Restless Leg Syndrome: A Mysterious Sleep Disorder

From sleep paralysis to exploding head syndrome, there are a number of very strange sleep disorders. Perhaps one of the most mysterious though is restless leg syndrome (RLS). Its mystique is exacerbated by fact that it affects up to 15% of the population, and we do not know its exact causes. What exactly is RLS? This week’s post takes a look at the profile of RLS, its deleterious effects, potential causes, and treatments.

RLS is characterized by tingly sensations in the lower legs, often between the knees and ankles. The sensations occur when an individual is still for any length of time and are relieved by getting up and moving around. These creepy crawly feelings can last for hours, often forcing people to continuously move late into the night. Specific leg movements may include jerky movements of the legs and flexion of the hips, knees, ankles, and toes (click here for a video of RLS symptoms).

RLS generally develops during one’s 40’s or 50’s but can develop at much younger age as well (RLS is common in children diagnosed with ADHD). While sleep researchers have a firm grasp on the clinical features of RLS, its causes are still unclear. One belief is that it is a genetic disorder, and you are five times as likely to develop RLS if a first degree relative is diagnosed (for those interested in genetics, the ME1S1 gene is believed to be the leading genetic risk factor).

Iron deficiency is also a proposed risk factor. For example, in several case studies of subjects with anemia, RLS was reported. Further, following intravenous iron therapy, RLS symptomology not only improved, but was eradicated. Similarly, pregnancy is a major risk factor for RLS, perhaps due to the deficiency of iron during pregnancy.

The causes of RLS remain opaque. Because of this, treatment is also difficult. In patients with moderate to severe RLS, drug therapy is needed (i.e. dopaminergic drugs, opioids, benzodiazepines, iron injections). In less severe cases, daytime exercise and massaging of the legs have been shown to help.

Taking all of his into consideration, it is clear that RLS is a dire disorder. Outside of its harmful effects on sleep, there are also other consequences commonly associated with RLS. The continuous movement of the limbs is associated with increased autonomic activity, which increases risk for high blood pressure and cardiovascular disease. Individuals afflicted with this are also at higher risks for depression, social withdrawal, headaches, and daytime fatigue.

RLS is a mysterious and harmful sleep disorder. If you think that you may have RLS, consult with your primary care physician or a sleep specialist.

 

Ekbom, K., & Ulfberg, J. (2009). Restless legs syndrome. Journal of internal medicine, 266(5), 419-431.

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Motivation, Coping with Stress, and Study Habits

For many high school and college students, this is the most stressful time of the year. All the big semester-long projects and papers are due, and there are multiple finals to take. People are probably spending a lot of time studying, so I thought it would be interesting to look at a study by Moneta & Spada (2009) concerning motivational factors and ways of coping with stress as predictors of how people study.

There are three different approaches a student can take to studying: a deep approach, a strategic approach, and a surface approach. The deep approach involves truly trying to understand the full scope of the material and integrating the new material with existing knowledge. The strategic approach also involves understanding the material, but a student using this approach will invest their studying efforts primarily into the concepts and ideas that will be assessed in the class. The surface approach favors the memorization of facts in order to satisfy an assessment criteria rather than understanding the material.

To illustrate this, imagine you are a student who is using the textbook to study for a test. A deep approach would be to read and understand the entire chapter, including the information that is not required by the class. A strategic approach would be to read and understand the sections of the chapter that are most relevant to the class, and a surface approach would be to memorize the glossary of key terms at the end of the chapter. Teachers and education researchers try to encourage the use of deep and strategic approaches to learning as they enable students to use material to solve practical problems and apply their knowledge of the material to related concepts. Surface learning approaches may be somewhat effective on vocab and other sorts of memory based tests, but overall, it does not lead to long term retention and is not useful for essay/application tests.

Moneta & Spada predict that intrinsic and extrinsic motivation should be highly related to studying approach. A person who is intrinsically motivated engages in a task because they find it interesting and enjoyable while a person who is extrinsically motivated engages in a task because of anticipated rewards or punishments. People who are intrinsically motivated should want to take a deep or strategic approach to studying because they naturally want to understand the material. People who are extrinsically motivated should use a surface approach to studying because the focus is on the grade rather than the knowledge.

