Can Caffeine Affect Your Circadian Rhythm?

Can Caffeine Affect Your Circadian Rhythm?Your circadian rhythm regulates your sleep cycle by telling your body when it’s time to sleep and when it’s time to be awake. This system can be disrupted by many external factors, including light exposure, food consumption, physical activity and certain medications. It’s well-known that caffeine can provide an energy boost, but is caffeine consumption another environmental factor that could affect your internal clock?

The Importance of a Regular Sleep-Wake Cycle

An irregular circadian rhythm can significantly effect your health and quality of life. Circadian rhythm disturbance can lead to an increased incidence of medical problems, such as:

  • Depression
  • Cancer
  • Cardiovascular disease
  • Diabetes

Caffeine’s Effect on Cellular Timekeeping

In past years, scientists have studied bread mold, green algae and fruit flies to discover that caffeine can alter the way certain cells keep time. This led one group of researchers to question whether caffeine has the same effect on human cells.

The study was conducted by a research team at the University of Colorado, Boulder. They conducted a 49-day double-blind, placebo-controlled sleep study. Participants were either exposed to caffeine, bright light or both 3 hours before bedtime. The caffeine dosage was equivalent to the amount in a double espresso.

Results of the study indicated that the caffeine dosage taken 3 hours before bedtime delayed circadian rhythm in the patients by approximately 40 minutes. Researchers also found that exposure to bright light before bedtime had a double effect of caffeine on participants.

There’s no denying that both caffeine and bright light have a significant impact on humans’ circadian rhythm.

Maintaining a Regular Circadian Rhythm

As this study suggests, it’s best to avoid caffeine at least 3 hours prior to regular bedtime. In addition to coffee, caffeine is also found in some teas, soda and chocolate.

When your internal clock is continually misaligned with your normal sleep schedule, it can put unnecessary stress on your body.

The effect of caffeine can vary from person to person based on a variety of factors, including genetics. Anyone who is sensitive to caffeine should be especially vigilant about the foods and beverages they consume later in the day.

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The Latest in Lung Transplant Research

The Latest in Lung Transplant ResearchSometimes patients suffer with lung diseases that don’t respond to treatment. In those instances, a lung transplant could be the only way to extend their lifespan and improve their quality of life. The lung transplant procedure is especially common in patients with end-stage lung disease.

Although it is a risky surgery, advancements in pre- and post-transplant procedures have improved patient outcomes. Here are two examples of recent findings that could lead to further improvements.

EVLP Can Expand the Donor Pool

Ex vivo lung perfusion (EVLP) is an innovative therapy that is applied to lungs outside of the body before transplantation. Within the past decade, the treatment has been used to improve the quality of organs so they can become suitable for transplant. It also allows more time to assess if the lungs have persistent dysfunction, which minimizes the chance of transplanting organs that can’t function properly.

A study published in 2018 revealed that an acellular normothermic EVLP technique could reduce cell-specific leukocyte gene expression over a 12-hour period. The technique also identified potential biomarkers that could improve the process for selecting lungs on EVLP. This process would select lungs that are suitable to be transplanted and predict the risk of primary graft dysfunction, a serious complication. Although further research is needed to validate these findings, the technique could identify marginal lungs that would be viable for transplant while simultaneously eliminating potential donor lungs that aren’t suitable.

Drug Combination May Minimize Chronic Rejection

Patients are at the highest risk for life-threatening complications within the first year of undergoing a lung transplant. High risk patients are required to take medications for the rest of their life to suppress the immune system and help prevent the body from rejecting the new lungs. Even with standard precautions and medical treatment, the median survival rate after lung transplant is less than six years. The most common causes of death are chronic rejection, infection and cancer.

In August 2019, researchers at the University of Maryland School of Medicine conducted a study that analyzed a database of over 9,000 lung transplants. Their research led to the identification of a drug combination that appears to significantly extend patient survival. The combination of tacrolimus, an immunosuppressant, and sirolimus, a cell cycle inhibitor, was associated with a better median survival than the current standard treatment.

While every patient’s treatment and recovery are unique, the findings of this study could make a difference in outcome for lung transplant patients in the future.


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How to Clean your CPAP Machine

How to Clean your CPAP Machine

Continuous positive airway pressure (CPAP) is a standard treatment for patients with obstructive sleep apnea and other sleep-related breathing disorders. Because patients use the machines every night, they need to be regularly cleaned and cared for.

