Serge Brand

Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions

Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.

Facing depression with botulinum toxin: A randomized controlled trial

Positive effects on mood have been observed in subjects who underwent treatment of glabellar frown lines with botulinum toxin and, in an open case series, depression remitted or improved after such treatment. Using a randomized double-blind placebo-controlled trial design we assessed botulinum toxin injection to the glabellar region as an adjunctive treatment of major depression. Thirty patients were randomly assigned to a verum (onabotulinumtoxinA, n = 15) or placebo (saline, n = 15) group. The primary end point was change in the 17-item version of the Hamilton Depression Rating Scale six weeks after treatment compared to baseline. The verum and the placebo groups did not differ significantly in any of the collected baseline characteristics. Throughout the sixteen-week follow-up period there was a significant improvement in depressive symptoms in the verum group compared to the placebo group as measured by the Hamilton Depression Rating Scale (F((6,168)) = 5.76, p < 0.001, η(2) = 0.17). Six weeks after a single treatment scores of onabotulinumtoxinA recipients were reduced on average by 47.1% and by 9.2% in placebo-treated participants (F((1,28)) = 12.30, p = 0.002, η(2) = 0.31, d = 1.28). The effect size was even larger at the end of the study (d = 1.80). Treatment-dependent clinical improvement was also reflected in the Beck Depression Inventory, and in the Clinical Global Impressions Scale. This study shows that a single treatment of the glabellar region with botulinum toxin may shortly accomplish a strong and sustained alleviation of depression in patients, who did not improve sufficiently on previous medication. It supports the concept, that the facial musculature not only expresses, but also regulates mood states.

The combined DEX-CRH test in treatment course and long-term outcome of major depression

Neuroendocrine studies strongly suggest that the hypothalamic-pituitary-adrenocortical (HPA) system plays a crucial role in the development and course of depression. The interaction between the disease process and HPA system function in long-term course, however, is unclear. Since improvement of HPA system deterioration has been demonstrated to be associated with treatment response, the question has arisen whether the course of therapy response as reflected by, for example, early improvement or response (after 1 or 2 weeks of therapy) is also based on HPA system dysfunction and whether the course of HPA regulation during treatment is only a state marker or has additional predictive implications for long-term outcome. In order to elucidate these questions a long-term study was carried out to investigate whether HPA system disturbance is associated (1) with the course of treatment response, predominantly early treatment response, during acute depression and (2) with the long-term course of depression, i.e. number of episodes. Twenty patients with affective disorders who participated in earlier controlled antidepressant treatment studies over 6 weeks were enrolled in an exploratory follow-up study. Using the combined DEX/CRH test it was demonstrated that (1) early improvement, early treatment response and beneficial treatment outcome after 6 weeks were associated with a lower HPA system activity and that (2) in long-term course of depression the HPA system deterioration increases in parallel with the number of previous episodes. These findings suggest that HPA system alterations are closely related to treatment response and long-term outcome of depression.

Influence of Mindfulness Practice on Cortisol and Sleep in Long-Term and Short-Term Meditators

Background: There is growing scientific interest in assessing the biological correlates of non-pharmacological interventions such as mindfulness. Examinations of the beneficial effects of mindfulness on hypothalamus-pituitary-adrenocortical system activity (HPA SA) and sleep are sparse. The aim of the present study was to explore the impact of long- and short-term meditation experience on HPA SA and sleep. Method: There were 20 participants, 9 of whom had long-term experience in meditation (mean = 264 months) and 11 novices. Novices underwent an 8-week course in Mindfulness-Based Stress Reduction (MBSR), and cortisol samples were taken in the lab at the beginning and end of the course. To assess the cortisol awakening response, 4 morning cortisol samples were collected. Sleep and mindfulness were assessed by self-rating questionnaires. Results: Among participants with long-term meditation experience, morning cortisol decreased with length of experience. For novices, after an 8-week introductory MBSR course, morning cortisol levels had decreased, while both sleep and self-attribution of mindfulness significantly improved. Cortisol levels did not, however, change between the beginning and end of individual MBSR sessions. Conclusions: The pattern of results lends support to the view that MBSR/meditation has a favorable influence both on biomarkers of stress regulation, such as cortisol secretion, and on sleep.

