Supplements Fail to Relieve Joint Pain in Study

Joint pain and swelling in postmenopausal women is common, and some studies have suggested that low vitamin D and calcium levels may be one cause. But a randomized clinical trial found that vitamin D and calcium supplements are no better than a placebo for relieving joint problems.

Researchers studied 1,911 women, half taking 1,000 milligrams of calcium and 400 units of vitamin D daily, the other half taking a placebo. The two groups had similar rates of joint pain and joint swelling, about 73 percent and 34 percent respectively. The groups were also similar in rates of smoking, physical activity, body mass index and other factors. The analysis is posted online in The Journal of the Academy of Nutrition and Dietetics.

After two years, 74.6 percent of the supplement group had joint pain, and so did 75.1 percent of the placebo group. Joint swelling was reported by 34.6 percent of those who took supplements and 32.4 percent of those who took the placebo. Both are statistically insignificant differences.

If calcium and vitamin D supplements are ineffective, what does work? The lead author, Dr. Rowan T. Chlebowski, a medical oncologist at the Los Angeles Biomedical Research Institute, is not hopeful. “I think over-the-counter pain relievers are the solution,” he said. But, he added, “We’re wearing down over time, and there’s not much to be done about it.”

Beers Implicated in Emergency Room Visits

Nationwide, roughly a third of all visits to emergency rooms for injuries are alcohol related. Now a new study suggests that certain beverages may be more likely to be involved than others.

The study, carried out over the course of a year at the Johns Hopkins Hospital in Baltimore, found that five beer brands were consumed most often by people who ended up in the emergency room. They were Budweiser, Steel Reserve, Colt 45, Bud Ice and Bud Light.

Three of the brands are malt liquors, which typically contain more alcohol than regular beer. Four malt liquors accounted for nearly half of the beer consumption by emergency room patients, even though they account for less than 3 percent of beer consumption in the general population.

Previous studies have found that alcohol frequently plays a role in emergency room admissions, especially those stemming from car accidents, falls, homicides and drownings, said the lead author of the study, David H. Jernigan of the Johns Hopkins Bloomberg School of Public Health. The new study, published in the journal Substance Use and Misuse, is the first to look at whether certain brands or types of liquor are overrepresented.

Dr. Jernigan said that the breakdown of liquor consumption in the study may be particular to Baltimore, and that he and his colleagues are hoping to study other cities as well. The findings could have policy implications, potentially influencing labeling requirements and marketing for higher-alcohol beers, Dr. Jernigan said.

Insomnia Is Linked to Trouble Breathing

Subtle breathing problems during sleep may play a larger role in causinginsomnia than the usual suspects, like stress and the need for a bathroom, a small study of poor sleepers suggests.

The report, published in the current issue of the journal Sleep, found that chronic insomniacs woke an average of about 30 times a night, and that a brief respiratory problem — a drop in the volume of oxygen inhaled, due to a narrowed airway, for instance — preceded about 90 percent of those interruptions. None of the people had any idea they had breathing problems during sleep.

The study is hardly conclusive, experts said, because it included only 20 people and had no control group of normal sleepers for comparison. But these experts said that it was worth following up, because it challenged the predominant theory of insomnia as a problem of “hyper-arousal,” in which the body idles on high psychologically and physiologically. Earlier studies have linked measures of hyper-arousal to delays in falling asleep and problems nodding off after interruptions. But the theory does not satisfactorily explain what prompts awakenings in the first place.

The new study compared chronic insomniacs’ opinions about why they awoke at night with data from a sleep test monitoring breathing and brain waves — and does provide a possible explanation.

“It is a striking finding that by no means can be discounted,” said Dr. Michael J. Sateia, a professor of psychiatry and sleep medicine at Dartmouth College’s school of medicine, who was not involved in the research. Still, he added, “we know arousal can in and of itself promote instability of the upper airway,” and it is not always clear which comes first.

Dr. Sateia co-wrote an editorial accompanying the study, with Wilfred R. Pigeon, of the Canandaigua VA Medical Center, in Canandaigua, N.Y.

In the study, sleep researchers in Albuquerque interviewed 20 men and women with chronic insomnia, asking about the causes of their nightly awakenings. The people all sought help at Maimonides Sleep Arts and Sciences, a private clinic. None showed signs of having a breathing disorder like sleep apnea, or sleep-disordered breathing, a milder form. Most were taking sleep pills.

The group members attributed most of their awakenings to nightmares, a need for the bathroom, pain or “racing thoughts.”

But their sleep told a different story. The participants each spent a night at the sleep clinic, wired to sensors that tracked brain waves and breathing. Researchers charted every awakening, when brain waves shifted to a waking state for at least 16 seconds, and every breathing issue causing oxygen intake to dip well below normal.

“Almost all of the awakenings turned out to be preceded within a second by an abnormal breathing process — which led to the awakening,” said Dr. Barry Krakow, medical director of the Maimonides clinic and its research arm, the Sleep and Human Health Institute.

Dr. Krakow’s co-authors were Victor A. Ulibarri and Shara Kikta, both of Maimonides; and Edward Romero, a third-year student at the University of New Mexico School of Medicine.

