Search

Spencer A Nielson,1 Daniel J Buysse,2 Daniel B Kay1 1Department of Psychology, Brigham Young University, Provo, UT, 84602, USA; 2Department of Psychiatry and Sleep Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USACorrespondence: Daniel B KayDepartment of Psychology, Brigham Young University, 1090 KMBL, Provo, UT, 84602, USATel +1 801-422-7949Email daniel_kay@byu.eduIntroduction: Daytime sleepiness is a common problem. Although sleepiness is primarily assessed at the self-report unit of analysis, factors that contribute to an individual’s experience and report of sleepiness remain poorly understood. While sleepiness is known to impact vigilance performance, the impact of vigilance performance on sleepiness reports is less well understood. We aimed to explore how performance on a psychomotor vigilance task (PVT) relates to changes in self-reported sleepiness in a rested condition.Methods: Participants were 66 adults (Mdn=23, range 18– 49 years old), 47% female, 88% white, with a wide range of insomnia symptoms. Participants rated their sleepiness on a scale from 1 (not sleepy) to 10 (extremely sleepy) at the start (pre) and the end (post) of a 10-minute computerized PVT. Ordinal regression determined whether mean reciprocal reaction time, a measure of overall performance, or the log-transformed signal-to-noise ratio (LSNR), a measure of fidelity of information processing, predicted post-sleepiness, adjusting for pre-sleepiness, insomnia, and potential confounds.Results: Lower LSNR predicted greater change in sleepiness (pre-to-post PVT) and higher post-sleepiness even after adjusting for pre-sleepiness, mean reciprocal reaction time, insomnia, and other potential confounds (p< 0.05).Discussion: When adjusting for insomnia symptoms and potential confounds, participants with lower fidelity of information processing reported higher sleepiness than they had reported at the start of the PVT. Possible mechanisms and explanations are discussed in relation to a 3-factor model of sleep-wake states. This line of research may contribute to innovative approaches to assessing and treating sleepiness.Keywords: psychomotor vigilance, sleepiness, insomnia, fidelity of information processing, self-report, context

Chronic insomnia is a prevalent disorder associated with significant psychosocial, health, and economic impacts. Cognitive behavioral therapies (CBTs) and benzodiazepine receptor agonist (BzRA) medications are the most widely supported therapeutic approach

This study examined the relation between sleep quality and cognitive performance in older adults, controlling for common medical comorbidities. Participants were community volunteers who, while not selected on the basis of their sleep, did report substantial variability in sleep quality. Good and poor sleepers differed on tests of working memory, attentional set shifting, and abstract problem solving but not on processing speed, inhibitory function, or episodic memory. Poor sleep was also associated with increased depressive symptomatology but only for functional symptoms (e.g., decreased concentration) and not for mood (e.g., sadness). The relationships between sleep quality and cognition were not explained by confound factors such as cerebrovascular disease, depression, or medication usage. Sleep problems may contribute to performance variability between elderly individuals but only in certain cognitive domains. [ABSTRACT FROM AUTHOR]

Objective: The authors sought to determine whether a greater frequency of interpersonal psychotherapy (IPT) sessions during maintenance treatment has a greater prophylactic effect than a previously validated once-a-month treatment.Method: A total of 233 women 20-60 years of age with recurrent unipolar depression were treated in an outpatient research clinic. After participants had achieved remission with weekly IPT or, if required, with weekly IPT plus antidepressant pharmacotherapy, they were randomly assigned to weekly, twice-monthly, or monthly maintenance IPT monotherapy for 2 years or until a recurrence of their depression occurred.Results: Among participants who remitted with IPT alone and entered maintenance treatment (N=99), 19 (26%) of the 74 who remained in the study throughout the 2-year maintenance phase experienced a recurrence of depression. Among participants who required the addition of a selective serotonin reuptake inhibitor to achieve remission (N=90), 32 (36%) sustained that remission through continuation treatment and drug discontinuation and began maintenance treatment; of these, 13 (50%) of the 26 who remained in the study throughout the maintenance phase experienced a recurrence. Survival analysis of time to recurrence by randomized treatment frequency showed no effect on recurrence-free survival in either treatment subgroup.Conclusions: These results suggest that maintenance IPT, even at a frequency of only one visit per month, is a good method of prophylaxis for women who can achieve remission with IPT alone. In contrast, among those who require the addition of pharmacotherapy, IPT monotherapy represents a significantly less efficacious approach to maintenance treatment. [ABSTRACT FROM AUTHOR]

PURPOSE OF REVIEW: Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research. RECENT FINDINGS: Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior. SUMMARY: Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of benzodiazepines and zolpidem tartrate in chronic insomnia based on a quantitative review of literature.Data Sources: Articles from 1966 to 1996 were identified using MEDLINE, by a manual review of relevant journals, and from bibliographies of identified articles.Study Selection: Studies using randomized, double-blind, placebo-controlled, parallel or crossover designs with benzodiazepines or zolpidem in adults younger than 65 years with chronic insomnia (modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for primary insomnia) were selected for review. Self-report and polysomnographic measures of sleep-onset latency, total sleep time, number of awakenings, and sleep quality were selected as outcomes.Data Extraction: Twenty-two studies met the selection criteria. A combined test of Pvalues was performed, pooling broadly from the 22 studies to determine whether medication was superior to placebo. A combined test of effect sizes was performed on the subset of studies that reported effect size information to determine the magnitude of medication effect.Data Synthesis: A homogeneous sample of studies summarized 1894 patients treated for a median duration of 7 days. The combined test of P values demonstrated that medication was superior to placebo in all 4 outcome measures. Treatment response was moderate in magnitude by the combined test of effect sizes.Conclusions: Benzodiazepines and zolpidem produced reliable improvements in commonly measured parameters of sleep in patients with chronic insomnia. Relative to the chronic and recurring course of insomnia, both the limited duration of treatments studied and the lack of follow-up data from controlled trials represent challenges for developing evidence-based guidelines for the use of hypnotics in the management of chronic insomnia. [ABSTRACT FROM AUTHOR]