Wish Fulfillment? No. But Dreams (and Sleep) Have Meaning

Dreams may not be the secret window into the frustrated desires of the unconscious that Sigmund Freud first posited in 1899, but growing evidence suggests that dreams - and, more so, sleep - are powerfully connected to the processing of human emotions.

According to new research presented last week at the annual meeting of the Associated Professional Sleep Societies in Seattle, adequate sleep may underpin our ability to understand complex emotions properly in waking life. "Sleep essentially is resetting the magnetic north of your emotional compass," says Matthew Walker, director of the Sleep and Neuroimaging Lab at the University of California, Berkeley. (See the top 10 scientific discoveries of 2008.)

A recent study by Walker and his colleagues examined how rest - specifically, rapid eye movement (REM) sleep - influences our ability to read emotions in other people's faces. In the small analysis of 36 adults, volunteers were asked to interpret the facial expressions of people in photographs, following either a 60- or 90-minute nap during the day or with no nap. Participants who had reached REM sleep (when dreaming most frequently occurs) during their nap were better able to identify expressions of positive emotions like happiness in other people, compared with participants who did not achieve REM sleep or did not nap at all. Those volunteers were more sensitive to negative expressions, including anger and fear.

Past research by Walker and colleagues at Harvard Medical School, which was published in the journal Current Biology, found that in people who were sleep deprived, activity in the prefrontal lobe - a region of the brain involved in controlling emotion - was significantly diminished. He suggests that a similar response may be occurring in the nap-deprived volunteers, albeit to a lesser extent, and that it may have its roots in evolution. "If you're walking through the jungle and you're tired, it might benefit you more to be hypersensitive to negative things," he says. The idea is that with little mental energy to spare, you're emotionally more attuned to things that are likely to be the most threatening in the immediate moment. Inversely, when you're well rested, you may be more sensitive to positive emotions, which could benefit long-term survival, he suggests: "If it's getting food, if it's getting some kind of reward, finding a wife - those things are pretty good to pick up on."

Our daily existence is largely influenced by our ability "to understand our societal interactions, to understand someone else's emotional state of mind, to understand the expression on their face," says Ninad Gujar, a senior research scientist at Walker's lab and lead author of the study, which was recently submitted for publication. "These are the most fundamental processes guiding our personal and professional lives."

REM sleep appears to not only improve our ability to identify positive emotions in others; it may also round out the sharp angles of our own emotional experiences. Walker suggests that one function of REM sleep - dreaming, in particular - is to allow the brain to sift through that day's events, process any negative emotion attached to them, then strip it away from the memories. He likens the process to applying a "nocturnal soothing balm." REM sleep, he says, "tries to ameliorate the sharp emotional chips and dents that life gives you along the way." (See the top 10 medical breakthroughs of 2008.)

"It's not that you've forgotten. You haven't," he says. "It's a memory of an emotional episode, but it's no longer emotional itself."

That palliative safety-valve quality of sleep may be hampered when we fail to reach REM sleep or when REM sleep is disrupted, Walker says. "If you don't let go of the emotion, what results is a constant state of anxiety," he says.

The theory is consistent with new research conducted by Rebecca Bernert, a doctoral candidate in clinical psychology at Florida State University who specializes in the relationship between sleep and suicidal thoughts and behaviors, and who also presented her work at the sleep conference this week.

In her study of 82 men and women between the ages of 18 and 66 who were admitted into a mental-health hospital for emergency psychiatric evaluation, Bernert discovered that the presence of severe and frequent nightmares or insomnia was a strong predictor of suicidal thoughts and behaviors. More than half of the study participants had attempted suicide at least once in the past, and the 17% of the study group who had made an attempt within the previous month had dramatically higher scores in nightmare frequency and intensity than the rest. Bernert found that the relationship between nightmares or insomnia and suicide persisted, even when researchers controlled for other factors like depression.

Past studies have also established a link between chronic sleep disruption and suicide. Sleep complaints, which include nightmares, insomnia and other sleep disturbances, are listed in the current Substance Abuse and Mental Health Services Administration's inventory of suicide-prevention warning signs. Yet what distinguishes Bernert's research is that when nightmares and insomnia were evaluated separately, nightmares were independently predictive of suicidal behavior. "It may be that nightmares present a unique risk for suicidal symptoms, which may have to do with the way we process emotion within dreams," Bernert says.

