Chapter 14. Biological Rhythms, Sleep, and Dreaming
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Jon Hamilton There's new evidence that the brain's activity during sleep isn't random. And the findings could help explain why the brain consumes so much energy even when it appears to be resting. "There is something that's going on in a very structured manner during rest and during sleep," says Stanford neurologist Dr. Josef Parvizi, "and that will, of course, require energy consumption." For a long time, scientists dismissed the brain's electrical activity during rest and sleep as meaningless "noise." But then studies using fMRI began to reveal patterns suggesting coordinated activity. To take a closer look, Parvizi and a team of researchers studied three people awaiting surgery for epilepsy. These people spent several days with electrodes in their brains to help locate the source of their seizures. And that meant Parvizi's team was able to monitor the activity of small groups of brain cells in real time. "We wanted to know exactly what's going on during rest," Parvizi says, "and whether or not it reflects what went on during the daytime when the subject was not resting." In the study published online earlier this month in Neuron, the team first studied the volunteers while they were awake and answering simple questions like: Did you drive to work last week? "In order to answer yes or no, you retrieve a lot of facts; you retrieve a lot of visualized memories," Parvizi says. © 2015 NPR
By Nicholas Bakalar A new study suggests that early to bed and early to rise makes a man healthy — although not necessarily wealthy or wise. Korean researchers recruited 1,620 men and women, ages 47 to 59, and administered a questionnaire to establish whether they were morning people or night owls. They found 480 morning types, 95 night owls, and 1,045 who fit into neither group. The scientists measured all for glucose tolerance, body composition and waist size, and gathered information on other health and behavioral characteristics. The study is online in The Journal of Clinical Endocrinology & Metabolism. After controlling for an array of variables, they found that compared with morning people, men who were night owls were significantly more likely to have diabetes, and women night owls were more than twice as likely to have metabolic syndrome — high blood sugar levels, excess body fat around the waist, and abnormal lipid readings. The reasons for the effect are unclear, but the scientists suggest that consuming more calories after 8 p.m. and exposure to artificial light at night can both affect metabolic regulation. Can a night owl become a morning person? “Yes,” said the lead author, Dr. Nan Hee Kim, an endocrinologist at the Korea University College of Medicine. “It can be modified by external cues such as light, activity and eating behavior. But it isn’t known if this would improve the metabolic outcomes.” © 2015 The New York Times Company
Link ID: 20781 - Posted: 04.10.2015
By Kate Galbraith Most evenings, before watching late-night comedy or reading emails on his phone, Matt Nicoletti puts on a pair of orange-colored glasses that he bought for $8 off the Internet. “My girlfriend thinks I look ridiculous in them,” he said. But Mr. Nicoletti, a 30-year-old hospitality consultant in Denver, insists that the glasses, which can block certain wavelengths of light emitted by electronic screens, make it easier to sleep. Studies have shown that such light, especially from the blue part of the spectrum, inhibits the body’s production of melatonin, a hormone that helps people fall asleep. Options are growing for blocking blue light, though experts caution that few have been adequately tested for effectiveness and the best solution remains avoiding brightly lit electronics at night. A Swiss study of 13 teenage boys, published in August in The Journal of Adolescent Health, showed that when the boys donned orange-tinted glasses, also known as blue blockers and shown to prevent melatonin suppression, in the evening for a week, they felt “significantly more sleepy” than when they wore clear glasses. The boys looked at their screens, as teenagers tend to do, for at least a few hours on average before going to bed, and were monitored in the lab. Older adults may be less affected by blue light, experts say, since the yellowing of the lens and other changes in the aging eye filter out increasing amounts of blue light. But blue light remains a problem for most people, and an earlier study of 20 adults ages 18 to 68 found that those who wore amber-tinted glasses for three hours before bed improved their sleep quality considerably relative to a control group that wore yellow-tinted lenses, which blocked only ultraviolet light. Devices such as smartphones and tablets are often illuminated by light-emitting diodes, or LEDs, that tend to emit more blue light than incandescent products. Televisions with LED backlighting are another source of blue light, though because they are typically viewed from much farther away than small screens like phones, they may have less of an effect, said Debra Skene, a professor of neuroendocrinology at the University of Surrey in England. © 2015 The New York Times Company
Patrick Fuller is a neuroscientist at Harvard Medical School's esteemed Division of Sleep Medicine. What have you found in your research on the "neurocircuit basis" that supports sleep? In specific reference to our recent work on the brainstem slow-wave-sleep promoter "center," we showed that this region of the brain is first connected (synaptically) to an important wake-promoting region of the brainstem that in turn is connected with important wake-promoting circuitry of the forebrain, which itself connects to the cerebral cortex. Essentially, we provided a circuit "wiring diagram" by which activation of brainstem sleep-promoting neurons might produce "whole brain" sleep. The reason I emphasize the word "neurocircuit" in our work is because I believe that in order to understand how the brain accomplishes virtually anything, one must first understand the functional cellular and synaptic "scaffolding" from which brain phenomena emerge. Tell me about how circadian regulation affects our sleep and wakeful consciousness. So it all starts (and ends!) with a little biological clock in our brain. The so-called "master" circadian clock is actually a collection of neurons located in a small region of the hypothalamus, itself a very small structure. (In humans, the hypothalamus is about the size of an almond.) This clock is remarkable for many reasons, perhaps most notably that no other region of the brain can assume its function if/when it is damaged. The clock's fundamental role is to keep us "synchronized" with the Earth's light-dark cycle as well as keep our body's internal rhythms synchronized with one another. And we now know that proper external and internal synchronization is fundamental to our physical and mental well-being. ©2015 TheHuffingtonPost.com, Inc.
