrating a protective effect of chocolate consumption on depressive symptoms be established, the biological mechanism needs to be understood to determine the type and amount of chocolate consumption for optimal depression prevention and management."

Chocolate is widely reported to have mood‐enhancing properties and several mechanisms for a relationship between chocolate and mood have been proposed.

Principally, chocolate contains a number of psychoactive ingredients which produce a feeling of euphoria similar to that of cannabinoid, found in cannabis. It also contains phenylethylamine, a neuromodulator which is believed to be important for regulating people's moods.

Experimental evidence also suggests that mood improvements only take place if the chocolate is palatable and pleasant to eat, which suggests that the experience of enjoying chocolate is an important factor, not just the ingredients present.

While the above is true of all types of chocolate, dark chocolate has a higher concentration of flavonoids, antioxidant chemicals which have been shown to improve inflammatory profiles, which have been shown to play a role in the onset of depression.

https://www.sciencedaily.com/releases/2019/08/190802145458.htm

Compound found in red wine opens door for new treatments for depression, anxiety

Resveratrol, found in grape skin, shuts down depression-causing enzyme in brain

July 29, 2019

Science Daily/University at Buffalo

Like to unwind with a glass of red wine after a stressful day? Don't give alcohol all the credit.

New research has revealed that the plant compound resveratrol, which is found in red wine, displays anti-stress effects by blocking the expression of an enzyme related to the control of stress in the brain, according to a University at Buffalo-led study.

The findings shed light onto how resveratrol impacts neurological processes. According to the Anxiety and Depression Association of America, depression and anxiety disorders affect 16 and 40 million people respectively in the United States.

"Resveratrol may be an effective alternative to drugs for treating patients suffering from depression and anxiety disorders," says Ying Xu, MD, PhD, co-lead author and research associate professor in the UB School of Pharmacy and Pharmaceutical Sciences.

The study, published on July 15 in the journal Neuropharmacology, was also led by Xiaoxing Yin, PhD, professor at Xuzhou Medical University in China.

Protection Against Extreme Stress

Resveratrol, which has been linked to a number of health benefits, is a compound found in the skin and seeds of grapes and berries. While research has identified resveratrol to have antidepressant effects, the compound's relationship to phosphodiesterase 4 (PDE4), an enzyme influenced by the stress hormone corticosterone, was unknown.

Corticosterone regulates the body's response to stress. Too much stress, however, can lead to excessive amounts of the hormone circulating in the brain and, ultimately, the development of depression or other mental disorders.

These unknown physiological relationships make drug therapy complex. Current antidepressants instead focus on serotonin or noradrenaline function in the brain, but only one-third of patients with depression enter full remission in response to these medications, says Xu.

In a study on mice, researchers revealed that PDE4, induced by excessive amounts of corticosterone, causes depression- and anxiety-like behavior.

The enzyme lowers cyclic adenosine monophosphate -- a messenger molecule that signals physiological changes such as cell division, change, migration and death -- in the body, leading to physical alterations in the brain.

Resveratrol displayed neuroprotective effects against corticosterone by inhibiting the expression of PDE4. The research lays the groundwork for the use of the compound in novel antidepressants.

Although red wine contains resveratrol, consumption of alcohol carries various health risks, including addiction.

https://www.sciencedaily.com/releases/2019/07/190729094553.htm

Brains work in sync during music therapy

Researchers make major breakthrough using brain hyperscanning

July 25, 2019

Science Daily/Anglia Ruskin University

For the first time researchers have been able to demonstrate that the brains of a patient and therapist become synchronised during a music therapy session, a breakthrough that could improve future interactions between patients and therapists.

The research, published in the journal Frontiers in Psychology, was carried out by Professor Jorg Fachner and Dr Clemens Maidhof of Anglia Ruskin University (ARU).

This is the first music therapy study to use a procedure called hyperscanning, which records activity in two brains at the same time, allowing researchers to better understand how people interact.

During the session documented in the study, classical music was played as the patient discussed a serious illness in her family. Both patient and therapist wore EEG (electroencephalogram) caps containing sensors, which capture electrical signals in the brain, and the session was recorded in sync with the EEG using video cameras.

Music therapists work towards "moments of change," where they make a meaningful connection with their patient. At one point during this study, the patient's brain activity shifted suddenly from displaying deep negative feelings to a positive peak. Moments later, as the therapist realised the session was working, her scan displayed similar results. In subsequent interviews, both identified that as a moment when they felt the therapy was really working.

