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Seit mehr als 60 Jahren wird die Aktigraphie eingesetzt, um den Schlaf-Wach-Rhythmus objektiv zu erfassen. Zunehmend werden verbesserte moderne Gerate angewendet, um schlafmedizinische Erkrankungen im klinischen Rahmen zu diagnostizieren. Aktigraphen sind zwar weniger genau als die Polysomnographie, aber ihr groster Vorteil liegt in der kostengunstigen Sammlung objektiver Daten uber langere Zeitraume unter Alltagsbedingungen. Da die Kosten der Handgelenksaktigraphie derzeit nicht erstattet werden, hat dieses Verfahren bisher keine breite Akzeptanz erlangt. In der vorliegenden Arbeit wird ein Uberblick uber die wesentlichen klinischen Anwendungen der Aktigraphie sowie uber die Empfehlungen der Fachgesellschaften gegeben.

Actigraphy has been used for more than 60 years to objectively measure sleep–wake rhythms. Improved modern devices are increasingly employed to diagnose sleep medicine disorders in the clinical setting. Although less accurate than polysomnography, the chief advantage of actigraphs lies in the cost-effective collection of objective data over prolonged periods of time under everyday conditions. Since the cost of wrist actigraphy is not currently reimbursed, this method has not enjoyed wide acceptance to date. The present article provides an overview of the main clinical applications of actigraphy, including the recommendations of specialist societies.

Referenzwerte/-intervalle dienen in der Medizin generell einer diagnostischen Einordnung von am Patienten erhobenen Befunden. Fur die Schlafmedizin sind nach den Empfehlungen der American Academy of Sleep Medicine (AASM) eine Reihe von Variablen im Befundbericht einer polysomnographischen Untersuchung mitzuteilen. Dazu zahlen respiratorische Ereignisse, Bewegungsereignisse, kardiale Ereignisse, Arousalereignisse sowie Parameter der Schlafarchitektur. In der vorliegenden Arbeit werden Referenzwerte speziell fur Parameter zur Charakterisierung der Schlafarchitektur vorgestellt. Es werden methodische Aspekte der Konstruktion von Referenzwerten (statistische und Auswahl der Referenzstichprobe), Darstellungsmoglichkeiten (tabellarisch und grafisch) sowie Gultigkeitsbereiche (Verwendung unterschiedlicher Referenzwerte fur Daten, die nach dem Standard gemas Rechtschaffen und Kales und dem AASM-Standard erhoben und ausgewertet wurden) diskutiert.

Zusammenfassung Digital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forschung notwendig zu sein scheint., Digitally provided psychological interventions for sleep disorders are currently a very intensively researched topic. In this review, original work and meta-analyses are summarized. Thus, it was shown that internet-based cognitive behavioral therapy for insomnia (CBT-I) in adults is consistently very effective, with only slightly reduced effects compared with the same treatment with the physical presence of therapists and patients. Treatment effects are also shown for secondary outcome parameters such as depression, anxiety, fatigue, and quality of life. On the other hand, research on the effectiveness of internet-based CGT-I in adults with comorbid mental disorders or physical illnesses, and on the issue of how much contact with therapists should be integrated into treatment, does not seem to provide any conclusive answers. Further research seems to be needed in these areas.

Torsten Eggert, Hans Dorn, Heidi Danker-Hopfe Charité – Universitätsmedizin Berlin, Competence Centre of Sleep Medicine, Berlin, GermanyCorrespondence: Heidi Danker-Hopfe, Email heidi.danker-hopfe@charite.dePurpose: The quantitative sleep EEG has been considered as electroencephalographic “fingerprint”, ie, it is stable within but differs between individuals. So far, however, almost all studies addressing this aspect have been conducted in young men. It was therefore of interest to know whether the sleep EEG fingerprint concept holds true in older samples of both sexes.Patients and Methods: Data from three different subsamples of 30 healthy individuals each were reused for the present secondary analysis (young men (YM) = 25.6 ± 2.4 years, elderly men (EM) = 69.1 ± 5.5 years, elderly women (EW) = 67.8 ± 5.7 years). Individuals slept ten times in the sleep laboratory, resulting in a total of 900 study nights. However, to avoid misinterpretation due to intervention-related changes in sleep EEG power spectra, only the 3 sham nights without any intervention were included, reducing the datasets to 270. To determine stability of NREM sleep EEG power spectra between sham night pairs, within- and between-subject Manhattan distance measures were computed separately by sample.Results: Regardless of subsample and sham night pair, lowest distance measures, ie, largest similarity, were observed for within-subject power spectra comparisons (range of mean distance measures for EW from 3.82 to 4.06, for EM from 3.55 to 3.63, and for YM from 3.04 to 3.62). Moreover, intraindividual similarity did not differ substantially between samples. Between-subject power spectra distance measures were considerably larger (range of mean distance measures for EW from 12.95 to 13.15, for EM from 12.21 to 12.57, and for YM from 10.33 to 10.78) and varied significantly between young and elderly individuals.Conclusion: The present results support the view that the sleep EEG power spectrum is an individual trait-like characteristic that remains unique up until old age. This finding may help to increase the sensitivity in measuring intervention effects.Keywords: sleep EEG power spectra, aging and sleep, heritability of sleep EEG, electroencephalographic fingerprint, trait-like quantitative EEG characteristics, individuality of sleep EEG

Sufficient and refreshing sleep is important for good health, physical and cognitive functioning as well as quality of life. An assessment of sleep quality and sleep disorders is therefore mandatory in geriatric patients. Despite a variety of clinical assessment tools for screening and diagnosing sleep disorders, only some of them have been validated in older subjects and nearly none in geriatric patients or in individuals with dementia. Therefore, the aim of this review is to present a concise overview of assessment tools for sleep disorders that are widely used in sleep medicine and to briefly discuss the suitability and limitations in geriatric patients and subjects with dementia.Ausreichender und erholsamer Schlaf ist wichtig für Gesundheit, körperliche und kognitive Funktionalität und Lebensqualität. Eine Einschätzung der Schlafqualität und von gestörtem Schlaf ist daher bei geriatrischen Patienten obligatorisch. Trotz einer Vielzahl von klinischen Bewertungsinstrumenten für das Screening und die Diagnostik von Schlafstörungen wurden nur wenige dieser Instrumente bei älteren Probanden und fast keine bei geriatrischen Patienten oder Personen mit Demenz validiert. Ziel dieser Arbeit ist es daher, einen prägnanten Überblick über die in der Schlafmedizin weit verbreiteten Bewertungsinstrumente für Schlafstörungen zu geben und deren Eignung bzw. Grenzen bei geriatrischen Patienten und Demenzpatienten kurz zu diskutieren.