Link ID: 20728 - Posted: 03.28.2015
Jane Brody The Holy Grail in any progressive disease is to find it early enough to start effective treatment before irreversible damage has occurred. For Parkinson’s disease, which afflicts 1.5 million Americans and growing, a new study has brought this goal a little closer. The study, conducted among more than 54,000 British men and women, identified a slew of symptoms that were more likely to be present in people who years later were diagnosed with Parkinson’s. The findings underscore the prevailing view among neurologists that the damage caused by this disease begins long before classic symptoms like tremors, rigidity and an unsteady gait develop and a definite diagnosis can be made. The study, by Dr. Anette Schrag and fellow neurologists at the University College London, was published in The Lancet in January. As many as five years before a diagnosis of Parkinson’s, those who developed it were more likely to have experienced tremor, balance problems, constipation, low blood pressure, dizziness, erectile and urinary dysfunction, fatigue, depression and anxiety. In addition, Dr. Claire Henchcliffe, director of the Parkinson’s Disease and Movement Disorders Institute at Weill Cornell Medical Center, said that REM sleep behavior disorder, characterized by a tendency to act out one’s dreams while asleep, is one of the strongest prediagnostic symptoms, along with a lost sense of smell and subtle changes in cognition. Dr. Melissa J. Nirenberg, a Parkinson’s disease specialist at New York University Medical Center, said, “Up to 80 percent of people with the sleep disorder get Parkinson’s or a similar neurodegenerative disease.” © 2015 The New York Times Company
Mo Costandi Neuroscientists in France have implanted false memories into the brains of sleeping mice. Using electrodes to directly stimulate and record the activity of nerve cells, they created artificial associative memories that persisted while the animals snoozed and then influenced their behaviour when they awoke. Manipulating memories by tinkering with brain cells is becoming routine in neuroscience labs. Last year, one team of researchers used a technique called optogenetics to label the cells encoding fearful memories in the mouse brain and to switch the memories on and off, and another used it to identify the cells encoding positive and negative emotional memories, so that they could convert positive memories into negative ones, and vice versa. The new work, published today in the journal Nature Neuroscience, shows for the first time that artificial memories can be implanted into the brains of sleeping animals. It also provides more details about how populations of nerve cells encode spatial memories, and about the important role that sleep plays in making such memories stronger. Karim Benchenane of the French National Centre for Scientific Research (CNRS) in Paris and his colleagues implanted electrodes into the brains of 40 mice, targeting the medial forebrain bundle (MFB), a component of the reward circuitry, and the CA1 region of the hippocampus, which contains at least three different cell types that encode the memories needed for spatial navigation. © 2015 Guardian News and Media Limited
By Nicholas Bakalar Sleeping more than eight hours a day is associated with a higher risk for stroke, a new study has found. Researchers studied 9,692 people, ages 42 to 81, who had never had a stroke. The study tracked how many hours a night the people slept at the beginning of the study and how much nightly sleep they were getting four years later. Over the 10-year study, 346 of the study subjects suffered strokes. After controlling for more than a dozen other health and behavioral variables, the researchers found that people who slept more than eight hours a day were 46 percent more likely to have had a stroke than those who slept six to eight hours. The study, published online last week in Neurology, also found that the risk of stroke was higher among people who reported that their need for sleep had increased over the study period. The authors caution that the data on sleep duration depended on self-reports, which can be unreliable. In addition, the study identified an association between sleep and stroke risk, rather than cause and effect. Sleeping more may be an early symptom of disease that leads to stroke, rather than a cause. “It could be that there’s already something happening in the brain that precedes the stroke risk and of which excessive sleep is an early sign,” said the lead author, Yue Leng, a doctoral candidate at the University of Cambridge. In any case, she added, “we don’t have enough evidence to apply this in clinical settings. We don’t want people to think if they sleep longer it will necessarily lead to stroke.” © 2015 The New York Times Company