Exercising, sleep-EEG patterns, and psychological functioning are related among adolescents

Abstract Objectives. Lay and scientific opinion alike hold that physical activity is efficient as both remedy and preventative measure for poor sleep. There is evidence that strenuous exercising of adolescent elite athletes leads to favourable sleep patterns. However, research on this in non-elite athletes is limited. The aim of the present study was to compare sleep-EEG patterns of higher leisure time exercisers and controls. Methods. A total 38 adolescents (M = 18.59) took part in the study; 17 were high, and 21 were low exercisers. Mean weekly exercise duration was 8.5 h for high and 2 h for low exercisers. Sleep-EEG recordings were performed following a day without exercise. Participants also completed questionnaires regarding their psychological functioning. Results. Compared to low exercisers, high exercisers had more slow wave sleep, and less light and REM sleep, higher scores for positive coping and curiosity, and lower scores for depressive symptoms and somatosensory amplification. Multiple regression analyses showed that weekly exercise duration predicted shortened SOL, low number of awakenings, and increased slow wave sleep. Conclusion. Regular, though not necessarily vigorous, exercise is related to improvement in objective sleep patterns and better psychological functioning. Regular physical activity should be promoted and access to sports facilities should be facilitated.

Daily Morning Running for 3 Weeks Improved Sleep and Psychological Functioning in Healthy Adolescents Compared With Controls

PURPOSE To compare sleep electroencephalographic patterns and psychological functioning of healthy adolescents running regularly in the mornings with those of control subjects. Although several studies have shown that regular moderate-to-vigorous exercise is related to favorable sleep and psychological functioning in adolescents, research on the effectiveness of short interventions is more limited. METHODS Fifty-one adolescents (mean age = 18.30 years; 27 female [53%]) took part in the study; they were randomly assigned either to a running or to a control group. The running group went running every morning for 30 minutes at moderate intensity during weekdays for 3 consecutive weeks. Sleep electroencephalographic patterns and psychological functioning were assessed in both groups before and after the 3-week period. All participants also kept a sleep log for 3 weeks. RESULTS Objective sleep improved (slow-wave sleep increased; sleep onset latency decreased) in the running group compared with the control group. Subjective sleep quality, mood, and concentration during the day improved, whereas sleepiness during the day decreased. CONCLUSIONS Thirty minutes of running in the morning during weekdays for 3 consecutive weeks impacted positively on sleep and psychological functioning in healthy adolescents compared with control subjects. Running is inexpensive and easy to implement during school schedules, and as both objective and subjective improvements were observed within 3 weeks, regular physical exercise should be promoted.

Are Adolescents With High Mental Toughness Levels More Resilient Against Stress

Mental toughness has been explored predominantly within sport contexts. Nevertheless, it is difficult to conceive mental toughness as only applicable to athletes. This study examines whether mentally tough participants exhibit resilience against stress. This is a cross-sectional study based on two different samples: Sample 1 consisted of 284 high school students (99 males, 185 females, M = 18.3 years). Sample 2 consisted of 140 first through fifth semester undergraduate students (53 males, 87 females, M = 20.0 years). Participants provided information about their level of perceived stress (10-item Perceived Stress Scale), mental toughness (48-item Mental Toughness Questionnaire) and depressive symptoms (Beck Depression Inventory). Consistent across the two samples, mental toughness mitigated the relationship between high stress and depressive symptoms. The interaction between stress and mental toughness explained 2% of variance in the adolescent sample and 10% of variance among young adults. The promotion of protective factors that foster resilient adaptation is a relevant issue. Mental toughness may appeal to individuals that are typically difficult to be reached with health interventions. Because mental toughness is part of young peoples daily speech, it may serve as a less academic resource than other health psychology concepts.

