Psychological treatment of insomnia in hypnotic-dependant older adults.

BACKGROUND: The existing literature does not address the question of whether cognitive-behavioral therapy would have an impact on insomnia in older adults who are chronic users of sleep medication and have current insomnia, but are also stable in their quantity of medication usage during treatment. The present report seeks to answer this question. METHODS: Hypnotic-dependant older adults, who were stable in their amount of medication usage and still met the criteria for chronic insomnia put forth by American Academy of Sleep Medicine, were treated using a cognitive-behavioral intervention for insomnia. The three-component treatment included relaxation training, stimulus control, and sleep hygiene instructions. Participants were randomly assigned to either the active treatment group or a comparably credible placebo control group, and were instructed not to alter their pattern of hypnotic consumption during treatment. RESULTS: The active treatment group had significantly better self-report measures of sleep at post-treatment. Statistically significant improvement was paralleled by clinically meaningful improvement for key sleep variables. As planned, there was no significant change in sleep medication usage from pre- to post-treatment. CONCLUSIONS: The findings support the use of cognitive-behavioral therapy for insomnia in hypnotic-dependant older adults.

Vitamins and sleep: an exploratory study.

STUDY OBJECTIVE: We analyzed archival data from an epidemiology study to test the association between vitamin use and sleep. DESIGN: Random digit dialing was used to recruit 772 people ranging in age from 20 to 98 for a study of people's sleep experience. These individuals completed a set of questionnaires about their sleep, health, and daytime functioning. Five hundred and nineteen of these participants had available vitamin use data. SETTING: Home. PARTICIPANTS: Five hundred and nineteen people participated. Recruitment applied minimal screening criteria and no attempt was made to favor people with or without sleep disturbance. INTERVENTIONS: This survey included no intervention. Participants completed 2 weeks of sleep diaries and a set of questionnaires. Of particular salience to the present study, participants reported their vitamin use in listing all medications and nutritional supplements being used currently. MEASUREMENTS AND RESULTS: For those individuals taking a multivitamin or multiple single vitamins, sleep diaries revealed poorer sleep compared to non-vitamin users in the number and duration of awakenings during the night. After controlling for age, ethnicity, and sex the difference in number of awakenings was still marginally significant. The rate of insomnia, conservatively defined, and consumption of sleep medication were also marginally significantly higher among individuals taking multi-/multiple vitamins compared to those not taking vitamins. CONCLUSIONS: Disturbed sleep maintenance was associated with multi-/multiple vitamin use. Five equally plausible explanations were advanced to explain this association including vitamins cause poor sleep, poor sleepers seek vitamins, and unidentified factors promote both poor sleep and vitamin use. These data are considered preliminary. Methodological characteristics of future studies were described that hold the promise of more clearly illuminating the association between vitamins and sleep.

Actigraphy validation with insomnia.

STUDY OBJECTIVE: Actigraphy, a method of inferring sleep from the presence or absence of wrist movement, has been well validated against polysomnography in trials with people without insomnia. However, the small amount of literature on validation with insomniacs has revealed an actigraphy bias toward overscoring sleep. The current validation trial with insomniacs used the largest number of subjects to date in such research and attracted participants with diverse demographic characteristics. DESIGN: People with insomnia slept 1 night in the laboratory while simultaneously being monitored by polysomnography, actigraphy (high-sensitivity algorithm of the Mini Mitter AW64 Actiwatch), and morning sleep diary. SETTING: Sleep disorders center. PARTICIPANTS: Participants were 57 volunteers from the community, 26 men and 31 women, ranging in age from 21 to 87 years. All participants satisfied conservative criteria for insomnia. The sample included subjects with primary insomnia, subjects with comorbid insomnia, and hypnotic users with current insomnia complaints. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Actigraphy was successfully validated on 4 measures of sleep pattern--number of awakenings, wake time after sleep onset, total sleep time, and sleep efficiency percentage--based on nonsignificant mean differences and significant correlation between actigraphy and polysomnography. Sleep-onset latency with actigraphy was not significantly different from polysomnography but was weakly correlated with polysomnography. Hypnotic use contributed to actigraphic overscoring of sleep. CONCLUSIONS: Actigraphy proved to be a satisfactory objective measure of sleep on 4 of 5 sleep parameters, but these results are specific to this particular instrument using this particular algorithm and should not be construed as a blanket endorsement of actigraphy for measuring insomnia.

Neuroimaging of NREM sleep in primary insomnia: a Tc-99-HMPAO single photon emission computed tomography study.

STUDY OBJECTIVES: The objectives of this study were to: 1) demonstrate the feasibility of combining polysomnography and SPECT neuroimaging to study NREM sleep in primary insomnia and 2) evaluate possible functional CNS abnormalities associated with insomnia. DESIGN: Patients with insomnia and good sleeper controls were studied polysomnographically for three nights with a whole brain SPECT Scan of NREM sleep on Night 3. Groups were screened for medical/psychiatric history, substance use, and matched on age, body mass index, and education. SETTING: Sleep Research Laboratory and Nuclear Medicine Center PARTICIPANTS: Nine females, 5 patients with chronic psychophysiologic insomnia and 4 healthy good sleepers (mean age 36 years, SD 12, range 27-55). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Tomographs of regional cerebral blood flow during the 1st NREM sleep cycle were successfully obtained. Contrary to our expectations, patients with insomnia showed a consistent pattern of hypoperfusion across all 8 pre-selected regions of interest, with particular deactivation in the basal ganglia (p=.006). The frontal medial, occipital, and parietal cortices also showed significant decreases in blood flow compared to good sleepers (p<.05). Subjects with insomnia had decreased activity in the basal ganglia relative to the frontal lateral cortex, frontal medial cortex, thalamus, occipital and parietal cortices (p<.05). CONCLUSIONS: This study demonstrated the feasibility of combining neuroimaging and polysomnography to study cerebral activity in chronic insomnia. These preliminary results suggest that primary insomnia may be associated with abnormal central nervous system activity during NREM sleep that is particularly linked to basal ganglia dysfunction.