Fatty liver disease, or the buildup of fat in the liver, and sleep apnea, marked by snoring and interruptions of breathing at night, share some things in common. The two conditions frequently strike people who are overweight or obese. Each afflicts tens of millions of Americans, and often the diseases go undiagnosed. Researchers used to believe that sleep apnea and fatty liver were essentially unrelated, even though they occur together in many patients. But now studies suggest that the two may be strongly linked, with sleep apnea directly exacerbating fatty liver. In a study published last year in the journal Chest, researchers looked at 226 obese middle-aged men and women who were referred to a clinic because they were suspected of having sleep apnea. They found that two-thirds had fatty liver disease, and that the severity of the disease increased with the severity of their sleep apnea. A study last year in The Journal of Pediatrics found a similar relationship in children. The researchers identified sleep apnea in 60 percent of young subjects with fatty liver disease. The worse their apnea episodes, the more likely they were to have fibrosis, or scarring of the liver. Though it is still somewhat unclear, some doctors suspect that the loss of oxygen from sleep apnea may increase chronic inflammation, which worsens fatty liver. Although fat in the liver can be innocuous at first, as inflammation sets in, the fat turns to scar tissue, and that can lead to liver failure. © 2015 The New York Times Company
Link ID: 20630 - Posted: 02.28.2015
By DENISE GRADY Faced with mounting evidence that general anesthesia may impair brain development in babies and young children, experts said Wednesday that more research is greatly needed and that when planning surgery for a child, parents and doctors should consider how urgently it is required, particularly in children younger than 3 years. In the United States each year, about a million children younger than 4 have surgery with general anesthesia, according to the Food and Drug Administration. So far, the threat is only a potential one; there is no proof that children have been harmed. The concern is based on two types of research. Experiments in young monkeys and other animals have shown that commonly used anesthetics and sedatives can kill brain cells, diminish learning and memory and cause behavior problems. And studies in children have found an association between learning problems and multiple exposures to anesthesia early in life — though not single exposures. But monkeys are not humans, and association does not prove cause and effect. Research now underway is expected to be more definitive, but results will not be available for several years. Anesthesiologists and surgeons are struggling with how — and sometimes whether — to explain a theoretical hazard to parents who are already worried about the real risks of their child’s medical problem and the surgery needed to correct it. If there is a problem with anesthesia, in many cases it may be unavoidable because there are no substitute drugs. The last thing doctors want to do is frighten parents for no reason or prompt them to delay or cancel an operation that their child needs. “On the one hand, we don’t want to overstate the risk, because we don’t know what the risk is, if there is a risk,” said Dr. Randall P. Flick, a pediatric anesthesiologist and director of Mayo Clinic Children’s Center in Rochester, Minn., who has conducted some of the studies in children suggesting a link to learning problems. “On the other hand, we want to make people aware of the risk because we feel we have a duty to do so.” © 2015 The New York Times Compan
The longer a teenager spends using electronic devices such as tablets and smartphones, the worse their sleep will be, a study of nearly 10,000 16- to 19-year-olds suggests. More than two hours of screen time after school was strongly linked to both delayed and shorter sleep. Almost all the teens from Norway said they used the devices shortly before going to bed. Many said they often got less than five hours sleep a night, BMJ Open reports. The teens were asked questions about their sleep routine on weekdays and at weekends, as well as how much screen time they clocked up outside school hours. On average, girls said they spent around five and a half hours a day watching TV or using computers, smartphones or other electronic devices. And boys spent slightly more time in front of a screen - around six and a half hours a day, on average. Playing computer games was more popular among the boys, whereas girls were more likely to spend their time chatting online. teen using a laptop Any type of screen use during the day and in the hour before bedtime appeared to disrupt sleep - making it more difficult for teenagers to nod off. And the more hours they spent on gadgets, the more disturbed their sleep became. When daytime screen use totalled four or more hours, teens had a 49% greater risk of taking longer than an hour to fall asleep. These teens also tended to get less than five hours of sleep per night. Sleep duration went steadily down as gadget use increased. © 2015 BBC
