Nocturnal penile tumescence in depressed men.

Nocturnal penile tumescence recordings were performed in 10 men with major depression and 10 age-matched healthy control subjects to evaluate the possibility that clinical disturbances in sexual interest and activity often reported by depressed persons are associated with objective changes in sexual neurophysiology. Depressed men had significantly reduced minutes of tumescence time, a finding that was not attributable to alterations in sleep efficiency or REM sleep time. Three depressed men had baseline tumescence profiles suggestive of "organogenic" impotence, which improved after recovery. The authors discuss the implications of such findings for clinical practice and future research.

Two-year follow-up of elderly patients with mixed depression and dementia. Clinical and electroencephalographic sleep findings.

In a two-year follow-up of 16 patients with mixed symptoms of depression and dementia, eight showed clinical improvement and eight showed deterioration. Improvement at two-year follow-up was associated with several baseline measures: a Folstein Mini-Mental State score of 21 or greater, a Hamilton Depression score of 21 or greater, and a sleep efficiency of less than 75%. These findings suggest that in the elderly with mixed symptoms of depression and dementia, a more favorable outcome is associated with initially greater depressive symptomatology, higher cognitive function, and moderate sleep continuity disturbance ("early morning awakening").

Body temperature and sleep architecture in response to a mild cold stress in women.

Six women participated in a seven consecutive night polygraphic sleep study during which both 24-hour rectal, body temperature and wrist activity were continuously sampled and stored at one-minute intervals. The study was designed to investigate the effects of a mild nocturnal cold stress on thermoregulation and sleep. On nights 4 and 5, subjects slept naked, without any bedcovers (mild cold stress) in a warm (26.7-28.3 degrees C) room. The daily mean rectal temperature and the daily nadir (low point) of the circadian temperature rhythm (CTR) showed a significant decrease between the baseline and cold stress conditions. The lowered nadir resulted in a significant amplitude increase in the daily CTR between the baseline and cold stress conditions. There were no significant changes in activity levels across experimental conditions. The ability to maintain a sleep state was significantly impaired during the cold stress. Stage 4 slow wave sleep increased, while Stage 3 decreased in response to the cold stress condition, and there was an associated lengthening of the first NREM period. These data suggest that challenges to the thermoregulatory system can be used as a vehicle to systematically alter sleep architecture in humans.

Sleep apnea in Alzheimer's dementia: correlation with mental deterioration.

In a prospective study of sleep-disordered breathing among healthy elderly controls (N = 23), major depressives (N = 17), and demented patients with probable Alzheimer's disease (N = 21), sleep apnea (defined as an apnea index of 5 or more) was found in 42.9% of demented patients, 17.6% of depressives, and 4.3% of controls (chi 2 = 9.90, p less than .01). A significant association between sleep apnea and dementia of the Alzheimer type was found in women but not in men. Moreover, severity of dementia was significantly correlated with apnea index. Possible neuropathologic and clinical implications of these findings are discussed.

EEG sleep in elderly depressed, demented, and healthy subjects.

In a prospective study of EEG sleep patterns in 25 elderly depressives, 25 elderly demented patients, and 25 healthy, elderly control subjects, the sleep of depressives was characterized by reduced REM sleep latency, increased REM percent and first REM period density, and altered temporal distribution of REM sleep, as well as by diminished sleep maintenance (correlated significantly with Hamilton ratings of depression: multiple R = -0.42, p less than 0.05). In contrast, the sleep of demented patients showed reduced REM sleep percent, but normal REM temporal distribution, increased loss of spindles and K-complexes (the latter correlating significantly with severity of cognitive impairment as measured by the Folstein score: multiple R = -0.59, p less than 0.01), and less severe sleep maintenance difficulty than for depressives. An examination of REM latency demonstrated a skewed distribution in depression (i.e., 42% of nights with sleep-onset REM periods), but a normal distribution in the controls and demented subjects. A REM latency cut-off score of 30 min correctly classified 68% of all patients (kappa = 0.36; p less than 0.005), compared with 78% correctly identified in our retrospective study (Reynolds et al. 1983).

Sleeping pills for the elderly: are they ever justified?

Sleep disturbances in the elderly are common but not trivial. They are almost always multiply determined by age-dependent changes in sleep (amount, composition, and circadian distribution), concurrent medical/neuropsychiatric disorders and their treatments, and psychosocial/environmental changes. Against this complex background, the widespread use of sleeping pills to treat insomnia in the elderly is inadequate and--because of delay in diagnosis, adverse effects on respiration during sleep, and impairment of daytime alertness--potentially dangerous. A more thoughtful, less reflexive, approach to the prescription of sleeping pills in the elderly is suggested.

Exercise and subsequent sleep in male runners: failure to support the slow wave sleep-mood-exercise hypothesis.

10 male joggers participated in a 3-week experimental protocol designed to look at the effects of three levels of energy expenditure (no exercise, regular exercise, and double exercise) on mood and subsequent nocturnal sleep focusing on REM sleep and delta sleep parameters. Exercise conditions were well discriminated by daily (F(2,18) = 65.8, p less than 0.0000) mean hip activity counts during monitored field exercise and by the mean weekly body weights (F(2,14) = 7.24, p less than 0.007). Subjects slept for 2 nights in the laboratory following each exercise condition and filled out two brief, clinical self-rating scales each night prior to sleep. These two self-rating instruments together index 105 somatic and psychobiological symptoms that are subsumed by the five major clinical symptom clusters of: Depression, Mania, Anxiety, Cognitive Disorganization, and Organicity. There were no significant differences in manually scored whole-night sleep parameters with the exception of REM latency (F(2,18) = 3.63, p less than 0.05), and there were no significant differences in self-ratings of psychobiological symptoms by night or exercise condition. These results are discussed in the context of failure to support either the slow wave sleep-exercise hypothesis or the exercise-mood elevation hypothesis.