The researchers examined activity in the brain's right and left frontal lobes where negative and positive emotions are processed, respectively. By analysing hyperscanning data alongside video footage and a transcript of the session, the researchers were able to demonstrate that brain synchronisation occurs, and also show what a patient-therapist "moment of change" looks like inside the brain.

Lead author Jorg Fachner, Professor of Music, Health and the Brain at Anglia Ruskin University (ARU), said: "This study is a milestone in music therapy research. Music therapists report experiencing emotional changes and connections during therapy, and we've been able to confirm this using data from the brain.

"Music, used therapeutically, can improve wellbeing, and treat conditions including anxiety, depression, autism and dementia. Music therapists have had to rely on the patient's response to judge whether this is working, but by using hyperscanning we can see exactly what is happening in the patient's brain.

"Hyperscanning can show the tiny, otherwise imperceptible, changes that take place during therapy. By highlighting the precise points where sessions have worked best, it could be particularly useful when treating patients for whom verbal communication is challenging. Our findings could also help to better understand emotional processing in other therapeutic interactions."

https://www.sciencedaily.com/releases/2019/07/190725114346.htm

How to consider nature's impact on mental health in city plans

July 24, 2019

Science Daily/University of Washington

Almost one in five adults in the U.S. lives with a mental illness. That statistic is similar worldwide, with an estimated 450 million people currently dealing with a mental or neurological disorder. Of those, only about a third seek treatment.

Interacting with nature is starting to be recognized as one way to improve mental health. A number of scientific studies have shown that nature experiences may benefit people's psychological well-being and cognitive function. But it has been difficult to find ways to quantify these benefits in a useful manner for cities or organizations that want to integrate nature to improve mental health.

Now, an international team led by the University of Washington and Stanford University has created a framework for how city planners and municipalities around the world can start to measure the mental health benefits of nature and incorporate those into plans and policies for cities and their residents. The study will appear July 24 in Science Advances.

"Thinking about the direct mental health benefits that nature contact provides is important to take into account when planning how to conserve nature and integrate it into our cities," said Greg Bratman, lead author and an assistant professor at the UW School of Environmental and Forest Sciences. "The purpose of this paper is to provide a conceptual model of one way we can start to think about doing this."

The study brought together more than two dozen leading experts in the natural, social and health sciences who study aspects of how nature can benefit human well-being. Their first step was to establish a baseline, collective agreement regarding the understanding of the impacts of nature experience on aspects of cognitive functioning, emotional well-being and other dimensions of mental health.

"In hundreds of studies, nature experience is associated with increased happiness, social engagement, and manageability of life tasks, and decreased mental distress," said senior author Gretchen Daily, faculty director at the Stanford Natural Capital Project. "In addition, nature experience is linked to improved cognitive functioning, memory and attention, imagination and creativity, and children's school performance. These links span many dimensions of human experience, and include a greater sense of meaning and purpose in life."

While this line of study is still emerging, experts agree that nature can reduce risk factors for some types of mental illnesses and improve psychological well-being. They also agree that opportunities for nature experiences are dwindling for many people around the world because of urban growth.

"For millennia, many different cultures, traditions, and religious and spiritual practices have spoken directly to our deep relationship with nature. And more recently, using other sets of tools from psychology, public health, landscape architecture and medicine, evidence has been steadily gathering in this emerging, interdisciplinary field," Bratman said.

The study outlines how city planners, landscape architects, developers and others could eventually anticipate the mental health impacts of decisions related to the environment.

Many governments already consider this with regard to other aspects of human health. For example, trees are planted in cities to improve air quality or reduce urban heat island effects, and parks are built in specific neighborhoods to encourage physical activity. But these actions don't usually directly factor in the mental health benefits that trees or a restored park might provide.

"We have entered the urban century, with two-thirds of humanity projected to be living in cities by 2050. At the same time, there is an awakening underway today, to the many values of nature and the risks and costs of its loss," Daily said. "This new work can help inform investments in livability and sustainability of the world's cities."

The research team built a conceptual model that can be used to make meaningful, informed decisions about environmental projects and how they may impact mental health. It includes four steps for planners to consider: elements of nature included in a project, say at a school or across the whole city; the amount of contact people will have with nature; how people interact with nature; and how people may benefit from those interactions, based on the latest scientific evidence.

The researchers hope this tool will be especially useful in considering the possible mental health repercussions of adding -- or taking away -- nature in underserved communities.