Background The manipulation of specific brain oscillations by applying transcranial electrical stimulation techniques in order to enhance memory processes during sleep has become an intriguing field of research. A seminal study found a positive effect of slow-oscillatory transcranial direct current stimulation (so-tDCS) on sleep-dependent consolidation of declarative memories. Since then several studies have tried to replicate this result with inconsistent findings. Objective/Hypothesis This study aimed to reexamine effects of so-tDCS on declarative memory observed in young participants based on a previously described stimulation protocol used in elderly subjects. Methods 23 healthy participants (mean ± SD: 23.2 ± 1.9 years; 13 women) completed a word-pair test and a sequential finger tapping test before and after sleep. Participants received anodal so-tDCS bifrontaly at a frequency of 0.75 Hz or sham stimulation during NREM sleep N2, following a double-blind, placebo controlled, counterbalanced, randomized crossover design. Data were analyzed with respect to possible effects of stimulation on memory performances, sleep staging, spindle densities and EEG power in eight frequency bands. Results Stimulation had no significant effect on sleep dependent memory consolidation or on sleep macro- and microstructure. Independent of stimulation, procedural memory performances increased and declarative memory performances decreased overnight. This decline was less pronounced when participants had more than one learning opportunity. Fast parietal but not slow frontal spindle densities diminished from baseline to stimulation-free intervals under both stimulation conditions. Conclusion The present study could not reproduce the results of the seminal study in young subjects, but it is consistent with results observed in elderly subjects using the same protocol. Irrespective of stimulation, re-encoding opportunities in the word-pair test had an impact on memory strength and retrieval performance.

The results of studies on possible effects of radiofrequency electromagnetic fields (RF‐EMFs) on human waking electroencephalography (EEG) have been quite heterogeneous. In the majority of studies, changes in the alpha‐frequency range in subjects who were exposed to different signals of mobile phone‐related EMF sources were observed, whereas other studies did not report any effects. In this review, possible reasons for these inconsistencies are presented and recommendations for future waking EEG studies are made. The physiological basis of underlying brain activity, and the technical requirements and framework conditions for conducting and analyzing the human resting‐state EEG are discussed. Peer‐reviewed articles on possible effects of EMF on waking EEG were evaluated with regard to non‐exposure‐related confounding factors. Recommendations derived from international guidelines on the analysis and reporting of findings are proposed to achieve comparability in future studies. In total, 22 peer‐reviewed studies on possible RF‐EMF effects on human resting‐state EEG were analyzed. EEG power in the alpha frequency range was reported to be increased in 10, decreased in four, and not affected in eight studies. All reviewed studies differ in several ways in terms of the methodologies applied, which might contribute to different results and conclusions about the impact of EMF on human resting‐state EEG. A discussion of various study protocols and different outcome parameters prevents a scientifically sound statement on the impact of RF‐EMF on human brain activity in resting‐state EEG. Further studies which apply comparable, standardized study protocols are recommended. Bioelectromagnetics. 2019;40:291–318. © 2019 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Studies have reported that exposure to radiofrequency electromagnetic fields (RF-EMF) emitted by mobile telephony might affect specific sleep features. Possible effects of RF-EMF emitted by Wi-Fi networks on sleep-dependent memory consolidation processes have not been investigated so far. The present study explored the impact of an all-night Wi-Fi (2.45 GHz) exposure on sleep-dependent memory consolidation and its associated physiological correlates. Thirty young males (mean �� standard deviation [SD]: 24.1 �� 2.9 years) participated in this double-blind, randomized, sham-controlled crossover study. Participants spent five nights in the laboratory. The first night was an adaptation/screening night. The second and fourth nights were baseline nights, each followed consecutively by an experimental night with either Wi-Fi (maximum: psSAR10g =

Background Although there are several human experimental studies on short-term effects of radiofrequency electromagnetic fields (RF-EMF) on sleep, the role of effect modification by sex or age in this context has not yet been considered. In an earlier study, we observed sex differences in RF-EMF effects in elderly subjects. The present study investigated possible RF-EMF effect modifications by age in men. Methods Data available for the present analysis come from three double-blind, randomized cross-over studies, in which effects of different RF-EMF exposure signals on sleep were investigated in young [sample 1: 25.3 (mean) ± 2.6 (SD) years; sample 2: 25.4 ± 2.6 years; n = 30, respectively] and older (69.1 ± 5.5 years; n = 30) healthy male volunteers. Studies comprised a screening/adaptation night followed by nine experimental nights at two-week intervals. RF-EMF exposure effect modifications by age were analysed for two different exposure signals (GSM900 at 2 W/kg, TETRA at 6 W/kg), each compared to a sham exposure. Polysomnography, during which the exposure signals were delivered by a head worn antenna, as well as sleep staging were performed according to the AASM standard. Four subjective and 30 objective sleep parameters were statistically analysed related to possible RF-EMF effects. Results Comparisons of sleep parameters observed under sham exposure revealed highly pronounced physiological differences between young and elderly men. A consistent exposure effect in both age groups was found for a shorter latency to persistent sleep under TETRA exposure reflecting a sleep-promoting effect. Exposure effect modifications by age were observed for two of the four self-reported sleep parameters following GSM900 exposure and for arousals during REM sleep under TETRA exposure. Conclusions As effects of a short-term all-night RF-EMF exposure on sleep occurred only sporadically in young and elderly men, it seems that age doesn't matter in this respect. However, as long as there are no corresponding data from young healthy women that would allow a comparison with the data from elderly women, this assumption cannot be conclusively verified. Nevertheless, the present results are not indicative of any adverse health effects.

