Factors related to sleep quality in healthy elderly women.

Elderly women in subjectively good health (free of acute illness and major sleep pathologies) who were self-identified as good (n?=?22) and poor (n?=?16) sleepers were compared on measures of physical health, psychological symptoms, psychosocial status, and life-style. Poor sleepers reported longer sleep latencies, less total sleep time, more nonrestorative sleep, and more daytime fatigue than did good sleepers. Sleep recordings confirmed subjective reports, with shorter total sleep times and trends for lower sleep efficiency, longer sleep latencies, and more wake-after-sleep onset among women with subjective poor sleep. Poor sleepers also were more frequent users of sedative–hypnotic medications in the past. Current medication use, alcohol and caffeine use, daytime napping, and exercise were equivalent in both groups. Psychosocial status failed to discriminate groups. Poor sleepers reported significantly more psychological symptoms than did good sleepers. The levels of both psychological symptoms and sleep disturbance were mild. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electrophysiological changes during the sleep onset period of psychophysiological insomniacs, psychiatric insomniacs, and normal sleepers

The electroencephalograms (EEGs) of the sleep onset period (SOP) of psychophysiogical insomniacs. psychiatric insomniacs, and controls were compared using power spectral analysis. We predicted that psychophysiological insomniacs would show elevated cortical arousal throughout their entry into sleep. Electroencephalograms, electrooculograms (EOGs), and electromyograms (EMGs) were recorded for two consecutive nights. Power spectral analysis of EEG from the sleep onset period was performed on all standard frequency bands. Psychophysiological insomniacs had less alpha during the first part of the SOP and did not show the dramatic drop in alpha across the SOP that characterizes normal sleep. They showed less delta in the last quartile of the chronological analysis of the SOP. Psychiatric insomniacs showed lower relative beta power values overall, while psychophysiological insomniacs showed higher relative beta power values during wakefulness. This microanalysis indicates that the SOP is generally similar for psychiatric insomniacs and normal sleepers but that clear differences in the SOP of psychophysiological insomniacs exist. They have higher cortical arousal during the SOP than do psychiatric insomniacs and controls. The dramatic changes in power values in the latter two groups as sleep begins are not seen in the psychophysiological insomniacs, which may help explain the difficulty that psychophysiological insomniacs have discriminating between wakefulness and sleep.     

Sleep patterns and aging: Comparison of older adults with and without insomnia complaints.

The nature of geriatric insomnia was studied by comparing older adults with (n?=?42) and without (n?=?30) insomnia complaints on measures of sleep, mood, life-style, health, and sleep-requirement expectations. Elderly persons with insomnia complaints reported longer sleep latency and more frequent and longer awakenings and used sleeping aids more often than those without insomnia complaints. Nocturnal sleep time was not a reliable discriminator. Poor sleepers showed greater discrepancies between their current sleep patterns and sleep-requirement expectations than did good sleepers. Elderly insomniacs acknowledged greater symptomatology of depression and anxiety than did good sleepers. Daytime napping and physical exercise were equivalent in both groups. Medical disorders, pain conditions, and drug usage (other than sleep aids) did not distinguish the two groups. Clinical implications for the treatment of geriatric insomnia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disqualified and qualified poor sleepers: Subjective and objective variables.

Investigated discrepancies between subjective reports and EEG measures in patients complaining of insomnia in order to aid in the clinical management and research of insomniacs. 30 laboratory-qualified poor sleepers (QPSs [mean age 20.5 yrs]) and 30 laboratory-disqualified poor sleepers (DPSs [mean age 19.7 yrs]), all male students at the Naval School of Health Sciences, were compared on subjective report, mood, and all-night sleep laboratory variables. Results show that QPSs had significantly lower sleep efficiency and total sleep time in the laboratory due to longer sleep latencies. QPSs gave accurate morning estimates of their laboratory sleep latencies, whereas DPSs were significantly more likely to exaggerate their sleep latencies. Although ways of predicting which poor sleepers would show sleep-onset insomnia in the sleep laboratory were not identified, it was found that in the population used there were poor sleepers who gave accurate reports of severe sleep-onset insomnia. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpharmacological interventions for insomnia in older adults: A meta-analysis of treatment efficacy.

