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|Episode Description
|Sunday, Oct 21, 2012 - 5:00 AM
"Syncopated City (1919-1933)"
Prohibition and the Jazz Age bring change and a mix of classes and cultures. In the spotlight are Eubie Blake, Al Jolson, The Marx Brothers, the Gershwins and Richard Rodgers and Lorenz Hart. With the stock market crash, the Great Depression and the new "talking picture' coming from Hollywood, cause a massive talent exodus to Hollywood. Part 2 of 6 G
Mountain Time
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Insomnia – Description
An in-depth report on the causes, diagnosis, treatment, and prevention of insomnia.
What Is Insomnia?
Insomnia can be a short-term or chronic condition, but it always involves problems with falling asleep or staying asleep. Short-term (transient) insomnia can be caused by illness, stress, travel, or environmental factors. Long-term (chronic) insomnia may be due to underlying psychological or physical conditions.
Who Is at Risk?
Anyone can get insomnia, but it is generally more common in women than in men. The elderly are particularly at risk for insomnia.
Diagnosing Insomnia
A doctor will make a diagnosis of insomnia based on information about your sleep patterns. Your doctor may ask:
- How long does it take you to fall asleep at night?
- How many times during the night do you wake up?
- Do you experience daytime fatigue?
- Do you have a medical condition that may interfere with sleep?
- What medications do you take (including prescription drugs, over the counter drugs, and herbs or supplements?)
- Do you drink alcohol or smoke?
Your doctor may also ask you to keep a sleep diary to record specific sleep-related information.
Treating Insomnia
Sleep hygiene is an important first step for controlling insomnia. These simple self-help measures include establishing a regular bedtime routine, regulating mealtimes and fluid consumption, and limiting caffeine consumption.
Behavioral therapy methods include various approaches for training new sleep behaviors and helping patients relax and sleep well. Behavioral therapy can help treat insomnia in people of all ages.
If self-help or behavioral therapy do not solve the problem, a doctor may prescribe medications for use on a short-term basis. Non-benzodiazepine sedative hypnotics are usually the preferred type of drugs. They include zolpidem (Ambien, generic), zaleplon (Sonata, generic), eszopiclone (Lunesta), and ramelteon (Rozerem). These drugs can cause side effects, and it is important that your doctor explains the risks of these drugs and the precautions you need to take.
Drug Approval
In 2011 the Food and Drug Administration (FDA) approved Intermezzo, a lower-dose form of zolpidem, for treating middle-of-the-night awakening. Patients who wake up abruptly in the middle of the night and then have trouble falling back asleep can dissolve the tablet under the tongue. People who use Intermezzo require at least 4 hours for sleep after taking the tablet. Higher-dose zolpidem pills (Ambien, generic) are used when first going to sleep and require at least 7 – 8 full hours of sleep.
Insomnia comes from the Latin words for "no sleep." Insomnia is characterized by:
- Difficulty falling asleep
- Difficulty staying asleep
- Waking up too early
- Poor quality ("non-restorative") sleep
Insomnia may be primary or secondary:
- Primary insomnia means that the inability to sleep is not caused by other health
- Secondary insomnia is due to other health conditions that interfere with sleep. It is also called "comorbid insomnia."
Duration of Insomnia
Insomnia is often categorized by how long it lasts:
- Transient insomnia lasts for a few days.
- Short-term insomnia lasts for no more than 3 weeks.
- Chronic insomnia occurs at least 3 nights per week for 1 month or
Related Disorders
Insomnia may also be defined in terms of inability to sleep at conventional times. The following examples are referred to as circadian rhythm disorders:
- Delayed Sleep-Phase Syndrome. Delayed sleep-phase syndrome is the term for a circadian clock that runs late but reliably. People who have this condition (usually adolescents) fall asleep very late at night or in early morning hours, and have difficulty waking up in the morning.
- Advanced Sleep-Phase Syndrome. This syndrome tends to develop in older people. It produces excessive sleepiness in the morning and undesired awakening early (3 – 5 a.m.) in the morning.
Healthy Sleep
In sleep studies, subjects spend about one-third of their time asleep, suggesting that most people need about 8 hours of sleep each day. Individual adults differ in the amount of sleep they need to feel well rested, however. (Infants may sleep as many as 16 hours a day.)
The daily cycle of life, which includes sleeping and waking, is called a circadian (meaning "about a day") rhythm, commonly referred to as the biologic clock. Hundreds of bodily functions follow biologic clocks, but sleeping and waking comprise the most prominent circadian rhythm. The sleeping and waking cycle is about 24 hours. It usually takes the following daily patterns:
Humans are designed for daytime activity and night time rest.
Additionally, there is a natural peak in sleepiness at mid-day, the traditional siesta time.
In addition, daily rhythms intermesh with other factors that may interfere or change individual patterns:
The monthly menstrual cycle in women can shift the pattern.
Light signals coming through the eyes reset the circadian cycles each day, so changes in season or various exposures to light and dark can unsettle the pattern. Sunlight is an important regulator of circadian rhythms. People who are blind commonly suffer from trouble sleeping and other circadian rhythm disruptions.
The Response in the Brain to Light Signals
The response to light signals in the brain is an important key factor in sleep:
Light signals travel to a tiny cluster of nerves in the hypothalamus in the center of the brain, the body's master clock, which is called the supra chiasmatic nucleus (SCN).
This nerve cluster takes its name from its location, which is just above (supra) the optic chiasm, a major junction for nerves transmitting information about light from the eyes.
The approach of dusk each day prompts the SCN to signal the nearby pineal gland (so named because it resembles a pinecone) to produce the hormone melatonin.
Melatonin is thought to act as the body's clock-setting hormone. The longer a person is in darkness the longer the duration of melatonin secretion. Secretion can be diminished by staying in bright light. Melatonin also appears to trigger the need to sleep.
Sleep Cycles
Sleep consists of two distinct states that alternate in cycles and reflect differing levels of brain nerve cell activity:
Non-Rapid Eye Movement Sleep (NonREM). NonREM sleep is also termed quiet sleep. NonREM is further subdivided into three stages of progression:
- Stage 1 (light sleep)
- Stage 2 (so-called true sleep)
- Stage 3 to 4 (deep "slow-wave" or delta sleep)
With each descending stage, awakening becomes more difficult. It is not known what governs NonREM sleep in the brain. A balance between certain hormones, particularly growth and stress hormones, may be important for deep sleep.
Rapid Eye-Movement Sleep (REM). REM sleep is termed active sleep. Most vivid dreams occur in REM sleep. In REM sleep, brain activity is comparable to that in waking, but the muscles are virtually immobilized, which prevents people from acting out their dreams. In fact, except for vital organs like lungs and heart, the only muscles not immobilized during REM are the eye muscles. REM sleep may be critical for learning and for day-to-day mood regulation. When people are sleep-deprived, their brains must work harder than when they are well rested.
The REM/NREM Cycle. The cycle between quiet (nonREM) and active (REM) sleep generally follows this pattern:
After about 90 minutes of nonREM sleep, eyes move rapidly behind closed lids, giving rise to REM sleep.
As sleep progresses the nonREM/REM cycle repeats.
With each cycle, nonREM sleep becomes progressively lighter, and REM sleep becomes progressively longer, lasting from a few minutes early in sleep to perhaps an hour at the end of the sleep episode.
Causes of Short-Term and Transient Insomnia
A reaction to change or stress is a common cause of short-term and transient insomnia. This condition is sometimes referred to as adjustment sleep disorder.
The trigger could be a major or traumatic event such as:
- An acute illness
- Injury or surgery
- The loss of a loved one
- Job loss
Temporary insomnia can also develop after a relatively minor event, including:
- Extremes in weather
- An exam
- Traveling, particularly across time zones
- Trouble at work
In most cases, normal sleep almost always returns when the condition resolves, the individual recovers from the event, or the person becomes used to the new situation. Treatment is needed if sleepiness interferes with functioning or if it continues for more than a few weeks. Individual responses to stress vary and some people may not experience insomnia at all, even during very stressful situations while others may suffer from insomnia in response to very mild stressors.
Female Hormonal Fluctuations
Fluctuations in female hormones play a major role in insomnia in women over their lifetimes. This insomnia is usually temporary.
During Menstruation. Progesterone promotes sleep, and levels of this hormone plunge during menstruation, causing insomnia. (When they rise during ovulation, women may become sleepier than usual.)
During Pregnancy. The effects of changes in progesterone levels in the first and last trimester can disrupt normal sleep patterns.
Menopause. Insomnia can be a major problem during the transition to menopause (perimenopause), when hormones are fluctuating intensely. Insomnia during this period may be due to several different factors. In some women, hot flashes, sweating, and a sense of anxiety can disrupt sleep and cause sudden and frequent awakening. In many cases, the insomnia is temporary. Treating hot flashes may help resolve chronic insomnia.
Jet Lag
Air travel across time zones often causes insomnia. After long plane trips, a day of adjustment is usually needed for each time zone crossed. Traveling from the east to an earlier time zone in the west seems to be less disruptive than traveling to a later time zone in the east because it is easier to lengthen a circadian phase than to shorten it.
Effect of Light and Other Environmental Disruptions
Light, noise, and uncomfortable temperatures can cause sleeplessness. Depending on the time of day, too much or too little light can disrupt sleep.
Excessive Light at Night. A person's biologic circadian clock is triggered by sunlight, and very bright artificial light maintains wakefulness.
Insufficient Light during the Day. Insufficient exposure to light during the day, as occurs in some disabled elderly patients who rarely venture outside, may also be linked with sleep disturbances.
Other Causes of Short-Term or Transient Insomnia
Caffeine. Caffeine is a stimulant, which can interfere with falling asleep.