Background and objective: The extent to which adult sleep varies depending on the day of the week has not yet been systematically investigated with electroencephalography (EEG) data. Whether such effects exist and whether they are related to age, gender, and employment status was retrospectively analyzed based on data from an experimental double-blind cross-over study in which effects of electromagnetic fields of a cell phone base station on the sleep of a general rural population had been examined. Methods: The sleep of 397 adults (age 45.0 +/- 14.2 years, range 18-81 years; 50.9% women) from ten different rural German villages was recorded for 12 nights with ambulatory devices. Self-reported sleep quality was recorded in morning and evening protocols. Friedman tests were used for statistical analysis of the comparison between the days, and the Kruskal-Wallis and Mann-Whitney U tests were used for pairwise comparisons of independent parameters between groups. Results: For the present analysis, data from 335 participants were considered. Overall, the differences between nights were small and the quality of sleep was good. Three of the five objective and all six self-rated sleep parameters differed significantly between the days of the week. While the objective and the self-estimated total sleep time were longest on Sunday nights, the qualitatively poorest values occurred on Monday nights. People who worked fulltime had the longest sleep latencies on Sunday nights. Friday nights were rated the best. Conclusion: The objective and self-rated sleep quality varied relatively little in a rural adult population over the course of the week, being worst on Monday nights and best on Friday nights., Hintergrund und Ziel: Inwiefern Schlaf von Erwachsenen in Abhängigkeit vom Wochentag variiert, wurde bisher nicht systematisch mittels auf Elektroenzephalographie (EEG-)basierten Daten untersucht. Ob es solche Effekte gibt, und ob diese mit Alter, Geschlecht und Beschäftigungsstatus zusammenhängen, wurde auf der Basis von Daten einer experimentellen doppelblinden Cross-over-Studie, in der der Einfluss elektromagnetischer Felder einer Mobilfunkbasisstation auf den Schlaf einer ländlichen Allgemeinbevölkerung untersucht wurde, retrospektiv analysiert. Methoden: Der Schlaf von 397 Erwachsenen (Alter: 45,0± 14,2 Jahre, Spannbreite: 18–81 Jahre; 50,9% Frauen) aus 10 verschiedenen ländlichen deutschen Orten wurde über jeweils 12 Nächte mit ambulanten Geräten untersucht. Die selbst eingeschätzte Schlafqualität wurde mit Morgen- und Abendprotokollen erfasst. Für die statistische Analyse des Vergleichs zwischen den Tagen wurden Friedman-Tests verwendet, für paarweise Vergleiche unabhängiger Parameter kamen der Kruskal-Wallis-Test und der Mann-Whitney-U-Test zum Einsatz. Ergebnisse: Für die vorliegende Analyse wurden Daten von 335 Personen berücksichtigt. Die Unterschiede zwischen den Nächten waren sehr gering und die Schlafqualität sehr gut. Ein signifikanter Unterschied zwischen den Wochentagen bestand bei 3 der 5 objektiven und bei allen 6 subjektiven Schlafparametern. Während die objektive und die selbst geschätzte Gesamtschlafzeit in den Sonntagnächten am längsten waren, traten die qualitativ schlechtesten Werte in den Montagnächten auf. Personen, die einer Vollzeitbeschäftigung nachgingen, zeigten am Sonntagabend die längsten Einschlaflatenzen. Am besten bewertet wurden die Freitagnächte. Schlussfolgerungen: Die objektive und selbst bewertetete Schlafqualität variierte relativ geringfügig in einer erwachsenen ländlichen Population im Laufe der Woche und war in Montagnächten am schlechtesten und in Freitagnächten am besten.

Difficulties in falling asleep and maintaining sleep, nonrestorative sleep and decreased daytime wakefulness represent very common but relatively unspecific health complaints. Around 100 specific sleep-related disorders will be classified in their own major chap. 7 (sleep wake disorders) for the first time in the upcoming 11th version of the International Classification of Diseases (ICD 11). With respect to the disciplines of psychiatry and psychotherapy there is a bidirectional relationship between mental health and sleep wake disorders. Sleep wake disorders can be an independent risk factor for the onset of a mental disorder and have a negative influence on the course of the disease. In addition, sleep wake disorders can also precede a mental disease as an early symptom and therefore be an important indication for early recognition. Many sleep wake disorders can be diagnosed based on the anamnesis and routine clinical investigations. In special cases, examination in a specialized sleep laboratory and treatment in a sleep medicine center following a staged care approach can be mandatory. Polysomnography represents the gold standard for the differential diagnostics; however, there is no legal foundation in the field of neuropsychiatric disorders for remuneration in the German healthcare system. This review summarizes the current guidelines with respect to the criteria for an investigation in a sleep laboratory from the perspective of the disciplines of psychiatry and psychotherapy. From this the requirements for guideline-conform diagnostics and treatment are derived.

Background Results from human experimental studies investigating possible effects of radiofrequency electromagnetic fields (RF-EMF) on sleep are heterogeneous. So far, there is no study on possible sex-differences in RF-EMF effects. Objectives The present study aimed at analyzing differences in RF-EMF effects on the macrostructure of sleep between healthy elderly males and females. Methods With a double-blind, randomized, sham-controlled cross-over design effects of two RF-EMF exposures (GSM900 and TETRA) on sleep were investigated in samples of 30 elderly healthy male and 30 healthy elderly female volunteers. Participants underwent each of the three exposure conditions on three occassions following an individually randomized order resulting in a total of nine study nights per participant. Exposure was delivered for 30 min prior to sleep and for the whole night (7.5 h) by a head worn antenna specifically designed for the projects. The peak spatial absorption rate averaged over time in head tissues (psSAR10g) was 6 W/kg for TETRA and 2 W/kg for GSM900. Thirty variables characterising the macrostructure of sleep and arousals as well as four subjective sleep variables were considered for statistical analyses. Results Multivariate analyses revealed that exposure to GSM900 and/or TETRA resulted in a significant reduction in arousals, a shorter latency to sleep stage N3, and a shorter self-reported time awake after sleep in both males and females. Exposure effects depending on sex (significant interactions) were observed. Latency to sleep stage R was shorter in females and tended to be longer in males under both exposures. Latency to stage N3 was shorter in females under TETRA exposure and almost not affected in males. The time awake within the sleep period under TETRA exposure was shorter in females and only slightly longer in males. Under GSM exposure, the self-rated total sleep time tended to be longer in females and to be shorter in males. Finally, the number of awakenings was lower only in females and tended to be higher in males under GSM exposure. Discussion With regard to RF-EMF effects on human sleep it seems that gender matters since GSM900 and TETRA led to significantly more exposure effects in females. Regardless of gender, none of the observed changes is indicative of a sleep disturbing effect of RF-EMF exposure. Observed effects might be mediated by skin related thermoregulatory mechanisms.