Neglecting to clean a CPAP machine can lead to bacterial growth that causes odor. In some cases, the bacteria may cause the equipment to breakdown prematurely. Luckily, the cleaning process is fairly simple for each component of the machines.

The CPAP Mask

Most CPAP masks are made of silicone. The masks should be cleaned daily with warm water and non-fragrant soap. You can also opt to purchase wipes or detergents made specifically to clean CPAP masks. Once a week, it’s recommended to soak the mask in a solution of one parts vinegar to three parts water, then rinse it with distilled water. The headgear and tubing of the mask should be cleaned weekly with warm soapy water.

To extend the life of a mask, wash your face thoroughly before bed and avoid using facial moisturizers.

The CPAP Humidifier

Most CPAP machines are equipped with a humidifier that helps reduce dry mouth. Daily cleaning is needed to prevent calcification and bacteria build-up.

To clean, the humidification chamber should be removed carefully so no water spills on the machine. You can then wash it with soapy water and leave it to dry on a clean surface. It should also be soaked in a water and vinegar solution weekly for 15-20 minutes, then rinsed with distilled water.

The CPAP Filters

Near the back of the machine, you’ll find the CPAP filter. This is the component that draws air from the room.

The gray non-disposable filters should be cleaned on a weekly basis. If you have pets or excessive dust inside your home, you may need to clean it more often. The non-disposable filters may need to be replaced every six months. The white disposable filters should be replaced monthly, or as needed.

To ensure that the equipment has time to dry during the day, try making CPAP maintenance a part of your morning routine. Another option is to use a cleaner and sanitizer machine that automatically cleans and dries your machine for you.

Consult your doctor or the product manufacturer if you have questions about maintenance for your specific machine.


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Vitamin C Could Help Infant Lungs if Mother Smoked During Pregnancy

Vitamin C Could Help Infant Lungs if Mother Smoked During Pregnancy

Smoking cigarettes is an unhealthy habit that is especially dangerous for women who are pregnant. Despite these risks, smoking during pregnancy is still a common problem. More than 12% of women who smoke are unable to quit while they are pregnant.

Women who are unable to quit smoking during their pregnancy put themselves and their baby at greater risk for medical complications, such as:

  • Fetal tissue injury, specifically in the lungs and brain
  • Preterm delivery
  • Low birth weight
  • Miscarriage
  • Sudden Infant Death Syndrome (SIDS)

Although it is recommended that women kick their smoking habit while pregnant, researchers have discovered that vitamin C may help combat lung problems in babies born to pregnant smokers.

The Research

In a double-blind study, one group of smokers took 500 mg of vitamin C supplementation daily during pregnancy. The second group was given a placebo tablet. All mothers in the study were encouraged to quit smoking for the duration of their pregnancy. Those who didn’t quit smoked an average of seven cigarettes a day. Both groups also took a prenatal vitamin.

Infants born to mothers who took vitamin C showed improved pulmonary function 48 hours after birth compared to infants whose mothers took placebo tablets. The vitamin C group also had fewer incidents of wheezing throughout their first year of life.

The study will continue until children from the study are six years old. This will provide data on their long-term respiratory health, specifically whether children born to smokers who took vitamin C are less likely to develop asthma. Future trials may examine whether benefits are greater if supplementation begins earlier in a pregnancy and continues in the infants after birth.

Researchers think vitamin C has this effect on infant respiration because of the vitamin’s ability to replace ascorbic acid that is depleted by cigarette usage.

Seeking Help

Vitamin C is a safe and inexpensive treatment that could potentially help infants born to mothers who can’t or won’t quit smoking. The top priority is to encourage women to quit smoking during their pregnancy.

If you or a loved one is trying to quit smoking, the dedicated team at PCCMA is here to help. Call us today at (717) 234-2561.


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What is Delayed Sleep Phase Syndrome?

What is Delayed Sleep Phase Syndrome?

Getting an adequate amount of sleep each night is vital to your body’s ability to function properly throughout the day. Those with Delayed Sleep Phase Syndrome (DSPS) are frequently deprived of quality rest.

DSPS is a disorder in which a person’s normal sleep is delayed by two or more hours. For example, a person with DSPS may find themselves falling asleep several hours after their desired bedtime. They may lie down before 10 p.m., but still be awake well after midnight.