Nicotine. Nicotine is also a stimulant, but quitting smoking can lead to transient insomnia.
Partner's Sleep Habits. A partner's sleep habits, including snoring, can impair one's own sleep.
Medications. Insomnia is a side effect of many common medications, including over-the-counter preparations that contain caffeine or decongestants. If you suspect your medications are causing you to lose sleep, check with your doctor or pharmacist.
Causes of Chronic Insomnia
Sleep problems seem to run in families. Many people with insomnia have a family history of insomnia, with the mother being the most commonly affected family member. Still, because so many factors are involved in insomnia, a genetic component is difficult to define.
Anxiety, Depression, and Other Mental Health Disorders
Many cases of chronic insomnia cases have an emotional or psychological basis. The disorders that most often cause insomnia are:
- Anxiety
- Depression
- Bipolar disorder
- Attention-deficit hyperactivity disorder
- Post-traumatic stress disorder
Insomnia may also cause emotional and mental health problems, such as depression and anxirty. It is often unclear which condition has triggered the other, or if the two conditions, in fact, have a common source.
Psychophysiologic Insomnia
In many cases, it is unclear if chronic insomnia is a symptom of some physical or psychological condition or if it is a primary disorder of its own. In most instances, a mix of psychological and physical conditions causes the insomnia.
Psychophysiologic insomnia occurs when:
Transient insomnia disrupts the person's circadian rhythm.
The patient begins to associate the bed not with rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges.
Over time, this event repeats, and bedtime becomes a source of anxiety. Once in bed, the patient broods over the inability to sleep, the consequences of sleep loss, and the lack of mental control. All attempts to sleep fail.
Eventually excessive worry about sleep loss becomes persistent and provides an automatic nightly trigger for anxiety and arousal. Unsuccessful attempts to control thoughts, images, and emotions only worsen the situation. After such a cycle is established, insomnia becomes a self-fulfilling prophecy that can persist indefinitely.
Medical Conditions and Their Treatments
Among the many medical problems that can cause chronic insomnia are allergies, benign prostatic hyperplasia (BPH), arthritis, gastroesophageal reflux disease (GERD), asthma, chronic obstructive pulmonary disorder (COPD), rheumatologic conditions, Alzheimer's disease, Parkinson's disease, hyperthyroidism, epilepsy, and fibromyalgia. Other types of sleep disorders, such as restless legs syndrome and sleep apnea, can cause insomnia. Many patients with chronic pain also sleep poorly.
Medications. Among the many medications that can cause insomnia are antidepressants (fluoxetine, bupropion), theophylline, lamotrigine, felbamate, beta-blockers, and beta-agonists.
Substance Abuse
Substance abuse can cause chronic insomnia. This is especially true for alcohol, cocaine, and sedatives. One or two alcoholic drinks may help reduce stress and initiate sleep. However, excessive alcohol use tends to fragment sleep and cause wakefulness a few hours later. It also increases the risk for other sleep disorders, including sleep apnea and restless legs. Alcoholics often suffer insomnia during withdrawal and, in some cases, for several years during recovery.
Risk Factors
More than a quarter of all Americans experience transient insomnia at some point during a year, and nearly 10% have chronic insomnia.
Overall, insomnia is more common in women than men, although men are not immune from insomnia. Sleep efficiency deteriorates equally in men and women as they get older.
Hormonal fluctuations that occur during menstruation, pregnancy, and menopause put women at higher risk of insomnia. Women are also more likely than men to suffer from anxiety and depressive disorders, which can cause insomnia.
Insomnia is more common in older people than younger people. As people grow older, sleep patterns change. Older adults tend to wake up frequently during the night, wake up earlier, and report waking up feeling unrefreshed.
Older people are more likely than younger people to have medical conditions that cause pain or nighttime distress. These conditions include arthritis, gastrointestinal distress, frequent urination, lung disease, and heart conditions. Neurologic conditions, such as Parkinson's and Alzheimer's, can also affect sleep patterns. Consequences of poor sleep in the elderly include increased risk of falls.
Shift Work
Shift workers are at considerable risk for insomnia. Workers over age 50 and those whose shifts are always changing are particularly susceptible to insomnia, although night-shift workers also have a high rate of sleeplessness. Night-shift workers are at risk for falling asleep on the job at least once a week, implying that their internal clocks do not adjust to unusual work times. (They are also at much higher risk than other workers for automobile accidents due to their drowsiness and may also have a higher risk for health problems in general.)
Insomnia itself is not life threatening, but it can increase the risk of accidents, psychiatric problems, and certain medical conditions, affect school and work performance, and significantly interfere with quality of life. Lack of sleep can cause weight gain and obesity.
Increased Risk of Accidents
Sleepiness increases the risk for motor vehicle accidents. Studies indicate that drowsy driving is as risky as drunk driving.
Quality of Life
Surveys show that people with severe insomnia have a quality of life that is almost as poor as those who have chronic medical conditions, such as heart failure. Daytime sleepiness can lead to decreased energy, irritability, mistakes at work and school, and poorer relationships.
Thinking and Performance
Insomnia makes it harder to concentrate and perform tasks. Deep sleep deprivation impairs the brain's ability to process information and reduces concentration.
Mood Disorders
Although stress and depression are major causes of insomnia, insomnia may also increase the activity of the hormones and pathways in the brain that are associated with mental health problems. Chronic insomnia may increase the risk of developing depression and anxiety.
Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood. In both children and adults, the combination of insomnia and daytime sleepiness can produce more severe depression than either condition alone.
Having a doctor diagnose sleep disturbance and its cause is the most important step in restoring healthy sleep. However, there is little agreement, even among doctors, on the best methods for effectively assessing a patient's insomnia.
Sleep Questionnaires
A number of questionnaires are available for determining whether a patient has insomnia or other sleep disorders. For example, the doctor may ask:
- How would you describe your sleep problem?
- How long have you had the sleep problem?
- How long does it take to fall asleep?
- How many times a week does it occur?
- How restful is sleep?
- Do you have trouble falling asleep or do you wake up too early?
- What is the sleep environment like? (Noisy? Not dark enough?)
- How does insomnia affect daytime functioning?
- What medications do you take? (Include herbs and over-the-counter or prescription drugs.)
- Are you taking or withdrawing from stimulants, such as coffee or tobacco?
- How much alcohol is consumed per day?
- What stresses or emotional factors may be present?
- Have you experienced any significant life changes?
- Do you snore or gasp during sleep (an indication of sleep apnea)?
- Do you have leg problems (cramps, twitching, crawling feelings)?
- If there is a bed partner? Is this person's behavior distressing or disturbing?
- Are you a shift worker?
Sleep Diary. If the patient cannot answer these questions, keeping a sleep diary is a helpful diagnostic tool. Every day for 2 weeks, the patient should record all sleep-related information (including responses to questions listed above). Other information should include the time the patient went to bed, time spent falling asleep, number of nocturnal awakenings, and rising time. A bed partner's observations of the patient's sleep behavior can also help.
Measuring Sleepiness
Actigraphy. Actigraphy uses a portable device with a sensor to monitor a patient's movement. Actigraphy may be used in some situations to help give a doctor a better picture of the patient's sleep pattern. It cannot, however, determine the severity of sleep problems. Most patients with insomnia are diagnosed and treated without this test. However, actigraphy may help identify insomnia in some patients.
Sleep Disorders Centers
If unexplained insomnia persists after treatment or there is evidence of a primary sleep disorder, such as sleep apnea or narcolepsy, the doctor may recommend a sleep specialist or a sleep disorders center. Centers are accredited by the American Academy of Sleep Medicine. Patients should investigate centers carefully, to be sure that they offer full sleep studies. [For more information, see In-Depth Report #65: Sleep apnea and #98: Narcolepsy.]
Among the signs that may indicate a need for a sleep disorders center are:
- Insomnia due to psychologic disorders
- Sleeping problems due to substance abuse
- Snoring and sudden awakening with gasping for breath (possible sleep apnea)
- Severe restless legs syndrome
- Persistent daytime sleepiness
- Sudden episodes of falling asleep during the day (possible narcolepsy)
At most sleep disorders centers, patients undergo an in-depth analysis, usually supervised by a multidisciplinary team of consultants who can provide both physical and psychiatric evaluations.
The American Academy of Sleep Medicine (AASM) recommends a number of behavioral methods and prescription medications as the main treatments for insomnia. According to the AASM, these treatment options can improve both quality and quantity of sleep for people with insomnia.
Doctors agree that behavioral therapies should be the first-line treatment for insomnia. For children in particular, medications should rarely be used as initial treatment.
Sleep Hygiene Tips
Proper sleep hygiene should accompany any behavioral method. The term sleep hygiene is used to describe simple behaviors that may help everyone improve their sleep. These include:
Establish a regular time for going to bed and getting up in the morning. Stick to this schedule even on weekends and during vacations.
Use the bed for sleep and sexual relations only, not for reading, watching television, or working. Excessive time in bed disrupts sleep.
Avoid naps, especially in the evening.
Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. Exercising close to bedtime, however, may increase alertness.
Taking a hot bath about 1.5 – 2 hours before bedtime may help you fall asleep more easily. (Taking a bath just before bed may increase alertness.)
Do something quiet and relaxing in the 30 minutes before bedtime. Reading, meditating, or a leisurely walk are all appropriate activities.
Keep the bedroom relatively cool and well ventilated.
Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
Eat light meals, and schedule dinner 4 – 5 hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
Spend at least a half hour in daylight every day. The best time is early in the day.
Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
Avoid stimulants such as caffeine or nicotine in the hours before sleep.
