Carol A. Landis

Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia

Objective The objective of this study was to describe perceived and polysomnograhic (PSG) sleep patterns and determine whether stress exposure, psychological distress, and physiological stress activation differed among midlife women with psychophysiologic-type (PP-type) or subjective only-type (SO-type) insomnia or no insomnia. Methods Women had their sleep monitored, collected urine samples, and completed questionnaires in a week-long field study, and 53 women met criteria for insomnia types or no insomnia based on reported sleep quality and PSG sleep efficiency. Results As expected, women with PP-type insomnia were found to have the lowest sleep efficiency, took longer to fall asleep, had more wakefulness after sleep onset, and had more fragmented sleep. Perceptions of stress exposure, either for major or minor events, did not differ among groups. Despite there being no differences in perceived stress exposure, women with both types of insomnia scored higher on psychological distress (SCL-90R), especially on the somatization subscale, than women with no insomnia. Of the physiological stress activation indicators tested, a morning-to-evening difference in urinary cortisol statistically differed across the groups (p < .005). Women in the PP-type insomnia group had the highest levels of urinary cortisol in an early morning urine sample. Conclusions These data provide support for the hypothesis that, in midlife women, cognitive or emotional arousal with chronic stress neuroendocrine activation underlies chronic insomnia, particularly the PP-type.

Sleep, psychological distress, and stress arousal in women with fibromyalgia

The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.

Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia.

BackgroundLimited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). ObjectivesTo compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. MethodsTwenty-three women with FM (M = 47.3, ± 6.7 years) and 22 control women (M = 43.5, ± 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. ResultsWomen with FM reported poorer sleep quality and more fatigue compared to controls (both p < .001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r = .635, p < .01) and inversely related to sleep fragmentation (r = − .46, p < .05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r = .57, p < .01), and inversely related to sleep efficiency (r = − .545, p < .01). DiscussionSelf-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.

Sleep fragmentation in the arthritic rat

&NA; We examined the diurnal sleep‐wake patterns in the adjuvant arthritic rat. In contrast to control rats, arthritic rats lacked a normal diurnal variation in sleep and wakefulness. Thus, arthritic rats exhibited no differences in the mean number or duration of bouts of sleep and episodes of wakefulness between light and dark hours. Arthritic rats also had a marked increase in the fragmentation of their sleep manifested by an increased number of sleep bouts and episodes of wakefulness and a decrease in the duration of episodes of deep sleep recorded both during the time of maximal sleep (08.00–11.00 h) and of maximal wakefulness (20.00–23.00 h). The possibility that the experience of chronic pain causes these marked changes in sleep patterns in the arthritic rat is discussed.

A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia

OBJECTIVE To test the effects of nightly valerian (Valeriana officinalis) extract to improve sleep of older women with insomnia. METHODS Participants in this phase 2 randomized, double-blind, crossover controlled trial were 16 older women (mean age=69.4+/-8.1 years) with insomnia. Participants took 300 mg of concentrated valerian extract or placebo 30 min before bedtime for 2 weeks. Sleep was assessed in the laboratory by self-report and polysomnography (PSG) at baseline and again at the beginning and end of each treatment phase (total of nine nights in the laboratory) and at home by daily sleep logs and actigraphy. RESULTS There were no statistically significant differences between valerian and placebo after a single dose or after 2 weeks of nightly dosing on any measure of sleep latency, wake after sleep onset (WASO), sleep efficiency, and self-rated sleep quality. In comparing each treatment to baseline in separate comparisons, WASO significantly increased (+17.7+/-25.6 min, p=.02) after 2 weeks of nightly valerian, but not after placebo (+6.8+/-26.4 min, NS). Side effects were minor and did not differ significantly between valerian and placebo. CONCLUSION Valerian did not improve sleep in this sample of older women with insomnia. Findings from this study add to the scientific evidence that does not support use of valerian in the clinical management of insomnia.

Guidelines for prescribing melatonin

Although compelling logic suggests that melatonin may be effective for a variety of disorders, there are few empirical clinical studies. The optimal dose of melatonin is not clear; most studies have used doses that produce supraphysiological blood levels. The timing of melatonin administration is important. Melatonin has few immediate side-effects except drowsiness, but the effects of chronic administration are unclear. Melatonin may be effective in reducing jet lag. In elderly patients with poor sleep and documented low melatonin production, melatonin may be helpful. In several studies, melatonin has been shown to shorten sleep latency. Further studies are needed to clarify the efficacy and safety of melatonin.

