Kelly Glazer Baron

Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia

OBJECTIVE To assess the efficacy of moderate aerobic physical activity with sleep hygiene education to improve sleep, mood and quality of life in older adults with chronic insomnia. METHODS Seventeen sedentary adults aged >or=55 years with insomnia (mean age 61.6 [SD±4.3] years; 16 female) participated in a randomized controlled trial comparing 16 weeks of aerobic physical activity plus sleep hygiene to non-physical activity plus sleep hygiene. Eligibility included primary insomnia for at least 3 months, habitual sleep duration <6.5h and a Pittsburgh Sleep Quality Index (PSQI) score >5. Outcomes included sleep quality, mood and quality of life questionnaires (PSQI, Epworth Sleepiness Scale [ESS], Short-form 36 [SF-36], Center for Epidemiological Studies Depression Scale [CES-D]). RESULTS The physical activity group improved in sleep quality on the global PSQI (p<.0001), sleep latency (p=.049), sleep duration (p=.04), daytime dysfunction (p=.027), and sleep efficiency (p=.036) PSQI sub-scores compared to the control group. The physical activity group also had reductions in depressive symptoms (p=.044), daytime sleepiness (p=.02) and improvements in vitality (p=.017) compared to baseline scores. CONCLUSION Aerobic physical activity with sleep hygiene education is an effective treatment approach to improve sleep quality, mood and quality of life in older adults with chronic insomnia.

Role of sleep timing in caloric intake and BMI

Sleep duration has been linked to obesity and there is also an emerging literature in animals demonstrating a relationship between the timing of feeding and weight regulation. However, there is a paucity of research evaluating timing of sleep and feeding on weight regulation in humans. The goal of this study was to evaluate the role of sleep timing in dietary patterns and BMI. Participants included 52 (25 females) volunteers who completed 7 days of wrist actigraphy and food logs. Fifty‐six percent were “normal sleepers” (midpoint of <5:30 am) and 44% were “late sleepers” (midpoint of sleep ≥5:30 am). Late sleepers had shorter sleep duration, later sleep onset and sleep offset and meal times. Late sleepers consumed more calories at dinner and after 8:00 pm, had higher fast food, full‐calorie soda and lower fruit and vegetable consumption. Higher BMI was associated with shorter sleep duration, later sleep timing, caloric consumption after 8:00 pm, and fast food meals. In multivariate models, sleep timing was independently associated with calories consumed after 8:00 pm and fruit and vegetable consumption but did not predict BMI after controlling for sleep duration. Calories consumed after 8:00 pm predicted BMI after controlling for sleep timing and duration. These findings indicate that caloric intake after 8:00 pm may increase the risk of obesity, independent of sleep timing and duration. Future studies should investigate the biological and social mechanisms linking timing of sleep and feeding in order to develop novel time‐based interventions for weight management.

Perceived barriers to psychological treatments and their relationship to depression

In spite of repeated calls for research and interventions to overcome individual and systemic barriers to psychological treatments, little is known about the nature of these barriers. To develop a measure of perceived barriers to psychological treatment (PBPT), items derived from 260 participants were administered to 658 primary care patients. Exploratory factor analysis on half the sample resulted in 8 factors, which were supported by confirmatory factor analysis conducted on the other half. Associations generally supported the criterion validity of PBPT scales, with self-reported concurrent use of psychotherapy and psychotherapy attendance in the year after PBPT administration. Depression was associated with greater endorsement of barriers. These findings suggest that the PBPT may be useful in assessing perceived barriers.

Circadian misalignment and health

Abstract Circadian rhythms are near 24-h patterns of physiology and behaviour that are present independent of external cues including hormones, body temperature, mood, and sleep propensity. The term ‘circadian misalignment’ describes a variety of circumstances, such as inappropriately timed sleep and wake, misalignment of sleep/wake with feeding rhythms, or misaligned central and peripheral rhythms. The predominance of early research focused on misalignment of sleep to the biological night. However, discovery of clock genes and the presence of peripheral circadian oscillators have expanded the definitions of misalignment. Experimental studies conducted in animal models and humans have provided evidence of potential mechanisms that link misalignment to negative outcomes. These include dysregulation of feeding behaviours, changes in appetite stimulating hormones, glucose metabolism and mood. This review has two foci: (1) to describe how circadian misalignment has been defined and evaluated in laboratory and field experiments, and (2) to describe evidence linking different types of circadian misalignment to increased risk for physical (cardiovascular disease, diabetes, obesity, cancer) and psychiatric (depression, bipolar, schizophrenia, attention deficit) disorders. This review will describe the role of circadian misalignment as a risk factor for disease in the general population and in clinical populations, including circadian rhythm sleep disorders and psychiatric disorders.

Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference.

BACKGROUND Alterations in circadian rhythms can have profound effects on mental health. High co-morbidity for psychiatric disorders has been observed in patients with circadian rhythm disorders, such as delayed sleep phase disorder (DSPD), and in those with an evening-type circadian preference. The aim of this study was to systematically determine the prevalence and type of Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM IV) Axis-I disorders in those with DSPD compared to evening-type controls. METHODS Forty-eight DSPD and 25 evening-type participants took part in this study. Sleep and wake parameters were assessed with actigraphy, diary and questionnaires (Pittsburgh Sleep Quality Index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ). Evening-type preference was defined by the Horne-Ostberg questionnaire. DSPD was determined by an interview according to International Classification of Sleep Disorders criteria. Current and past diagnoses of psychiatric disorders were assessed with a Structured Clinical Interview for DSM-IV disorders. RESULTS DSPD was associated with a later wake time, longer sleep time, higher PSQI score and lower Horne-Ostberg and FOSQ scores compared to evening-types. There were no significant differences in the prevalence or type of Axis-I disorders between those with DSPD or evening-type preference. Over 70% of participants met criteria for at least one past Axis-I disorder. Approximately 40% of both the DSPD and evening-types met criteria for a past diagnosis of mood, anxiety (most frequently phobia) or substance-use disorders. Evening types were more likely to have a past diagnosis of more than one Axis-I disorder. CONCLUSIONS These results highlight the important link between circadian rhythms and mental disorders. Specifically, an evening circadian chronotype regardless of DSPD status is associated with a risk for anxiety, depressive or substance-use disorders.

Exercise to improve sleep in insomnia: exploration of the bidirectional effects.

BACKGROUND Exercise improves sleep quality, mood, and quality of life among older adults with insomnia. The purpose of the study was to evaluate the daily bidirectional relationships between exercise and sleep in a sample of women with insomnia. METHODS Participants included 11 women (age M = 61.27, SD 4.15) with insomnia who engaged in 30 min of aerobic exercise 3 times per week. Self-reported sleep quality was assessed at baseline and at 16 weeks. Sleep and exercise logs and wrist activity were collected continuously. Sleep variables included subjective sleep quality and objective measures recorded via wrist actigraphy (sleep onset latency [SOL], total sleep time [TST], sleep efficiency [SE], wake after sleep onset [WASO], and fragmentation index [FI]). Age, subjective sleep quality, TST, SOL, and physical fitness at baseline were tested as moderators of the daily effects. RESULTS TST, SE, and self-reported global sleep quality improved from baseline to 16 weeks (p values < 0.05). Baseline ratings of sleepiness were negatively correlated with exercise session duration (p < 0.05). Daily exercise was not associated with subjective or objective sleep variables during the corresponding night. However, participants had shorter exercise duration following nights with longer SOL (p < 0.05). TST at baseline moderated the daily relationship between TST and next day exercise duration (p < 0.05). The relationship between shorter TST and shorter next day exercise was stronger in participants who had shorter TST at baseline. CONCLUSION Results suggest that sleep influences next day exercise rather than exercise influencing sleep. The relationship between TST and next day exercise was stronger for those with shorter TST at baseline. These results suggest that improving sleep may encourage exercise participation.

