Auricular Acupuncture and Cognitive Behavioural Therapy for Insomnia: A Randomised Controlled Study.

Objective. The most effective nonpharmacological treatment for insomnia disorder is cognitive behavioural therapy-insomnia (CBT-i). However CBT-i may not suit everyone. Auricular acupuncture (AA) is a complementary treatment. Studies show that it may alleviate insomnia symptoms. The aim of this randomised controlled study was to compare treatment effects of AA with CBT-i and evaluate symptoms of insomnia severity, anxiety, and depression. Method. Fifty-nine participants, mean age 60.5 years (SD 9.4), with insomnia disorder were randomised to group treatment with AA or CBT-i. Self-report questionnaires, the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16), Epworth Sleepiness Scale (ESS), and Hospital Anxiety and Depression scale (HAD), were collected at baseline, after treatment, and at 6-month follow-up. A series of linear mixed models were performed to examine treatment effect over time between and within the groups. Results. Significant between-group improvements were seen in favour of CBT-i in ISI after treatment and at the 6-month follow-up and in DBAS-16 after treatment. Both groups showed significant within-group postintervention improvements in ISI, and these changes were maintained six months later. The CBT-i group also showed a significant reduction in DBAS-16 after treatment and six months later. Conclusions. Compared to CBT-i, AA, as offered in this study, cannot be considered an effective stand-alone treatment for insomnia disorder. The trial is registered with ClinicalTrials.gov NCT01765959.

Is excessive daytime sleepiness a separate manifestation in Parkinson's disease?

BACKGROUND: Excessive daytime sleepiness (EDS) is common in Parkinson's disease (PD), but its role and relation to other PD features is less well understood. OBJECTIVE: To investigate potential predictors of EDS in PD and to explore how EDS relates to other motor and non-motor PD features. METHODS: 118 consecutive persons with PD (54% men; mean age, 64) were assessed regarding EDS using the Epworth Sleepiness Scale (ESS) and a range of motor and non-motor symptoms. Variables significantly associated with ESS scores in bivariate analyses were used in multiple regression analyses with ESS scores as the dependent variable. Principal component analysis (PCA) was conducted to explore the interrelationships between ESS scores and other motor and non-motor PD aspects. RESULTS: Among 114 persons with complete ESS data, significant independent associations were found between ESS scores and axial/postural/gait impairment, depressive symptoms, and pain (R2, 0.199). ESS scores did not load significantly together with any other PD features in the PCA. CONCLUSIONS: Only a limited proportion of the variation in EDS could be accounted for by other symptoms, and EDS did not cluster together with any other PD features in PCAs. This suggests that EDS is a separate manifestation differing from, for example, poor sleep quality and fatigue.

Sweet taste perception not altered after acute sleep deprivation in healthy young men.

BACKGROUND: We hypothesized that acutely sleep-deprived participants would rate ascending concentrations of sucrose as more intense and pleasant, than they would do after one night of normal sleep. Such a finding would offer a potential mechanism through which acute sleep loss could promote overeating in humans. METHOD: A total of 16 healthy normal-weight men participated in 2 conditions: sleep (permitted between 22:30 and 06:30 h) and total sleep deprivation (TSD) respectively. On the morning after regular sleep and TSD, circulating concentrations of ghrelin and glucose were measured. In addition, participants hunger level was assessed by means of visual analogue scales, both before and after a caloric preload. Finally, following the preload, participants rated both intensity and pleasantness of six orally presented yogurt probes with varying sucrose concentrations (2-29 %). RESULTS: Feelings of hunger were significantly more intense under both fasted and sated conditions when subjects were sleep-deprived. In contrast, the change in hunger induced by the preload was similar between the sleep and TSD conditions. Plasma concentrations of ghrelin were significantly higher under conditions of TSD, whereas plasma glucose did not differ between the conditions. No effects were found either on sweet taste intensity or on pleasantness after TSD. CONCLUSION: One night of TSD increases morning plasma concentrations of the hunger-promoting hormone ghrelin in healthy young men. In contrast, sweet taste perception was not affected by nocturnal wakefulness. This suggests that an altered sweet taste perception is an unlikely mechanism by which TSD enhances food intake.

Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population.

OBJECTIVES: Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middle-aged population predicted total mortality and CAD mortality. DESIGN: A population-based prospective study. Setting. The County of Dalarna, Sweden. SUBJECTS AND METHODS: In 1983, a random sample of 1870 subjects aged 45-65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983-95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks. RESULTS: At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, difficulties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% confidence interval (CI), 1.5-6.3; P < 0.01], but not in females. Short or long sleep duration did not influence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1-8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1-4.5; P < 0.05). CONCLUSION: These results provide evidence that there is an association between difficulties falling asleep and CAD mortality in males.

Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents' perceptions.

Associations between sleep and behaviour in 635 children, aged six to eight years, were investigated using parental responses to a sleep habits questionnaire, and to a behavioural screening form, the Strengths and Difficulties Questionnaire (SDQ). Global reports of sleep problems in 4.9% of the children were associated with a total SDQ score indicative of behaviour problems in 36% of the cases. Conversely, 15% of children with behaviour problems had global reports of sleep problems. Associations between specific sleeping features and different dimensions of behaviour and emotions were also explored. Hyperactivity was associated with tossing and turning during sleep, and with sleep walking; conduct problems were related to bedtime resistance; and emotional symptoms were associated with night terrors, difficulty falling asleep and daytime somnolence. Peer problems were associated with somewhat shorter total sleep time. Finally, a total SDQ score indicative of behaviour problems was associated with bedwetting, nightmares, tossing and turning during sleep and sleep walking, as well as with a slightly shorter total sleep time. We conclude that sleep and behaviour problems are associated in children, and that characteristic associations exist between particular sleep disturbances and specific dimensions of behaviour.

Short-term prospective study of sleep disturbances in 5-8-year-old children.

UNLABELLED: The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5-8-y-old children, at baseline and at follow-up, 14 +/- 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow-up; night-waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow-up, while night-waking at baseline was related to co-sleeping at follow-up. Snoring at baseline was associated with a trend towards restless sleep at follow-up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow-up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow-up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems. CONCLUSION: During middle childhood, difficulties falling asleep, night-waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.

Sleep disturbances in outpatients with ankylosing spondylitisa questionnaire study with gender implications.

OBJECTIVE: To study the sleep pattern in ankylosing spondylitis, and to investigate gender differences in sleep, pain, and fatigue. METHODS: Forty-three male and 27 female patients with ankylosing spondylitis completed a sleep questionnaire and the results were compared with earlier findings in 3,558 persons randomly selected from the general population. RESULTS: Too little sleep was reported by 80.8% of the female and 50.0% of the male patients, compared to 28.8% and 21.8% respectively in the reference group (p<0.0001). The main reason was pain in the pre-sleep and sleep-periods (p<0.0001). Daytime fatigue was a major problem (p<0.0001). Higher correlation was found between pain and daytime fatigue than between sleep disturbance and daytime fatigue. CONCLUSION: Sleep disturbance is a significant problem in ankylosing spondylitis. The disturbance is closely related to pain at bedtime and during the night. Gender differences exist in the subjective sleep disturbance, fatigue, and pain.

Relationship between insomnia, depression, and mortality: a 12-year follow-up of older adults in the community.

The purpose of the study was to investigate the natural history of insomnia and its association with depression and mortality. In 1983, 1,870 randomly selected subjects aged 45-65 years answered a questionnaire on sleep and health. Of the 1,604 survivors in 1995, 1,244 (77.6%) answered a new questionnaire with almost identical questions. Mortality data were collected for the 266 subjects that had died during the follow-up period. Chronic insomnia was reported by 36.0% of women and 25.4% of men (chi2 = 9.7; p < .01). About 75% of subjects with insomnia at baseline continued to have insomnia at follow-up. Insomnia in women predicted subsequent depression (odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.1-7.2) but was not related to mortality. In men, insomnia predicted mortality (OR = 1.7; 95% CI 1.2-2.3), but after adjustment for an array of possible risk factors, this association was no longer significant. Men with depression at baseline had an adjusted total death rate that was 1.9 times higher than in the nondepressed men (95% CI: 1.2-3.0).