The benefit of nonpharmacological interventions for insomnia in old age was investigated. A total of 13 single-outcome studies from 1966–1998 involving 388 patients (mean age exceeding 60 years, minimum age in sample, 50 years) were included in a meta-analysis of treatment efficacy. This analysis demonstrated that behavioral interventions produce improvements in sleep parameters of older insomniacs, measured in terms of sleep-onset latency, number of nocturnal awakenings, time awake after sleep onset, and total sleep time. Clinical improvements seen at posttreatment were maintained at followups (averaging 6 months). It is concluded that behavioral treatments produce significant and long-lasting improvements in the sleep pattern of older insomniacs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do our methods lead to insomniacs' madness?: Daytime testing after laboratory and home-based polysomnographic studies

Complaints of daytime dysfunction are common among chronic insomniacs, but laboratory comparisons of insomniacs and age-matched and gender-matched normal controls have generally failed to document these complaints. However, a few studies, which allowed subjects to sleep in their homes on the nights before daytime testing, have shown some relative diurnal deficits among insomniacs. The current study compared the effects of nocturnal laboratory and home polysomnogram (PSG) studies on subsequent daytime test results among older insomniacs and normal sleepers. Insomniacs (n = 32) and normal sleepers (n = 32) were randomly assigned to first undergo three nights of nocturnal PSG monitoring either in the sleep laboratory (16 insomniacs, 16 normal sleepers) or in their homes (16 insomniacs, 16 normal sleepers). Following the third night of PSG monitoring, subjects spent 1 day in the sleep laboratory, where they completed a four-trial multiple sleep latency test along with four trials of a computer-administered performance test battery. Results showed that insomniacs, as a group, were slightly, albeit consistently, sleepier than were normal sleepers following nights of home sleep monitoring, but a reverse of this trend was found among subjects who underwent nocturnal laboratory PSG before daytime testing. Furthermore, normal sleepers showed faster reaction times on a signal detection task than did insomniacs within the subgroup who underwent home PSGs prior to such testing. However, within the subgroup that underwent nocturnal laboratory PSGs, insomniacs' signal detection reaction times were significantly faster than those shown by normal sleepers. Results provide some support for the speculation that the nocturnal PSG monitoring site, used as a precursor to daytime testing, may systematically affect daytime comparisons between insomniacs and matched controls. Moreover, these results suggest that the use of home-based nocturnal PSG monitoring prior to daytime testing may provide an enhanced understanding of insomniacs' diurnal complaints.     

Phenomenology of sleep among insomniacs and good sleepers: Wakefulness experience when cortically asleep.

25 insomniacs and 10 good sleepers (undergraduates) slept in a laboratory for 2 consecutive nights and for an intervening daytime nap session. Ss were awakened at the end of the 10th consecutive epoch of initial Stage 2 sleep and were asked to report on their experiences of sleep or wakefulness. EEG data were also collected. Insomniacs reported less sleep experience than did good sleepers in both the night and nap sessions. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Daytime melatonin administration in elderly good and poor sleepers: effects on core body temperature and sleep latency

Melatonin has been shown to have hypnotic and hypothermic effects in young adults and has been proposed as treatment for insomnia. However, the hypnotic and thermoregulatory effects of melatonin remain to be simultaneously investigated for aged good and poor sleepers. The aim of this study was to explore the short-term effects of exogenous oral daytime melatonin on core body temperature, sleep latency, and subjective vigor and affect in aged women. Twelve sleep maintenance insomniacs and 10 good sleeping postmenopausal female subjects [mean (SD) age = 65.2 (7.4) years] participated in a double-blind, crossover study in which they received a capsule containing either melatonin (5 mg) or a placebo at 1400 hours. Continuous core body temperature and hourly multiple sleep latency tests (MSLT) were collected from 1100-2030 hours. Self-reported estimates of global vigor (sleepiness) and affect were collected prior to each MSLT using visual analog scales. Comparison of good and poor sleepers failed to reveal any significant differences in core body temperature, sleep latency, or subjective vigor and affect. However, for both groups combined, melatonin administration [absolute postadministration mean (SEM) = 36.9 (0.05) degrees C] significantly lowered core body temperature compared with placebo [37.1 (0.05) degrees C]. Similarly, melatonin administration significantly reduced latency to stage 1 (SOL1) and stage 2 (SOL2) [absolute postadministration mean SOL1 = 20.1 (1.7) and SOL2 = 20.7 (1.6) minutes] compared with placebo [SOL1 = 24.3 (1.2) and SOL2 = 25.2 (1.1) minutes]. Treatment had no significant effect on either vigor or affect. Overall, our results suggest that although short-term exogenous oral daytime melatonin has significant hypothermic and hypnotic effects in aged women, the size of the effects is modest.     