Avoid alcohol in the hours before bedtime. While alcohol may help you fall asleep quickly, it can cause you to awaken in the middle of the night.
If still awake after 15 – 20 minutes, go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. (Don't watch television or use bright lights.)
If distracted by a sleeping bed partner, moving to the couch or a spare bed for a couple of nights might be helpful.
If a specific worry is keeping you awake, thinking of the problem in terms of images rather than in words may help you to fall asleep more quickly and to wake up with less anxiety.
Behavioral Therapy
Various approaches are available to help people learn how to relax and sleep well. Behavioral techniques can actually cure chronic insomnia in many cases, and studies report that they help nearly all patients with primary chronic insomnia. The benefits of psychological and behavioral therapy in managing insomnia are long lasting.
Although medications can help people with insomnia to sleep, they cannot cure the condition. In addition, behavioral methods act faster. Behavioral methods work for all age groups, including children and elderly patients.
Behavioral methods include:
- Stimulus control
- Cognitive behavioral therapy
- Relaxation training and biofeedback
- Sleep restriction
All behavioral approaches have the same basic goals:
- To reduce the time it takes to go to sleep to below 30 minutes
- To reduce wake-up periods during the night
Studies report that the majority of patients who are treated with non-drug methods experience improved sleep. Furthermore, most of those who have been taking drugs are able to stop or reduce their use.
Stimulus Control. Stimulus control is considered the standard treatment for primary chronic insomnia and may also be helpful for some patients with secondary insomnia. The primary goal of stimulus control is to regain the idea that the bed is for sleeping. It involves the following:
- Go to bed only when ready to sleep or for sex.
- If unable to sleep within 15 – 20 minutes, get up and go into another room. (People who find it physically difficult to get out of bed should sit up and do something relatively arousing, like reading a book.)
- Maintain a regular wake-up time no matter how few hours you actually sleep.
- Avoid naps.
Cognitive-Behavioral Therapy. Cognitive behavioral therapy (CBT) is a form of therapy that emphasizes observing and changing negative thoughts about sleep such as, "I'll never fall asleep." It uses actions intended to change behavior. The goal is to change or correct misconceptions about the ability to fall and stay asleep. Emphasis is on reinforcing the need for 7 – 8 hours of sleep each night and addressing the anxiety that patients with insomnia often develop around sleep. Many studies have shown it to work as well or better than drugs. According to several studies, adding medication to CBT does not provide additional benefit.
Relaxation Training and Biofeedback. Relaxation training includes breathing and guided imagery techniques. Progressive muscle relaxation is another technique for inducing sleep that works well for many people. It takes about 10 minutes to perform:
Focus on one specific muscle group at a time. Most people start with the muscles in one foot. Inhale and tense the foot muscles for about 8 seconds. (Do this gently. It is not intended to cause severe pain or muscle contractions.)
Relax the foot, and let it become loose and limp. Stay relaxed for 15 seconds, then repeat with the other foot.
Move up to the next muscle group and repeat the sequence, doing one side of the body at a time. Move progressively from each foot and leg up through the abdomen and chest, to each hand and arm, then to the neck, shoulders, and face.
Biofeedback may be combined with relaxation techniques. Biofeedback involves being monitored with an electroencephalogram (EEG), a device that measures brain waves. Patients are given feedback to recognize certain states of tension or sleep stages so that they can either avoid or repeat them voluntarily.
Paradoxical Intention and Sleep Restriction Therapies. Paradoxical intention is a type of cognitive technique that aims to conquer anxiety about insomnia by forcing the patient to stay awake. Not trying to fall asleep may help relieve performance anxiety associated with sleep.
Sleep restriction therapy is similar to paradoxical intention. It involves limiting the time spent in bed to the number of hours that are typically actually spent asleep. Eventually the sleep loss helps some people fall asleep faster and spend more time asleep. As sleep improves, the hours spent in bed are increased.
Drug Therapy
In general, the following considerations are important regarding the use of medications for the treatment of insomnia:
Underlying mental health problems, such as anxiety or depression, should be addressed first.
Behavioral or psychologic techniques can actually correct insomnia, while prolonged use of sleeping pills can only produce temporary improvement.
Non-benzodiazepine sedative hypnotics may be better tolerated than benzodiazepines and have less risk of dependency. However, these drugs may cause hazardous or strange behaviors, such as driving, making phone calls, or eating while asleep. If you need to take one of these prescription drugs, start with as low a dose as possible.
For adults over age 60 years, studies suggest that the risks of sedative hypnotics may far outweigh their benefits. Sleep medications increase the risks for falls, depression, and memory loss in older patients. Elderly patients should generally start sleep medications at lower doses than younger patients.
As a general rule, do not take either prescription nor non-prescription sleeping pills on consecutive days or for more than 2 – 4 days a week.
If insomnia is still a problem after stopping the drug and continuing with good sleep hygiene, this pattern can be repeated again, but for only up to 4 weeks.
Medication should be withdrawn gradually, and the patient should be aware of the possibility of rebound insomnia after stopping medication. Rebound insomnia is the the return of insomnia after medication is discontinued. It usually lasts for several days and can be more severe than the original insomnia.
Alcohol intensifies the side effects of all sleeping medication and should be avoided.
If chronic insomnia is accompanied by depression or anxiety, treating these problems first may be the best approach.
Many older Americans use some form of sleep aid pill, including prescription or over-the-counter drugs. Over-the-counter (nonprescription) medications make use of the drowsiness caused by some common medications. Prescription drugs used specifically for improving sleeping are called sedative hypnotics. These drugs include benzodiazepines and non-benzodiazepines.
Sedative hypnotics carry risks for dependence, tolerance, and rebound insomnia:
Dependence means relying on a drug for falling asleep and having difficulty falling asleep or achieving restful sleep without it.
Tolerance is being unable to fall asleep using the original dose and needing to take progressively higher doses of medication.
Rebound insomnia can occur after a patient stops taking the drug. It typically causes 1 – 2 nights of sleep disturbance, daytime sleepiness, and anxiety. In some cases, patients may experience a temporary worsening of long-term insomnia.
Common Non-Prescription Sleep Medications
Brands with Antihistamines. Many over-the-counter sleeping medications use antihistamines, which cause drowsiness. Diphenhydramine (Benadryl, generic) is the most common antihistamine used in non-prescription sleep aids.
Some drugs marketed as sleep aids contain diphenhydramine alone, while others contain combinations of diphenhydramine with pain relievers (such as Tylenol PM and its generic forms). Doxylamine (Unison, generic) is another antihistamine used in sleep medications. Certain antihistamines indicated only for allergies, such as chlorpheniramine (Chlor-Trimeton, generic) or hydroxyzine (Atarax, Vistaril, generic) may also be used as mild sleep-inducers.
Unfortunately, most of these drugs leave patients feeling drowsy the next day and may not be very effective in providing restful sleep. Side effects include:
- Daytime sleepiness
- Cognitive impairment
- Dizziness
- Drunken movements
- Blurred vision
- Dry mouth and throat
In general, people with angina, heart arrhythmias, glaucoma, or problems urinating should avoid these drugs. They should not be used at the same time as medications that prevent nausea or motion sickness. Patients with chronic lung disease should also avoid some non-prescription sleeping aids, such as those containing doxylamine.
Common Pain Relievers. When sleeplessness is caused by minor pain, simply taking acetaminophen (Tylenol, generic) or a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, generic), can be very helpful without causing any daytime sleepiness. The extra "P.M." antihistamine found in combination products is simply an extra, needless chemical in these situations.
Non-Benzodiazepine Hypnotics
Newer short-acting non-benzodiazepines can induce sleep with fewer side effects than benzodiazepines. Both benzodiazepine and non-benzodiazepine sedative hypnotics act on gamma-aminobutyric acid (GABA) receptor sites in the brain, but non-benzodiazepines are more specific in the subunits they target. These drugs are now the preferred sedative hypnotic drugs for the treatment of insomnia. In general, non-benzodiazepine hypnotics are recommended for short-term use (7 – 10 days), and treatment should not exceed 4 weeks.
Brands. Non-benzodiazepine hypnotics currently approved in the United States are:
- Zolpidem (Ambien, Ambien CR, generic) is one of the most commonly prescribed drugs for insomnia. It lasts longer than zaleplon. Patients should not take it unless they plan on getting at least 7 – 8 hours of sleep. A lower-dose, sublingual (under-the-tongue) formulation of zolpidem (Intermezzo) is approved for patients who wake up abruptly in the middle of the night and have trouble falling back asleep. Patients take it as needed when they awaken in the night (but must be able to get at least 4 hours of sleep after taking.
- Zaleplon (Sonata, generic) is the shortest-acting hypnotic available. Because it is rapidly eliminated from the body it may be best for people who have difficulty falling asleep, not those who wake up often throughout the night. The drug takes effect within 30 minutes and may be taken at bedtime or later as long as the patient can sleep for at least 4 hours.
- Eszopiclone (Lunesta) may help improve both sleep maintenance and daytime alertness. Eszopiclone is related to zopiclone (Imovane), which has been used for many years in Europe. Unlike other sleep medications, eszopiclone was the first sleep medication approved to be taken on a long-term basis.
- Ramelteon (Rozerem) is the newest type of sedative hypnotic but it is not technically a non-benzodiazepine hypnotic. Unlike other prescription sleep drugs, which target GABA receptors, ramelteon works by targeting melatonin receptors. Ramelteon is not habit forming and is the first sleep drug not designated as a controlled substance.
Side Effects. All of these drugs have fewer morning side effects than the benzodiazepines, including morning sedation and memory loss (although they can occur to some degree). When patients first start taking any of these drugs, they should use caution during morning activities until they are sure how the drug affects them.