DSPS affects approximately 15% of teens and adults, according to the American Sleep Association. DSPS often begins in adolescence and continues into adulthood. Genetic and environmental factors may also lead to the development of this sleep disorder.

Symptoms of DSPS include:

  • Inability to fall asleep
  • Difficulty waking up at a desired hour
  • Daytime sleepiness
  • Frequent napping to balance sleep deprivation
  • Depression and behavioral problems (especially in children and adolescents)

Another symptom is simply the lack of other sleep problems. Those with DSPS typically sleep through the night without trouble. When they can sleep freely on their delayed sleep and wake schedules, they will awake refreshed later in the day.

Most people with this disorder describe themselves as “night owls.” The problem occurs when that person lacks sleep because they must wake up early for school, work and other responsibilities.

Treating Delayed Sleep Phase Syndrome

Those who are unable to correct their sleeping pattern may need to seek the help of medical professionals who specialize in sleep disorders. There are two treatments that have been successful in treating DSPS.

  1. Bright light therapy, also known as phototherapy, is a technique that gradually shifts sleeping patterns. The patient is exposed to bright lights in the morning, shortly after they wake up, and avoids bright outdoor light in the evening. When properly executed, the treatment has been shown to normalize the patient’s circadian rhythm.
  2. Chronotherapy corrects the patient’s circadian rhythm by delaying their bedtime by two hours every few days. It is used less frequently than bright light therapy because it can disrupt their normal schedule of activity.

If you think you or a loved one are suffering from Delayed Sleep Phase Syndrome, consult your doctor for diagnosis and treatment.

Wasp Venom May Combat Lung Diseases

Wasp Venom May Combat Lung Diseases

When you think of wasp venom, you typically associate it with disrupting a person’s breathing, not improving it. However, along with toxic properties, some insect venom is full of compounds that kill bacteria.

The venom’s toxicity makes it impossible for us to use it as an antibiotic drug, but variants of a peptide with antimicrobial properties could be an alternative to some antibiotic-resistant bacterial strains.

Researchers at the Massachusetts Institute of Technology have repurposed peptides from Brazilian wasp (Polybia paulista) venom to make an antibiotic drug that isn’t toxic to humans.

One study tested the wasp venom peptides on mice with Pseudomonas aeruginosa, a deadly bacteria strain that is resistant to most antibiotics. This bacteria causes infections in the respiratory system that could spread throughout the body. Pseudomonas aeruginosa is also known to cause pneumonia and urinary tract infections in people with weak immune systems, a complication that is common for patients with cystic fibrosis.

Prior to being tested on the mice, the refined peptides were tested for toxicity on human kidney cells that were grown in a lab. The most promising peptides were then tested on mice with Pseudomonas aeruginosa.

The presence of the bacteria was significantly reduced after several peptides were tested against it. The infection was eliminated by a high dosage of variant peptides.

Comparison to Traditional Antibiotics

Antibiotics we use today must be taken for one or two weeks to clear an infection. The compound derived from wasp venom cleared an infection in just four days. However, researchers are still testing whether the drug is equally as effective with a lower—and therefore safer—amount of wasp venom. They are hopeful that infections could be cleared with lower doses once additional variants are created.

In the United States alone, the CDC reports that antibiotic-resistant bacteria causes over 2 million illnesses and 23,000 deaths each year. The World Health Organization has long warned of the threat these bacteria pose.

One of the most important parts of this discovery is the precedent it sets. Principles that were discovered in this study could be applied to other peptides derived from nature, which improves our ability to discover new treatments for diseases that were previously untreatable.

Surgical Menopause May Lead to Decreased Sleep Quality

Surgical Menopause May Lead to Decreased Sleep Quality

Most women experience menopause naturally. It is the stage when a woman permanently stops having menstrual periods. The average age of menopause is 51, but it can vary.

Nearly 26 percent of postmenopausal women report severe sleep disturbances, making insomnia one of the most common symptoms of menopause. This symptom often begins during perimenopause, which is a 3- to 10-year period of time before menopause occurs.

A study published in 2018 suggests that sleep quality is often worse for women who undergo surgical menopause than for women who experience menopause naturally.

What is Surgical Menopause?