Treating arousals during sleep using behavioral self-management.

Found that self-management training was associated with increased sleep efficiency, reduced number of arousals and minutes awake after sleep onset during the 1st 3rd of the night, reported improvements in the sleep quality, and less daytime sleepiness for a 58-yr-old female S. These effects were documented using laboratory and home sleep recordings and self-reports over a 5-yr period. The results suggest 2 important leads for the further development of strategies for treating the complaint of insomnia. First, multicomponent strategies to modify a variety of daytime and nighttime variables based on individual behavioral analyses may be needed. Second, maintaining improvement in sleep and daytime behavior may require that clients learn problem-solving and self-management skills, with an emphasis on experiencing a greater sense of control over factors related to good and poor sleep. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptions of life stress and chronic insomnia in older adults.

This study compared the level of self-reported stress of 42 older good sleepers (M age?=?68.2 years) and 42 poor sleepers (M age?=?68.7 years). The relations among subjective ratings of sleep, level of perceived stress, and negative mood were analyzed for each group. Good and poor sleepers reported similar amounts of life stress, but the relations between life stress and sleep perceptions differed for the 2 groups. Specifically, within the group of poor sleepers, those with higher life stress had greater difficulty falling asleep and less early morning waking than did poor sleepers with lower life stress. There was no association between life stress and any sleep measures for good sleepers. These results are compatible with the notion that good and poor sleepers may have different susceptibilities to poor sleep despite experiencing similar stressful life events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countercontrol treatment of sleep-maintenance insomnia in relation to age.

Administered countercontrol behavioral therapy for sleep-maintenance insomnia to 34 insomniacs (aged 35–78 yrs) in small groups. 22 Ss received immediate and 12 received delayed treatment. Three self-report measures of sleep disruption were collected on daily sleep diaries at baseline, termination of treatment, 1-mo follow-up, and 12-mo follow-up. Although amount of time awake at night was correlated with age, response to treatment was not. Even though older Ss experienced more time awake after sleep onset prior to treatment, they were able to profit from therapy as well as the younger insomniacs. Countercontrol therapy reduced the sleep complaint for the total group by about 30% at the end of treatment, with gradual improvement continuing through a 4-wk follow-up. It is suggested, however, that sleep-maintenance insomnia may be more difficult to treat than sleep-onset problems. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does phenobarbital used for febrile seizures cause sleep disturbances?

The effect of phenobarbital on total sleep time, night awakenings, and lengthy awakenings was examined as part of a randomized trial of children with febrile seizures; information about sleep patterns was gathered by parental observation. Children were between ages 8-36 months at enrollment and were examined subsequently for 2 1/2 years. Night awakenings were not more common in children assigned to phenobarbital except for those who were poor sleepers at the beginning of the study. Total sleep time was no different in children assigned to phenobarbital than in those assigned to placebo. It is concluded that sleep problems reported in most young children with febrile seizures treated with phenobarbital did not exceed those reported in children treated with placebo, but a subset of predisposed children did experience an increase in night awakenings.     