General side effects may include:
- Drowsiness
- Dizziness
- Fatigue
- Headache
- Unpleasant taste
- Diarrhea
All non-benzodiazepine drugs carry labels warning that that these drugs can cause sleep-related behavior, including driving, making phone calls, and preparing and eating food while asleep. (Most cases of sleepwalking and sleep driving likely occur when patients use zolpidem along with alcohol or other drugs or take more than the recommended dose.) In addition, severe allergic reactions (anaphylaxis) and facial swelling (angioedema) can occur even the first time one of these drugs is taken.
Anyone who receives a prescription for these medicines will get a patient medication guide explaining the risks of the drugs and the precautions to take. Talk to your doctor if you have any questions concerning these drugs or their potential side effects.
Patients should carefully read the information labels for all drugs and follow the directions. Some sleeping pills take 30 – 60 minutes to take effect, while others (such as zolpidem) act quickly. For zolpidem, patients should:
- Take zolpidem immediately before going to sleep
- Take zolpidem only when able to get a full night's sleep (7 – 8 hours)
- Not drink alcohol the same evening
- Not take more than the prescribed dose
- Use caution in the morning when getting out of bed, driving, or operating heavy machinery
Interactions. As with any hypnotics, alcohol increases the sedative effects of these drugs. These hypnotics also interact with other drugs, including rifampin, ketoconazole, erythromycin, and cimetidine. They may also interfere with or be interfered by other drugs. Patients should report all medications to their doctors.
Rebound Insomnia, Dependence, and Tolerance. The risk for rebound insomnia, dependence, and tolerance is lower with non-benzodiazepine hypnotics than with benzodiazepine drugs. These drugs are still subject to abuse. In any case, no hypnotic should be taken for more than 7 – 10 days or at higher than the recommended dose without a doctor's approval.
Benzodiazepine Hypnotics
Benzodiazepines used to be the most commonly prescribed sedative hypnotics. Originally developed in the 1960s to treat anxiety, these drugs nonselectively target receptor sites in the brain that modulate the effects of the GABA neurotransmitter.
Brands. Commonly prescribed benzodiazepines:
- Long-acting benzodiazepines include flurazepam (Dalmane, generic), clonazepam (Klonopin, generic), and quazepam (Doral).
- Medium- to short-acting benzodiazepines include triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), oxazepam (Serax), and estazolam (ProSom), which are all available as generics. Short-acting benzodiazepines may be useful for air travelers who want to reduce the effects of jet lag.
Side Effects. Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people. They should not take long-acting forms.
Side effects may differ depending on whether the benzodiazepine is long or shorting acting. They include:
- Severe allergic reactions, including facial swelling, can occur even with the first use of a benzodiazepine drug.
- Respiratory problems may occur with overuse or in people with pre-existing respiratory illness
- The drugs may increase depression, a common co-condition in many people with insomnia.
- Respiratory depression (abnormally slow and shallow breathing) may occur with overuse or with people with pre-existing respiratory illness.
- Long-acting drugs have a very high rate of residual daytime drowsiness compared to other types of sleeping pills. They have been associated with a significantly increased risk for automobile accidents and falls in the elderly, particularly in the first week after taking them. Shorter-acting benzodiazepines do not appear to pose as high a risk.
- Memory loss, sleepwalking, sleep driving, eating while asleep, and other odd mood states may occur. These effects are enhanced by alcohol.
- Urinary incontinence may occur, particularly in older patients and when taking long-acting formulations.
- Because these drugs cross the placenta and enter breast milk, pregnant women or nursing mothers should not use them. Benzodiazepine use in the first trimester of pregnancy may be associated with the development of cleft lip in newborns.
- In rare cases, overdoses can be fatal.
Interactions. Benzodiazepines are potentially dangerous when combined with alcohol. Some medications, like the ulcer medication cimetidine, can slow the metabolism of the benzodiazepine.
Withdrawal Symptoms. Withdrawal symptoms usually occur after prolonged use and indicate dependence. They can last 1 – 3 weeks after stopping the drug and may include:
- Gastrointestinal distress
- Sweating
- Disturbed heart rhythm
- In severe cases, patients might hallucinate or experience seizures, even a week or more after the drug has been stopped.
- The chances for rebound insomnia are higher with the short-acting benzodiazepines than with the longer-acting ones.
Antidepressants are sometimes used to treat insomnia that may be caused by depression (secondary insomnia). In addition, certain types of antidepressants with sedating properties are prescribed for the treatment of primary insomnia, generally in lower doses than used to treat depression.
For example, the antidepressant trazodone (Desyrel, generic) is prescribed in low doses as a hypnotic to help induce sleep. A very low dose formulation of the tricyclic antidepressant doxepin (Silenor) is approved for treatment of insomnia. Other antidepressants used for insomnia include the tricyclics trimipramine (Surmontil, generic) and amitriptyline (Elavil, generic) and the tetracyclic antidepressant mirtazapine (Remeron, generic). Care should be taken in the use of trazodone and other sedating antidepressants in elderly patients, due to the risk for side effects (daytime sleepiness, dizziness, priapism, and increased risk of falls) and drug interactions.
Herbs and Supplements
More than 1.5 million Americans use complementary and alternative therapies to treat insomnia. Many people choose herbal and dietary supplement remedies. (Valerian and melatonin are among the most popular alternative remedies for insomnia.) Some, such as chamomile tea or lemon balm, are generally harmless for most people. Others have more serious side effects and interactions.
The American Academy of Sleep Medicine (AASM) advises that there is only limited scientific evidence to show that herbal and dietary supplements are effective sleep aids. The AASM recommends that these products should be taken only if approved by a doctor. Be sure to talk to your doctor if you are considering taking any herbal or dietary supplement. Some of these products can interact with prescription medications.
Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Patients should always check with their doctors before using any herbal remedies or dietary supplements.
Melatonin. Melatonin is the most studied dietary supplement for insomnia. It appears to reduce the time to fall asleep (sleep onset) and the time spent asleep (sleep duration). However, there are no consistent standards on melatonin doses. Some research suggests that 0.3 mg may be the most effective dosage in many people with insomnia. However, higher doses may keep some people awake and may also cause mental impairment, severe headaches, and nightmares. Although melatonin may not have many benefits for most people with chronic insomnia, studies suggest that it may help travelers with jet lag and people with delayed sleep syndrome.
Valerian root. Valerian is an herb that has sedative qualities and is commonly used by people with insomnia. Some studies have indicated that it may help improve the quality of sleep, but there have been few rigorous and well-conducted trials to prove it is effective.
Kava. Kava has been used to relieve anxiety and improve sleep. It is dangerous. There have been reports of liver failure and death from this herb, with highest risk in those with liver disease. Kava can interact dangerously with certain medications, including alprazolam, an anti-anxiety drug. Kava also increases the strength of certain other drugs, including other sleep medications, alcohol, and antidepressants. Do not use this herb.
Tryptophan and 5-L-5-hydroxytryptophan (HTP). Tryptophan is an amino acid used in the formation of the neurotransmitter serotonin, which is associated with healthy sleep. L-tryptophan used to be marketed for insomnia and other disorders but was withdrawn after contaminated batches caused a rare but serious and even fatal disorder called eosinophilia myalgia syndrome. 5-HTP, a byproduct of tryptophan, is still available as a supplement. There is little evidence that 5-HTP relieves insomnia.
www.aasmnet.org — American Academy of Sleep Medicine
www.nhlbi.nih.gov/about/ncsdr/index.htm — National Center for Sleep Disorders Research
www.sleepfoundation.org — National Sleep Foundation
yoursleep.aasmnet.org — Your Sleep from the American Academy of Sleep Medicine
Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis. Am J Med. 2006 Dec;119(12):1005-12.
Bliwise DL, Ansari FP. Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. Sleep. 2007 July 1;30(7):881-884.
Centers for Disease Control and Prevention (CDC). Perceived insufficient rest or sleep among adults – United States, 2008. MMWR Morb Mortal Wkly Rep. 2009 Oct 30;58(42):1175-9.
Kamel NS, Gammack JK. Insomnia in the elderly: cause, approach, and treatment. Am J Med. 2006 Jun;119(6):463-9.
Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B, et al. Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep. 2007 Apr 1;30(4):519-29.
Morin CM, Bélanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009 Mar 9;169(5):447-53.
Morin CM, Benca R. Chronic insomnia. Lancet. 2012 Mar 24;379(9821):1129-41. Epub 2012 Jan 20.
Morgenthaler T, Kramer M, Alessi C, Friedman L, Boehlecke B, Brown T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep. 2006 Nov 1;29(11):1415-9.
Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep. 2006 Nov 1;29(11):1398-414.
Neckelmann D, Mykletun A, Dahl AA. Chronic insomnia as a risk factor for developing anxiety and depression. Sleep. 2007 July 1;30(7):873-880.
Parish JM. Sleep-related problems in common medical conditions. Chest. 2009 Feb;135(2):563-72.
Ramakrishnan K, Scheid DC. Treatment options for insomnia. Am Fam Physician. 2007 Aug 15;76(4):517-26.
Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008 Oct 15;4(5):487-504.
Taibi DM, Landis CA, Petry H, Vitiello MV. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Med Rev. 2007 Jun;11(3):209-30.
van Straten A, Cuijpers P. Self-help therapy for insomnia: a meta-analysis. Sleep Med Rev. 2009 Feb;13(1):61-71. Epub 2008 Oct 26.
Wilson JF. In the clinic. Insomnia. Ann Intern Med. 2008 Jan 1;148(1):ITC13-1-ITC13-16.