By James Gallagher Health editor, Our internal body clock has such a dramatic impact on sporting ability that it could alter the chances of Olympic gold, say researchers. The team at the University of Birmingham showed performance times varied by 26% throughout the day. Early risers reached their athletic peak around lunchtime, while night owls were best in the evening. The researchers say it could even explain why Spanish teams have more success in European football. The body clock controls everything - from alertness to the risk of a heart attack - in a daily rhythm. Some aspects of sporting ability were thought to peak in early afternoon but a study in the journal Current Biology suggests each competitor's sleeping habits have a powerful impact. They took 20 female hockey players and asked them to perform a series of 20m runs in shorter and shorter times. And they did it at six different times of day between 07:00 and 22:00. The results showed a peak performance in late afternoon, but then the scientists looked separately at early-type people, late-type people and those in the middle. This time the gap between the best and worst times was 26%, and a far more complicated picture emerged. Lead researcher Dr Roland Brandstaetter told the BBC News website: "Athletes and coaches would benefit greatly if they knew when optimal or suboptimal performance time was." He said a 1% difference in performance would be the difference between fourth place and a medal in many Olympic events. Body clocks can be adjusted. Jet lag is when you feel rough before adjusting to a new time. "So if you're an early type in a competition in the evening, then you're impaired, so you could adjust sleeping times to the competition," Dr Brandstaetter said. © 2015 BBC.
Keyword: Biological Rhythms
Link ID: 20540 - Posted: 02.02.2015
Over-the-counter sleeping aids and hayfever treatments can increase the risk of Alzheimer’s disease, a study has found. The sleeping medication Nytol and anti-allergy pills Benadryl and Piriton all belong to a class of drug highlighted in a warning from researchers. Each of these drugs has “anticholinergic” blocking effects on the nervous system that are said – at higher doses – to raise the likelihood of developing Alzheimer’s and other forms of dementia significantly over several years. Other drugs on the risk list include older “tricyclic” antidepressants such as doxepin, and the bladder control treatment Ditropan (oxybutynin). Many of these medicines are taken by vulnerable older people, according to the scientists, who say their findings have public health implications. Anticholinergic drugs block a nervous system chemical transmitter called acetylcholine, which can lead to side-effects including drowsiness, blurred vision and poor memory. People with Alzheimer’s disease are known to lack acetylcholine. The leader of the US study, Professor Shelly Gray, director of the geriatric pharmacy programme at the University of Washington School of Pharmacy, said: “Older adults should be aware that many medications – including some available without a prescription, such as over-the-counter sleep aids – have strong anticholinergic effects. And they should tell their healthcare providers. “Of course, no one should stop taking any therapy without consulting their healthcare provider. Healthcare providers should regularly review their older patients’ drug regimens – including over-the-counter medications – to look for chances to use fewer anticholinergic medications at lower doses.”
by Bethany Brookshire Drugs that treat anxiety can be real downers. While they may help you feel less anxious, drugs such as Valium and Xanax can leave you drowsy and unfocused. Long-term use of these compounds, a class of drugs called the benzodiazepines, can lead to dependence and tolerance. And patients often need higher and higher doses to calm their anxiety. Getting off the drugs requires careful weaning to avoid insomnia, tremors and other nasty withdrawal effects. But Subhashis Banerjee and colleagues at the Scripps Research Institute in Jupiter, Fla., have identified a potential new target for anti-anxiety drugs that avoids the drowsiness and other side effects that come with the standard treatments. The target is an integral part of the body’s internal clock, and in tests in mice, compounds aimed at it reduced measures of anxiety while keeping the mice awake. The possibilities show how basic science questions, such as how the body produces sleep and internal rhythms, could have clinical applications. But it’s important to remember that it’s a long way between mice and people. The proteins REV-ERB alpha and REV-ERB beta are found in cell nuclei throughout the body. These proteins are receptors that sense levels of heme, subsections of chemicals in the body containing iron atoms. Levels of heme rise and fall based on a cell’s activity. REV-ERB responds to these heme level changes by controlling the activation of genes within the cell’s nucleus that govern the cell’s 24-hour internal clock. This circadian rhythm plays an important role in controlling our sleep. © Society for Science & the Public 2000 - 2015.