They also say that the way a person copes with stress should be related to that person’s study approach. There are several ways to cope with stress, but the two that have been found to be most highly related to studying are active coping and avoidance coping. An active form of coping with the stress of multiple tests would be to rank the tests by importance and allot a certain number of hours for each. This removes the stress by directly resolving the source of stress. On the other hand, an avoidant form of coping would be to watch Netflix for 5 hours. This does not remove the stress, but temporarily helps the procrastinator reduce his/her anxiety about the tests. Moneta and Spada hypothesized that the relationship between motivation and study approach would be mediated by coping style. That is, intrinsic motivation should lead to doing more active coping behaviors and less avoidance behaviors, which would then lead to using a deep or strategic approach to studying.

Moneta & Spada tested this by assessing college students on motivation, coping styles, and study approach one week before finals. They found that intrinsic motivation had both a direct and indirect (mediated by coping) relationship to study approach. Intrinsic motivation positively predicted the use of active coping strategies, and deep and strategic study approaches, and negatively predicted avoidance coping and the surface study approach. Extrinsic motivation positively predicted the use of avoidance coping and the surface study approach.

These relationships may be explained by how we perceive stress. When two people are exposed to the same stressor, they can still evaluate it in different ways. One person may see the stress as a challenge to overcome while the other may see the stress as a threat to be feared. People who are intrinsically motivated will tend to  see an exam as a challenge; as a way to prove their mastery of the subject. Because of this, they will be more likely to do active coping behaviors and take a deep approach to studying. People who are extrinsically motivated will be more likely to see an exam as a threat; as a possible negative assessment of their intelligence. Thus, they will want to avoid that fear and will take a surface approach to studying.

So, if you are a student studying for finals this week, know that the deeper approaches to studying will be more effective especially if your tests involve essays or applying knowledge to related concepts. So as you’re studying, you may want to ask yourself some questions. What are you studying for? Everyone wants to get good grades, but is that all you want or do you also want to understand the material? If you are a procrastinator, ask yourself why. Are you procrastinating as a way to avoid dealing with the stress of studying for finals? If you’d like to change your studying approach from surface learning to a deeper learning, maybe start by trying to addressing motivation and avoidant coping behaviors.

 

Moneta, G.B., & Spada, M.M. (2009). Coping as a mediator of the relationships between trait intrinsic and extrinsic motivation and approaches to studying during academic exam preparation. Personality and Individual Differences, 46, 664-669.

Circadian Rhythms Strongly Influence Monday Night Football In The NFL

In the human brain, the hypothalamus houses a small region called the suprachiasmatic nuclei, which is responsible for our circadian rhythms. Our most notable circadian rhythm is our sleep-wake cycle, but there are also less obvious ones. Perhaps one of the most influential is our alteration of arousal throughout the day. When we are most lively (it peaks in the morning and early evening), physical and mental performance is at its highest. Conversely, they are at their lowest when you get closer to midnight.

Previous studies have shown us that our peak athletic performance is in the late afternoon, and athlete’s subjective reports corroborate these findings. Given this, it would make sense then that Monday Night Football games in the NFL do not facilitate peak performance, since our rhythms are continuously dipping during this time of the night. This may be true, but is it for every team?

Sleep scientists at Stanford answered this question with a retrospective study of Monday Night Games over a 25 year period. They hypothesized that west coast football teams would have an innate advantage over east coast teams when playing in the east coast (e.g. the San Francisco 49’s playing at the Detroit Lions). This prediction was based solely on circadian preferences. On Monday Night Football games being played on the east coast, both teams are playing at 9:00pm, but the west coast team is essentially playing at 6:00pm, which is very close to the time of day that allows peak performance.