Source: Insomnia | University of Maryland Medical Center http://umm.edu/health/medical/reports/articles/insomnia#ixzz3cCTT3xMf
University of Maryland Medical Center


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DailyDirt: The End of Men?
from the urls-we-dig-up dept
- Japanese scientists have grown mice sperm cells in a test tube. Someday, this could either cure male infertility... or completely obviate the need for men, depending on how you look at it. [url]
- Dilbert-creator Scott Adams sparked a bit of debate over the men's rights movement. Adams should know better than to compare women to the mentally handicapped -- even if he wrote it in a tongue-in-cheek way. [url]
- The sense of touch can affect how people perceive gender. We'll leave it to the comments to come up with a joke about how squeezing a soft ball tends to get people to classify a face as female... [url]
- Men in the US are becoming less educated than their female peers, but they don't have to commit to long-term relationships as much. The laws of supply and demand affect relationships, too. [url]
- To discover more interesting gender-related issues, check out what's currently floating around the StumbleUpon universe. [url]


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From BioenergyWiki
Bioenergy > Climate change/Forests >
Reduced Emissions from Deforestation and Forest Degradation (REDD)
This page provides resources on the issue of "REDD - Reduced Emissions from Deforestation and Degradation in Developing Countries", "avoided deforestation", and "REDD+" ("REDD Plus").
Tropical rainforests are estimated to contain roughly 25% of all the carbon in our terrestrial biosphere. (PDF)). Global Canopy Programme argue, without a post-Kyoto international climate agreement that focuses on protecting existing carbon sinks by avoiding tropical deforestation. (See The Little REDD+ Book (PDF)) The REDD framework is a mechanism initially proposed at the 2005 COP 11 meeting of the United Nations Climate Change Conference in Montreal, which aims to reduce the global greenhouse gas emissions resulting from deforestation and degradation of forests, by providing economic incentives to rainforest nations to keep their tropical forests intact. At the upcoming COP 15 United Nations Framework Convention on Climate Change in December of 2009 in Copenhagen (Denmark) , nations will negotiate a new treaty to address international climate change that may include a REDD framework.
Background on REDD
- The Intergovernmental Panel on Climate Change (IPCC) noted "that reducing and/or preventing deforestation is the mitigation option with the largest and most immediate carbon stock impact in the short term per hectare and per year globally".[1] REDD provides strategies and incentives for reducing emissions from deforestation and degradation as a key mechanism for international governments and partners to address global warming. [2] (PDF file)
- According to the IPCC's Fourth Assessment Report, deforestation and forest degradation are estimated to account for 17 per cent of total global greenhouse gas emissions. [3] The IPCC finds that deforestation for agriculture and other land uses "results in immediate release of the carbon originally stored in the trees as CO2 emissions (with small amounts of CO and CH4), particularly if the trees are burned and the slower release of emissions from the decay of organic matter". [4] Each year, approximately 13 million hectares of land is deforested (1990-2005 data). [5]
Background on "REDD Plus" (REDD+)
- "REDD+" (REDD Plus) refers to "Reducing emissions from deforestation and degradation, conservation of existing carbon stocks and enhancement of carbon stocks" (PDF file)
- While reducing global forest loss from deforestation and degradation would result in a decrease in further emissions of carbon into the atmosphere, leaving growing forests intact should also increase the removal of carbon already in the atmosphere, a process known as carbon sequestration. The REDD+ proposed mechanism is a new development in the REDD strategizing process designed "to support the voluntary efforts of developing country Parties to mitigate climate change by reducing emissions from deforestation and forest degradation, [to promote] conservation and the sustainable management of forests, and...[to enhance] forest carbon stocks." (PDF)
- Exactly how nations will agree to a system of emissions reductions that would finance REDD and channel compensation for avoided deforestation to developing countries in an effective, fair and transparent way remains to be decided.
- Some environmental groups argue that REDD does not sufficiently address conservation, and is too limited in its focus only on tropical forests. The Wild Foundation acknowledges that, while important, REDD is only "a partial approach: it only addresses incentives for conservation in tropical forests, so it does not maximize the carbon sequestration potential of natural systems worldwide - nor their social and biodiversity benefits." [6]
"REDD+" (REDD Plus)
- "REDD+" (REDD Plus),The Wild Foundation encourages, "draws attention to the huge potential of carbon sequestration through wilderness protection." [7]
See books, reports, scientific papers, position papers and websites for additional useful resources.
- Forest Carbon Portal Forest Carbon Portal is an "information clearinghouse on terrestrial carbon. The Forest Carbon Portal tracks news, resources, events and nearly 100 forest carbon projects around the world. This new version offers a more interactive site where users can create profiles in the member directory; join discussions in 'Carbon Connections'; comment on articles; as well as upload projects, resources, events and job opportunities."
- Can REDD make natural forests competitive with oil palm? (PDF) by By Lian Pin Koh and Rhett A. Butle for the International Tropical Timber Organization's (ITTO) newsletter, February 2010. "The authors... note that since REDD carbon credits are currently limited to voluntary markets... they are unlikely to compete financially with oil palm on most types of land."
- Tenure in REDD, Start-point or afterthought? (PDF file) - 2009 publication by International Institute for Environment and Development (UK) on tenure regimes in rainforest countries and challenges they present for REDD, usage rights in key rainforest countries, and the potential for REDD to have a sustainable impact. Profiles seven rainforest countries: Brazil, Cameroon, Democratic Republic of Congo, Guyana, Indonesia, Malaysia and Papua New Guinea.[8]
- Putting the Brakes on Drivers of Forest Destruction: A Shared Responsibility - December 2009 Environmental Investigation Agency Copenhagen Climate Talks Briefing.
- This report provides an overview of why climate negotiators should address the drivers of global deforestation and degradation and how indiscriminate demand for commodities drives forest loss. Two case studies are presented: "Plantation development in Indonesia's Papua provinces" and "Combating illegal logging at a global level: A priority for REDD". [9]
- Madagascar Conservation & Development Interview: REDD in Madagascar (PDF file): Interview with Tiina Vahanen, senior officer at the UN - REDD Programme.
- REDD in Madagascar: An Overview of Progress (PDF file) Analysis of existing REDD projects in Madagascar by Barry Ferguson of the University of East Anglia.
- The Little REDD+ Book: An updated guide to governmental and non-governmental proposals for reducing emissions from deforestation and degradation (PDF file) - 2009 publication by the Global Canopy Programme Oxford, (UK) on REDD+, the REDD framework, governmental and non-governmental REDD proposal summaries, and current research on the scope, distribution and financing of REDD. [10]
- REDD as an option for climate protection: Causes for deforestation and baseline development in a pilot study in Madagascar (PDF File), by the Institute of Forest Based Sector Economics, Hamburg, Germany: "Economic causes for deforestation are analysed in three project regions in Madagascar in order to identify their significance and their impact on a national baseline as well as for the identification of the economic advantage generated by forest use." [11]
- Tenure in REDD, Start-point or afterthought? (PDF file) - 2009 publication by International Institute for Environment and Development (UK) on tenure regimes in rainforest countries and challenges they present for REDD, usage rights in key rainforest countries, and the potential for REDD to have a sustainable impact. Profiles seven rainforest countries: Brazil, Cameroon, Democratic Republic of Congo, Guyana, Indonesia, Malaysia and Papua New Guinea.[12]
- 6 April 2010, London, UK: Dialogue on Forests, Governance and Climate Change. (Themes: climate change, forests, indigenous people, policies, REDD)
- 13-14 May 2010, London, UK: Forestry, Biomass and Sustainability. (Themes: biofuels, biomass, carbon offset, forestry, REDD, sustainability)
- 10-11 June 2010, Washington, DC, USA: Forestry Carbon Markets and REDD.(Themes: forestry, greenhouse gases, REDD)
- 22 June 2010, Washington, D.C., USA: Rights and Resources Initiative Dialogues on Forests, Governance and Climate Change. (Themes: forests, indigenous people, REDD, UNFCCC)
- 28 June - 2 July 2010, Edinburgh, Scotland, UK: 18th Commonwealth Forestry Conference. (Themes: climate change, forests, REDD, wood)
- 27-29 May 2009, Bali, Indonesia: 8th Meeting of the Asia Forest Partnership (AFP) and AFP Dialogue: REDD and Combating Illegal Logging.
- 28 May 2009, Washington, D.C.: Dealing with Climate Change - The Need to Include Agriculture and Land Use, by the International Food Policy Research Institute (IFPRI)
- 1 June 2009, Bonn, Germany: A Better Way of Dealing with Degradation, side event on degradation and community-based approaches for measuring carbon stocks by the K:TGAL project at the UNFCCC climate talks.
- 1-12 June 2009, Bonn, Germany: Thirtieth sessions of the UNFCCC Convention subsidiary bodies.
- 2 June 2009, Bonn, Germany: A Global Mechanism for REDD+: side-event at the UNFCCC meeting Hosted by The Nature Conservancy. (Themes: Climate change, REDD, land use change, forests).
- 14-15 June 2009, Montreux, Switzerland: UN-REDD 2nd Policy Board Meeting
- 26-27 August 2009, Sao Paulo, Brazil: International Workshop on Solutions to Deforestation and Greenhouse Gas Emissions Caused by Cattle ExpansionHosted by the National Wildlife Federation in partnership with Amigos da Terra, Allianca da Terra,Imazon, Forest Footprint Disclosure and Greenpeace (Themes: forests, Brazil, deforestation, GHG emissions, REDD, cattle)
- 6-7 October 2009, Accra, Ghana: Katoomba XV - Ghana: Payments for Ecosystem Services in West Africa (and looking forward to Central Africa) (Themes: REDD, local peoples, ecosystem services, West Africa, Central Africa, developing countries, forests)
Note: See also REDD-related news at REDD-Monitor's "REDD-in-the-news" page'
- Indonesia puts moratorium on new forest clearing, 27 May 2010 by Reuters: "Indonesia will place a two-year moratorium on new concessions to clear natural forests and peatlands under a deal signed with Norway aimed at reducing greenhouse gases, the government said in a statement."