"If the evidence shows that nature contact helps to buffer against negative impacts from other environmental predictors of health, then access to these landscapes can be considered a matter of environmental justice. We hope this framework will contribute to this discussion," Bratman said. "Eventually, it could be developed and potentially used to help address health disparities in underserved communities."

https://www.sciencedaily.com/releases/2019/07/190724155935.htm

Obstructive sleep apnea may be one reason depression treatment doesn't work

July 23, 2019

Science Daily/Medical College of Georgia at Augusta University

When someone is depressed and having suicidal thoughts or their depression treatment just isn't working, their caregivers might want to check to see if they have obstructive sleep apnea, investigators say.

That's true even when these individuals don't seem to fit the usual profile of obstructive sleep apnea, which includes males who are overweight, snore and complain of daytime sleepiness, says Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University.

"No one is talking about evaluating for obstructive sleep apnea as a potential cause of treatment-resistant depression, which occurs in about 50 percent of patients with major depressive disorder," says McCall, corresponding author of the study in The Journal of Psychiatric Research. Now he hopes they will.

The investigators found clinically relevant disease in 14 percent of 125 adult patients with major depressive disorder, insomnia and suicidal thoughts, even though the sleep-wrecking apnea was an exclusion criterion for the original study.

While more work remains, McCall reasons that the new evidence already suggests that testing for obstructive sleep apnea should be part of the guidelines for managing treatment resistant depression.

"We were completely caught by surprise that people did not fit the picture of what obstructive sleep apnea is supposed to look like," says McCall.

While it's known that people with obstructive sleep apnea have higher rates of depression than other populations, little is known about rates of obstructive sleep apnea in patients with major depressive disorder, so investigators decided to look in a population of patients they already were studying.

The primary intent of the original study was looking at whether treating patients' insomnia in addition to their depression reduced suicidal thoughts. Patients considered at risk for obstructive sleep apnea were excluded since sleeping pills tend to relax muscle and already-too relaxed throat muscles is a primary problem in obstructive sleep apnea. Also excluded were individuals with restless leg syndrome, which is common with sleep apnea even in patients on therapy, and those with morbid obesity, considered a major risk for obstructive sleep apnea.

But when the 125 people enrolled were actually tested with a sleep study at home or in a sleep center, investigators still found disease in 17.

The investigators note that neither the degree of daytime sleepiness nor insomnia accurately predicted the severity of obstructive sleep apnea they identified in these patients and that six of the 17 individuals diagnosed were female, not obese and reporting insomnia rather than classic daytime sleepiness.

Treatment of obstructive sleep apnea may improve symptoms of depression, and comprehensive screening for the sleep problem should be included for treatment resistant depression, write the team of investigators that also includes researchers from the University of California, Irvine; the University of Wisconsin in Madison; Wake Forest School of Medicine in Winston-Salem, North Carolina; and the University of California, San Francisco

It's acknowledged that undetected medical or psychiatric conditions can be a cause of treatment-resistant depression, but obstructive sleep apnea is not on the relatively long list that includes endocrine disorders, like hypothyroidism, as well as problems like coronary artery disease and cancer.

In the quest to find a reason for a lack of response, patients may get an MRI scan, carotid artery studies even a spinal tap.

"I am thinking before we do a spinal tap for treatment-resistant depression, we might need to do a sleep test first," says McCall. He notes that even other depression treatment options, like transcranial magnetic stimulation, which uses rapid magnetic pulses to change brain activity, while noninvasive are still far more costly than a sleep study.

"We know that patients with sleep apnea talk about depression symptoms," McCall says. "We know that if you have obstructive sleep apnea, you are not going to respond well to an antidepressant. We know that if you have sleep apnea and get CPAP, it gets better and now we know that there are hidden cases of sleep apnea in people who are depressed and suicidal."

Forty-four percent of the 125 patients in this study had treatment-resistant depression and four of the 17 diagnosed with obstructive sleep apnea had severe problems. Most with obstructive sleep apnea were in the upper end of the age range of 18 to 65 -- sleep apnea and other sleep problems tend to increase with age -- and were similar in other respects like sex and weight.

Ten years ago in a study of 73 outpatients with depression and insomnia but considered at low risk for sleep apnea, McCall identified 8.2 percent actually had moderate sleep apnea. A subsequent larger study by another group found 14 percent of 703 adults with depression also had obstructive sleep apnea, and others have reported similar findings. This appears to be the first study in which suicidality also was a factor.

Important remaining questions include whether when suicide is also a factor, does treating sleep apnea also reduce suicidal thoughts, says McCall, an expert in the trifecta of depression, insomnia and suicide.

McCall and others have shown that if you don't sleep you get depressed and depression is a major risk for suicide. In fact, McCall reported several years back that when people lose hope of ever getting another good night's sleep, they are at high risk for suicide.