Amazingly, this is exactly what they found; west coast teams won more often and by more points per game than the east coast teams. Over this 25 year period, west coast teams won 59.3% of their home games, and 71% of Monday Night Football home games. East coast teams won 56.5% of their home games, but only 48.3% of their Monday Night Football home games. When an east coast team plays a team in any other time zone, their win percentage jumps up to 67.5%.   Similarly, when a west coast team plays a non-east coast team, their winning percentage drops to 58.1%. These numbers tell us that when a west coast team plays on Monday night versus an east coast team, whether it be home or away, their circadian rhythm gives them a strong advantage.

What makes this finding even more incredible is that these analyses took the point spread into account, which thwarts the argument that west coast teams just might be better than east coast teams (the point spread is a metric which includes a number of factors that would place one team at an advantage over the other: skill, injuries, etc.).

Since this study, NFL teams have taken their circadian rhythms into serious consideration when preparing for their next game; teams will often hire sleep specialists to coordinate travel plans for away games. In my own personal opinion, this is one of the main reasons why there will never be a permanent NFL team in London. It would offer a distinct home field advantage for the London team, and will confer a serious disadvantage for away games due to their constant travel across the pond. If the NFL wants an team in London, they must take their player’s biological rhythms into consideration.

 

Smith, R. S., Guilleminault, C., & Efron, B. (1997). Sports, sleep, and Circadian rhythms Orcadian rhythms and enhanced athletic performance in the National football league. Sleep, 20(5), 362-365.

Can I Start Occupational Therapy School with a Psychology Degree?

 

Written by Alisha Kriss

 

First, I’ll start by introducing myself and mentioning my educational background. My name is Alisha Kriss, and I received my Master’s Degree in Occupational Therapy and a Bachelor’s Degree in Psychology from Grand Valley State University in Michigan. Second, I wanted to thank Mike Mead for allowing me to share my viewpoints regarding the relationship between Psychology and the profession of Occupational Therapy.

I am not sure how familiar everybody is with the profession of Occupational Therapy, but typically, people either think we focus on hands, or that we help people find jobs (because of the term, ‘occupation’). This may be a surprise, but we actually are trained to do much more than that! I have discovered an easier way to think about the term ‘occupation,’ rather than thinking of it as another word for ‘job’ or ‘profession.’ We, as occupational therapists, focus on anything and everything that occupies a person’s time. We are trained to use a holistic perspective to assess how any disability, injury, or illness may be affecting individuals in their everyday life. A holistic perspective is non-judgmental and is interested in assessing multiple perspectives of an idea without presenting judgment. Does this sound familiar to anyone with a Psychology background? Well, it sounded familiar to me when I began Occupational Therapy school! I immediately realized that I had the talents and resources to implement this type of thinking with my clients, and it has been truly beneficial while working in the field. Because of my Psychology background, I am able to interpret individual behavior, respond appropriately, and help individuals feel comfortable in an open and non-threatening environment. Therefore, I can quickly build therapeutic relationships with my clients, and we can immediately begin working together towards maximizing their independence and safety post injury or disability.

An interesting fact that people may not realize about Occupational Therapy is that its history actually originates with mental health. Over a century ago, the profession of Occupational Therapy was established upon the belief of more humane conditions and treatments of individuals with mental illnesses (Christiansen & Haertl, 2014). Since then, occupational therapists have worked to develop and perfect treatment interventions for this population. Occupational therapists embody extensive knowledge of the physical, cognitive, social, and emotional barriers that interfere with everyday life for people with mental illnesses. Exemplifying a non-judgmental perspective is imperative while working in any healthcare field, especially when you are working with individuals in their most vulnerable state. If you have the talents to exemplify holistic and non-judgmental thinking from your Psychology background, and have a passion to help individuals gain their lives back after an injury or disability, then Occupational Therapy may be the right profession for you!

Christiansen, C.H., & Haertl, K. (2014). A contextual history of occupational therapy. In B.A. Schell, G. Gillen, & M.E. Scaffa (Eds.), Willard and spackman’s occupational therapy (12th ed.) (pp. 9-34). Philadelphia, PA: Lippincott, Williams & Wilkins.

