Laura Creti

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.

Poor sleepers who do not complain of insomnia: Myths and realities about psychological and lifestyle characteristics of older good and poor sleepers

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality—they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements—difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.

Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease – A randomized study

INTRODUCTION Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinsons disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinsons disease. METHODS We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinsons patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinsons disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.

Thoughts During Awake Times in Older Good and Poor Sleepers—The Self-Statement Test:60+

In a previous investigation we showed thatthoughts experienced during periods of nocturnalwakefulness contribute to understanding the insomniacomplaint. We also demonstrated the problems withopen-ended thought listings, such as low thoughtfrequencies, large standard deviations, loss of subjectsdue to missing data, and difficulties withstates-of-mind (SOM) ratios. Because of thesedifficulties and the expertise and expense involved in codingthoughts, in the current study we developed andevaluated the Self-Statement Test:60+ (SST:60+) -- a34-item inventory measure of thoughts reported by olderindividuals while trying to fall asleep. Results on 445individuals showed good reliability and validity for themeasure. The findings also demonstrated that negativethoughts and the SOM ratio provide good indices of dysfunctional thinking during periods ofnocturnal arousal. Positive thinking, which appears tobe a strategy to combat negative thoughts, may serve tobuffer the impact of negatives.

Time Estimation in Good and Poor Sleepers

Time estimation was examined in 148 older good and poor sleepers in analogue and naturalistic sleep settings. On analogue tasks, both “empty” time and time listening to an audiobook were overestimated by both good and poor sleepers. There were no differences between groups. “Empty” time was experienced as “dragging.” In the sleep setting, most poor sleepers underestimated nocturnal sleep and overestimated awake times related to their own sleep problem: sleep onset vs. sleep maintenance insomnia. Good sleepers did the opposite. Severity of sleep problem and size of time estimation errors were unrelated. Greater night-to-night wake time variability was experienced by poor than by good sleepers. Psychological adjustment was unrelated to time estimations and to magnification or minimization of sleep problems. The results suggest that for poor sleepers who magnify their sleep problem, self-monitoring can be of benefit by demonstrating that the sleep problem is not as severe as believed.

Role of Thoughts During Nocturnal Awake Times in the Insomnia Experience of Older Adults

The frequency of difficulty initiating and maintaining sleep increases with age. Yet, not all poor sleepers complain of insomnia. Our cognitive model of insomnia predicts that sleep complaints in poor sleepers are a function of negative thinking during nocturnal wakefulness as well as of poor sleep quality. To test descriptive aspects of the model, we examined the content and valence of thoughts listed or endorsed by two large samples of older adults. We compared positive and negative thoughts reported by good sleepers and by 2 types of poor sleepers: those experiencing either high or low distress about their insomnia. Thought listing and inventory results both support the model: negative thought frequencies were closely related to poor sleep, distress about insomnia, and poor daytime psychological adjustment. The findings provide an empirical basis for the modification of maladaptive cognitions as potentially important in therapeutic intervention for insomnia.

What Do Older Good and Poor Sleepers Do During Periods of Nocturnal Wakefulness? The Sleep Behaviors Scale: 60+

To determine whether older good and poor sleepers with and without insomnia complaints differ in the nature of activities they engage in during periods of nocturnal wakefulness, the authors developed and evaluated the Sleep Behaviors Scale: 60+. Good sleepers (n = 163), low-distress poor sleepers (n = 49), and high-distress poor sleepers (n = 28) were compared on this measure as well as on sleep parameters, personality, lifestyle, and cognitive-affective variables. Findings indicate good psychometric properties for the new measure, offer a rationale for examining the frequency of the nocturnal behaviors reflected by the measures 4 subscales (Active Behaviors, Relaxation, Cognitive Arousal, and Medication), and suggest a possible role for these behaviors in the etiology and treatment of insomnia.

Prostatectomy and Inguinal Hernia Repair: A Comparison of the Sexual Consequences

This study investigated whether psychosexual changes found after surgery for benign prostatic enlargement relate specifically to the prostatectomy procedure or to the stresses of surgery in general. The sexual adjustment of 91 married men (ranging in age from 51 to 77) who had undergone either transurethral prostatectomy or inguinal hernia repair was compared using the same measures and experimental design. Results show that both surgeries appeared to result in relatively minor but widespread negative consequences for sexual adjustment and expression. Findings on both individual and couple sexual adjustment suggest that the psychosexual consequences of the two procedures do not differ substantially. As expected, the one exception was retrograde ejaculation, which was more likely to be experienced by men who had undergone prostate surgery. The results illustrate the necessity of conducting comparative studies when evaluating the sexual consequences of surgical procedures and highlight the importance of taking age into consideration when conducting research on the effects of surgery on older men.

Cognitions and sexual expression in the aging

This study investigated the relation of cognitions to sexual expression in aging couples where the male had undergone transurethral prostatectomy. Cognitive factors explored were sexual efficacy expectations, value of sex, sexual attitudes, and sexual knowledge. Sexual expression was defined in terms of the following three dimensions: couple sexual frequency, desired sexual frequency, and quality of sexual functioning. Subjects consisted of 32 married couples whose ages ranged from 50 to 77 years. In this sample of sexually active couples, the cognitive variables most highly correlated with all the dimensions of sexual expression were efficacy expectations for the males sexual performance and individual sexual drive. High sexual efficacy expectations predicted high couple sexual frequency and good male and female sexual functioning. High individual sexual drive predicted high actual and desired couple sexual interaction. In general, it was the male partners sexual confidence and drive that was highly related to couple sexual expression.

Transurethral Prostatectomy: Differential Effects of Age Category and Presurgery Sexual Functioning on Postprostatectomy Sexual Adjustment

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question “Does transurethral prostatectomy affect sexual function?” must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.