Thomas Unbehaun

How smoking affects sleep: a polysomnographical analysis.

OBJECTIVE Subjective quality of sleep is impaired in smokers compared with non-smokers, but there is only limited evidence from methodologically sound studies about differences in polysomnography (PSG) sleep characteristics. Therefore, this study used PSG to evaluate sleep in smokers and non-smokers while controlling for other parameters that affect sleep. METHODS After an adaptation night, PSG sleep laboratory data were obtained from 44 smokers (29 men and 15 women, median age 29.6 years) and compared with PSG data from 44 healthy, sex- and age-matched never smokers. Exclusion criteria were alcohol or other substance abuse, psychiatric or endocrine diseases, and treatment with any kind of psychotropic medication. Nicotine and cotinine plasma levels were measured (in the smoking group) and subjective sleep quality assessed in both groups. RESULTS The smokers had a Fagerström tolerance score of 6.4, consumed an average of 21.2 cigarettes per day and had been smoking for 13.1 years (median). Smokers had a shorter sleep period time, longer sleep latency, higher rapid eye movement sleep density, more sleep apneas and leg movements in sleep than non-smokers. There were no differences regarding parameters of spectral analysis of the sleep electroencephalogram as well as in the sleep efficiency measured by PSG. Nevertheless smokers rated their sleep efficiency lower on the Pittsburgh Sleep Quality Index compared with non-smoking individuals, but no differences were detected on the SF-A. Plasma cotinine level correlated negatively with slow wave sleep in the smoking group. CONCLUSIONS Smokers showed a number of insomnia-like sleep impairments. The findings suggest that it is important for sleep researchers to control smoking status in their analyses. Further research should focus on the causes and consequences of impaired sleep during tobacco cessation, as sleep disturbances are a known risk factor for early relapse after initial tobacco abstinence.

Patients with primary insomnia in the sleep laboratory: do they present with typical nights of sleep?

The validity of sleep laboratory investigations in patients with insomnia is important for researchers and clinicians. The objective of this study was to examine the first‐night effect and the reverse first‐night effect in patients with chronic primary insomnia compared with good sleeper controls. A retrospective comparison of a well‐characterised sample of 50 patients with primary insomnia and 50 good sleeper controls was conducted with respect to 2 nights of polysomnography, and subjective sleep parameters in the sleep laboratory and the home setting. When comparing the first and second sleep laboratory night, a significant first‐night effect was observed across both groups in the great majority of the investigated polysomnographic and subjective variables. However, patients with primary insomnia and good sleeper controls did not differ with respect to this effect. Regarding the comparison between the sleep laboratory nights and the home setting, unlike good sleeper controls, patients with primary insomnia reported an increased subjective sleep efficiency on both nights (in part due to a reduced bed time) and an increased subjective total sleep time on the second night. These results suggest that even the second sleep laboratory night does not necessarily provide clinicians and researchers with a representative insight into the sleep perception of patients with primary insomnia. Future studies should investigate whether these findings also hold for other patient populations.

Sleep-related arousal versus general cognitive arousal in primary insomnia.

STUDY OBJECTIVES The present study aimed at further investigating trait aspects of sleep-related cognitive arousal and general cognitive arousal and their association with both objective and subjective sleep parameters in primary insomnia patients. METHODS A clinical sample of 182 primary insomnia patients and 54 healthy controls was investigated using 2 nights of polysomnography, subjective sleep variables, and a questionnaire on sleep-related and general cognitive arousal. RESULTS Compared to healthy controls, primary insomnia patients showed both more sleep-related and general cognitive arousal. Furthermore, sleep-related cognitive arousal was closely associated with measures of sleep-onset and sleep-maintenance problems, while general cognitive arousal was not. CONCLUSIONS Cognitive-behavioral treatment for insomnia might benefit from dedicating more effort to psychological interventions that are able to reduce sleep-related cognitive arousal.

Management of insomnia: update and new approaches

Insomnia is the most prevalent sleep disorder worldwide. A number of studies evaluated the efficacy of pharmacological and nonpharmacological treatment approaches. To obtain long-term effects in the management of chronic insomnia, cognitive-behavioral therapy for insomnia (CBT-I) is the treatment of first choice, encompassing education about sleep and sleep hygiene, sleep restriction, stimulus control, relaxation techniques, and cognitive strategies to combat nocturnal ruminations. Short-term effects can easily be achieved by the administration of hypnotic drugs. Gaining access to all types of treatment can still be considered a problem, especially CBT-I seems to be available only at specialized centers but not in general health care. New approaches to treatment delivery seem to be necessary to provide adequate care for patients who may seek help or have not entered the health care system yet. Internet-based treatment options and stepped-care models might be feasible options for the future. Otherwise, the direct and indirect costs associated with insomnia might further increase for our societies, in addition to the personal impact on aspects of quality of life and impaired daytime functioning for each individual with insomnia. Besides, well-established psychological and pharmacological treatment options, alternative treatments like acupuncture might constitute new nonpharmacological possibilities. Randomized controlled studies are needed to evaluate the efficacy of this and other new approaches to treat insomnia.

