Learning to Submit (1Night Stand Book 69)


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Up Against the Centerfold: What It Was Like to Report on Feminism for Playboy in

Over the course of three unrelated stories, Jamaican-American writer Fiona Zedde taps into queer romances that span the spectrum from innocent to just plain dangerous. The story uncoils around Teri Carter, a lawyer whose sex life is less than exciting. Lucky for her, a man named Josh Williams knows just what to do with her briefs.

Erotica maven Rachel Kramer Bussel lends her editorial curation to another collection of reads for lusty ladies. This one, however, dedicates every inch to women with actual bodies. Jayne Renault devotes an minute or so read to the modern mating jungle that is blind Internet dating. The story begins with a few swipes and ends with two women making the most out of a confined airport bathroom stall. Nicole Falls pretty much says it all with the title of her quick-and-dirty novella. Obesity also contributes to obstructive sleep apnea OSA.

This most likely occurs through fat deposition in airways, causing them to narrow. The relationship has been found in well-designed epidemiological studies of young children Locard et al. Taken as a whole, the body of evidence suggests that the serious public health problem of obesity may continue to grow as sleep loss trends continue to worsen.

It also suggests that addressing obesity will likely benefit sleep disorders, and treating sleep deprivation and sleep disorders may benefit individuals with obesity Taheri et al. Two large epidemiological studies and one experimental study found an association between sleep loss and diabetes, or impaired glucose tolerance.

Impaired glucose tolerance, which is a precursor to diabetes, is manifested by glucose levels rising higher than normal and for a longer period after an intravenous dose of glucose. In the Sleep Heart Health Study, which is a community-based cohort, adults middle-aged and older who reported 5 hours of sleep or less were 2. Those reporting 6 hours per night were about 1. Both groups were also more likely to display impaired glucose tolerance. Adults with sleep times of 9 hours or more also showed these effects, a finding consistent with the Nurses Health Study. Adjustment for waist girth, a measure of obesity, did not alter the significance of the findings, suggesting that the diabetes effect was independent of obesity.

Sleep duration impacts prevalence of diabetes. NOTE: Data were adjusted for age, sex, race, waist girth, caffeine, alcohol, smoking, and apnea-hypopnea index. The relationship between shorter sleep times and impaired glucose tolerance is also supported by an experimental study in which 11 healthy male volunteers were restricted to 4 hours of sleep for a total of six nights Spiegel et al. Even after this relatively short period of time, the study found that sleep loss, compared with a fully rested state, led to impaired glucose tolerance.

The effect resolved after restoring sleep to normal. Glucose clearance was 40 percent slower with sleep loss than with sleep recovery. Further, mice that have a mutation in a gene that regulates circadian rhythms have metabolic disorders Turek et al. The association between sleep loss and diabetes or impaired glucose tolerance may mediate the relationship between sleep loss and cardiovascular morbidity and mortality, as discussed below.

Sleep loss and sleep complaints are associated with heart attacks myocardial infarction and perhaps stroke, according to several large epidemiological studies Eaker et al.


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One of these studies, of incident cases of heart attacks in the Nurses Health Study, was discussed earlier because it also found increased incidence of diabetes Ayas et al. The cohort had no coronary heart disease at baseline. Ten years later, in , the likelihood of nonfatal and fatal heart attack was modestly increased for both short and long sleep duration.

Similarly elevated risks were also found for sleeping 9 hours or more. The effects were independent of a history of hypertension or diabetes because additional adjustment for these conditions yielded slightly lower, but still significantly elevated, relative risks. Several potential mechanisms could explain the link between sleep loss and cardiovascular events, including blood pressure increases, sympathetic hyperactivity, or impaired glucose tolerance.

Experimental data, showing that acute sleep loss 3. Sleep loss is associated with adverse effects on mood and behavior.

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Adults with chronic sleep loss report excess mental distress, depressive symptoms, anxiety, and alcohol use Baldwin and Daugherty, ; Strine and Chapman, ; Hasler et al. A meta-analysis of 19 original articles found that partial sleep deprivation alters mood to an even greater extent that it does cognitive or motor functions Pilcher and Huffcutt, Several studies of adolescents, including one with more than 3, high school students, found that inadequate sleep is associated with higher levels of depressed mood, anxiety, behavior problems, alcohol use Carskadon, ; Morrison et al.

Nevertheless, it is not clear from cross-sectional studies whether sleep influences mood or anxiety level, or vice versa. On the other hand, a large, 3-year longitudinal study of more than 2, middle school students ages 11 to 14 found that self-reported sleep loss was associated with more depressive symptoms and lower self-esteem over time Fredriksen et al. Therefore, although this study suggests an association, the evidence is still limited. Sleep loss is also associated with increased age-specific mortality, according to three large, population-based, prospective studies Kripke et al.

