Showing papers in "Behavioral Sleep Medicine in 2007"
TL;DR: Examination of the effect of diverse psychosocial stressors on polysomnographic measures of sleep results in fairly consistent changes: decreases in slow wave sleep, REM sleep, and sleep efficiency (SE), as well as increases in awakenings.
Abstract: This systematic review examines the effect of diverse psychosocial stressors on polysomnographic measures of sleep. Sixty-three articles were located and categorized in terms of the types of stressors imposed. Experimental stress resulted in fairly consistent changes: decreases in slow wave sleep, REM sleep, and sleep efficiency (SE), as well as increases in awakenings. Data were limited in terms of response to non-experimental stressors, except for the case of post-traumatic stress disorder (PTSD) on sleep, where a number of reports suggest that PTSD patients have increased awakenings and decreased SE. Future research needs to define stress more precisely in terms of duration and severity and to measure its impacts on sleep in populations that differ in terms of age, comorbid illness, gender, and so forth. Without such fine-grained analyses, it is difficult to draw definitive conclusions about this important area.
311 citations
TL;DR: The association of noise-induced sleep disturbance with age has an inverse U-shape, with the strongest reaction found between 50 and 56 years of age.
Abstract: This study establishes functions that specify self-reported sleep disturbance in relation to the exposure to nighttime transportation noise, by reanalyzing pooled data from previous studies. Results are based on data from 28 original datasets obtained from 24 field studies (4 studies collected data regarding 2 sources) including almost 23,000 participants exposed to nighttime levels ranging from 45 to 65 dB. Functions are presented that give the percentage highly sleep disturbed, sleep disturbed, and (at least) a little sleep disturbed people due to aircraft, road traffic, and railway noise in relation to the average nighttime outdoor exposure level at the facade most exposed to the source concerned. These functions show that at the same average nighttime noise-exposure level, aircraft noise is associated with more self-reported sleep disturbance than road traffic, and road traffic noise is associated with more sleep disturbance than railways. The association of noise-induced sleep disturbance with age has an inverse U-shape, with the strongest reaction found between 50 and 56 years of age.
223 citations
TL;DR: Examination of sleep–wake patterns of young adolescents attending urban, public middle schools with early versus late school start times found students at the late-starting school reported waking up over 1 hr later on school mornings and obtaining 50 min more sleep each night, less sleepiness, and fewer tardies.
Abstract: With the onset of adolescence, teenagers require 9.2 hr of sleep and experience a delay in the timing of sleep. In the "real world" with early school start times, however, they report less sleep, striking differences between their school-weekend sleep schedules, and significant daytime sleepiness. Prior studies demonstrated that high schoolers with later school starts do not further delay bedtime but obtain more sleep due to later wake times. This study examined sleep-wake patterns of young adolescents attending urban, public middle schools with early (7:15 a.m.) versus late (8:37 a.m.) start times. Students (N = 205) were assessed at 2 time periods. Students at the late-starting school reported waking up over 1 hr later on school mornings and obtaining 50 min more sleep each night, less sleepiness, and fewer tardies than students at the early school. All students reported similar school-night bedtime, sleep hygiene practices, and weekend sleep schedules.
198 citations
TL;DR: Perceived stress and stress-related avoidance behaviors were associated with multiple indexes of physiological arousal during NREM sleep in patients with chronic, primary insomnia.
Abstract: The objective of this study was to evaluate cross-sectional relationships among symptoms of psychological stress, sleep, and physiological arousal during non-rapid eye movement (NREM) sleep in a sample of 30 patients with chronic, primary insomnia (mean age, 30.2 years, 60% female). Study measures included indexes of subjective stress, visually scored sleep, and physiological arousal during NREM sleep: quantitative electroencephalogram (QEEG) and quantitative electrocardiogram (QEKG) measures. Psychological stress was more strongly related to indexes of physiological arousal during NREM sleep than to visually scored measures of sleep. Higher levels of perceived stress were associated with decreased EEG delta power (rho = -0.50, p < .01) and increased EEG beta power (rho = 0.38, p < .05). Increased frequency of stress-related avoidance behaviors was associated with decreased EKG high-frequency power (rho = -0.46, p < .05). Although QEEG measures were significantly correlated with sleep maintenance (QEEG delta power rho = 0.45, p < .01; QEEG beta power rho = -0.54, p < .01) and time spent in delta sleep (QEEG delta power rho = 0.65, p < .001; QEEG beta power rho = -0.65, p < .001), QEKG measures were unrelated to visually scored measures of sleep. Perceived stress and stress-related avoidance behaviors were associated with multiple indexes of physiological arousal during NREM sleep in patients with chronic, primary insomnia.