Sleep apnea tends to produce excessive daytime sleepiness but this study was recruiting for patients with insomnia, and most with insomnia don't have sleep apnea, rather issues like anxiety, stress and depression and other emotional and psychological factors are more likely interfering with their sleep. Rather than complain of daytime sleepiness, females are more likely to say they are unable to fall asleep and stay asleep at night and are more likely to be depressed, McCall says.

Treatment-resistant depression also can result as a side effect of other medications, including commonly prescribed drugs like beta blockers and corticosteroids for problems like lupus and rheumatoid arthritis.

"The fact is depression treatment often does not work very well," says McCall. In fact, evidence has shown that patients who do not respond to one antidepressant are actually progressively less likely to respond to subsequent drugs that are tried. "It's the law of diminishing returns," McCall says.

https://www.sciencedaily.com/releases/2019/07/190723104041.htm

Widespread aspirin use despite few benefits, high risks

July 22, 2019

Science Daily/Beth Israel Deaconess Medical Center

Medical consensus once supported daily use of low dose aspirin to prevent heart attack and stroke in people at increased risk for cardiovascular disease (CVD). But in 2018, three major clinical trials cast doubt on that conventional wisdom, finding few benefits and consistent bleeding risks associated with daily aspirin use. Taken together, the findings led the American Heart Association and American College of Cardiology to change clinical practice guidelines earlier this year, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.

Aspirin use is widespread among groups at risk for harm including older adults and adults with peptic ulcers -- painful sores in the lining of the stomach that are prone to bleeding that affect about one in ten people. In a research report published today in Annals of Internal Medicine, researchers from Beth Israel Deaconess Medical Center (BIDMC) report on the extent to which Americans 40 years old and above use aspirin for primary prevention of cardiovascular disease.

"Although prior American Heart Association and American College of Cardiology guidelines recommended aspirin only in persons without elevated bleeding risk, the 2019 guidelines now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke," said senior author Christina C. Wee, MD, MPH, a general internist and researcher at BIDMC and Associate Professor of Medicine at Harvard Medical School. "Our findings suggest that a substantial portion of adults may be taking aspirin without their physician's advice and potentially without their knowledge."

Using data from the 2017 National Health Interview Survey (NHIS), a nationally representative survey of U.S. households conducted before the release of the new guidelines, Wee and colleagues characterized aspirin use for primary prevention of CVD. The team found that about a quarter of adults aged 40 years or older without cardiovascular disease -- approximately 29 million people -- reported taking daily aspirin for prevention of heart disease. Of these, some 6.6 million people did so without a physician's recommendation.

Concerningly, nearly half of adults 70 years and older without a history of heart disease or stroke reported taking aspirin daily. The authors noted that a history of peptic ulcer disease -- another contraindication for the routine use of aspirin -- was not significantly associated with lower aspirin use as one would have expected.

"Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease," said lead author Colin O'Brien, MD, a senior internal medicine resident at BIDMC and fellow at Harvard Medical School.

Coauthor, Stephen Juraschek, MD, PhD, a primary care physician at BIDMC, cautions that "these findings are applicable to adults who do not have a history of cardiovascular disease or stroke. If you are currently taking aspirin, discuss it with your doctor to see if it is still needed for you."

https://www.sciencedaily.com/releases/2019/07/190722182126.htm

New study explains the molecular mechanism for the therapeutic effects of cilantro

Herbs, including cilantro, have long been used as folk remedies

July 22, 2019

Science Daily/University of California - Irvine

Herbs, including cilantro, have a long history of use as folk medicine anticonvulsants. Until now, many of the underlying mechanisms of how the herbs worked remained unknown. In a new study, researchers uncovered the molecular action that enables cilantro to effectively delay certain seizures common in epilepsy and other diseases.

The study, published in FASEB Journal, explains the molecular action of cilantro (Coriandrum sativum) as a highly potent KCNQ channel activator. This new understanding may lead to improvements in therapeutics and the development of more efficacious drugs.

"We discovered that cilantro, which has been used as a traditional anticonvulsant medicine, activates a class of potassium channels in the brain to reduce seizure activity," said Geoff Abbott, PhD, professor of physiology and biophysics at the UCI School of Medicine and principal investigator on the study. "Specifically, we found one component of cilantro, called dodecenal, binds to a specific part of the potassium channels to open them, reducing cellular excitability. This specific discovery is important as it may lead to more effective use of cilantro as an anticonvulsant, or to modifications of dodecenal to develop safer and more effective anticonvulsant drugs."