Fitness and exercise as correlates of sleep complaints: is it all in our minds?

PURPOSE Restoring sleep is associated with psychological well-being. In contrast, poor sleep leads to impaired daily cognitive, emotional, and social functioning. Both commonplace and expert opinion hold that exercise has a favorable impact on preventing poor sleep and improving its quality. However, the scientific basis for this opinion remains limited, and results are mixed. The aim of the present study, therefore, was to explore the impact of perceived physical fitness, exercise, and a perceived lack of activity on sleep in early adulthood. Gender-related patterns were also examined. METHODS A total of 862 participants (639 females and 223 males; mean +/- SD = 24.67 +/- 5.91 yr) took part in the study. Respondents completed a series of self-report questionnaires assessing perceived physical fitness, exercise, perceived lack of physical activity, insomnia (Insomnia Severity Index), dysfunctional sleep-related thoughts (Fragebogen zur Erfassung allgemeiner Persönlichkeitsmerkmale Schlafgestörter), and quality of sleep (Pittsburgh Sleep Quality Index). RESULTS High perceived physical fitness, but not exercise, was associated with favorable scores for various sleep indicators. A perceived lack of physical activity was associated with poor sleep. Perceived physical fitness and exercise were moderately correlated. Compared with males, females reported more sleep difficulties and also more dysfunctional sleep-related thoughts. CONCLUSIONS For early adulthood, findings did not support commonplace or expert opinion that exercise behavior has a favorable influence on sleep. Rather, the findings lend support to the importance of cognitive processes in the onset and maintenance of sleep complaints.

Increased self-reported and objectively assessed physical activity predict sleep quality among adolescents

Both scientists and the general public assume that physical activity (PA) is an effective, non-pharmacological approach to improvement in sleep quality. However, objective and reliable data on this relationship are scarce, particularly for adolescents. Therefore, the aims of the present study were to test the relationship by assessing both PA and sleep subjectively and objectively. A total of 56 adolescent vocational school students (Mean age=17.98, SD=1.36; 28 males, 28 females) participated in the study. Sleep and PA were subjectively assessed via questionnaires. Accelerometers objectively assessed PA, while sleep-EEG devices objectively assessed sleep. The data supported our prediction that adolescents with high PA levels would have longer TST, fewer wakening at night (WASO), fewer symptoms of insomnia, and higher sleep quality. However, gender influenced this pattern of results in that significant findings were only found between high self-reported PA levels and shorter perceived sleep onset latency (SOL). Though self-reported PA levels were a better predictor of good sleep than objectively assessed PA levels, gender was associated with sleep complaints; females reported more sleep complaints. Results indicate that among a non-clinical sample of adolescents increased PA is favorably associated with restoring sleep. Therefore, PA seems beneficial not only for physical and mental health, but also for sleep restoration.

Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children : association with hypothalamic-pituitary-adrenocortical (HPA) activity

BACKGROUND Various studies of adult endocrinology and sleep show close connections between poor sleep quality, deterioration of the HPA axis and negative psychological characteristics. However, the extent to which these associations may have already emerged and developed in childhood remains unclear. METHODS A total of 82 preschoolers (age 4.91+/-0.48) underwent activity monitoring for seven consecutive days and nights, wearing a digital movement-measuring instrument. Additionally, on the first and on the last morning of sleep registration, the activity of the HPA axis was assessed via the amount of cortisol in the saliva. Psychological and behavioral assessments were also made. RESULTS Three sub-groups of good (22%), normal (58.5%) and poor (19.5%) sleepers were distinguished. Poor sleep patterns were associated with higher HPA activity and with behavioral/emotional difficulties. CONCLUSIONS The interplay between unfavorable sleep patterns, deterioration of the HPA axis and behavioral/emotional difficulties is already apparent in pre-school children.