If that's the case, it may help explain the recurring nightmares that characterize psychiatric conditions like posttraumatic stress disorder (PTSD), Walker says. "The brain has not stripped away the emotional rind from that experience memory," he says, so "the next night, the brain offers this up, and it fails again, and it starts to sound like a broken record ... What you hear [PTSD] patients describing is, 'I can't get over the event.' "

At the biological level, Walker explains, the "emotional rind" translates to sympathetic nervous-system activity during sleep: faster heart rate and the release of stress chemicals. Understanding why nightmares recur and how REM sleep facilitates emotional processing - or hinders it, when nightmares take place and perpetuate the physical stress symptoms - may eventually provide clues to effective treatments of painful mental disorders. Perhaps, even, by simply addressing sleeping habits, doctors could potentially interrupt the emotional cycle that can lead to suicide. "There is an opportunity for prevention," Bernert says.

The new findings highlight what researchers are increasingly recognizing as a two-way relationship between psychiatric disorders and disrupted sleep. "Modern medicine and psychiatry have consistently thought that psychological disorders seem to have co-occuring sleep problems and that it's the disorder perpetuating the sleep problems," says Walker. "Is it possible that, in fact, it's the sleep disruption contributing to the psychiatric disorder?"

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Heart Disease: Combined Treatment Is Best

March 23, 2009 -- Heart disease patients who achieve normal blood pressure and very low cholesterol levels with aggressive drug therapy do better than patients who achieve only one of these goals, new research suggests.

Using ultrasound to identify plaque buildup within the artery walls as a measure of disease progression, Cleveland Clinic researchers found that patients who were able to get their low-density lipoprotein (LDL) cholesterol below 70 mg/dL and their systolic blood pressure (the top number in a blood pressure reading) below 120 with medication had less plaque buildup over the course of the study than patients who reached just one or neither of these targets.

The findings highlight the importance of treating all risk factors for heart disease progression, rather than targeting just one, study co-author Stephen J. Nicholls, PhD, tells WebMD.

“I think sometimes we aggressively try to manage one risk factor and lose sight of the fact that we need to manage all of them,” Nicholls says. “If we want to get the greatest bang for our buck in terms of treatment, we need to focus on all risk factors.”

‘Lower Is Better’ for LDL

Earlier research by Nicholls and Cleveland Clinic colleagues helped establish the “lower is better” strategy for controlling LDL cholesterol with statin drugs like Lipitor, Crestor, and Zocor in patients at high risk for having heart attacks, strokes, or other cardiovascular events.

As a result of their work and the work of others, national treatment goals for LDL were recently lowered to less than 100 for patients with established heart disease and less than 70 for the highest-risk patients.

Current guidelines identify a resting systolic blood pressure of 120 or below as normal; a reading of 140 or above is high.

A reading of between 120 and 140 is considered "prehypertension.”

There are no widely accepted guidelines for treating patients who fall into this category, but the new research suggests that maybe there should be, Nicholls says.

“We know that (heart attack and stroke) risk starts to increase at about 115,” he says. “This study suggests that treating to lower blood pressure levels is probably beneficial, but we need clinical trials to test this.”

The Cleveland Clinic study included 3,437 heart disease patients whose arterial plaque progression was monitored with intravascular ultrasound.

The monitoring revealed that:

• Patients who achieved LDL levels below 70 and systolic blood pressures of below 120 had the slowest progression, as measured by increase in plaque volume.
• Those with LDL levels below 70 and systolic blood pressures above 120 had more rapid plaque buildup, but these patients fared slightly better than patients with LDL levels above 70 and systolic blood pressures over 120.
• Patients with LDL levels above 70 and systolic blood pressures above 120 had the most rapid increase in plaque volume.

“With the powerful statin drugs we have today, we see a lot of patients who reach their cholesterol goals but not their blood pressure goals,” study co-author Steven E. Nissen, MD, tells WebMD. “This suggests that we need to aggressively target blood pressure and cholesterol to stop disease progression and even reverse it.”

More Study Needed

The study appears in the March 31 issue of the Journal of the American College of Cardiology.

In an accompanying editorial, UCLA heart disease researchers Jonathan Tobis, MD, and Alice Perlowski, MD, urged caution in interpreting the study.

