Polysomnographic and quantitative EEG analysis of subjects with long-term insomnia complaints associated with mild traumatic brain injury.

OBJECTIVE: The aims of this study were (1) to characterise the extent and nature of disrupted sleep in individuals with long-term sleep complaints subsequent to mild traumatic brain injury (MTBI), and (2) to determine whether sleep disturbances in MTBI subjects were more characteristic of psychophysiological, psychiatric, or idiopathic insomnia. METHODS: Nine MTBI patients (27.8 months post-injury; SD=15.5 months) and nine control subjects underwent polysomnographic testing and completed self-report questionnaires on sleep quality. Power spectral (FFT) analysis of the sleep onset period was conducted, with both the power and variability in power being quantified. RESULTS: Individuals with MTBI exhibited long-term sleep difficulties, along with various cognitive and affective abnormalities. The MTBI group had 4% less efficient sleep (p=0.019), shorter REM onset latencies (p=0.011), and longer sleep onset latencies, although the latter were highly variable in the MTBI group (F-test: p=0.012). FFT analysis revealed greater intra-subject variability in the MTBI group in sigma, theta, and delta power during the sleep onset period. CONCLUSIONS: MTBI patients with persistent sleep complaints differ significantly from controls on a number of electrophysiological outcomes, but could not be easily classified into existing insomnia subtypes. SIGNIFICANCE: Sleep disturbances can persist well after the injury in a subset of patients with MTBI.

Lack of efficacy of music to improve sleep: a polysomnographic and quantitative EEG analysis.

An increasing number of studies have been examining non-pharmacological methods to improve the quality of sleep, including the use of music and other types of auditory stimulation. While many of these studies have found significant results, they suffer from a combination of subjective self-report measures as the primary outcome, a lack of proper controls, often combine music with some type of relaxation therapy, or do not randomise subjects to control and treatment conditions. It is therefore difficult to assess the efficacy of music to induce or improve sleep. The present study therefore examined the effects of music using standard polysomnographic measures and quantitative analysis of the electroencephalogram, along with subjective ratings of sleep quality. In addition, a tones condition was used to compare any effects of music with the effects of general auditory stimulation. Using a counter-balanced within-subjects design, the music was not significantly better than the tones or control conditions in improving sleep onset latency, sleep efficiency, wake time after sleep onset, or percent slow wave sleep, as determined by objective physiological criteria.

EEG activities during elicited sleep onset REM and NREM periods reflect different mechanisms of dream generation. Electroencephalograms. Rapid eye movement.

OBJECTIVE: To be the first to compare EEG power spectra during sleep onset REM periods (SOREMP) and sleep onset NREM periods (NREMP) in normal individuals and relate this to dream appearance processes underlying these different types of sleep periods. METHODS: Eight healthy undergraduates spent 7 consecutive nights in the sleep lab including 4 nights for SOREMP elicitation using the Sleep Interruption Technique. This enabled us to control preceding sleep processes between SOREMP and NREMP. EEG power spectra when participants did and did not report 'dreams' were compared between both types of sleep. Sleep stages, subjective measurements including dream property scores, sleepiness, mood, and tiredness after awakenings were also examined to determine their consistency with EEG findings. RESULTS: Increased alpha EEG activities (11.72-13.67 Hz) observed mainly in the central area were related to the absence of SOREMP dreams and appearance of NREMP dreams. Analyses of sleep stages combining two studies (16 participants) also supported the Fast Fourier Transform findings, showing that when dreams were reported there were decreased amounts of stage 2 and increased stage REM in SOREMP and increased stage W in NREMP. SOREMP dreams were more bizarre than NREMP dreams. Participants felt more tired after SOREMP with dreams than without dreams, while the opposite was observed after NREMP episodes. CONCLUSIONS: EEG power spectra patterns reflected different physiological mechanisms underlying generation of SOREMP and NREMP dreams. The same relationships were also reflected by sleep stage analyses as well as subjective measurements including dream properties and tiredness obtained after awakenings. This study not only supports the hypothesized relationships between REM mechanisms and REM dreams as well as arousal processes and NREM dreams, it also provides a new perspective to dream research due to its unique techniques to awaken participants and collect REM dreams during experimentally induced SOREMP.

The process of falling asleep.

The process of falling asleep can best be measured by considering a convergence of behavioural, EEG, physiological and subjective information. Doing so allows one to see sleep processes as they unfold, but relying on any single sleep index can bias the description of this complex process. The studies reviewed do not support the idea that sleep begins "in a moment", but rather that entry into sleep is a continuous, interwoven series of changes which begin in relaxed drowsiness and continue through stage 1, often into the first minutes of stage 2. The transition from waking brain to sleeping brain is traced accurately by Hori's nine-stage EEG system. Event-related potential (ERP) studies map complex changes in information processing as sleep begins, while quantitative EEG investigations have identified important spatiotemporal re-organisations of primary EEG frequencies which take place as one moves from waking to sleeping mode. To consider evidence from multiple levels of analysis, a three step electrophysiological model of central nervous system (CNS) regulation during sleep onset is proposed: initial processes appear to be alpha-related; intermediate processes, poorly studied to date, parallel the development of theta and vertex sharp wave activity, while the processes which terminate wakefulness are sigma sleep spindle-related. Clinical investigations of the sleep onset period in people with narcolepsy, insomnia, depression or sleep apnoea appear to indicate the presence of relatively unique electrophysiological signatures which may be of clinical significance. 2001 Harcourt Publishers Ltd