Psychomotor effects of zaleplon and thioridazine coadministration.

OBJECTIVE: To assess the potential pharmacokinetic and pharmacodynamic interaction of zaleplon and thioridazine administered concomitantly in healthy volunteers. METHODS: A three-period, double-blind, randomized crossover study of the psychomotor effects of single oral doses of zaleplon 20 mg alone, thioridazine 50 mg alone, or the two drugs administered concomitantly was performed in 12 healthy subjects. Pharmacodynamic testing was performed before, and at 1, 2, 4, and 8 h after drug administration. Critical flicker fusion (CFF), tapping rate (TR), reaction time (RT) with dominant and nondominant hands, and digit symbol substitution test (DSST) were used to assess psychomotor performance. RESULTS: Pharmacokinetic results showed that coadministration of zaleplon and thioridazine did not alter the pharmacokinetic profile of either drug. In both CFF and TR tests, values for change from baseline with combined treatment were not significantly different from those with thioridazine at any time point, indicating no pharmacodynamic interaction. RT test values with coadministered treatment were significantly different from those with thioridazine alone at 1 h after administration, indicating additivity. Supra-additivity was observed in DSST results at 1, 2, and 4 h. There was no interaction at 8 h. CONCLUSION: The results of single-dose administration showed an additive pharmacodynamic interaction between zaleplon and thioridazine at 1 h in one of four tests and supra-additivity for 4 h in another test. This interaction is relatively short in duration due to the short half-life of zaleplon.

Insomnia as an interaction between sleep-interfering and sleep-interpreting processes.

The present paper reviews theories and empirical research concerning the role of psychological processes in insomnia. It is argued that two kinds of psychological processes are involved in insomnia: sleep-interfering processes and sleep-interpreting processes. A theoretical model is sketched, where it is argued that psychological vulnerability factors may predispose the individual to (1) respond with sleep-interfering processes to stressful life events, and to (2) engage in dysfunctional sleep-interpreting processes. Examples of the first kind of variables are arousability, slow recuperation after stress, worrying, and emotional conflicts in relation to significant others; examples of the latter are sleep-related beliefs, attitudes, and perfectionistic standards.

Parents' reports of disturbed sleep in 5-7-year-old Swedish children.

Parents' reports on 1844 five to seven year olds from the general population were used to provide a detailed update about prevalence and correlates of sleep disturbances in children. Five different sleep disturbances were focused on: difficulty falling asleep, reported in 5.6% of the children; night waking in 15.5%; snoring in 7.7%; nightmares in 3.1%, and bedwetting in 5.3% of the children. Coexisting sleep disturbances were frequent in children with difficulties falling asleep, night waking and nightmares, but bedwetting usually emerged as a singular sleep disturbance. Nightmares were associated with serious health problems or handicaps, sleep problems in conjunction with life events, and female gender. Snoring as well as bedwetting were associated with reports of "very active" children. In 6.7% of the total sample, parents had previously consulted the healthcare services for a sleep problem in their child. These children had reports of colic during infancy, eczema, serious health problems or handicaps, current snoring and current nightmares. Only 1.1% (n = 21) of the children were said to have a present need to remedy sleep problems. The reports on these children included coexisting sleep disturbances, previous consultations for sleeping problems, parents' perceptions of "very active" children, diagnoses of attention deficit hyperactivity disorder, and major life events which had triggered sleep problems. In conclusion, although sleep disturbances are common in 5-7-y-old children, parents seldom express a need to remedy sleep problems in their children of this age.

Psychometric properties of a Swedish version of the "Strengths and Difficulties Questionnaire".