Why is my Candy Bowl Empty?

When you think about trick-or-treating, you might remember types of houses you visited either as a child or with your children. There was always the spooky house with the realistic decorations, the house that gave out really awful candy, and the most perplexing house of all: the house with the unattended candy bowl. Every Halloween there seems to be at least one house with an unattended candy bowl and a sign that says “take one”. This candy bowl presents quite a dilemma for trick-or-treaters. Do you obey the sign and only take one piece of candy? Or should you take an extra piece? Or should you just dump the whole bowl of fun-sized snickers into your bag and go? No one is going to find out what you did, so what do you decide to do?

This dilemma was turned into an interesting study of anonymity and loss of personal accountability in groups. In 1976, Edward Diener and colleagues conducted a study observing 1,352 trick-or-treaters to see under what circumstances children would take extra candy from an unattended bowl. They believed that children would be more likely to take extra candy when they were anonymous, when they were in a group rather than alone, and when one member was held responsible for the entire group’s behavior.

To study this, the researchers had female experimenters hand out candy at homes throughout the city. Trick-or-treaters would naturally come to the houses either alone, in groups or with parents. For the children who came without parents, the experimenter would identify some children by asking for their name and would leave others anonymous. Children who came with parents became their own special category. The experimenter would then tell the children that they could take one piece of candy, but then say that she had to go back into the house.

For some of the children who came in groups, the experimenter would designate the smallest person in the group (who was least likely to have a strong influence on the group) as being responsible for any extra candies that were missing. In the first condition, none of the group member were anonymous, in the second, only the responsible child was non-anonymous, and in the third, all group members were anonymous. The experimenter then went inside the house and a hidden observer recorded how many children took more than one piece of candy.

The researchers found was when a parent was present, only 8% of children disobeyed the experimenter’s instructions to take one piece of candy. When the children were non-anonymous without parents, 7.5% of children who were alone and 21% of children in groups took extra candy. When the children were anonymous, that number rose to 21% of children who were alone and 58% of children who were in groups. There was a similar pattern when the experimenter designated one person as being responsible for making sure everyone only took one piece. When none of the group members were anonymous, only 10.5% took extra candy. That number rose to 27% when only the responsible child was non-anonymous, and jumped to 80% when all of the group members were anonymous!

So, children who were anonymous were more likely to take extra candy, particularly if they were in a group and someone else was being held responsible for the group’s behavior. Anonymity has been found to increase antisocial, impulsive, and unethical behaviors because the rule-breakers believe they can’t be caught. Being in a group only worsens this because it diffuses responsibility across the group and lessens personal accountability. When one anonymous group member is held responsible for the group’s actions, this further absolves the other group members of responsibility. So if you’re thinking of setting out an unattended candy bowl this Halloween, be aware that trick-or-treaters, particularly those in groups, are probably going to take more than one piece.

Diener, E., Fraser, S.C., Beaman, A.L., & Kelem, R.T. (1976). Effects of deindividuation variables on stealing among Halloween trick-or-treaters. Journal of Personality and Social Psychology, 33(2), 178-183.

Later Weekday Bedtimes May Be an Independent Risk Factor for Obesity

In one of my previous posts I detailed how eating close to bedtime impairs your sleep quality, which may confer risk for obesity. Similarly, this week we look at a recent finding that having a consistent later bedtime can lead to increases in BMI over time.

It is important to view obesity from a developmental perspective; in many cases obesity starts in childhood and can progress into adulthood.  In fact, the current childhood obesity rates are alarming.  In 2012 data, 17% of children 2-19 were obese. While this number is down from recent years, this is still far too high.

 When looking at this data, one of the questions is always “why is this happening?’  One potential explanation may simply be how late you decide to go to bed.  A 2015 study by Asarnow and colleagues found that no matter how long participants slept, later weekday bedtimes were associated with increases in BMI over time.  This study not only controlled for sleep duration, but also fast food consumption and exercise frequency.  So, regardless of how long you long you sleep, how infrequently you exercise, or how much fast food you consume, going to bed at a later time can be a risk factor for obesity.