- Under a bilateral agreement, "Norway will invest $1 billion in forest conservation projects in Indonesia."
- "The suspension would encourage the development of new plantations 'on degraded lands rather than vulnerable forests and peatlands'."
- "Palm oil firms such as Wilmar and Indofood Agri Resources have big expansion plans in Indonesia, already the largest producer of an oil used to make everything from biscuits to soap."
- "Part of Norway's $1 billion will be spent on creating monitoring systems and pilot projects under a U.N.-backed forest preservation scheme called Reduced Emissions from Deforestation and Degradation (REDD)."
- "REDD allows developing nations to earn money by not chopping down their trees and preserving carbon-rich peatlands, seen as key to slowing climate change because forests soak up huge amounts of greenhouse gases."[13]
- Rainforests Lose Out in Senate's New Climate Bill, 18 May 2010 by Time: "The climate bill passed by the House of Representatives last June set an ambitious goal of conserving the carbon trapped in forests equal to 10% of U.S. emissions, and in doing so, set aside 5% of total emissions allowance value from carbon auctions, which could bring $3 to $5 billion a year, to the protection of forests in developing nations."
- "But while the Kerry-Lieberman bill in the Senate has the same broad goal for conserving forests, it devotes no specific funds to stopping deforestation."
- "The Senate bill also excludes private sector investment in rainforest conservation for the next 10 years. Under the House bill, private companies that invest in rainforest offsets — paying to keep trees standing in tropical countries — could generally claim credits against their carbon cap. Under the Senate bill, they won't be able to do so, for the most part, unless tropical nations already have a national or state-level deforestation cap in place, which will likely take years to develop."
- "That's a major blow to the development of a global conservation process called REDD...which would allow developed countries to invest in rainforest protection in the tropical world in exchange for carbon credits."
- "Although the Senate bill does give the President the authority to designate up to 5% of carbon revenue to deforestation or other international aims within the context of a global deal, which is meaningful, it's not as effective as specifically dedicating money to stop deforestation. Further, limiting REDD in a U.S. climate bill could make getting a global deal — already a near impossible challenge — even tougher. REDD was one of the few areas that showed glimmers of promise at the chaotic U.N. climate summit in Copenhagen last December....But as the Senate bill stands now, REDD could end up dead."[14]
- The Scientists' Letter on the Copenhagen Commitment for Tropical Forests, April 2010 by the Union of Concerned Scientists on behalf of over 200 scientists: "The Scientists' Letter on the Copenhagen Commitment for Tropical Forests is a letter asking members of Congress to keep the commitment made by the United States in Copenhagen on December 16, 2009. There the United States promised $1 billion over 3 years for tropical forest conservation."
- "Tropical forests contain half of all carbon stored in terrestrial vegetation, and clearing and degradation of tropical forests constitutes about 15% of all anthropogenic carbon emissions. REDD+ [Reducing Emissions from Deforestation and forest degradation in Developing countries] can greatly strengthen measures to reduce carbon emissions, protect biodiversity, and provide other human benefits."
- "REDD+ is an inexpensive solution relative to alternatives such as industrial energy efficiency or solar or nuclear power and an immediate solution too — $20 billion could cut emissions by half a billion tons and do so by 2020."
- Read the PDF version of the The Scientists' Letter on the Copenhagen Commitment for Tropical Forests (PDF) here.
- Copenhagen: Non-binding political accord under discussion as talks near an end, 18 December 2009 by Yale Environment 360: "With time running out in at the climate summit, negotiators are considering issuing a political statement, "The Copenhagen Accord," that would not lead to a binding climate agreement next year but rather set a goal of halving global greenhouse gas emissions by 2050."
- "The accord would delay formal consideration of a treaty reducing greenhouse gas emissions until 2012, and in the meantime set a goal for industrialized nations to slash their greenhouse emissions by 80 percent below 1990 levels by 2050, with emissions from all nations being cut by 50 percent by 2050."
- In Copenhagen's Dark Mood, a Ray of Light for Forests 17 December 2009 by TIME: "there has been progress on ...REDD, which would allow developed nations to pay countries to preserve their rain forests and earn carbon credits. A draft text presented to the delegations on Wednesday had most, if not all, of the major issues ironed out."
- "REDD got another boost on Wednesday when U.S. Agriculture Secretary Tom Vilsack announced that the U.S. would commit $1 billion over the next three years to help protect tropical forests."
- "Negotiators of the draft text say far more will eventually be needed, somewhere north of $20 billion, but the U.S. pledge is a good start and perhaps the first of many others."
- REDD Deal Close, but Where's the Money?, by Steve Zwick of the Katoomba Group's Ecosystem Marketplace: Current negotiating "text implies the creation of a global infrastructure for making direct payments to forest custodians to ensure the preservation of the rainforests, but falls short of spelling that apparatus out."
- "It shows agreement in principle...on the establishment of a fund or facility for building up facilities in developing countries for monitoring the amount of carbon captured in trees ("capacity building"), but then gets gooey in the parts that talk about creating market-based mechanisms to pay for the long-term policing of the rainforest to prevent illegal logging or to compensate locals for not turning their forests into farms."
- REDD in Madagascar, 8 December 2009 by Mongabay.com: "Barry Ferguson of the University of East Anglia reviews Madagascar's five current REDD Pilot Projects".
- "Ferguson...notes some of the pitfalls of REDD, including questions of land use rights, meeting the needs of local forest users, and fair distribution of REDD money. Two main suggestions emerge from his review:
- Community Forest Management will be the Basic Building Block for REDD in Madagascar – but it needs a lot more support to make it work
- Many Malagasy could be considered as 'Indigenous Peoples' and 'Forest Dwellers' and as such they should have legal rights over their lands including forests"
- "Ferguson...notes some of the pitfalls of REDD, including questions of land use rights, meeting the needs of local forest users, and fair distribution of REDD money. Two main suggestions emerge from his review:
- Indonesia could double oil palm plantation area, 2 December 2009 by Mongabay: "Indonesia has 18 million hectares of land suitable for oil palm cultivation, nearly twice the 9.7 million hectares that have already been allocated for plantations, said Agriculture Minister Suswono...at the opening of the 5th Indonesian Palm Oil Conference in Bali."
- "[E]conomic returns from oil palm plantations could soon face competition under a scheme (known as REDD for reducing emissions from deforestation and degradation) that would compensate countries for protecting carbon sinks, notably tropical forests and possibly peatlands. Under some circumstances carbon conservation could outperform palm oil production....Indonesia's recent announcements about oil palm expansion across peatlands may in fact be posturing to win more compensation under a REDD mechanism."[15]
- Standards proposed for REDD-plus, 12 October 2009 by carbonpositive: The Climate, Community & Biodiversity Alliance (CCBA) and CARE have produced the 'REDD+ SE' standard, "a qualitative approach setting out the basic principles a REDD programme would need to follow to ensure people's rights and environmental impacts are properly recognised and accounted for. The eight principles, and criteria for the minimum requirements in meeting them, were identified in a series of stakeholder consultations run by CCBAand CARE this year." [16]
- UN's forest protection scheme at risk from organised crime, experts warn, 5 October 2009 by guardian.co.uk: "International police, politicians and conservationists warn that the UN's programme to cut carbon emissions by paying poor countries to preserve their forests is 'open to wide abuse'".
- "...academics and environment groups with long experience working with the logging industry and indigenous communities said that both government and private schemes are being set up with no guarantees to protect communities who depend on the forests. 'Decisions are being rushed, communities are not consulted or compensated and the lure of money from cutting emissions is overiding everything,' says Rosalind Reeve of forestry watchdog group Global Witness."
- Redd in Africa: 'how we can earn money from air by harvesting carbon', 5 October 2009 by guardian.co.uk: "Kenyan ranch shows how UN scheme could protect forests that absorb CO2 and earn billions of dollars for their owners."
- "The carbon saved would be traded on the growing voluntary carbon market and after 2012 when the next round of the Kyoto treaty becomes affective, Rukinga could qualify as an official Kenyan government Redd scheme, attracting public money from Britain and other rich countries seeking to offset emissions they have legally committed to cut."
- "Hans Brattskar, director of Norway's Forest and Climate Programme whose country is funding the UN-Redd programme, said he envisaged some difficulties could be overcome by sophisticated hi-tech surveillance mixed with on-the-spot monitoring by indigenous peoples. 'We know that Redd will needs new laws, land reform and new institutions. But if countries do not perform they will not be paid. This is payment for services. The consequences if we fail are enormous.'"
- Tasmania gets Australia's first REDD deal, 27 July 2009 by mongabay.com: "A forest conservation project in Tasmania has become Australia's first Reduced Emissions from Deforestation and Degradation (REDD) project to meet Climate, Community and Biodiversity Standards."
- "'The goal is to protect half a million hectares across Australia within the next 5 years...'"
- "Recent biomass surveys have found that some old-growth forests in Tasmania store more than 650 tons of carbon per hectare, exceeding the amount of carbon stored in the vegetation of most tropical rainforests. Plantations established in place of old-growth forests after clearing store considerable less carbon." [17]
- `REDD plus' to give RI double benefits, 8 July 2009 by The Jakarta Post: "the REDD-plus...mechanism will pave the way for developing countries to seek greater incentives if they conserve forest areas, adopt sustainable environment management programs or plant new trees."