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The studies were of large cohorts, ranging from 83, to 1. In three studies, respondents were surveyed about their sleep duration, and then they were followed for periods ranging from 6 to 14 years. Deaths in short or long sleepers were compared with those who slept 7 hours the reference group , after adjusting for numer ous health and demographic factors. Sleeping 5 hours or less increased mortality risk, from all causes, by roughly 15 percent. The largest American study, depicted in Figure , graphically illustrates what has been found in all three studies: a U-shaped curve, showing that progressively shorter or longer sleep duration is associated with greater mortality.

Other epidemiological studies suggest that sleep-loss-related mortality is largely from acute heart attacks et al. Potential pathophysiological mechanisms accounting for the relationship, while poorly understood, have become the focus of growing interest and are discussed later in this chapter. Shorter or longer sleep duration is associated with greater mortality. Management and treatment of sleep loss are rarely addressed by clinicians, despite the large toll on society Chapters 4 , 5 , and 7. There are no formal treatment guidelines in primary or specialty care for dealing with sleep loss Dinges et al.

The most effective treatment for sleep loss is to sleep longer or take a short nap lasting no more than 2 hours Veasey et al.

How stress affects your sleep

Catching up on sleep on the weekends—a popular remedy for sleep loss—does not return individuals to baseline functioning Szymczak et al. In a randomized clinical trial caffeine and modafinil showed similar benefits for performance and alertness Wesensten et al. Modafinil is the only FDA-approved drug for shift work sleep disorder, although it is not approved for sleep loss. Behavioral approaches developed for insomnia also may be useful for sleep loss, but no formal studies have been undertaken expressly for sleep loss.

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Furthermore, there have been no large-scale clinical trials examining the safety and efficacy of modafinil, or other drugs, in children and adolescents. Sleep-disordered breathing refers to a spectrum of disorders that feature breathing pauses during sleep.

The most common disorder is characterized by obstructive apneas and hypopneas White, , where repeated episodes of collapse apneas or partial collapse of the pharyngeal airway occur, usually a result of obstruction by soft tissue in the rear of the throat. Snoring, which is produced by vibrations of the soft tissues, is a good marker for OSA Netzer, et al. Apneas or hypopneas a reduction without cessation in airflow or effort typically result in abrupt and intermittent reduction in blood oxygen saturation, which leads to sleep arousal, often accompanied by loud snorts or gasps as breathing resumes.

Episodic interruptions of breathing also frequently cause cortical and brainstem arousals, interrupting sleep continuity, reducing sleep time, and causing increased sympathetic nervous system activation. These broad systemic effects on gas exchange and nervous system activation may lead to a range of systemic effects that affect vascular tone, levels of inflammatory mediators, and hormonal changes.


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  8. As discussed in the following sections, these in turn may contribute to the development of hypertension, coronary artery disease, congestive heart failure, arrhythmias, stroke, glucose intolerance, and diabetes. The defining symptom of sleep-disordered breathing is excessive daytime sleepiness. The symptom is likely influenced by sleep fragmentation tied to recurrent arousals that occur in response to breathing pauses. Other symptoms of fragmented sleep include decreased concentration and mood changes. The diagnosis of OSA requires detection, by polysomnography, of at least five or more apneas or hypopneas per hour of sleep Thorpy, This rate is expressed as an index, the apnea-hypopnea index or respiratory disturbance index , which is the average hourly number of apneas plus hypopneas.

    OSA is found in at least 4 percent of men and 2 percent of women in the middle-aged workforce, according to the first major United States population-based study of the condition conducted about 15 years ago Young et al. Those prevalence figures are based on a cutoff apnea-hypopnea index of 5 or higher, plus a requirement for daytime sleepiness. The prevalence is higher, 9 percent of women and 24 percent of men, with the same apnea-hypopnea index cutoff Box , but without the daytime sleepiness requirement.

    In view of the epidemic increase of obesity an important determinant of OSA in recent years, these numbers might underestimate the current prevalence. However, other more recent population-based studies support these prevalence figures Bixler et al. Definitions Impact Disease Prevalence Estimates.


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    6. The metric used most commonly to define obstructive sleep apnea and to quantify its severity is the apnea-hypopnea index, derived by identifying and manually counting each respiratory disturbance apnea more OSA prevalence appears to increase with age. Adults 65 to 90 years of age had a threefold higher prevalence rate than middle-aged adults Ancoli-Israel et al. Less than 1 percent of older adults in primary care are referred for polysomnography Haponik, , although these numbers might have increased in recent years due to increased awareness of the disease.

      Although OSA can occur in children of any age, it is most common at preschool ages, a time coincident with tonsils and adenoids being largest relative to the underlying airway Jeans et al.

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      OSA causes chronic elevation in daytime blood pressure Young et al. The strongest evidence for a rise in systemic hypertension comes from several large, well-designed epidemiological studies, both cross-sectional Young et al.

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