Sleep medicine specialists usually treat insomnia with talk therapy intended to unwind people’s mistaken, and often subconscious, assumptions about sleeping. These include thinking of sleep as an exercise in frustration and approaching the bed with performance anxiety. Medications can help, too, but rarely resolve the underlying problems.

The new finding, if replicated, suggests that breathing disorders may be an underappreciated cause of insomnia and treatment of those problems could help. Doctors can prescribe dental inserts to keep airways open during sleep, or in more extreme cases, a “positive airway pressure” machine, known as a CPAP.

Such sleep therapies can run into the thousands of dollars and are not always covered by insurers. “A larger, controlled replication study would not only clarify the central question of whether” breathing problems are common in insomniacs, Dr. Sateia and Dr. Pigeon wrote in their editorial, but “perhaps even change reimbursement policies.”

How Exercise Can Help Us Sleep Better

As a clinical psychologist and sleep researcher at the Feinberg School of Medicine at Northwestern University, Kelly Glazer Baron frequently heard complaints from aggrieved patients about exercise. They would work out, they told her, sometimes to the point of exhaustion, but they would not sleep better that night.

Dr. Baron was surprised and perplexed. A fan of exercise for treating sleep problems, but also a scientist, she decided to examine more closely the day-to-day relationship between sweat and sleep.

What she and her colleagues found, according to a study published last week in The Journal of Clinical Sleep Medicine, is that the influence of daily exercise on sleep habits is more convoluted than many of us might expect and that, in the short term, sleep might have more of an impact on exercise than exercise has on sleep.

To reach that conclusion, Dr. Baron and her colleagues turned to data from a study of exercise and sleep originally published in 2010. For that experiment, researchers had gathered a small group of women (and one man) who had received diagnoses of insomnia. The volunteers were mostly in their 60s, and all were sedentary.

Then the researchers randomly assigned their volunteers either to remain inactive or to begin a moderate endurance exercise program, consisting of three or four 30-minute exercise sessions a week, generally on a stationary bicycle or treadmill, that were performed in the afternoon. This exercise program continued for 16 weeks.

At the end of that time, the volunteers in the exercise group were sleeping much more soundly than they had been at the start of the study. They slept, on average, about 45 minutes to an hour longer on most nights, waking up less often and reporting more vigor and less sleepiness.

But Dr. Baron wondered if the novice exercisers had experienced immediate improvements in their sleep patterns. And on a day-to-day basis, had working out on any given day produced better sleep that night?

Boring deep into the data contained in the exercising group’s sleep diaries and other information for the new study, Dr. Baron discovered that the answer to both questions was a fairly resounding no. After the first two months of their exercise program, the exercising volunteers (all of them women) were sleeping no better than at the start of the study. Only after four months of the program had their insomnia improved.

They also rarely reported sleeping better on those nights when they had had an exercise session. And perhaps most telling, they almost always exercised for a shorter amount of time on the days after a poor night’s sleep.

In other words, sleeping badly tended to shorten the next day’s workout, while a full-length exercise session did not, in most cases, produce more and better sleep that night.

At first glance, these results might seem “a bit discouraging,” Dr. Baron said. They also would seem to be at odds with the earlier conclusion that four months of exercise improved insomniacs’ sleep patterns, as well as a wealth of other recent science that has typically found that regular exercise lengthens and deepens sleep.

But, Dr. Baron pointed out, most of these other studies employed volunteers without existing sleep problems. For them, exercise and sleep seem to have a relatively uncomplicated relationship. You work out, fatigue your body and mind, and sleep more soundly that night.

But people with insomnia and other sleep disturbances tend to be “neurologically different,” Dr. Baron said. “They have what we characterize as a hyper-arousal of the stress system,” she said. A single bout of exercise on any given day “is probably not enough to overcome that arousal,” she explained. It could potentially even exacerbate it, since exercise is itself a physical stressor.

Eventually, however, if the exercise program is maintained, Dr. Baron said, the workouts seem to start muting a person’s stress response. Her or his underlying physiological arousal is dialed down enough for sleep to arrive more readily, as it did in the 2010 experiment.

Of course, both of these studies were small, involving fewer than a dozen exercising volunteers, all of them middle-aged or older women. “We think the findings would apply equally to men,” Dr. Baron said. But that idea has yet to be proved.

Likewise, it is impossible to yet know the sleep-related impacts of workouts of different types (like weight training), intensities or timing, including morning or late-evening sessions.

Still, the preliminary message of these findings is heartening. If you habitually experience insomnia and don’t currently exercise, Dr. Baron said, start. Don’t, however, expect that you will enjoy or even complete workouts the day after a broken night’s sleep, or that you will sleep better hours after you’ve exercised.

The process is more gradual and less immediately gratifying than the sleep-deprived might wish. But the benefits do develop. “It took four months” in the original study, Dr. Baron said, but at that point the exercising volunteers “were sleeping at least 45 minutes more a night.” “That’s huge, as good as or better” than most current treatment options for sleep disturbances, including drugs, she said.