By James Gallagher Health editor, BBC News website The key to learning and memory in early life is a lengthy nap, say scientists. Trials with 216 babies up to 12 months old indicated they were unable to remember new tasks if they did not have a lengthy sleep soon afterwards. The University of Sheffield team suggested the best time to learn may be just before sleep and emphasised the importance of reading at bedtime. Experts said sleep may be much more important in early years than at other ages. People spend more of their time asleep as babies than at any other point in their lives. Yet the researchers, in Sheffield and Ruhr University Bochum, in Germany, say "strikingly little is known" about the role of sleep in the first year of life. Learn, sleep, repeat They taught six- to 12-month-olds three new tasks involving playing with hand puppets. Half the babies slept within four hours of learning, while the rest either had no sleep or napped for fewer than 30 minutes. The next day, the babies were encouraged to repeat what they had been taught. The results, published in Proceedings of the National Academy of Sciences, showed "sleeping like a baby" was vital for learning. On average one-and-a-half tasks could be repeated after having a substantial nap. Yet zero tasks could be repeated if there was little sleep time. Dr Jane Herbert, from the department of psychology at the University of Sheffield, told the BBC News website: "Those who sleep after learning learn well, those not sleeping don't learn at all." © 2015 BBC
ARE you spending enough time in the sun? As well as keeping our bones strong, vitamin D – the hormone our skin makes when exposed to ultraviolet rays – may also help regulate our body clocks. We all have a small group of "clock genes" which switch on and off during the day. As a result, the levels of the proteins they code for rise and fall over a 24-hour period. Enforced routines such as night shift work can play havoc with our health – increasing our risk of a stroke, for example. To find out whether a lack of vitamin D might be responsible, Sean-Patrick Scott and his colleagues at the Monterrey Institute of Technology and Higher Education in Mexico looked at the behaviour of two clock genes in human fat cells. When the cells were immersed in blood serum, they acted as they would in the body: the clock genes' activity oscillated over a 24-hour period. Dosing the cells with vitamin D instead produced the same effect. No such effect was seen in cells placed inside a nutrient broth. "Vitamin D synchronises the cells," says Scott. "Our results explain some of the benefits of sunlight," he says. "Vitamin D is one of the ways we might be able to maintain circadian rhythms in the body." Julia Pakpoor of the University of Oxford says clinical trials are needed to confirm the effect in people, but she adds, "We should all make sure we are vitamin D replete regardless." The work was presented at the World Stem Cell Summit in San Antonio, Texas, last month. © Copyright Reed Business Information Ltd.
Keyword: Biological Rhythms
Link ID: 20454 - Posted: 01.06.2015
By Nicholas Bakalar Planning to read in bed tonight? It may be better to read an actual book instead of an e-book reader. A small study has found that reading light-emitting electronic devices before bedtime is a recipe for poor sleep. Researchers randomly assigned 12 healthy young adults to one of two activities: reading a light-emitting e-book in a dimly lit room for about four hours before bedtime on five consecutive evenings, or reading a printed book for the same amount of time. All participants did both tasks. The researchers took blood samples to measure melatonin levels, and electronically tracked how long it took to fall asleep and how much time was spent in each sleep stage. The study, done at Brigham and Women’s Hospital in Boston, is online in the Proceedings of the National Academy of Sciences. Compared with a printed book, a light-emitting e-book decreased sleepiness, reduced REM sleep (often called dream sleep), and substantially suppressed the normal bedtime rise of melatonin, the hormone that regulates the sleep and wake cycle. The e-book users took longer to fall asleep and felt sleepier in the morning. “Much more has to be known about the kind of impact these devices have on our health and well-being,” said the lead author, Anne-Marie Chang, an assistant professor of biobehavioral health at Penn State. “The technology moves quickly, and the science lags.” © 2014 The New York Times Company
By James Gallagher Health editor, BBC News website Higher rates of obesity and ill-health have been found in shift workers than the general population. Health Survey for England data showed they were in worse health despite often being young. The lead researcher told the BBC that the rise of zero-hours contracts may be increasing the numbers doing shift work and could raise "pretty serious problems" for the nation's health. Scientists said it was "fairly clear now" that shift work was unhealthy. The report, by the Health and Social Care Information Centre, showed 33% of men and 22% of women of working age were doing shift work. They defined shifts as employment outside 0700-1900. Rachel Craig, the research director for the Health Survey for England, told the BBC: "Overall, people who are doing shift work are not quite as healthy as their counterparts doing regular working