- Cambodia signs REDD agreement, 24 June 2009 by Mongabay.com: "Terra Global Capital, a San Francisco-based firm seeking to capitalize on emerging markets for ecosystem services, has signed an avoided deforestation deal with the government of Cambodia."
- "Cambodia has one of Asia's highest rates of forest loss. Between 2000 and 2005 the country lost 29% of its primary forests, while overall deforestation was 218,800 hectares of forest per year".
- "The project...expects to reduce emissions from deforestation by 8.5 million tons of carbon dioxide over 30 years. Terra Global Capital is seeking accreditation for the project under the Voluntary Carbon Standard (VCS)."
- Deforestation and carbon credits: Seeing REDD in the Amazon, 11 June 2009 by The Economist: "Saving rainforests needs both property rights and payment."
- "A law approved this month by Brazil's Congress...would grant title to all landholdings up to 1,500 hectares (3,700 acres) occupied before 2005 in the Amazon, comprising an area the size of France, and ban further land claims. The law entrenches injustice: it risks rewarding people who used violence to obtain land, including large land holders who occupy almost 90% of the area under discussion."
- "As with other forms of carbon credit, today's voluntary and experimental REDD schemes will need to be replaced by more rigorously accredited and monitored schemes. But they have a chance of working only if the countries in which they operate define forest land rights clearly. Brazil's flawed attempt to do this is a step forward."
- How Carbon Markets Can Make Both Economic and Ecological Sense, 7 June 2009 by The New York Times: "...researchers found that paying to conserve forest was more valuable than plantations as long as poorer nations could earn between $10 and $33 for each tonne of CO2 saved. Currently a credit representing a tonne of CO2 sells for about $20 in the European Union..."
- "...opponents of a payment system insist that verifying emissions reductions would be too hard. They also say such a system could rob deprived areas of the world of the chance for economic development."
- Papua New Guinea and carbon trading: Money grows on trees 6 June 2009 by Economist.com: "Irregular carbon credits cause upheaval in the government of Papua New Guinea".
- "Poor governance, on top of poorly defined and defended forest property rights, mean that without proper care REDD could become a recipe for disaster rather than part of a solution the world needs."
- Rainforest conservation more profitable than palm oil production, 5 June 2009 by redOrbit.com: "...paying to reduce rainforest carbon emissions could actually amount to more income than initiatives to use the deforested land for palm oil production."
- Indonesia needs $4b to avert deforestation, 4 June 2009 by The Jakarta Post: "...Indonesian deforestation could be averted if international communities grant US$4 billion until 2012 to finance the livelihood of local peoples and stop forest conversions....The Forestry Ministry said the money would be used to address the main causes of deforestation prior to the implementation of the reducing emissions from deforestation and degradation (REDD) mechanism."
- "Many have criticized the Indonesian government for its failure to combat high rates of deforestation, which have risen to over one million hectares per year."
- "Indonesia has about 120 million hectares of rainforest – the third-largest on the planet after Brazil and Congo."
- "...illegal logging [can] be seen from the expansion of oil palm estates in protected areas and conservation forests in the country....local administrations still [award] licenses for forest conversion, including for plantations."
- Climate Change Scientist Says Forests Have Broader Role Than REDD in Addressing Climate Change, 31 May 2009 by JakartaGlobe: "...with REDD Plus, discussions on forests would not be limited to reducing carbon emissions."
- "'We have a new term, REDD Plus, which is not just about reducing emissions but also relates to the roles of conservation, sustainable forest management and the enhancement of forest carbon stocks in developing countries,' Daniel Murdiyarso, a climate change scientist at the Center for International Forestry Research (Cifor), said at the 8th Asia Forest Partnerships conference."
- "'We are not just talking about compensation on [preventing] degradation but also talking about the possibilities for conservation areas to also keep their carbon stocks,' he said, adding that efforts to get carbon credits through REDD Plus would not be limited to reducing emissions."
- Palm oil could scuttle forest carbon plan: experts, 29 May 2009 by Reuters: "Carbon credits derived from a fledgling forest conservation scheme for developing nations will struggle to compete with palm oil as an investment..."
- "...REDD allows developing countries to raise potentially billions of dollars in carbon credits in exchange for conserving and rehabilitating forests...However, profits from palm oil plantations could, in some cases, out-compete revenue from selling REDD credits…"
- "...REDD credits arising from 10,000 hectares (25,000 acres) of conserved forest sold over a 30-year period -- where payments were front-loaded so that most of the money was delivered within the first eight years -- could fetch about $118 million if those credits could be used to meet emissions obligations for rich nations."
- "The same credits would fetch only $14 million if their purchase was voluntary...'Whereas high-yield palm oil would get about $96 million'..."
- Forests and the Planet 28 May 2009 editorial in The New York Times: It is critical that "the right incentives [are put] in place — first as part of broad climate change legislation in the United States, then as part of a new global treaty that the world's nations hope to negotiate" in Copenhagen in December 2009.
- "Deforestation accounts for one-fifth of the world's greenhouse gases — about the same as China's emissions, more than the emissions generated by all of the world's cars and trucks."
- "An estimated 30 million acres of rain forest disappear every year, destroying biodiversity and pouring billions of tons of carbon dioxide into the atmosphere."
- "The global warming bill now working its way through the [U.S. House of Representatives] seeks to change this destructive dynamic in two ways. It sets up a carbon trading system that is expected to raise upward of $60 billion annually through the sale of pollution allowances. Five percent of that would be set aside to help prevent deforestation, either through a special international fund or as bilateral grants to poor countries."
- U.N. launches program to cut deforestation emissions, 24 September 2008 by Reuters: "The United Nations launched a program that it...hopes could be the foundation for a system in which rich countries would pay poor ones to slow climate change by protecting and planting forests."
Other links
International frameworks
- UN Collaborative Programme on Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (UN-REDD) (PDF file) - 20 June 2008: Explains the framework for collaboration among FAO, UNDP, and UNEP and other members of the Collaborative Partnership on Forests.[19]
- UN-REDD Programme Fund - United Nations Development Programme (UNDP) overview of the UN collaborative programme on reduced emissions from deforestation and forest degradation in developing countries.
Information-sharing websites
- Clark Labs Blog on Land Change Modeling for REDD - Reducing Emissions from Deforestation and Forest Degradation - "The Land Change Modeler is a...land cover change analysis and prediction software for REDD projects which also incorporates tools that allow you to analyze, measure and project the impacts on habitat and biodiversity."
- Forest Carbon Portal - An initiative of the Katoomba Group's Ecosystem Marketplace.
- Forests Now - an initiative of the Global Canopy Programme
- REDD information sharing web platform - hosted by the UNFCCC
REDD overviews
"REDD+" ("REDD Plus") overviews
- UNFCCC Article for the REDD+ Mechanism: Papua New Guinea submission (PDF File) - May 2009 synthesis of related joint submissions from multiple country parties. [20]
REDD in US Climate Legislation
- Forests & REDD: US climate bills compared - Overview of the two US climate bills as they relate to international forests and Reducing Emissions from Deforestation and Degradation, prepared by Carbon Positive, 6 Jan 2010.
- Climate, Community & Biodiversity Alliance- "CCBA has developed voluntary standards to help design and identify land management activities that simultaneously minimize climate change, support sustainable development and conserve biodiversity." Recent REDD-related reports include: "REDD+ Social & Environmental Standards" (Oct 2009) and "REDD Project Financial Feasibility Tool"(Sept2009).[21]
- Avoided Deforestation Partners - AD Partners "advances the adoption of U.S. and international climate policies that include effective, transparent, and equitable market and non-market incentives to reduce tropical deforestation."[22]
- Initiatives include the REDD Methodology Project
- Global Canopy Program - "an alliance of 37 scientific institutions in 19 countries, which lead the world in forest canopy research, education and conservation."[23]
- Works "to define and explore the range and economic value of forest ecosystem services."
- The Wildlife Conservation Society (WCS) is involved in multiple biodiversity conservation projects in Madagascar. In 2008 WCS officially established the Makira Carbon Company to aid Madagascar's government in marketing and selling carbon offsets from the nation's largest remaining contiguous block of tropical rainforest, to private investors in order to "safeguard this African nation's wildlife-rich Makira Forest,...contribute to the economic wellbeing of people living around Makira, and help fight global climate change." [24]
REDD glossary
- Avoided deforestatiaon
- Bali Action Plan
- Co-benefits
- Multi-donor trust fund[25]
|Woody biomass | Wood waste | Deforestation (REDD)
Forests and climate: Tropical Forest and Climate Unity Agreement
What is bioenergy? | Benefits/Risks | Who is doing what?


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Featured News - Current News - Archived News - News Categories
In its ongoing efforts to assist practices in utilizing technology to improve the quality and coordination of patient care, HEALTHeLINK recently recognized the achievements of 59 primary care practices, including five in Niagara County, that have reached Patient Centered Medical Home certification from the National Committee for Quality Assurance by using Western New York's clinical information exchange.
With the support of a New York State Health Care Efficiency and Affordability Law Phase 10 grant, which was awarded to HEALTHeLINK, these practices used PCMH standards to organize care around their patients, utilize technology wherever possible, and work with other health care professionals to coordinate and track care over time, including arranging for appropriate care with other qualified providers as needed. In addition, HEALTHeLINK worked with Catholic Medical Partners, Health Now, Independent Health Association and P2 Collaborative of Western New York to support the implementation of these PCMH standards.