A new English instrument for screening mental health in children and adolescents, the Strengths and Difficulties Questionnaire (SDQ), was translated into Swedish and used for parental ratings of 900 children aged 6-10 years from the general population. The SDQ which comprises 25 items, divided into 5 subscales (prosocial, hyperactivity, emotional symptoms, conduct problems, and peer problems) was developed from the Rutter scales. An earlier English validation study has shown the two instruments to have equal ability to identify child psychiatric cases, but the SDQ also provides screening on empathy and prosocial behaviour which are aspects of child development emphasized in current child psychiatry. The design of the SDQ with both strengths' and difficulties' items supposedly increases acceptability of the instrument on behalf of informants and makes the questionnaire especially suitable for studies of general population where the majority of children are healthy. Our results, which are novel findings on the instrument, confirmed the postulated factor structure and showed significant gender-differences in results on the total scale, prosocial and hyperactivity subscales and on some of the single items. Moreover, our investigation showed that a Swedish translation of the parental version of the SDQ worked well.

Brain networks affected by synchronized sleep visualized by positron emission tomography.

Nineteen lightly sleep-deprived healthy volunteers were examined with H2(15)O and positron emission tomography (PET). Scanning was performed during wakefulness and after the subjects had fallen asleep. Sleep stage was graded retrospectively from electroencephalogram (EEG) recordings, and scans were divided into two groups: wakefulness or synchronized sleep. Global flow was quantified, revealing no difference between sleep and wakefulness. A pixel-by-pixel-blocked one-way analysis of variance (ANOVA) was performed after correcting for differences in anatomy and global flow. The sum of squares of the z-score distribution showed a highly significant (P < 0.00001) omnibus difference between sleep and wakefulness. The z-score images indicated decreased flow in the thalamus and the frontal and parietal association cortices and increased flow in the cerebellum during sleep. A principal component (PC) analysis was performed on data after correction for global flow and block effects, and a multivariate analysis of variance (MANOVA) on all PC scores revealed significant (P = 0.00004) differences between sleep and wakefulness. Principal component's 2 and 5 correlated to sleep and revealed distinct networks consisting of PC 2, cerebellum and frontal and parietal association cortices, and PC 5, thalamus.

Insufficient sleep in the general population.

A questionnaire was sent out to a randomly selected, age (20-34, 35-49, and 50-64 years) and sex stratified sample of 600 adult inhabitants in Uppsala County, Sweden. Overall response rate was 68%. The questionnaire comprised questions about sleep and sleep complaints. Subjects were also asked to rate the degree of a number of proposed causes and consequences of insufficient sleep, in accordance with how they had perceived them when they had experienced insufficient sleep. Results showed that twelve percent of the total sample fulfilled the criteria for persistent insufficient sleep (PIS), an operationally defined condition of considerable chronic sleep loss. One-half of these subjects also reported concomitant sleeping difficulties. In subjects with PIS without sleeping difficulties, the most conspicuous causes of insufficient sleep were work-related factors and simply too little time for sleep. As for the effects of insufficient sleep in subjects with PIS with concomitant sleep complaints, factors relating to somatic symptoms, dysphoric mood and impaired cognition were the most prominent, while dysphoric mood was most noticeable in subjects with PIS without sleep complaints.

Quality of life in adults with growth hormone (GH) deficiency: response to treatment with recombinant human GH in a placebo-controlled 21-month trial.

We examined the effect of GH supplementation on the psychological capacity and sense of well-being in 36 patients with adult-onset GH deficiency (GHD). Recombinant human GH was given in a 21-month cross-over, double blind trial, and quality of life was assessed by using three self-rating questionnaires: the Hopkins Symptom Check List (HSCL), the Nottingham Health Profile (NHP), and the Psychological General Well-Being index. In addition, at the final examination the spouses completed a short questionnaire concerning their partner. Before treatment, the patients had lowered quality of life as determined by the HSCL and NHP inventories, and a correlation between the duration of GHD and the reported symptoms was observed. Upon treatment, the HSCL score was lower (better) after placebo administration (mean +/- SD, 84 +/- 21.3) than at baseline (89 +/- 18.9; P = NS) and fell to 80.2 +/- 18.5 (P < 0.001) when active drug was given. The subscales regarding anxiety, fearfulness, and cognition were the most sensitive. It was apparent that the effect determined after GH therapy in part was due to a placebo effect. With NHP, the dimensions of energy and emotions responded most to treatment. Further, the spouses observed their partners to be improved in several aspects of mood and behavior (P < 0.05 to P < 0.0001) when active drug was given. The data thus demonstrate that GH, which is known to have multiple somatic effects, produces an improvement in the quality of life of adults with GHD.