 This is pretty amazing.  This could also help explain why obesity rates in children are so high.  Surveys have shown that around 40% of teens prefer later bedtimes, and onset of puberty delays a night owl’s sleep period even more.  In another study of high school upperclassmen, 60% of them stated that they also prefer staying up late.

 But why is this happening?  Late bedtimes, which can desynchronize your internal and external biological clocks, have been shown to lead to metabolic disturbances such as disturbed glucose and insulin metabolism (my next post will explain how poor sleep is a risk factor for Type 2 Diabetes).  These disturbed process are then what contribute to the physiological changes that lead to increases in BMI.

This has important implications for public health and intervention research.  If future studies are able to replicate this effect, bed times can be a target for prevention and treatment for obesity. This is a very hot topic right now, and it will be exciting to see what comes out in the following years!

Asarnow, L. D., McGlinchey, E., & Harvey, A. G. (2015). Evidence for a Possible Link between Bedtime and Change in Body Mass Index. Sleep.

For statistics on childhood obesity: http://www.cdc.gov/obesity/data/childhood.html

Using eReaders Near Bedtime Impairs Sleep Quality

Sleep science has produced considerable evidence showing that exposure to light before bedtime is bad for sleep. This light can come from computers, phones, night-lights, streetlights outside, and other various sources. One unexpected source has become increasingly common; electronic readers. Light emitting eReaders are exceptionally convenient, in that you can store your whole library of books in it. Moreover, you can now surf the web and do other related activities on them. As many people like to read before bed, one must wonder if eReaders affect your sleep. In a recent study, Chang and colleagues (2015) tackled this question.

Before getting to the results of that study, let’s go over some basic sleep physiology. Our body has what is called a circadian clock, which gives us our daily rhythms of arousal and sleep drive. This clock is driven by both biological and environmental factors. Biologically speaking, our propensity for sleep is driven by melatonin. When our internal clock tells us it’s time for bed, it starts to release melatonin, which makes us sleepy and facilitates sleep onset.

Our social environment serves as our external clock, and also plays a vital role. We rely on specific cues that tell our body that it is time for sleep. Light is the most influential of these factors. Light delays the sleep process by its suppressing effects on melatonin. To get the best quality sleep, our internal and external clocks need to be in synch with one another. When this does not happen, it can lead to sleep difficulty.

So how do eReaders affect sleep? Researchers brought in 12 young, healthy adults into a sleep lab, and had them complete two consecutive conditions of a single study (each participant completed both conditions). This is a within-subjects design, which allows us to compare each of the two conditions within the same participant. Doing this really allows researchers to compare the two conditions of a study. In the first condition, participants spent five consecutive nights in the lab, and read an eReader in a dim room about four hours before bedtime. The second condition consisted of five more nights, but they read a hard copy book. Half of the participants completed the eReader condition first, and the other half completed the hard copy first.

They found that when using the eReader before bed, participants had a whole lot of problems. Their melatonin levels were suppressed by more than 50%, delaying their internal clock by about 90 minutes. Using the eReader lead to participants taking 10 minutes longer to fall sleep, and they also spent less time in REM during sleep. Using the eReader also lead to greater self reported pre-sleep arousal and decreased alertness the following morning.

This study shows that eReaders not only delay your propensity for sleep, but it also decreases sleep quality, leading to decreases in daytime arousal. In a previous post I’ve detailed all the poor health effects of insufficient sleep, but this study adds to that. Melatonin is important in more ways than making sleep come easier to us. Melatonin suppression has been associated with increased risk for breast cancer, colorectal cancer, prostate cancer, and a number of sleep disorders. When approaching bedtime, we should consider that various light sources that may be influencing not only our sleep, but also our health.

Chang, A. M., Aeschbach, D., Duffy, J. F., & Czeisler, C. A. (2015). Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. Proceedings of the National Academy of Sciences, 112(4), 1232-1237.