hours." The data showed 30% of shift workers were obese, compared with 24% of men and 23% of women doing normal hours. Meanwhile, 40% of men and 45% of women on shifts had long-standing health conditions such as back-pain, diabetes or chronic obstructive pulmonary disease compared with 36% and 39% of the rest of the population. Younger people Shift working is most common in the 16-24 age group with nearly half of men and a third of women having this working pattern. The rates fell with age so that fewer than a third of men and a fifth of women were working shifts after the age of 55. Ms Craig said that, overall, young people should be in better health: "You'd expect less ill-health and fewer long-standing conditions that reflect lifestyle like obesity, so it makes it an even stronger relationship [between shifts and poor health]." BBC © 2014
By Nicholas Bakalar Poor sleep in older adults may be linked to brain changes associated with dementia, a new study has found. Researchers studied 167 men who underwent sleep tests in 1999 and died by 2010. The study, in Neurology, recorded sleep duration, periods of waking up and episodes of apnea, and used pulse oximetry to measure oxygen saturation of their blood. On autopsy, they found that those in the highest one-quarter for duration of sleep at oxygen saturation of less than 95 percent were almost four times as likely to have higher levels microinfarcts, small areas of dead tissue caused by deprivation of blood supply, as those in the lowest one-quarter. Compared with those in the lowest 25 percent for duration of slow-wave (deep) sleep, those in the highest one-quarter were about a third as likely to have moderate or high levels of generalized brain atrophy. “Prior studies have shown an association between certain types of sleep disturbance and dementia,” said the lead author, Dr. Rebecca P. Gelber, an epidemiologist with the Veterans Administration in Hawaii. “These lesions may help explain the association.” © 2014 The New York Times Company
Kelly Servick* Anesthesiologists and surgeons who operate on children have been dogged by a growing fear—that being under anesthesia can permanently damage the developing brain. Although the few studies of children knocked out for surgeries have been inconclusive, evidence of impaired development in nematodes, zebrafish, rats, guinea pigs, pigs, and monkeys given common anesthetics has piled up in recent years. Now, the alarm is reaching a tipping point. “Anything that goes from [the roundworm] C. elegans to nonhuman primates, I've got to worry about,” Maria Freire, co-chair of the U.S. Food and Drug Administration (FDA) science advisory board, told attendees at a meeting the agency convened here last month to discuss the issue. The gathering came as anesthesia researchers and regulators consider several moves to address the concerns: a clinical trial of anesthetics in children, a consensus statement about their possible risks, and an FDA warning label on certain drugs. But each step stirs debate. Many involved in the issue are reluctant to make recommendations to parents and physicians based on animal data alone. At the same time, more direct studies of anesthesia's risks in children are plagued by confounding factors, lack of funding, and ethical issues. “We have to generate—very quickly—an action item, because I don't think the status quo is acceptable,” Freire said at the 19 November meeting. “Generating an action item without having the data is where things become very, very tricky.” © 2014 American Association for the Advancement of Science
By CATHERINE SAINT LOUIS Nearly 55 percent of infants nationwide are put to bed with soft blankets or covered by a comforter, even though such bedding raises the chances of suffocation or sudden infant death syndrome, federal researchers reported Monday. Their study, published in the journal Pediatrics, is the first to estimate how many infants sleep with potentially hazardous quilts, bean bags, blankets or pillows. Despite recommendations to avoid putting anything but a baby in a crib, two-thirds of black and Latino parents still use bedding that is both unnecessary and unsafe, the study also found. “I was startled a little bit by the number of people still using bedding in the sleep area,” said Dr. Michael Goodstein, a neonatologist in York, Pa., who serves on a task force on sleep-related infant deaths at the American Academy of Pediatrics. “Sleeping face down on soft bedding increases the risks of SIDS 21-fold.” Among the risk factors for SIDS, “bedding has fallen through the cracks,” said Dr. Thomas G. Keens, the chairman of the California SIDS Advisory Council. “This article is a wake-up call.” The new analysis looked at data gathered from 1993 to 2010 in the National Infant Sleep Position Study, which surveyed a random sample of nearly 19,000 parents by telephone. Use of infant bedding declined roughly 23 percent annually from 1993 to 2000. In recent years, however, the declines have slowed or stalled entirely. From 2001 to 2010, use of inappropriate bedding for white and Hispanic infants declined just 5 to 7 percent annually. There was no decline in the use of such bedding for black infants. Parents in the new study were not asked their reasons for using bedding. Previous research has found that they worry infants will be cold, or that the crib mattress is too hard. © 2014 The New York Times Company