124 citations
TL;DR: In this paper, self-reported sleep complaints and current cognitive functioning were assessed in 375 nondemented participants ages 75 to 85 years (134 men and 241 women) as part of enrollment in the Bronx aging study, an ongoing longitudinal community-based study of cognitive aging.
Abstract: Self-reported sleep complaints and current cognitive functioning were assessed in 375 nondemented participants ages 75 to 85 years (134 men and 241 women) as part of enrollment in the Bronx aging study, an ongoing longitudinal community-based study of cognitive aging. This study only reports on the baseline data collected from 1980 to 1983. Sleep complaints were common, occurring in about 25% of the sample. Furthermore, after controlling for depression, use of hypnotic medication, physical morbidity, age, and education, participants who reported longer sleep onset latencies performed significantly worse on measures of verbal knowledge, long-term memory and fund of information, and visuospatial reasoning. Participants who reported longer sleep durations did significantly worse on a measure of verbal short-term memory. These results suggest that perceived sleep is related to select objective cognitive abilities even when accounting for commonly recognized mediating variables, such as depression, medical comorbidity, age, or use of hypnotic medication. Given the restricted range of this nondemented sample, these results may underestimate the relation between cognitive abilities and sleep.
115 citations
TL;DR: A replication study enhanced by a longer follow up and additional data are presented to suggest that 6-month adherence can be predicted within the first days of PAP use.
Abstract: Obstructive sleep apnea (OSA) is a serious disorder with significant daytime consequences. Treatment for OSA most commonly takes the form of positive airway pressure (PAP). Although effective, PAP adherence is often below expectations. Previous studies have suggested that early PAP use can predict long-term adherence, but these studies have not been replicated, nor has follow up been longer than 3 months. This article presents a replication study enhanced by a longer follow up and additional data to suggest that 6-month adherence can be predicted within the first days of PAP use. This article also discusses how this might relate to the experience of significant side effects of treatment.
110 citations
TL;DR: Treatment approaches to phase change the delayed sleep circadian rhythm such as morning bright light exposure, exogenous melatonin administration, and chronotherapy as well as some behavioral strategies are described.
Abstract: Delayed Sleep Phase Disorder is a circadian rhythm disorder that results in a late timed sleep pattern. Individuals have difficulty falling asleep at a conventional hour and difficulty waking in the morning. We discuss the contributing factors and consequences of a delayed sleep phase and describe treatment approaches. These include therapies to phase change the delayed sleep circadian rhythm such as morning bright light exposure, exogenous melatonin administration, and chronotherapy as well as some behavioral strategies.
77 citations
TL;DR: Both brief therapies decreased PAP discontinuation compared to standard care and the MET therapy performed best under the condition of flexible delivery of PAP, although differences were not statistically significant.
Abstract: Sleep apnea syndrome (SAS) is a serious disorder with significant daytime consequences. Treatment for SAS most commonly takes the form of positive airway pressure (PAP). Although effective, PAP adherence is often below expectations. Previous studies have suggested that the provision of information on the importance of PAP use can enhance adherence. In this study, we compare 2 brief behavioral approaches-traditional education (ED) and a motivational enhancement therapy (MET)-designed from theories of behavior change to standard clinical care. PAP discontinuation and adherence are the primary outcome measures. Both brief therapies decreased PAP discontinuation compared to standard care. The MET therapy performed best under the condition of flexible delivery of PAP, although differences were not statistically significant. Implications are discussed.
69 citations
TL;DR: A Time × Treatment interaction for BSI Global Severity Index (GSI) reveals significant pre- to post-treatment reductions in GSI with O2 supplementation and therapeutic CPAP, but not placebo CPAP.