Schlafbezogene Atmungsstorungen gehen neben einer erheblichen Storung der Befindlichkeit auch mit dem Risiko fur ernsthafte Gesundheitsfolgen, einschlieslich psychischer Erkrankungen einher. Zustatzlich liegen bei Menschen mit psychischen Erkrankungen vermehrte Risikofaktoren fur das Auftreten schlafbezogener Atmungsstorungen vor. Ziel der Untersuchung war es, nun erstmals fur Deutschland die Pravalenz der obstruktiven Schlafapnoe (OSAS) als haufigster Form der schlafbezogenen Atmungsstorungen bei Patienten mit psychiatrischen Krankheitsbildern zu erheben. An 10 Kliniken im Bundesgebiet und einer Einrichtung in der Schweiz wurde bei insgesamt 249 Probanden, die sich als stationare Patienten in den jeweiligen psychiatrischen Kliniken befanden, ein Schlafapnoescreening durchgefuhrt. Mit einem auffalligen Screeningergebnis bei 23,7 % der Probanden war eine hohe Pravalenz hinsichtlich des Vorliegens schlafbezogener Atmungsstorungen zu verzeichnen. Mannliches Geschlecht, hoheres Alter und hoher BMI erwiesen sich als wesentliche Risikofaktoren fur die Detektion eines OSAS. Obwohl das Schlafapnoesyndrom zu ausgepragten Storungen der Befindlichkeit fuhren kann und unbehandelt mit ernsthaften somatischen Gesundheitsfolgen einhergeht, gehort eine diesbezugliche schlafmedizinische Diagnostik gegenwartig nicht zur diagnostischen Routine an psychiatrischen Krankenhausern, sodass schlafbezogene Atmungsstorungen bei dieser Patientengruppe vermutlich haufig nicht diagnostiziert werden. Mit Blick auf die Ergebnisse dieser und vorhergehender Studien sollte dieser Themenkomplex Gegenstand weiterer Forschung sein.

Background The World Health Organization (WHO) is currently assessing the potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMFs) in the general and working population. Related to one such health effect, there is a concern that RF-EMFs may affect cognitive performance in humans. The systematic review (SR) aims to identify, summarize and synthesize the evidence base related to this question. Here, we present the protocol for the planned SR. Objectives The main objective is to present a protocol for a SR which will evaluate the associations between short-term exposure to RF-EMFs and cognitive performance in human experimental studies. Data sources We will search the following databases: PubMed, Embase, Web of Science, Scopus, and the EMF-Portal. The reference lists of included studies and retrieved review articles will be manually searched. Study eligibility and criteria We will include randomized human experimental studies that assess the effects of RF-EMFs on cognitive performance compared to no exposure or lower exposure. We will include peer-reviewed articles of any publication date in any language that report primary data. Data extraction and analysis Data will be extracted according to a pre-defined set of forms developed and piloted by the review author team. To assess the risk of bias, we will apply the Rating Tool for Human and Animal Studies developed by NTP/OHAT, supplemented with additional questions relevant for cross-over studies. Where sufficiently similar studies are identified (e.g. the heterogeneity concerning population, exposure and outcome is low and the studies can be combined), we will conduct random-effects meta-analysis; otherwise, we will conduct a narrative synthesis. Assessment of certainty of evidence The certainty of evidence for each identified outcome will be assessed according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Performing the review according to this protocol will allow the identification of possible effects of RF-EMFs on cognitive performance in humans. The protocol has been registered in PROSPERO, an open-source protocol registration system, to foster transparency.

Zusammenfassung. Chronische Alpträume verursachen im Rahmen der kriegsbedingten Posttraumatischen Belastungsstörung (PTBS) bei Soldaten einen hohen Leidensdruck. Ihre Behandlung wurde bisher bei traumatisierten, deutschen Soldaten nicht untersucht. Die vorliegende Pilotstudie untersucht die Wirksamkeit einer adaptierten, standardisierten Imagery Rehearsal Therapy (IRT) unter stationären Bedingungen im komplementären Setting. 14 kriegstraumatisierte Soldaten mit Alptraumstörung und chronischer PTBS wurden im Rahmen von 10 Einzelsitzungen behandelt. Die Soldaten wurden vor der Intervention (t1) sowie 2 Wochen (t2) und 3 Monate (t3) danach hinsichtlich verschiedener Parameter der Schlaf- und Alptraumsymptomatik, der Traumasymptomatik, der Depression und der allgemeinen psychischen Belastung untersucht. Der Fokus der imaginativen Modifikation lag auf der gezielten Entwicklung von „compassionate imagery“. Die Alptraumhäufigkeit reduzierte sich kurz- und langfristig signifikant (t1–t2, Effektstärke d: 1.8; t1–t3, Effektstärke d: 1.4). Die Schlafqualität und deren Auswirkungen auf verschiedene Lebensbereiche, die Depressionssymptomatik, die allgemeine psychische Beeinträchtigung und die Traumasymptomatik zeigten signifikante Effekte. Die adaptierte IRT mit spezifischer imaginativer Modifikation von traumabedingten Alpträumen kann eine wertvolle Erweiterung des komplementären Versorgungsangebotes für chronisch kriegstraumatisierte Soldaten mit PTBS darstellen.

In the present study, the benefits of a short-term sleep coaching intervention embedded in the workplace health promotion (WHP) program of the German Armed Forces was investigated. Well-being, self-care awareness, self-care behavior and irritation of participants attending the sleep coaching (n = 24) and participants attending other courses offered in the WHP program (n = 24) were assessed before and after the intervention. Participants attending the sleep coaching had a significant increase in well-being, self-care behavior and self-care awareness and a significant decrease in their irritation score after attending the sleep coaching. In the control group, no significant change in the dependent variables was observed; furthermore, participants’ evaluation of the sleep coaching was positive on both affective reactions and utility judgements. Results show that the sleep coaching intervention evaluated is practically feasible and able to improve important indicators of employees’ well-being and self-care in WHP programs.