The researchers note that a direct relationship between plaque progression as measured by the ultrasound technique used in the study and hard clinical events like heart attack and stroke has not been established.

They write that clinical trials examining these hard endpoints are needed to confirm that very aggressive treatment of cholesterol and blood pressure is beneficial for patients with established heart disease.

Cardiologist James T. Dove, MD, agrees.

Dove is a clinical professor of medicine at Southern Illinois School of Medicine and the immediate past president of the American College of Cardiology.

“In high-risk patients, very aggressive treatment might well be the best approach, but the operative phrase is ‘might well be,’” he tells WebMD. “There is a downside to very aggressive treatment that needs to be considered, especially with blood pressure.”

Very low blood pressure can result in dizziness that can increase a patient’s risk for falls.

Dove says clinical trials are definitely needed to determine if the “lower is better” treatment strategy results in better clinical outcomes for patients with established heart disease.

“The ‘lower is better’ approach may be the way to go, but we need more information to be sure about that,” he says.
www.webmd.com

How to Slow Down a Fast Beating Heart (Tachycardia)

By DrJewell, eHow Expert in Health

Smoking Linked to More Than Lung Cancer

Jan. 22, 2009 -- It is widely accepted that tobacco smoke causes most lung cancer deaths. A new study shows that tobacco smoke -- including secondhand smoke -- may also contribute to non-lung cancers more than previously thought.

Researchers used data from the National Center for Health Statistics and concluded that tobacco smoke may have led to more than 70% of cancer deaths among Massachusetts men in 2003.

"This study provides support for the growing understanding among researchers that smoking is a cause of many more cancer deaths besides lung cancer," says researcher Bruce Leistikow, a University of California, Davis associate adjunct professor of public health sciences, in a news release. "The full impacts of tobacco smoke, including secondhand smoke, have been overlooked in the rush to examine such potential cancer factors as diet and environmental contaminants. As it turns out, much of the answer was probably smoking all along."

Researchers compared death rates from lung cancer to death rates from other cancers from 1979 to 2003 among Massachusetts males. Their analysis revealed that the two rates changed in tandem year-by-year from 1979 to 2003.

The researchers conclude that the close relationship between the rates suggests that they have the same cause, which is tobacco smoke.

"The fact that lung and non-lung cancer death rates are almost perfectly associated means that smokers and nonsmokers alike should do what they can to avoid tobacco smoke," Leistikow says in the news release. "It also suggests that increased attention should be paid to smoking prevention in health care reforms and health promotion campaigns."

In the study, published online in BMC Cancer, the researchers called for increased tobacco control efforts.

Depression: Recognizing the Physical Symptoms

Most of us know about the emotional symptoms of depression. But you may not know that depression can cause physical symptoms, too.

In fact, many people with depression feel pain or other physical symptoms. These include:

• Headaches. These are fairly common in people with depression. If you already had migraine headaches, they may become worse if you're depressed.
  
• Back pain. If you already suffer with back pain, it may get worse if you become depressed.
  
• Muscle aches and joint pain. Depression can make any kind of chronic pain worse.
  
• Chest pain. Obviously, it's very important to get chest pain checked out by an expert right away. It can be a sign of serious heart problems. But chest pain is also associated with depression.
  
• Digestive problems. You might feel queasy or nauseous. You might have diarrhea or become chronically constipated.
  
• Exhaustion and fatigue. No matter how much you sleep, you may still feel tired or worn out. Getting out of the bed in the morning may seem very hard, even impossible.
  
• Sleeping problems. Many people with depression can't sleep well anymore. They wake up too early or can't fall asleep when they go to bed. Others sleep much more than normal.
  
• Change in appetite or weight. Some people with depression lose their appetite and lose weight. Others find they crave certain foods -- like carbohydrates -- and weigh more.
  
• Dizziness or lightheadedness.
  

Many depressed people never get help, because they don't know that their physical symptoms might be caused by depression. A lot of doctors miss the symptoms, too.

These physical symptoms aren't "all in your head." Depression can cause real changes in your body. For instance, it can slow down your digestion, which can result in stomach problems.

Depression seems to be related to an imbalance of certain chemicals in your brain. Some of these same chemicals play an important role in how you feel pain. So many experts think that depression can make you feel pain differently than other people.