Slow wave sleep in elderly depressed, demented, and healthy subjects.

The application of automated analysis in the measurement of sleep electroencephalogram delta activity allows a more precise temporal description of slow wave sleep changes in normal and pathological aging than do standard, all-night, slow wave sleep measures. Thus, with a baseline crossing technique, elderly depressives were shown to have a higher delta count per minute during the second NREM sleep period than did controls or demented subjects. This difference reflected greater activity per minute in the 2-3 Hz frequency band (75-200 microV).

Polysomnographic telemetry using Telediagnostic and Oxford Medilog 9000 systems.

Sleep was recorded in 24 normal adult sleepers (21-42 years of age) for 4 consecutive nights (2 nights in the laboratory and 2 nights in the home environment) using one of two commercially available telemetry systems, either the Telediagnostic or the Oxford Medilog 9000. Modifications to each system were necessary to approximate standard laboratory techniques for polysomnography. With comparability in recording techniques between systems, there were no qualitative or quantitative differences in standard electroencephalogram sleep parameters recorded in either the home or laboratory environment.

Sleep of healthy seniors: a revisit.

In an EEG sleep study of 40 healthy seniors (19 men and 21 women) aged 58-82 years, men could not maintain sleep as well as women and experienced less stage 3 sleep. The increased wakefulness after sleep onset among the men was particularly marked during the last 2 h of recording. REM density (during the first and second REM periods) showed an interaction of sex and age effects: thus, women in their 60s had higher REM density than men, whereas men in their 70s had higher REM density than women. In both men and women, however, regardless of age, the temporal distribution of REM sleep and REM density during the night was flat. Finally, only a mild degree of sleep-disordered breathing was noted, with positive age effects on apnea/hypopnea index and maximal duration of apnea. These findings are reviewed in relation to the sleep and aging literature.

Elevated red blood cell/plasma choline ratio in dementia of the Alzheimer type: clinical and polysomnographic correlates.

In a prospective study we have observed a shift in distribution of red blood cell (RBC)/plasma choline ratios among patients with probable dementia of the Alzheimer type (DAT), compared with healthy controls and depressed patients. Fifteen of 22 DAT patients (68%) showed RBC/plasma choline ratios greater than 1.9, in contrast to 9 of 26 healthy controls (35%) and 7 of 20 depressives (35%). These significant differences confirm and expand earlier observations. The subgroup of DAT patients with elevated RBC/plasma choline ratios is older and more cognitively impaired, shows later onset of dementia, and has less rapid eye movement (REM) sleep than the DAT subgroup with normal RBC/plasma choline ratios. Within the entire group of DAT patients, moreover, the RBC/plasma choline ratio shows a significant inverse correlation with REM sleep latency. These findings are discussed in relation to abnormalities in other nonneural Alzheimer tissues and within the context of cholinergic involvement in both DAT and the timing of REM sleep.

Depressive psychopathology in male sleep apneics.

Depression has been reported to be frequent in sleep apnea syndromes. In a sample of 25 consecutive male sleep apneics, 40% met Research Diagnostic Criteria for an affective disorder or for alcohol abuse. A multiple regression analysis indicated that 61% of the variance in depression ratings could be explained by four variables: age, REM activity, REM latency (square root), and presence or absence of antihypertensive medications (multiple R = 0.78). The use of these variables in a discriminant function analysis correctly predicted the membership of 68% of the sample in either a low or high depression group (kappa = 0.44; p less than .01). These findings are reviewed in relation to other research on age-related sleep changes and vulnerability to depression.

Persistent psychophysiologic insomnia: preliminary Research Diagnostic Criteria and EEG sleep data.

Some patients with persistent psychophysiologic insomnia have a history of generalized anxiety, minor depression, or drug misuse. Their sleep resembles sleep of patients with generalized anxiety (except for night 2 improvement in the insomniacs' sleep continuity) but differs from sleep of patients with major depression.

Multiple Sleep Latency Test findings in Kleine-Levin syndrome.

Multiple Sleep Latency Test (MSLT) findings in a case of Kleine-Levin syndrome are reported for the first time. MSLT data indicate sleepiness as severe as in narcolepsy or obstructive sleep apnea and the occurrence of four sleep onset rapid eye movement (REM) periods, with a greater REM propensity at 2:00 p.m. and 4:00 p.m. than at 10:00 a.m. and 12:00 noon. The replication of such findings might suggest that Kleine-Levin syndrome could be considered a form of periodic REM sleep disinhibition. Therefore, the traditional hypothesis of diencephalic dysfunction may require modification to include the role of more caudal brain stem structures specifically activated during REM sleep.

NREM sleep continuity and the sense of having slept in normal sleepers.

We assessed the effects of the length of sleep prior to awakening on the sense of having been asleep in 11 normal, healthy, young adults. They were awakened a total of 194 times out of stage 2 sleep, 153 times out of REM sleep, and 13 times out of slow-wave sleep over 54 nights in the laboratory. At each awakening, subjects were asked if they had been awake or asleep prior to the arousal. Continuous sleep time prior to the awakening was calculated in minutes to the first visually scorable alpha intrusion exceeding 10 s on either the central or occipital electroencephalogram (EEG) tracings. The sense of having been asleep prior to a NREM sleep awakening is dependent on the length of continuous, prior sleep time. However, the sense of having been asleep when aroused out of REM sleep shows no relationship to the length of continuous, prior sleep time.