Ferritin expression after in vitro exposures of human alveolar macrophages to silica is iron-dependent

OBJECTIVE: Sleep State Misperception insomnia has been commonly viewed as a perceptual or psychological problem. It was hypothesized that Sleep State Misperception insomnia, like psychophysiological insomnia, could be associated with increased physiological activation, here indexed by whole body metabolic rate. METHOD: Groups of nine patients with Sleep State Misperception insomnia and age-, sex-, and weight-matched normal sleepers were evaluated on sleep, performance, mood, personality, and metabolic measures over a 36-hour sleep laboratory stay. RESULTS: Sleep State Misperception insomniacs had a subjective history of poor sleep and perceived their laboratory sleep as poor but had electroencephalogram (EEG) parameters that did not differ statistically from matched normal controls. Sleep State Misperception insomniacs had abnormal MMPI values and were subjectively more confused, tense, depressed, and angry than matched normals. Sleep State Misperception insomniacs also had a significantly increased 24-hour metabolic rate, compared with matched normals. CONCLUSIONS: The overall increase in whole body oxygen use was less than that seen in psychophysiological insomniacs but was consistent with the view that Sleep State Misperception insomnia may be a mild version or a precursor to psychophysiological insomnia.     

Relaxation treatment for insomnia: A component analysis.

Compared 4 relaxation treatments—progressive relaxation, progressive relaxation without tension release, imagery with tension release, and imagery without tension release—for sleep onset insomnia with a waiting-list control (no treatment). Analysis of data from 44 19–71 yr old insomniacs recruited from the community showed all treatment conditions to be superior to no treatment in reducing latency of sleep onset and ratings of fatigue. The presence of muscle-tension release was unrelated to outcome. There was a nonsignificant trend for visual imagery treatments to be superior to somatic-focusing treatments in reducing sleep onset latencies. Treatments using visual focusing were superior to somatic-focusing treatments in reducing the number of nocturnal awakenings. At 6 mo follow-up, only the imagery treatments showed significant improvement over pretreatment levels on latency of sleep onset. Visual-focusing treatments produced significantly greater reductions in sleep onset latency at follow-up than did the somatic-focusing treatments. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paradoxical giving up and the reduction of sleep performance anxiety in chronic insomniacs.

Paradoxical intention has been shown to improve sleep performance in chronic insomniacs, presumably by interrupting their overly anxious sleep efforts. It was hypothesized that instructions to simply give up such sleep intentions—without trying to stay awake—could have a similar effect. Giving-up instructions framed as a paradoxical sleep-improvement method ("try giving up") were compared with giving up presented as a way to improve nighttime comfort and morning restedness without any sleep improvement ("give up trying"), along with a placebo-attention (self-monitoring) treatment. The 3 treatments were embodied in a printed booklet delivered by mail and evenly distributed among 33 20–56 yr old chronic insomniacs recruited from the general community. All 3 treatment groups improved in daily sleep estimates ("sleep efficiency") after treatment, but only the giving-up groups improved on a self-report measure of sleep performance anxiety. It is suggested that such a reduction in performance anxiety may be an important therapeutic outcome, with or without sleep improvement. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints.

Examined the beliefs and attitudes about sleep among 145 older adults. Ss were either chronic insomniacs (n?=?74) or self-defined good sleepers (n?=?71). They rated their level of agreement or disagreement (visual analog scale) with 28 statements tapping various beliefs, expectations, and attributions about several sleep-related themes. The results showed that insomniacs endorsed stronger beliefs about the negative consequences of insomnia, expressed more hopelessness about the fear of losing control of their sleep, and more helplessness about its unpredictability. Findings suggest that some beliefs and attitudes about sleep may be instrumental in perpetuating insomnia. The main clinical implication is that these cognitions should be identified and targeted for alteration in the management of late-life insomnia. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Induction of visual imagery during NREM sleep

In an attempt to induce eye movements (EMs) in non-rapid eye movement sleep, light and sound stimuli were presented to human subjects (at below-waking threshold) during stage 2 sleep. EMs were used as an indicator of ponto-geniculo-occipital (PGO) wave activity. When at least one concurrent EM in response to the stimuli was observed, the subjects were awakened and mentation reports collected. Compared to equivalent control periods with no stimulation, awakenings from the stage 2 stimulation condition showed a higher frequency of visual imagery reports, electroencephalogram alpha activity, and k-complexes. Additional control and stimulation conditions elicited from rapid eye movement sleep awakenings showed no significant differences in the frequency of visual imagery reports. When the amount of alpha activity before stage 2 awakenings from which imagery was reported was compared to that from which imagery was not reported, imagery awakenings showed significantly more alpha. Results can be interpreted as evidence for a link between PGO activity and dreaming in humans or in terms of an arousal-window hypothesis of visual hallucinations.     