Researchers screened cilantro leaf metabolites, revealing that one -- the long-chain fatty aldehyde (E)-2-dodecenal -- activates multiple potassium channels including the predominant neuronal isoform and the predominant cardiac isoform, which are responsible for regulating electrical activity in the brain and heart. This metabolite was also found to recapitulate the anticonvulsant action of cilantro, delaying certain chemically-induced seizures. The results provide a molecular basis for the therapeutic actions of cilantro and indicate that this ubiquitous culinary herb is surprisingly influential upon clinically important potassium channels.

Documented use of botanical folk medicines stretches back as far as recorded human history. There is DNA evidence, dating back 48,000 years, that suggests the consumption of plants for medicinal use by Homo neanderthalensis. Archaeological evidence, dating back 800,000 years, suggests a non-food use of plants by Homo erectus or similar species. Today, evidence of the efficacy of botanical folk medicines ranges from anecdotal to clinical trials. In many cases, these "medicines" are currently consumed, often on a large scale, as foodstuffs or food flavoring. Cilantro, known as coriander in the UK, is one example. Cilantro has been consumed by human beings for at least 8,000 years. It was found in the tomb of Tutankhamen and is thought to have been cultivated by the ancient Egyptians.

"In addition to the anticonvulsant properties, cilantro also has reported anti-cancer, anti-inflammatory, anti-fungal, antibacterial, cardioprotective, gastric health and analgesic effects," said Abbott. "And, the best part is it tastes good!"

https://www.sciencedaily.com/releases/2019/07/190722132511.htm

Gut microbes may affect the course of ALS

Researchers isolated a molecule that may be under-produced in the guts of patients

July 22, 2019

Science Daily/Weizmann Institute of Science

Researchers at the Weizmann Institute of Science have shown in mice that intestinal microbes, collectively termed the gut microbiome, may affect the course of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. As reported today in Nature, progression of an ALS-like disease was slowed after the mice received certain strains of gut microbes or substances known to be secreted by these microbes. Preliminary results suggest that the findings on the regulatory function of the microbiome may be applicable to human patients with ALS.

"Our long-standing scientific and medical goal is to elucidate the impact of the microbiome on human health and disease, with the brain being a fascinating new frontier," says Prof. Eran Elinav of the Immunology Department. His team performed the study together with that of Prof. Eran Segal of the Computer Science and Applied Mathematics Department. Segal elaborates: "Given increasing evidence that microbiome affects brain function and disease, we wanted to study its potential role in ALS." The study was led by postdoctoral fellows Drs. Eran Blacher and Stavros Bashiardes, and by staff scientist Dr. Hagit Shapiro, all in the Elinav lab. They collaborated with Dr. Daphna Rothschild, a postdoctoral fellow in Eran Segal's lab, and Dr. Marc Gotkine, Head of the Motor Neuron Disease Clinic at Hadassah Medical Center, as well as with other scientists from Weizmann and elsewhere.

The scientists started out demonstrating in a series of experiments that the symptoms of an ALS-like disease in transgenic mice worsened after these mice were given broad-spectrum antibiotics to wipe out a substantial portion of their microbiome. In addition, the scientists found that growing these ALS-prone mice in germ-free conditions (in which, by definition, mice carry no microbiome of their own), is exceedingly difficult, as these mice had a hard time surviving in the sterile environment. Together, these results hinted at a potential link between alterations in the microbiome and accelerated disease progression in mice that were genetically susceptible to ALS.

Next, using advanced computational methods, the scientists characterized the composition and function of the microbiome in the ALS-prone mice, comparing them to regular mice. They identified 11 microbial strains that became altered in ALS-prone mice as the disease progressed or even before the mice developed overt ALS symptoms. When the scientists isolated these microbial strains and gave them one by one -- in the form of probiotic-like supplements -- to ALS-prone mice following antibiotic treatment, some of these strains had a clear negative impact on the ALS-like disease. But one strain, Akkermansia muciniphila, significantly slowed disease progression in the mice and prolonged their survival.

To reveal the mechanism by which Akkermansia may be producing its effect, the scientists examined thousands of small molecules secreted by the gut microbes. They zeroed in on one molecule called nicotinamide (NAM): Its levels in the blood and in the cerebrospinal fluid of ALS-prone mice were reduced following antibiotic treatment and increased after these mice were supplemented with Akkermansia, which was able to secrete this molecule. To confirm that NAM was indeed a microbiome-secreted molecule that could hinder the course of ALS, the scientists continuously infused the ALS-prone mice with NAM. The clinical condition of these mice improved significantly. A detailed study of gene expression in their brains suggested that NAM improved the functioning of their motor neurons.

https://www.sciencedaily.com/releases/2019/07/190722111923.htm