The recording of slow pupillary oscillations in complete darkness is a promising approach for objective evaluation of daytime sleepiness at the physiological level. The aim of the present study was to analyze the magnitude of between- and within-subject variation of the pupillary unrest index (PUI) in a sample of healthy individuals. The present data were collected within the framework of a mobile phone study on possible effects of radiofrequency electromagnetic fields (RF-EMF) on the central nervous system. Pupillary behavior was monitored in 30 young healthy male volunteers (age 18–30 years) on ten non-consecutive experimental days at 11:00 a.m. and 04:00 p.m., using infrared video pupillography (compact integrated pupillograph, CIP). Since RF-EMF had no impact on the PUI, data were pooled for the present analysis. Mixed-model analyses of variance (ANOVAs) showed that the PUI was subject to higher interindividual variation as compared to intraindividual variation at both times of measurement. This resulted in intraclass correlation coefficients pointing to a substantial stability of these interindividual differences. A comparison of the PUI results with currently used cutoff values revealed that more than 50% of recordings from young, healthy, non-sleep-disturbed males showed values beyond the “normal” range. The significant interindividual variability implies that the PUI is not only a state marker. Evaluations of such measurements should therefore consider the PUI as a possible trait marker to ensure comparability and correct interpretation.

The prevalence of sleep problems in soldiers is higher than in the general population and impaired sleep prior to deployment increases the risk for developing new mental disorders after return from deployment. To prevent development of sleep disorders and concomitant psychiatric problems, early preventive strategies provided within occupational health management (OHM) programs are needed. A sleep coaching program was developed and evaluated and is currently implemented as a preventive tool to improve sleep quality in the German armed forces. A four-step approach to development, evaluation, and dissemination of sleep coaching is presented. In a first step, a sleep coaching program was developed and offered in a pilot phase of the OHM program of the German armed forces. In a next step, the sleep coaching program was comprehensively evaluated by ambulatory polysomnography and sleep-related questionnaires in a crossover waiting list study. In a third step, psychologists of the German armed forces will be trained to provide the sleep coaching program within the OHM program. The last step comprises development of an internet-based sleep coaching program to improve accessibility and availability. Sleep coaching is an effective tool for improving sleep quality in military personnel. In a pilot phase, measures of wellbeing, self-care behavior, and self-care awareness were positively influenced in participants of the sleep coaching program. In a second study, objective and subjective sleep quality improved significantly after participating in the sleep coaching program. Sleep coaching is a preventive intervention method to improve sleep quality and increase health resilience by providing helpful strategies in case of (subjectively) impaired sleep.

Summary In this prospective study, subjective sleep quality and excessive daytime sleepiness prior to, during and after deployment of German soldiers in Afghanistan were examined. Sleep quality (Pittsburgh Sleep Quality Index; PSQI) and daytime sleepiness (Epworth Sleepiness Scale; ESS) were assessed in 118 soldiers of the German army, who were deployed in Afghanistan for 6 months (deployment group: DG) and in 146 soldiers of a non-deployed control group (CG) at baseline. Results of the longitudinal analysis are reported, based on assessments conducted prior to, during the deployment and afterwards in the DG, and in the CG in parallel. Sleep quality and daytime sleepiness in the DG were already impaired during the predeployment training phase and remained at that level during the deployment phase, which clearly indicates the need for more attention on sleep in young soldiers, already at this early stage. The percentage of impaired sleepers decreased significantly after deployment. Programmes to teach techniques to improve sleep and reduce stress should be implemented prior to deployment to reduce sleep difficulties and excessive daytime sleepiness and subsequent psychiatric disorders.

Aims. This prospective study aims to identify patient characteristics as predictors for treatment outcome during inpatient detoxification treatment for drug and alcohol dependent patients.Methods. A mixed gender sample of 832 consecutively admitted drug and alcohol dependent patients were interviewed by an experienced physician. The impact of a variety of factors concerning social environment, therapy motivation, impulsivity related variables, medical history, and addiction severity on treatment outcome was examined.Results. 525 (63.1%) of the patients completed detoxification treatment whereas 307 (36.9%) dropped out prematurely. Being female, living in a partnership, having children, being employed, and having good education were predictive for a positive outcome. Family, health, the fear of losing the job, prosecution, and emergency admission were significant motivational predictors for treatment outcome. Being younger, history of imprisonment, and the number of previous drop-outs were predictive for a negative outcome.Conclusions. Variables concerning social environment and the number of previous drop-outs have been identified as best predictors for treatment outcome. Socially stable patients benefit from the current treatment setting and treatment shall be adapted for patients with negative predictors. Treatment may consequently be tailored with respect to intervention type, duration, and intensity to improve the outcome for those patients that fulfil criteria with negative impact on treatment retention.

A new head exposure system for double-blind provocation studies investigating possible effects of 2.45 GHz Wi-Fi exposure on human sleep was developed and dosimetrically analyzed. The exposure system includes six simultaneously radiating directional antennas arranged along a circle (radius 0.6 m) around the test subject's head, and enables a virtually uniform head exposure, i.e. without any preferred direction of incidence, during sleep. The system is fully computer-controlled and applies a real wireless local area network (WLAN) signal representing different transmission patterns as expected in real WLAN scenarios, i.e. phases of "beacon only" as well as phases of different data transmission rates. Sham and verum are applied in a double-blind crossover study design and all relevant exposure data, i.e. forward and reverse power at all six antenna inputs, are continuously recorded for quality control. For a total antenna input power (sum of all antennas) of 220 mW, typical specific absorption rate (SAR) in cortical brain regions is approximately 1-2 mW/kg (mass average SAR over respective brain region), which can be seen as a realistic worst-case exposure level in real WLAN scenarios. Taking into account variations of head positions during the experiments, the resulting exposure of different brain regions may deviate from the given average SAR levels up to 10 dB. Peak spatial 10 g average SAR in all brain and all head tissues is between 1.5-3.5 and 10.4-25 mW/kg, respectively. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.