Sleep disturbances in patients with primary Sjögren's syndrome.

A standardized sleep questionnaire was used to investigate the sleeping habits of outpatients with primary Sjögren's syndrome (pSS) (n = 40) and RA (n = 42). Sleep deficit (difference between need of sleep and actual sleeping time) was significantly higher in patients with pSS when compared with healthy matched controls (P < 0.0001), and with patients suffering from RA (P < 0.001). When trying to fall asleep, patients with pSS were significantly more often disturbed by muscular tension (45%) and restless legs (24%), than patients with RA (12%, P < 0.01 and 2%, P < 0.01), and they were also significantly more troubled by nocturnal pain than patients with RA (P < 0.01). The pSS group reported significantly more disturbing by awakening during the night and was awake for longer periods than the RA group. Fatigue was a significantly more frequent complaint in patients with pSS. Polysomnography showed that all recorded patients (n = 10) had some sleep disturbances; reduced sleep efficiency (n = 8), increased number of awakenings (n = 5) and increased wakefulness surrounded by sleep (n = 9). Five patients had alpha intrusion in their sleep EEGs. The sleep disturbances seen in patients with primary Sjögren's syndrome may contribute to the fatigue associated with this disease.

The effects of chlormethiazole in EEG recorded sleep in normal elderly volunteers.

Chlormethiazole has sedative, hypnotic and anticonvulsant properties, and is used in the treatment of sleep disorders and confusion in the elderly. In this study we examined the effects of chlormethiazole on EEG recorded sleep in six normal volunteers aged 67-74 years. After baseline registration, chlormethiazole (base), 384 mg p.o. (i.e. 2 capsules), was administered during 5 nights followed by one withdrawal registration. Sleep latency decreased from 52 to 27 min during the treatment period (P less than 0.01) and increased to 57 min during withdrawal. Wakeful periods during sleep decreased from 106 to 62 min during the treatment period and increased during withdrawal to 104 min (P less than 0.001). The sleep efficiency improved slightly during chlormethiazole treatment. The distribution of the sleep stages was essentially unaffected by chlormethiazole. According to subjective assessment the subjects rated their ability to fall asleep and their sleep quality as significantly better during the drug period. Based on sleep recordings and subjective ratings, there was no evidence of rebound insomnia on withdrawal. Psychoperformance tests revealed no evidence of hangover effects.

Effects of stimulus content and brain lateralization on the habituation of the electrodermal orienting reaction (OR).

Slides with either a six-letter word or a complex spatial pattern were repeatedly flashed either to the left or to the right of a center fixation point (i.e. visual half-field technique) in an electrodermal orienting paradigm. Skin conductance (SC) was recorded from both the left and right hand. Half of the subjects had the slides projected 6.0 degrees of visual angle lateral to fixation, the other half had the stimuli projected 2.5 degrees lateral to fixation. There were 15 presentations of each stimulus with a mean inter-trial interval (ITI) of 30 sec. Results showed significantly larger mean SCR-amplitudes across trials to the verbal stimuli compared to the spatial patterns when presented in the right visual half-field, and larger amplitudes to the spatial stimuli when presented in the left half-field. However, this was only true for the 6.0 degrees condition, but not for the 2.5 degrees condition. No differences were found between left and right hand recording. The present data imply a functional relationship between electrodermal orienting habituation and hemispheric asymmetry.