A behavioural basis for distinguishing wakefulness from sleep in insomniac and good sleepers.

Distinguished between the sleep of normal Ss and insomniacs, using the behaviorally-based sleep/wake monitor. 18 Ss with insomnia (aged 26–65 yrs) and 11 controls (aged 30–44 yrs) underwent a hearing test, and completed the Brock Sleep and Insomnia Questionnaire (K. A. Cote and R. D. Ogilvie, 1993). They used the behavioral response sleep/wake monitors for 3 consecutive nights, to assess behavioral sleep data. Results indicate group differences for wakefulness, sleep onset latency, total percent sleep, and percent wakefulness prior to sleep onset. Significant night effects were present in a number of measures. Group by Night interactions were found for total percent sleep, and after sleep onset, total percent wakefulness and after sleep onset. These findings support differences between normal and insomniac sleep. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep compression and sleep education for older insomniacs: Self-help versus therapist guidance.

A treatment package consisting of a bed-time restriction strategy and education was administered to 50 insomniacs and 50 noninsomniacs 60 years or older. Half of the insomniacs and noninsomniacs received treatment through a self-help video only, whereas the remaining treated participants received therapist guidance to supplement the video. A waiting-list control group of 25 senior insomniacs was also included. Sleep knowledge was equivalent for senior insomniacs and noninsomniacs. The self-help insomniac group exhibited improvement on multiple sleep variables, but the addition of therapist guidance appeared to enhance treatment outcome for sleep latency wake time after sleep onset, and sleep satisfaction. Control participants also improved across time but were generally outperformed by treated insomniacs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Bacterial surface display: trends and progress

BACKGROUND: Previous small trials have suggested that nefazodone does not suppress rapid-eye-movement (REM) sleep or increase REM latency in depressed patients, in contrast to fluoxetine. The effects of nefazodone and fluoxetine on sleep architecture and on clinician- and patient-rated sleep measures were directly compared in this 8-week, multicenter, double-blind, randomized, parallel-group study. METHOD: Forty-four outpatients with moderate to severe, nonpsychotic major depressive disorder (DSM-III-R) and insomnia were randomly assigned to receive nefazodone (Days 1-7, 200 mg/day; Days 8-56, 400 mg/day) or fluoxetine (Days 1-56, 20 mg/day). Sleep measures were obtained at baseline, while patients were unmedicated, and at Weeks 2, 4, and 8 of treatment. RESULTS: In 43 evaluable patients (23 nefazodone, 20 fluoxetine), nefazodone and fluoxetine demonstrated similar antidepressant efficacy. All significant values were p < .05. Fluoxetine significantly decreased sleep efficiency and REM sleep and increased number of awakenings, Stage 1 sleep, and REM latency compared with baseline. In contrast, nefazodone significantly decreased percentage of awake and movement time and did not alter sleep efficiency or number of awakenings, Stage 1 or REM sleep, or REM latency compared with baseline. Nefazodone was associated with significantly less change from baseline for sleep efficiency, number of awakenings, percentage of awake and movement time, percentage of REM and Stage 1 sleep, and REM latency compared with fluoxetine. Both fluoxetine- and nefazodone-treated patients also showed significant improvement in some clinician- and patient-rated sleep disturbance scores, but nefazodone-treated patients improved to a significantly greater extent than fluoxetine-treated patients in most measures. CONCLUSION: While nefazodone and fluoxetine showed equivalent antidepressant efficacy, more objective, subjective, and clinician-rated measures of sleep disturbance were improved during treatment with nefazodone than with fluoxetine. These results suggest that antidepressant effects of medications can occur independently of drug-induced changes in objective, subjective, and clinician-rated measures of sleep. Further studies, including parallel placebo-controlled comparisons with nefazodone, are needed to further test this hypothesis.