Medical procedures that interfere with ovarian function can often cause premature menopause. For example, if a premenopausal woman has one or both ovaries removed, she may experience abrupt menopause. Surgical menopause may also stem from radiation of the pelvis and ovaries during cancer treatment.

Potential Causes of Increased Sleep Issues

Menopause can be challenging for any woman, but women who undergo surgical menopause tend to have increased symptoms of menopause. This includes a decrease in sleep quality. One possible cause for the difference is that surgical menopause results in a sharper drop in estrogen levels as opposed to the more gradual hormonal changes that result from natural menopause.

In one study, women were twice as likely to suffer from insomnia if they experienced surgical menopause. They also reported worse sleep quality, especially regarding the duration of sleep.

Hot flashes and night sweats are two well-known symptoms of menopause, which only serves to worsen sleep quality. Since all menopausal symptoms tend to be more intense in women who undergo surgical menopause, these severe physiological symptoms may make it psychologically harder to fall asleep and stay asleep.

The Importance of Early Treatment

Poor sleep quality can cause daytime fatigue, lower quality of life and a higher risk for other serious health conditions if the insomnia persists. The most common treatment for menopausal symptoms is hormone replacement therapy (HRT), but treatment may vary on a case-by-case basis.

Women who are experiencing sleep problems after natural or surgical menopause should consult their doctor to determine the best course of treatment for their condition.

Caring for a Child with Cystic Fibrosis

Caring for a Child with Cystic Fibrosis

Cystic fibrosis (CF) is a complex genetic disease that requires a consistent care plan. Children and infants with CF rely on parents and caretakers to be proactive with their treatment, which can be a time-consuming part of each day.

For many families, adhering to a care routine becomes easier over time. There are proactive steps to help protect a child’s health as the years go on.

Become Educated on Care Practices

After a child or infant is diagnosed with CF, doctors provide resources to help the adults in the child’s life learn about the disease and recommended treatments. Understanding the disease will make it easier to see the importance of consistent treatment.

Commit to Your Routine

The treatment regimen for a CF patient starts in the morning and ends at bedtime, making it a staple in the lives of both a child and those around them.

Throughout the day, caring for a child’s CF will typically take over an hour. Chest physiotherapy — also known as airway clearance treatment — is usually done at least once a day but may be prescribed more frequently. These treatments loosen mucous from the child’s lungs, helping to maintain pulmonary function.

Try to develop a ritual that makes the treatment an important part of each day, making the experience as pleasant for the child as possible.

Take Precautions to Prevent Germs

Children with CF are at a higher risk of developing lung infections. To reduce the risk of infection for a child with this chronic disease, make sure you and other household members have up-to-date vaccines. If someone has a contagious disease, you should ask them to physically distance themself from the child until the illness subsides. Practicing proper hygiene is also crucial.

Don’t Skip Health Check-Ups

Regular health check-ups can aid in managing a child’s symptoms. The doctors will look for signs of complications and provide much-needed support. Ask your child’s doctor how often you should have checkup appointments to monitor your child’s health.

Encourage Children to Be Involved in their Treatment

As a child gets older, they can be more active participant in their CF treatment. When a child takes more responsibility for their care, it teaches self-management skills and independence.

Start by talking to the child about their condition, including how to tell other people about it. Eventually, they can assume the responsibility of using therapeutic equipment and taking medications. Remember that the quality of treatment should always take priority, so treatment should be supervised until the child is ready.

It’s estimated that only 12 to 16 percent of children with cystic fibrosis receive the recommended caloric intake per day. Other important aspects of treatment, such as airway clearance, completing aerosolized medications and taking enzymes are also lacking in many cases. There is a need to understand and address barriers that prevent children from adhering to a regular schedule of treatment.

Pregnant? Sleep Apnea Can Affect Your Baby

Pregnant? Sleep Apnea Can Affect Your Baby

Sleep apnea can have serious health implications for anyone, but the risk is amplified for pregnant women if the disease goes untreated.

Millions of Americans live with sleep apnea, but many are never diagnosed. The disease is not only dangerous for the health of a pregnant woman, but also the health of their unborn child.

Causes and Risk Factors

Sleep disorders are fairly common during pregnancy. This is because of both hormonal and physiological changes.

Obstructive sleep apnea is more prevalent in women who were overweight before pregnancy because excess tissue in the airway can block airflow during sleep. High blood pressure and gestational diabetes are two additional risk factors for developing sleep apnea.