"Health information technology is a vital component of a fully functioning Patient Centered Medical Home model, as exhibited by these practices," said Daniel Porreca, HEALTHeLINK's executive director. "This certification shows a deep commitment by the practice to provide the highest quality of patient care."
By building on current health information and using improved clinical processes, these primary care practices are now able to pull labs, radiology and hospital results through HEALTHeLINK, and then integrate these results with electronic patient data generated from the practice to provide well-informed diagnoses and care coordination for patients. Throughout the three-year project, HEALTHeLINK more than tripled the original goal of assisting 15 practices in achieving PCMH certification.
Those following practices in Niagara County were recognized by HEALTHeLINK for achieving PCMH certification:
•Dr. Christopher Beney, Lockport
•Dr. Ronald J. Clarke, Niagara Falls
•Eaton Medicine, Lockport
•Niagara Family Medicine, Lewiston
•Suresh Sofat, MD, Lockport
•TMO Medical, Niagara Falls
About HEALTHeLINK
The not-for-profit organization was established through funding from BlueCross BlueShield of Western New York, The Catholic Health System, Erie County Medical Center Corporation, Independent Health Association, Kaleida Health, Roswell Park Cancer Institute, Univera Healthcare and the Health Care Efficiency and Affordability Law for New Yorkers Capital Grant Program from New York state. HEALTHeLINK also received one of the country's largest awards as part of the U.S. Department of Health and Human Services' Beacon Community Cooperative Agreement Program.
HEALTHeLINK stakeholders include a broad representation of health care professionals and organizations throughout the eight-county Western New York region, including the State University of New York at Buffalo, P2 Collaborative, Chautauqua County Health Network, the WNY Rural Area Health Education Center and local county public health departments.
For more information on HEALTHeLINK, visit www.wnyhealthelink.com.


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Three helpful tips for sunroom or porch decorating
There's nothing quite like having a sunroom or an enclosed porch where you can enjoy the weather without actually being outdoors and exposed to the elements. However, this room can be tricky to decorate if you've never designed a space with a large number of windows before. Don't be discouraged if you aren't an experienced designer - here are some tips you can use to dress up your sunroom with the perfect discount window treatments, accent pieces and furniture.
1. Welcome in sunlight with the right window treatments.
For your sunroom or porch, you might want to consider custom window shades to fit the unique windows throughout the space. This also gives you the opportunity to design window treatments to reflect your personal style and taste. Just remember to steer clear of opaque material to allow as much beautiful sunlight in as possible!
2. Create a theme.
One tactic you can use when you're having trouble decorating a room in your home is to think of a theme for the space. HGTV recommends an ocean theme in your sunroom if you want to reminisce about the beach, or perhaps you'll want to choose a country style to give your space a personal touch.
3. Go natural when choosing furniture.
Wicker is a popular material in indoor and outdoor spaces because it's light, natural and fits perfectly into casual porches and sunrooms. However, don't count out other varieties of wood that can possibly mesh well with your theme. For example, bamboo furniture can seamlessly work with a tropical or beach theme by giving it an exotic touch.
Whether you already have an interior design in mind for your sunroom or you're still narrowing down your options, these three tips can make the decorating process simpler.


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Thursday, 22 January 2009
did you guess?
Anyone pick what was unusual about my little hair makeover? Am hoping not, because that means I did good job! The whole thing was DIY: the colour and cut. And yes, this deserves its own post because it's hard work cutting your own hair without making it look like you cut your own hair. To be honest, there are a few floaty longer bits that Steve needs to tidy up for me, but overall? I'm rather thrilled. Haven't been to a hairdresser for about 18 months - Steve and I usually play hairdressers on the deck every few months. But I just might go soon and get them to do the colour properly. This is a wash-out, because there was no way I was braving anything longer than a week or so first time around! So yes, all that back-patting you hear is coming from me! And thanks for compliments! x
Posted by belinda graham at 15:53
1 comment:
- amy turn sharp of doobleh-vay said...
you look great bravo!!!
- 23 January 2009 at 00:38
Subscribe to: Post Comments (Atom)


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Updated: Michael Gambon Taken Ill; to be Replaced in UK Stage Production by Richard Griffiths
Oct 02, 2009
HP Cast
UPDATE: TLC has spoken directly to reps for Michael Gambon, who have reassured us that the beloved actor is on the road to recovery from this minor illness, and will be back to work, up and jumping again in a few weeks time. Of special interest to Harry Potter fans is word that yes indeed, Michael Gambon will be able to film his role as the beloved Albus Dumbledore for Harry Potter and the Deathly Hallows later this fall.
What's On Stage is reporting today that actor Michael Gambon (Professor Dumbledore) has canceled his upcoming appearance in a UK play this fall due to an undisclosed illness. While the appearance of this acclaimed actor on the stage again was widely anticipated, the part will now be performed by fellow Harry Potter actor and Tony award winner Richard Griffiths (Uncle Vernon). Quotage:
"Michael Gambon has pulled out of the upcoming world premiere of Alan Bennett's new play The Habit of Art under doctor's advice while he recovers from an undisclosed minor illness. He will be replaced by Richard Griffiths as poet WH Auden opposite Alex Jennings as composer Benjamin Britten in the production, directed by NT artistic director Nicholas Hytner which is still due to open in the NT Lyttelton on 17 November 2009 (previews from 5 November). The actor said today: "I'm really disappointed to be pulling out of
this play, as I'm temporarily not firing on all cylinders. The timing
is very unfortunate, but I have been told to rest for a couple of
weeks. This means I must let the show go on without me."
Please join us here at TLC as we wish Mr. Gambon a very speedy recovery.


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Wiki page, Web update - Website review
Budget $10-30 USD
Two small jobs
1. Website update , [login to view URL]
2. Wiki page creation
18 freelancere byder i gennemsnit $61 på dette job
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ANGOLA, Ind. - It was not an ideal day for the 17th ranked Trine University football squad as they dropped their first conference game in four seasons, 26-7 to Adrian College. The Thunder are now 3-1 on the season and 0-1 in the conference.
From the start the Trine offense was unable to gain any momentum against the Bulldogs defense. Neither team was able to find the end zone in the first quarter as it appeared Trine was able to get a hand on 22 yard field goal attempt by Logan Mitseff that missed wide left. After Trine's next possession went three and out, the Thunder forced a fumble on Danny Cobb starting their drive near midfield. On the first play, Trine was pushed back by a penalty and three players later it the Bulldogs who forced the fumble and recovered. Three players later, Brandon Miller found Justin Hemm for 43 yards. With the ball at the three, Adrian pushed it in from there to take the 7-0 lead.
Trine's next possession resulted in short punt, but this time the defense held strong and against forced a fumble recovering it on their six yard line. However, it would be another turnover, this time an interception by quarterback Ryan Hargraves. With the ball on the Trine 17, once again the Thunder defense held strong as they forced the Bulldogs to settle for a 27 yard field goal.
On Trine's ensuing possession, the offense manages just 22 yards before being forced to punt. On the punt, Adrian blocked the Nick Muir kick and recovered to start their drive at the Trine 25 yard line. Three plays later it was Miller finding Mitch Gabriele for a 21 yard touchdown. Trine followed with another three and out possession that was hindered by another penalty. Using just 50 seconds off the clock, Adrian would score another field goal this time from 47 yards by Mitseff. Despite out-scoring the Thunder 20-0 in the quarter, Trine actually held the ball for almost three more minutes, as Adrian out-gained the Thunder by just 24 total yards in the quarter.
The third quarter was similar to the first in that neither team would score. Trine actually held the ball for most the period, using up just over 11 minutes. The quarter saw two big plays go against the Thunder. First, Ja Vontae Hence returned a punt down to about the Adrian 20, but was called back due to an illegal block. The second came on the ensuing possession. After driving to the Adrian 24, Hargraves was against picked off inside the Bulldogs 10 yard line.
Trine was able to get on the board during their next possession after forcing another three and out on defense. The Thunder drove 59 yards before Hargraves found Will Chrystal from seven yards out. After forcing Adrian to punt on another three and out, Hargraves threw his third pick of the day on the first play of the Trine drive. Adrian then drove 61 yards scoring the final points if the game. Trine would drive down the field 76 yards, but Hargraves pass in the end zone was intercepted.
Hargraves finished the day going 16-for-33, for 130 yards with a touchdown and four interceptions. Kent Biller led the offense with a game-high 126 rushing yards. Hence led Trine with seven receptions for 44 yards while Chrystal had four catches for 40 yards. Despite the score, Trine gained more total yards than the Bulldogs 278-to-264. Trine also led time of possession 32:31-to-27:29. Penalties also hurt the Thunder as they were flagged nine times for 72 yards.
The loss snaps the Thunders 20-game conference, 20-game regular season and 22-game home regular season winning streaks.
Trine will look to rebound as they travel to LaGrange, Georgia as they take on non-conference opponent LaGrange College on October 8.


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Aurifil Thread, 100% Cotton, Very Light Delft #2770, 50 wt, 1422 yards
Very Light Delft #2770. 50 weight Makó Cotton Aurifil thread is the #1 seller in the quilting industry for a high quality thread. Each spool of Aurifil Cotton Makó is mercerized - this enables fiber's contraction and increases the efficiency during the drying procedure. The result is a high sheen thread with a great washing resistance. The superior, long staple cotton boasts high tensile strength and a wonderful silky touch. The finest of the cotton Makó threads. Quilters love it for piecing and quilting. It's fantastic for fine machine quilting stitch, excellent for machine appliqué and piecing, recommended for miniature patchwork projects, and very good for piecing and quilting in both top and bottom. Imported from Italy. Large spool contains 1422 yards. 100% long staple Eqyptian cotton.