Timing and Intensity of Light Correlate with Body Weight in Adults

Light exposure can influence sleep and circadian timing, both of which have been shown to influence weight regulation. The goal of this study was to evaluate the relationship between ambient light, sleep and body mass index. Participants included 54 individuals (26 males, mean age 30.6, SD = 11.7 years). Light levels, sleep midpoint and duration were measured with wrist actigraphy (Actiwatch-L) for 7 days. BMI was derived from self-reported height and weight. Caloric intake was determined from 7 days of food logs. For each participant, light and activity data were output in 2 minute epochs, smoothed using a 5 point (10 minute) moving average and then aggregated over 24 hours. The mean light timing above 500 lux (MLiT500) was defined as the average clock time of all aggregated data points above 500 lux. MLiT500 was positively correlated with BMI (r = 0.51, p<0.001), and midpoint of sleep (r = 0.47, p<0.01). In a multivariable linear regression model including MLiT500 and midpoint of sleep, MLiT500 was a significant predictor of BMI (B = 1.26 SE = 0.34, β = 0.53 p = 0.001, r 2 Δ = 0.22). Adjusting for covariates, MLiT500 remained an independent predictor of BMI (B = 1.28 SE = 0.36, β = 0.54, p = 0.002, r 2 Δ = 0.20). The full model accounted for 34.7% of the variance in BMI (p = 0.01). Exposure to moderate levels of light at biologically appropriate times can influence weight, independent of sleep timing and duration.

EEG Measures Index Neural and Cognitive Recovery from Sleep Deprivation

Sleep deprivation impairs many cognitive abilities, but these impairments can be reversed after a certain quantity and quality of sleep. The ability to inhibit responding is particularly susceptible to disruption after prolonged wakefulness. How recovery sleep (RS) alters brain activity, leading to improved performance on a variety of cognitive tasks, remains unclear. This issue was examined in the current study using spectral analysis of electroencephalogram (EEG) data during sleep. These measures of sleep physiology were acquired after both normal sleep (NS) and RS, and were related to measures of inhibitory control and concurrent brain activity. Subjects were nine young adults who underwent functional magnetic resonance imaging twice, after 9 h of NS and after 10 h of RS that followed 38 h of being awake. A multiple regression model was used to examine differences between conditions in (1) EEG spectral power during sleep, (2) probability of successful inhibition in a go/no-go task, and (3) activation within a region of right prefrontal cortex during the task. Performance recovery, as indexed by reduced performance differences between conditions, was predicted by increased delta power and decreased sigma power in RS compared with NS. These EEG variables predicted most of the variance in inhibitory performance difference between conditions. Regressions also suggested that RS improved performance because of changes in brain function including prefrontal regions that resulted from delta rebound. We thus propose that slow waves, reflected in delta power during RS, act to restore brain function, thereby improving cognitive performance that entails response inhibition.

Meal timing influences daily caloric intake in healthy adults

The role that meal pattern plays in weight regulation is a popular topic of scientific and common debate. The goal of this study was to evaluate the relationship between meal timing with caloric intake and body mass index (BMI). We hypothesized that late meal timing and eating closer to sleep onset time would be associated with greater energy intake and higher BMI. Participants included 59 individuals recruited from the community. Rest/activity patterns were assessed using 7 days of wrist actigraphy, and caloric intake was evaluated using 7 days of diet logs. Results demonstrated that the timing of meals was associated with overall energy intake but not with BMI. In multivariate analyses controlling for age, sex, sleep duration, and timing, eating more frequently, later timing of the last meal, and a shorter duration between last meal and sleep onset predicted higher total caloric intake. In a mediational model, eating frequency explained the relationship between eating closer to sleep onset and total caloric intake. Results suggest that later relative timing of meals, particularly eating close to sleep, could lead to weight gain due to a greater number of eating occasions and higher total daily caloric intake. These findings have important implications for the development of novel, time-based interventions for weight management.

Race and Ethnic Variation in Excessive Daytime Sleepiness: The Multi-Ethnic Study of Atherosclerosis

This cross-sectional study utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA). The sample included 5,173 older adults (mean age = 66.4 years) recruited from 6 field centers in the United States. Excessive daytime sleepiness (EDS) was evaluated using two measures: self-report of feeling excessively sleepy ≤ 5 days per month and the Epworth Sleepiness Scale (ESS) > 12. White participants were more likely than other groups to report EDS ≤ 5 days per month. After controlling for covariates, African American and Hispanic participants remained less likely to report EDS ≤ 5 days per month. African Americans were more likely to score > 12 on the ESS than White participants. Odds ESS > 12 in African American participants were attenuated but remained significant after controlling for covariates. Results indicate measurement of race/ethnic differences in EDS may result in conflicting estimates of race/ethnic variation. Furthermore, attenuation of differences in ESS < 12 suggests this measure has a stronger association with current health.