Background Studies on effects of radio frequency-electromagnetic fields (RF-EMF) on the macrostructure of sleep so far yielded inconsistent results. This study investigated whether possible effects of RF-EMF exposure differ between individuals. Objective In a double-blind, randomized, sham-controlled cross-over study possible effects of electromagnetic fields emitted by pulsed Global System for Mobile Communications (GSM) 900 and Wideband Code-Division Multiple Access (WCDMA)/Universal Mobile Telecommunications System (WCDMA/UMTS) devices on sleep were analysed. Methods Thirty healthy young men (range 18–30 years) were exposed three times per exposure condition while their sleep was recorded. Sleep was evaluated according to the American Academy of Sleep Medicine standard and eight basic sleep variables were considered. Results Data analyses at the individual level indicate that RF-EMF effects are observed in 90% of the individuals and that all sleep variables are affected in at least four subjects. While sleep of participants was affected in various numbers, combinations of sleep variables and in different directions, showing improvements but also deteriorations, the only consistent finding was an increase of stage R sleep under GSM 900 MHz exposure (9 of 30 subjects) as well as under WCDMA/UMTS exposure (10 of 30 subjects). Conclusions The results underline that sleep of individuals can be affected differently. The observations found here may indicate an underlying thermal mechanism of RF-EMF on human REM sleep. Nevertheless, the effect of an increase in stage R sleep in one third of the individuals does not necessarily indicate a disturbance of sleep.

Background The use of wireless telecommunication systems such as wireless fidelity (Wi-Fi)-enabled devices has steadily increased in recent years. There are persistent concerns that radiofrequency electromagnetic field (RF-EMF) exposure might affect health. Possible effects of RF-EMF exposure on human sleep were examined with regard to mobile phones and base stations, but not with regard to Wi-Fi exposure. Objectives The present double-blind, sham-controlled, randomized, fully counterbalanced cross-over study addressed for the first time the question whether a whole night Wi-Fi exposure has an effect on sleep. Methods Thirty-four healthy young male subjects (mean ± SD: 24.1 ± 2.9 years) spent five nights in the sleep laboratory. A screening and adaptation night was followed by two experimental nights. Each of the experimental nights was preceded by a baseline night. Sleep was evaluated at the subjective level by a questionnaire and at the objective level (macro- and microstructure) by polysomnography. Either 2.45 GHz Wi-Fi (max psSAR10g of 6.4 mW/kg) or sham signals were delivered by a newly developed head exposure facility. Results Results showed no statistically significant acute effects of a whole-night Wi-Fi exposure on subjective sleep parameters as well as on parameters characterizing the macrostructure of sleep. Analyses of the microstructure of sleep revealed a reduction in global EEG power in the alpha frequency band (8.00–11.75 Hz) during NREM sleep under acute Wi-Fi exposure compared to sham. Discussion The results of the present human experimental study are well in line with several other neurophysiological studies showing that acute RF-EMF exposure has no effect on the macrostructure of sleep. The slight physiological changes in EEG power observed under Wi-Fi exposure are neither reflected in the subjective assessment of sleep nor at the level of objective measurements. The present results are not indicative of a sleep disturbing effect of Wi-Fi exposure.

In diesem Beitrag hat sich unter „Einhaltung ethischer Richtlinien“ ein Fehler bei der Angabe der Interessenkonflikte eingeschlichen. Korrekt ist: David D. Ebert und Dirk Lehr sind Gesellschafter des GET.ON Instituts. Die fehlende Nennung dieses Interessenkonflikts wurde durch einen …

Aims. Sleep disturbances are common in addiction and withdrawal. This study examined the course of sleep quality in a population of alcohol dependent patients during qualified detoxification treatment in a psychiatric hospital. Methods. The Pittsburgh Sleep Quality Index (PSQI) was administered to 77 electively admitted alcohol dependent patients hospitalized for qualified detoxification treatment. Sleep quality was measured at admission and at discharge. Results. The prevalence of bad sleep as measured by a PSQI-score > 5 was 70.1% at admission. During detoxification, male and female patients were equally affected by sleep disturbances and improvement of sleep was not significantly different between males and females. The PSQI score at admission predicted the change of the PSQI score during qualified detoxification treatment. After inpatient detoxification, sleep disturbances persisted in 59.7% of the patients. Conclusions. Contrary to our expectations, the average patient’s sleep quality improved in our study after two weeks of detoxification treatment. Sleep disturbances nevertheless persisted in almost two-thirds of the patients. In the view of that finding, patients may require individual evaluation of sleep quality and insomnia-specific treatment in the course of detoxification therapy.

STUDY OBJECTIVES: To develop and evaluate a brief manual-based sleep health program within the workplace health promotion of the German Armed Forces. METHODS: The sleep health program comprised four weekly group sessions. Sixty-three members (48 males) were randomly allocated to either a treatment group or a waiting control group matching for age, sex, and baseline Pittsburgh Sleep Quality Index (PSQI). The control group had to wait before participating in the sleep health program until the treatment group finished the intervention. Sleep was assessed by ambulatory polysomnography (PSG) as well as with evening and morning protocols at baseline (t0), directly after the treatment group participated in the sleep health program (t1), and after the control group finished participation (t2). The PSQI, the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS) were applied at the same three time points, and during a 3-month follow-up evaluation (t3). RESULTS: Fifty-seven out of the 63 randomized individuals (42 males, mean age = 40.6 years; complete PSG data: n = 36; complete questionnaire data: n = 39) participated in the sleep health program. Objective wake after sleep onset, sleep efficiency, latency to persistent sleep, self-reported sleep latency, restfulness, PSQI, and ISI scores improved with medium or large effects in both groups. ESS scores decreased with moderate effects in the treatment group only. CONCLUSIONS: The sleep health program had a positive and stable effect on objective and self-reported sleep parameters, and it is suitable as a preventive measure in members of the German Armed Forces. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Development and Evaluation of a Sleep-coaching Program; Identifier: NCT02896062; URL: https://clinicaltrials.gov/ct2/show/record/NCT02896062 CITATION: Sauter C, Kowalski JT, Stein M, Röttger S, Danker-Hopfe H. Effects of a workplace-based sleep health program on sleep in members of the German Armed Forces. J Clin Sleep Med. 2019;15(3):417–429.