Treating Physical Symptoms

In some cases, treating your depression -- with therapy or medicine or both -- will resolve your physical symptoms.

But make sure to tell your health care provider about any physical symptoms. Don't assume they'll go away on their own. They may need additional treatment. For instance, your doctor may suggest an antianxiety medicine if you have insomnia. Those drugs help you relax and may allow you to sleep better.

Since pain and depression go together, sometimes easing your pain may help with your depression. Some antidepressants, such as Cymbalta and Effexor, may help with chronic pain, too.

Other treatments can also help with painful symptoms. Certain types of focused therapy -- like cognitive behavioral -- can teach you ways to cope better with the pain.

Buner Health

HealthDay News) -- Bad breath can be caused by something potent you had for lunch, but it can also signal an underlying health problem.

Following is the list of possible causes of bad breath that may need to be checked by your doctor:

• An abscessed tooth or cavity, or wearing dentures.
• Alcoholism or smoking.
• Taking certain medications.
• Having a foreign object lodged in the nostril (most common in children).
• An impacted tooth, gum disease or bad dental hygiene.
• Taking significant amounts of vitamins.
• A throat or lung infection, or sinusitis.

10 Reasons Not to Skimp on Sleep
Too busy to go to bed? Having trouble getting quality sleep once you do? Your health may be at risk

You may literally have to add it to your to-do list, but scheduling a good night's sleep could be one of the smartest health priorities you set. It's not just daytime drowsiness you risk when shortchanging yourself on your seven to eight hours. Possible health consequences of getting too little or poor sleep can involve the cardiovascular, endocrine, immune, and nervous systems. In addition to letting life get in the way of good sleep, between 50 and 70 million Americans suffer from a chronic sleep disorder—insomnia or sleep apnea, say—that affects daily functioning and impinges on health. Consider the research:

1) Less may mean more. For people who sleep under seven hours a night, the fewer zzzz's they get, the more obese they tend to be, according to a 2006 Institute of Medicine report. This may relate to the discovery that insufficient sleep appears to tip hunger hormones out of whack. Leptin, which suppresses appetite, is lowered; ghrelin, which stimulates appetite, gets a boost.

2) You're more apt to make bad food choices. A study published this week in the Journal of Clinical Sleep Medicine found that people with obstructive sleep apnea or other severely disordered breathing while asleep ate a diet higher in cholesterol, protein, total fat, and total saturated fat. Women were especially affected.

3) Diabetes and impaired glucose tolerance, its precursor, may become more likely. A 2005 study published in the Archives of Internal Medicine found that people getting five or fewer hours of sleep each night were 2.5 times more likely to be diabetic, while those with six hours or fewer were 1.7 times more likely.

4) The ticker is put at risk. A 2003 study found that heart attacks were 45 percent more likely in women who slept for five or fewer hours per night than in those who got more.

5) Blood pressure may increase. Obstructive sleep apnea, for example, has been associated with chronically elevated daytime blood pressure, and the more severe the disorder, the more significant the hypertension, suggests the 2006 IOM report. Obesity plays a role in both disorders, so losing weight can ease associated health risks.

6) Auto accidents rise. As stated in a 2007 report in the New England Journal of Medicine, nearly 20 percent of serious car crash injuries involve a sleepy driver—and that's independent of alcohol use.

7) Balance is off. Older folks who have trouble getting to sleep, who wake up at night, or are drowsy during the day could be 2 to 4.5 times more likely to sustain a fall, found a 2007 study in the Journal of Gerontology.

8) You may be more prone to depression. Adults who chronically operate on fumes report more mental distress, depression, and alcohol use. Adolescents suffer, too: One survey of high school students found similarly high rates of these issues. Middle schoolers, too, report more symptoms of depression and lower self-esteem.

9) Kids may suffer more behavior problems. Research from an April issue of the Archives of Pediatric and Adolescent Medicine found that children who are plagued by insomnia, short duration of sleeping, or disordered breathing with obesity, for example, are more likely to have behavioral issues like attention deficit hyperactivity disorder.

10) Death's doorstep may be nearer. Those who get five hours or less per night have approximately 15 percent greater risk of dying—regardless of the cause—according to three large population-based studies published in the journals Sleep and the Archives of General Psychiatry.