Sleep measurement and monitoring in children with Down syndrome: a review of the literature, 1960-2010.

Children with Down syndrome (DS) are at risk for sleep disturbances due to the anatomical features of the syndrome. Over the past 50 years research studies have measured sleep in children with DS to characterize sleep architecture and its relation to developmental delay. In the 1980s sleep disordered breathing (SDB) was recognized as a major cause of sleep disturbance in DS. The aim of this comprehensive review is to synthesize studies and present the historical context of evolving technologies, methodologies, and knowledge about SDB and DS. Future research opportunities and practice implications are discussed.

Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial

ObjectiveThe aim of this study was to determine the effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes. MethodsA randomized, blinded, multicenter, placebo-controlled parallel-group 8-week trial with 205 women (95 African American, 102 white, 8 other) was conducted between July 2009 and June 2010. The participants received escitalopram (10-20 mg/d) or placebo. Insomnia symptoms (Insomnia Severity Index [ISI]) and subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]) at weeks 4 and 8 were the prespecified secondary outcomes. A total of 199 women (97%) provided ISI data, and 194 (95%) women provided PSQI data at follow-up. ResultsAt baseline, mean hot flash frequency was 9.78 per day (SD, 5.60), mean ISI was 11.4 (SD, 6.3), and mean PSQI was 8.0 (SD, 3.7). Treatment with escitalopram reduced ISI at week 8 (mean difference, −2.00; 95% CI, −3.43 to −0.57; P < 0.001 overall treatment effect), with mean differences of −4.73 (95% CI, −5.72 to −3.75) in the escitalopram group and −2.73 (95% CI, −3.78 to −1.69) in the placebo group. The reduction in PSQI was greater in the escitalopram than in the placebo group at week 8 (mean difference, −1.31; 95% CI, −2.14 to −0.49; P < 0.001 overall treatment effect). Clinical improvement in insomnia symptoms and subjective sleep quality (≥50% decreases in ISI and PSQI from baseline) was observed more frequently in the escitalopram group than in the placebo group (ISI, 50.0% vs 35.4%, P = 0.04; PSQI, 29.6% vs 19.2%, P = 0.09). ConclusionsAmong healthy perimenopausal and postmenopausal women with hot flashes, escitalopram at 10 to 20 mg/day compared with placebo reduced insomnia symptoms and improved subjective sleep quality at 8 weeks of follow-up.

Subjective and objective sleep indices in women with irritable bowel syndrome.

Abstract  Patients with irritable bowel syndrome (IBS) commonly report sleep disturbances. This study examined self‐report (Pittsburgh Sleep Quality Inventory) sleep quality and polysomnography (PSG) sleep variables in 18 women with mild‐to‐moderate IBS, 18 with severe IBS and 38 with age‐ and gender‐matched controls. All women were studied on two consecutive nights in a sleep research laboratory where PSG data were collected. Retrospective and daily measures were obtained of self‐reported sleep quality, psychological distress and gastrointestinal symptoms across one menstrual cycle. Self‐report measures of psychological distress and sleep quality were significantly worse in the IBS‐severe (IBS‐S) group compared with controls. Rapid eye movement (REM) latency was higher in the two IBS groups on Night 1 than the control group (P = 0.06). Percentage time in REM was highest in the IBS‐S on Night 2. All groups demonstrated greater sleep disruption on Night 1 (adaptation) when compared with Night 2. These results highlight the importance of considering the ‘first‐night effect’ in those with IBS and the lack of concordance between self‐report and objective indices of sleep in women with IBS.

Multimodality Sensor System for Long-Term Sleep Quality Monitoring

Sleep monitoring is an important issue and has drawn considerable attention in medicine and healthcare. Given that traditional approaches, such as polysomnography, are usually costly, and often require subjects to stay overnight at clinics, there has been a need for a low-cost system suitable for long-term sleep monitoring. In this paper, we propose a system using low-cost multimodality sensors such as video, passive infrared, and heart-rate sensors for sleep monitoring. We apply machine learning methods to automatically infer a persons sleep state, especially differentiating sleep and wake states. This is useful information for inferring sleep latency, efficiency, and duration that are important for long-term monitoring of sleep quality in healthy individuals and in those with a sleep-related disorder diagnosis. Our experiments show that the proposed approach offers reasonable performance compared to an existing standard approach (i.e., actigraphy), and that multimodality data fusion can improve the robustness and accuracy of sleep state detection.