Physiological changes can contribute to sleep apnea during pregnancy. For example, excess hormones may cause congestion in mucous membranes, increasing the likelihood of sleep apnea. There is also a genetic component.


Pregnant women with sleep apnea are more likely to experience complications before, during and after childbirth. Examples include preeclampsia, congestive heart failure, pulmonary embolism, a longer hospital stay and an increased likelihood of admission to the intensive care unit. Sleep apnea may also increase cognitive decline over time.

Sleep apnea during pregnancy can affect the baby, as well. Serious complications may include:

  • Preterm delivery
  • Low birth weight
  • A higher likelihood of admission to the NICU (neonatal intensive care unit)
  • Low Apgar scores

Sleep apnea is also linked to impaired fetal growth, according to a 2017 study.

Luckily, early diagnosis and treatment of sleep apnea during pregnancy can mitigate these complications.

Managing Sleep Apnea During Pregnancy

Any pregnant woman who suspects a sleep disorder should consult their doctors immediately. Symptoms include snoring, pauses in breathing while asleep, and sputtering after a pause in breathing. Daytime tiredness, depression and headaches can also indicate a sleep disorder, but there are other potential causes for those symptoms. (Sleep Disorders May Affect Women Sooner than Men)

The most definitive test for sleep apnea is a sleep study. The study allows doctors to diagnose the sleep apnea and determine the best course of treatment. (5 Things to Know Before Your Sleep Study)

Most common treatments are the use of a CPAP (continuous positive airway pressure) machine or oral appliances, but surgery is sometimes necessary.

By diagnosing a maternal sleep disorder in the early stages, both mom and baby have the best chance of avoiding complications.

PCCMA Hires Four New Medical Staff

Independent practice adds experienced physician and supporting medical staff to growing practice

Pulmonary and Critical Care Medicine Associates

LEMOYNE, Pa. — Pulmonary & Critical Care Medicine Associates (PCCMA), an independent medical practice based in Lemoyne, today announced four new hires to meet increasing demand for its pulmonary, critical care and sleep lab services.

Dr. Charles Inner, M.D. joined PCCMA as a physician and Cara Centrella joined as a physician assistant. Kellie Shapiro and Sherry Ayler joined as nurse practitioners. The new team members increase the practice’s total number of employees to 50 with expectations of adding additional staff throughout 2019.

“We are very excited to expand our medical team and continue to provide our patients with expert and compassionate care,” said Jason Alexander, Executive Director of PCCMA. “Charles, Cara, Kellie and Sherry add a wealth of diverse experience to our clinical team. We are proud of our continued growth as Central Pennsylvania’s largest independent pulmonary practice group.”

Dr. Inners will focus on seeing pulmonary patients at PCCMA’s Lemoyne office. He has served as president of the medical staff at LifeCare Hospitals of Mechanicsburg since 2013. Dr. Inners graduated first in his class at John Hopkins University School of Medicine.

Centrella will work with the practice’s outpatient pulmonary and sleep patients. She previously worked as a family medicine physician assistant at UPMC Pinnacle Health Medical Group. She received her master of science degree in physician assistant studies from Marywood University.

Ayler will serve as a nurse practitioner supporting outpatient and sleep patients. She has worked in nursing for more than 23 years. Ayler’s previous experience includes 16 years at Penn State Hershey Medical Center. She received her master of science degree in nursing from Millersville University.

Shapiro will support pulmonary and sleep lab patients and will spend time in community hospitals and clinics. Shapiro previously worked as an adjunct and assistant professor at Harrisburg Area Community College teaching classes for licensed practical nursing (LPN). She received her bachelor of science degree in nursing from Marywood University and is expected to receive her master of science in nursing from Purdue Global in May.

In addition to its Lemoyne office, PCCMA also has offices in Carlisle and York and is UPMC Pinnacle’s select provider of pulmonary and critical care at UPMC Pinnacle hospitals in Central Pennsylvania.

Lemoyne: 50 N. 12th Street, Lemoyne, PA 17043
Carlisle: 220 Wilson Street, Suite 104, Carlisle, PA 17013

Phone: (717) 234-2561

For medical emergencies, call 911.

© 2019 Pulmonary & Critical Care Medicine Associates