The aim of the present study was to investigate the effect of experiencing potentially traumatic events during deployment on post-deployment sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI) and the Addendum for Post-Traumatic Stress Disorder (PTSD) of the Pittsburgh Sleep Quality Index (PSQI-A). Deployment related experiences were quantified on a standardised list of the Mental Health Advisory Team of the U.S. armed forces. The original sample consisted of 118 soldiers of the German armed forces who were deployed to Afghanistan for six months. The present analyses focused on data assessed after deployment (n = 70) and in a three-month follow-up (n = 51). Results indicate that immediately after return experiences during deployment had an independent significant effect on sleep quality but not three months later. Immediately after return depressive and stress symptoms significantly affected sleep quality while three months later somatic symptoms were significant. At both time points sleep prior to deployment was a significant predictor of sleep quality following deployment. Given the importance of sleep quality prior to deployment as a known independent risk factor for newly occurring mental disorders after deployment, these results underline the need to improve sleep quality already at an early stage.

Zusammenfassung Ziel der Studie: Rauchen ist ein hoher vermeidbarer Risikofaktor. Diese Studie untersucht, ob militärische Auslandseinsätze, im Vergleich zur Einsatzvorbereitung, das Risiko mit dem Rauchen zu beginnen erhöhen, die Tabakabhängigkeit steigern und ob sich Moderatorvariablen zum Rauchverhalten identifizieren lassen. Methodik: Die Studie wurde an 2 Panzergrenadierbataillonen mit N=264 Soldaten durchgeführt. Die Einsatzgruppe absolvierte einen Auslandseinsatz in Afghanistan, die Vergleichsgruppe nahm währenddessen an einer Einsatzvorbereitung teil. Zu 3 Messzeitpunkten wurden Tabakabhängigkeit, posttraumatische Symptome, Depression und Stress gemessen. Die erste Datenerhebung erfolgte vor und die dritte Erhebung nach dem Auslandseinsatz bzw. der Einsatzvorbereitung. Die Messung zum zweiten Messzeitpunkt erfolgte während des Auslandseinsatzes bzw. der Einsatzvorbereitung. Ergebnisse: Die Prävalenzrate der rauchenden Soldaten betrug 56,4%. 51,1% (n=135) aller untersuchten Soldaten rauchten mehr als 20 Zigaretten pro Tag. Für die Einsatzgruppe zeigte sich im Vergleich zur Vergleichsgruppe ein signifikanter Anstieg der mittels Fagerström-Test erfassten Tabakabhängigkeit vom ersten zum dritten Messzeitpunkt (p=0,040). In beiden Gruppen gab es während des Untersuchungszeitraums keine erhöhte Anzahl von Soldaten, die mit dem Rauchen begannen (χ² Schlussfolgerung: Eventuell lässt sich der Anstieg der Tabakabhängigkeit für die Einsatzgruppe auf die spezifischen Belastungen des Einsatzes zurückführen. Wenn sich die hohen Raucherquoten auch in anderen Truppengattungen zeigen, sollten vermehrt Entwöhnungsprogramme angeboten werden.

The purpose of the present study was to analyse gender- and age-specific variations in microstructures of rapid eye movement (REM) sleep and to provide reference values for microstructures. The results are based on Somnolyzer 24 × 7 (The Siesta Group Schlafanalyse GmbH., Vienna, Austria) evaluation of data from the SIESTA database. Data from 160 healthy subjects (74 men and 86 women; age range 20–95 years) were considered and a total of 11 REM sleep-related variables analysed. Some of the variables, i.e., REM and slow eye movement (SEM) density, SEM intensity and the REM sleep arousal index, are fairly constant across ages and do not differ between men and women. The atonia index shows gender-specific differences, but does not vary with age among healthy subjects; whereas REM intensity and the time in tonic REM sleep decrease with age, without differences between men and women. Time in stage R sleep (minutes and percentage of total sleep time, TST) and the time in phasic stage R sleep vary with both age and gender. Given the relevance of sleep microstructures in research and potentially also in clinical studies, there is a need for reference values indicating the range of variation of these variables in healthy subjects. Reference values always have the limitation that they refer to the specific method of assessment. Where different detection algorithms are used, the reference values might vary. The reference values presented here—where necessary for men and women separately and/or stratified by age—refer to microstructures assessed by the feature extraction module of the Somnolyzer 24 × 7.

The purpose of the present analysis was to quantify the magnitude of intersubject and intrasubject variation of sleep spindle characteristics in a sample of healthy young males. A total of 32 volunteers (age range 20–30 years) participated in a crossover study aimed at investigating possible effects of Terrestrial Trunked Radio (TETRA) signals on cognitive performance and human brain activity during sleep and waking. Sleep was polysomnographically assessed on nine identically organized study nights per individual. The inter- and intraindividual variability of automatically detected stage 2 non-rapid eye movement (NREM) sleep spindle (11–16 Hz) characteristics (number, density, duration, frequency, amplitude) derived from C3-A2 was determined. Stability of individual differences and the underlying variations were quantified using intraclass correlation (ICC) and coefficients of variation (CV), respectively. Note that there was no significant exposure effect on the considered sleep spindle characteristics. All sleep spindle variables showed an ICC coefficient higher than 0.8, indicating almost perfect stability of interindividual differences. Interindividual variability differed strongly between the considered spindle parameters (CV range: 2–53 %). Intraindividual variability was for all parameters less pronounced (mean CV range: 1–24 %), but their ratios underline the high degree of individuality of each of the investigated parameters. The present analysis confirms the strong individual night-to-night stability of sleep spindle characteristics reported by previous studies. The results provide further evidence for treating sleep spindles as a possible trait, an issue which should be considered in studies relying on a parallel-group design. These data can also be used as reference values.