Sleep changes in smokers before, during and 3 months after nicotine withdrawal

Nicotine may affect sleep by influencing sleep‐regulating neurotransmitters. Sleep disorders can increase the risk for depression and substance dependency. To detect the influence of sleep disturbances on the effect of smoking cessation, we investigated polysomnographically (PSG) the sleep of smoking subjects during a period of smoking, during withdrawal and after a period of abstinence from nicotine. Thirty‐three smokers (23 male, 10 female, median age 29 years, Fagerström Test for Nicotine Dependence score 6.3) were examined during smoking, 24–36 hours after smoking and 3 months after cessation. All subjects had an adaptation night followed by the PSG night. Compared with the smoking state, we found increased arousal index and wake time during nicotine withdrawal. Smokers who later relapsed (11) presented a higher degree of nicotine dependence and more withdrawal symptoms than those who abstained (22) and were characterized by less rapid eye movement (REM) sleep, a longer REM latency as well as by more intense sleep impairments in the subjective sleep rating during the withdrawal. Impairments of sleep during the withdrawal phase may reflect more severe nicotine dependence and may contribute to earlier relapse into smoking behaviours.

The Influence of 8 and 16 mg Nicotine Patches on Sleep in Healthy Non-Smokers

The purpose of this study was to determine whether sleep changes are a consequence of nicotine presence or withdrawal during the night, we examined 66 healthy non-smokers (33 males, 33 females, age: 20–25 years) after an adaptation night in a sleep laboratory setting. Subjects were randomized to receive placebo or either 8 or 16 mg nicotine patches during the day or during the night in a double blind, parallel group design. The 16 mg nicotine patch applied during the night caused a reduced sleep period time and sleep efficiency as well as an increased wake time. A reduced REM-sleep latency and subjective sleep quality rating were found in subjects receiving nicotine during the night. Arousals, apneas and periodic leg movements were not affected by nicotine. This study documents insomnia-like sleep changes in healthy non-smokers caused by nicotine in a dose-dependent manner. There was no evidence for sleep-related withdrawal symptoms after 13 h of nicotine application.

Mütter und Töchter – eine Schicksalsgemeinschaft?

erhöhtes Risiko haben, eine depressive Episode selbst zu erleben. Es ist jedoch immer noch unklar, woher diese signifikante Erhöhung des Risikos rührt. In unserer Längsschnittstudie untersuchen wir Mädchen zwischen 9 und 14 Jahren, deren Mütter mehrere diagnostizierte klinische depressive Episoden während der Lebenszeit ihrer Töchter hatten, aber derzeit nicht depressiv sind. Die Töchter hingegen haben keine akute Störung und auch keine Geschichte psychischer Störungen. Wir vergleichen diese Risikogruppe mit gleichaltrigen Töchtern von Müttern ohne psychische Erkrankung. Die Töchter werden zum ersten Messzeitpunkt einer Reihe von Tests unterzogen: von Fragebögen über kognitive Experimente und biologische Maße der Stressreaktion bis hin zu einem funktionellen Magnetresonanztomographie (fMRT)Scan und genetischen Analysen. In jährlichen Abständen werden diese Töchter und ihre Mütter nachuntersucht. Diese Studie führe ich in Kollaboration mit Ian Gotlib an der Stanford University durch.

Richtlinien für Autoren

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Psychologische Behandlung bei Schlafstörungen

Empirische Arbeiten und Therapiemanuale gibt es in der kognitiven Verhaltenstherapie von Schlafstörungen insbesondere im Bereich der Insomnien. Bestandteile der kognitiven Verhaltenstherapie sind dabei die Psychoedukation über Schlaf und die Regeln der Schlafhygiene, die Stimuluskontrolle und Schlafrestriktion sowie kognitive Techniken und Entspannungsverfahren. Ergebnisse aus Meta-Analysen und systematischen Reviews haben gezeigt, dass die kognitiv-verhaltenstherapeutischen Techniken eine hohe Wirksamkeit aufweisen und zu langfristigen Verbesserungen des Schlafs führen können. Zu den neuen Behandlungselementen zählen Achtsamkeitsübungen und das speziell für die Insomnietherapie entwickelte «Intensive Sleep Retraining». Da die psychologischen Techniken allerdings momentan nur für einen kleinen Teil aller Insomnie-Patienten verfügbar sind, werden vermehrt Internet-basierte Behandlungsprogramme, Selbsthilfekonzepte und Stepped-Care-Modelle auf ihre Wirksamkeit hin überprüft, um den Zugang zu kognitiver Verhaltenstherapie von Schlafstörungen zu verbessern.