[Options to enhance the efficacy of cognitive-behavior therapy of insomnia]. / Vozmozhnosti povysheniya effektivnosti kognitivno-povedencheskoi terapii insomnii.

Cognitive-behavior therapy of insomnia (CBT-I) is first-line treatment for insomnia, but it produces a clinical significant result only in 60-80% of patients. Addition reason of reduction of CBT-I efficacy is a relatively low adherence: the attrition rate is 10-39%. The authors discuss options to enhance efficacy of the therapy by usage of complex approach, individualized choice of technics, motivating a patient and his relatives, and combination of CBT-I with hypnotics.

European guideline for the diagnosis and treatment of insomnia

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

[Night sleep structural alteration as a function of individual strategy of adapting to 520-isolation].

Purpose of the work was to establish a relationship between trends in sleep alteration and individual adaptation to the stress-factors in the 520-day isolation study. Psychological evaluations using a battery of motivation tests and L. Sobchik's modification of the Luscher personality test, and Mirror coordinograph enabled to differentiate groups reacting to the stress on the pattern of "control" (G-1) or "search" (G-2) manifested in individual styles of behavior and operator's activity. The 2 groups showed different dynamics of the night sleep structure. Difficulties with falling asleep in G-1 arose on the eve of "landing onto Mars" and end of the experiment, whereas in G-2 they were evident prior to the end only. Besides, the micro- and segmental sleep structures were more stable in G-1 suggesting the integrity of somnogenic mechanisms despite difficult sleep initiation.

[Moving activity and wakefulness-sleep cycle changes in a mouse MPTP model of Parkinson's disease].

A group of mice with preliminary implanted (under general anesthesia) electrodes for cortical EEG and nuchal EMG was subjected to continuous baseline 24-hr video and digital polysomnographic recording with the 12/12 light/dark schedule, and then injected subcutaneously with 24 or 48 mg/kg of MPTP toxin or (the control group) saline. The recordings were continued for 2 weeks more. A significant increase in activity and the waking percentage as well as decrease in REM sleep and NREM sleep (tendency) during the dark period as compared to the baseline and control recordings was found. The effect was seen just on the 7th day following MPTP administration and became significant by the 14th day. The effect was more pronounced after 48 mg/kg injection than after 24. There were no changes during the light period. Morphological control revealed a 70% and 35% decreases in the amount of tyrosine hydroxylase positive neurons in substancia nigra/pars compacta after 48 and 24 mg/kg of MPTP, respectively, as compared to the saline group.

[Sleep structure instability in healthy men under conditions of 105-day isolation experiment "Mars-105"].

Night-to-night stability of falling asleep and duration of wakefulness in the sleep was studied in six healthy male subjects under conditions of 105-day isolation experiment "Mars-105". Polysomnography records were carried out in each subject during five nights taken in regular intervals within the experiment. Three subjects demonstrated high stability of falling asleep and wakefulness in sleep (group I), whereas in the remaining three subjects stability of these characteristics was low (group [I). Delta-sleep was shown to be deepened in subjects of group II (significant prevalence of stage 4 (47.3 min) over stage 3 (32.9 min)). In subjects of group I, the duration of stage 3 was 44.9 min and that of stage 4 was 26.6 min. We suggest that night-to-night instability of falling asleep and duration of wakefulness in sleep in combination with delta sleep is the special individual form of sleep adaptation to conditions of chronic isolation stress.

[Effects of long-term isolation and anticipation of significant event on sleep: results of the project "Mars-520"].

The purpose of the research was to study effect of long-term isolation on night sleep. The data were collected during international ground simulation of an interplanetary manned flight--"Mars-500". The polysomnographic recordings of six healthy men were performed before, four times during and after 520-days confinement. During the isolation sleep efficiency and delta-latency decreased, while sleep latency increased. Post-hoc analysis demonstrate significant differences between background and the last (1.5 months before the end of the experiment) measure during isolation. Frequency of nights with low sleep efficiency rose on the eve of the important for the crew events (simulation of Mars landing and the end of the confinement). Two weeks after the landing simulation, amount of the nights with a low sleep efficiency significantly decreased. Therefore, anticipation of significant event under condition of long-term isolation might result in sleep worsening in previously healthy men, predominantly difficulties getting to sleep.