Schlaflabore stellen die zentrale Untersuchungseinheit in der Schlafmedizin dar. Eine Qualitatssicherung dieser Untersuchungseinheit ist ein besonders wichtiges Anliegen der klinischen Schlafmedizin. Sie erfolgt durch einen formalen Akkreditierungsprozess. Die Voraussetzungen und die Ablaufe der Akkreditierung werden in diesem Leitfaden der Deutschen Gesellschaft fur Schlafforschung und Schlafmedizin beschrieben und, soweit moglich, mit Begrundung ausgefuhrt. Ein erster Leitfaden zur Akkreditierung wurde im Jahr 2000 veroffentlicht. Aufgrund der aktuellen Veranderungen ist es geboten, den Leitfaden zu aktualisieren, um wissenschaftliche Erkenntnisse und Leitlinien mit zu berucksichtigen. Hierzu gehoren die Einfuhrung neuer Aufzeichnungs- und Auswertungsvorschriften fur die kardiorespiratorische Polysomnographie sowie neue Diagnosemanuale fur Schlafstorungen.

An experimental investigation of warming and warmth perception caused by handset EMF exposure was performed in order to examine its possible impact on blinding. Healthy male participants (15) were exposed to three different exposure conditions: sham and Terrestrial Trunked Radio (TETRA) handsets with maximum 10 g averaged SAR values of 1.5 and 6 W/kg each on three days. The study followed a randomized, double-blind design. TETRA signals simulated exposure from a handheld device consisting of a 385 MHz carrier modulated with a pulse length of 14.17 ms and a pulse period of 56.67 ms (i.e., duty cycle 25%; 17.65 Hz pulse modulation). A body worn antenna was used and fixed at the left ear. In addition to subjective ratings, skin temperatures at two locations close to the radiating element of the body-worn antenna were measured. The measurements revealed a temperature rise proportional to the supplied RF power with an average temperature increase measured at the two locations of 0.8 °C following the high exposure level of 6 W/kg. However, subjects were not able to distinguish between exposure conditions based on their subjective perception and thus the double-blinding was ensured. Bioelectromagnetics. 35:452–458, 2014. © 2014 Wiley Periodicals, Inc.

Background Although electroconvulsive therapy (ECT) is the most effective acute antidepressant intervention, sustained response rates are low. It has never been systematically assessed whether psychotherapy, continuation ECT, or antidepressant medication is the most efficacious intervention to maintain initial treatment response. Methods In a prospective, randomized clinical trial, 90 inpatients with major depressive disorder (MDD) were treated with right unilateral ultra-brief acute ECT. Electroconvulsive therapy responders received 6 months guideline-based antidepressant medication (MED) and were randomly assigned to add-on therapy with cognitive-behavioral group therapy (CBT-arm), add-on therapy with ultra-brief pulse continuation electroconvulsive therapy (ECT-arm), or no add-on therapy (MED-arm). After the 6 months of continuation treatment, patients were followed-up for another 6 months. The primary outcome parameter was the proportion of patients who remained well after 12 months. Results Of 90 MDD patients starting the acute phase, 70% responded and 47% remitted to acute ECT. After 6 months of continuation treatment, significant differences were observed in the three treatment arms with sustained response rates of 77% in the CBT-arm, 40% in the ECT-arm, and 44% in the MED-arm. After 12 months, these differences remained stable with sustained response rates of 65% in the CBT-arm, 28% in the ECT-arm, and 33% in the MED-arm. Conclusions These results suggest that ultra-brief pulse ECT as a continuation treatment correlates with low sustained response rates. However, the main finding implicates cognitive-behavioral group therapy in combination with antidepressants might be an effective continuation treatment to sustain response after successful ECT in MDD patients.

BackgroundAntidepressants reduce depressive symptoms in patients with coronary heart disease, but they may be associated with increased mortality. This study aimed to examine whether the use of tricyclic antidepressants (TCA) or selective serotonin reuptake inhibitors (SSRI) is associated with mortality in patients with coronary heart disease, and to determine whether this association is mediated by autonomic function.MethodA total of 956 patients with coronary heart disease were followed for a mean duration of 7.2 years. Autonomic function was assessed as heart rate variability, and plasma and 24-h urinary norepinephrine.ResultsOf 956 patients, 44 (4.6%) used TCA, 89 (9.3%) used SSRI, and 823 (86.1%) did not use antidepressants. At baseline, TCA users exhibited lower heart rate variability and higher norepinephrine levels compared with SSRI users and antidepressant non-users. At the end of the observational period, 52.3% of the TCA users had died compared with 38.2% in the SSRI group and 37.3% in the control group. The adjusted hazard ratio (HR) for TCA use compared with non-use was 1.74 [95% confidence interval (CI) 1.12–2.69, p = 0.01]. Further adjustment for measures of autonomic function reduced the association between TCA use and mortality (HR = 1.27, 95% CI 0.67–2.43, p = 0.47). SSRI use was not associated with mortality (HR = 1.15, 95% CI 0.81–1.64, p = 0.44).ConclusionsThe use of TCA was associated with increased mortality. This association was at least partially mediated by differences in autonomic function. Our findings suggest that TCA should be avoided in patients with coronary heart disease.

Investigate the hypnotic effects of repeated doses of neurokinin-1 receptor antagonist, vestipitant, in primary insomnia.Randomized, double-blind, placebo-controlled 28-day parallel-group study.Eleven sleep centers in Germany.One hundred sixty-one patients with primary insomnia.Patients received vestipitant (15 mg) or placebo for 28 days; 2-night polysomnographic assessment occurred on nights 1/2 and 27/28.Wake after sleep onset (WASO) was improved on nights 1/2 and 27/28 (ratio, vestipitant versus placebo [95% confidence interval]: 0.76 [0.65, 0.90], P = 0.001 and 0.79 [0.65, 0.96], P = 0.02, respectively), demonstrating maintenance of the effect following repeated dosing. Latency to persistent sleep was shorter with vestipitant on nights 1/2 (P = 0.0006 versus placebo), but not on nights 27/28. Total sleep time (TST) improved with vestipitant (nights 1/2: P0.0001, nights 27/28: P = 0.02 versus placebo). Next-day cognitive function tests demonstrated no residual effects of vestipitant (P0.05 versus placebo). Adverse events (AEs) occurred in 25% of vestipitant patients versus 22% for placebo. Headache was the most common AE (8% of vestipitant patients versus 9% for placebo).Vestipitant improved sleep maintenance in patients with primary insomnia, with no associated next-day cognitive impairment. The effects on wake after sleep onset and total sleep time were maintained following repeated dosing.