Abstract: Psychological symptom improvement has been observed after continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA). Because CPAP normalizes both sleep disruption and oxyhemoglobin desaturation, the mechanism of psychological symptom improvement is unclear. Using a 3-arm placebo-controlled design, we parsed out the separate effects of treatment on psychological symptoms. OSA patients (N = 38) were monitored 2 nights with polysomnography and then randomized to 2-weeks therapeutic CPAP, placebo CPAP, or O(2) supplementation. Pre and post-treatment, patients completed the Brief Symptom Inventory (BSI): Higher scores indicate greater severity. Repeated measures analysis of covariance reveals a Time x Treatment interaction for BSI Global Severity Index (GSI): significant pre- to post-treatment reductions in GSI with O(2) supplementation and therapeutic CPAP, but not placebo CPAP. A Time x Treatment interaction was also found for depression: Depression decreased with O(2) supplementation but not with therapeutic CPAP or placebo CPAP. Both therapeutic CPAP and O(2) supplementation resulted in decreased psychological symptoms. Results suggest hypoxemia may play a stronger role than sleep disruption vis-a-vis OSA related psychological distress.
64 citations
TL;DR: The Sleep Apnea Self-Management Program (SASMP) has the potential to be an effective and practical way to improve CPAP adherence and is designed for integration into current OSA clinical processes.
Abstract: Obstructive sleep apnea (OSA) is a condition with serious medical and psychosocial consequences. Low patient adherence to nasal continuous positive airway pressure (CPAP) limits the effectiveness of treatment. Intervention studies based on intensive support protocols have shown modest improvement in CPAP adherence; however, this approach would require significant resources and effort for integration into the existing U.S. health care system. The purpose of this article is to describe the self-management approach to chronic illness, justify the self-management approach as applied to sleep apnea patients prescribed CPAP, and to report initial pilot data on feasibility and efficacy of the Sleep Apnea Self-Management Program. CPAP adherence measured at the end of the 4-session program averaged 5.5 +/- 2.3 hr per night. The Sleep Apnea Self-Management Program (SASMP) has the potential to be an effective and practical way to improve CPAP adherence and is designed for integration into current OSA clinical processes.
61 citations
TL;DR: For patients with low early treatment expectations for improvement, those perceiving the therapist as higher in affiliation had greater reduction in sleep problems, and for dropouts experiencing their therapist as more critically confrontive, it was generally associated with less treatment satisfaction.
Abstract: Despite growing evidence for the efficacy of cognitive-behavioral therapy for insomnia (CBT-I), few data exist on the relation between process and outcome for this treatment. Drawing on interpersonal theory and the broader psychotherapy literature, this study examined the contribution of patient expectations and the therapeutic alliance to outcomes in group CBT-I. For patients with low early treatment expectations for improvement, those perceiving the therapist as higher in affiliation had greater reduction in sleep problems. Perceiving the therapist as critically confrontive was generally associated with less treatment satisfaction, and particularly so for those individuals who came to treatment with high expectations for improvement. Critical confrontation also differentiated dropouts from continuers, with dropouts experiencing their therapist as more critically confrontive.
TL;DR: In this paper, the relation between daytime functioning and chronic insomnia was investigated, and subjective well-being was found to be compromised in insomniacs as compared to control participants, but no differences in the level of performance were found.
Abstract: In this ambulatory study, the relation between daytime functioning and chronic insomnia was investigated. The study sample consisted of 39 chronic insomniacs and 20 healthy control participants. Performance (vigilance, working memory, motor control) and well-being (concentration, fatigue, mood, sleepiness) were assessed by means of a validated test battery, and intra-individual sleep variability was taken into account. Subjective well-being was found to be compromised in insomniacs as compared to control participants, but no differences in the level of performance were found. Evening cortisol levels did not indicate increased levels of arousal in the insomniacs. Although the absence of an effect of chronic insomnia on objectively measured performance may be due to experimental or statistical factors, this study hypothesizes that the insomniacs studied in the field may have been able to exert compensatory effort to overcome their self-perceived fatigue.
TL;DR: Behavioral training was implemented to increase adherence with positive airway pressure (PAP) in 4 preschool children and all 4 children tolerated PAP while sleeping for age appropriate durations.
Abstract: Behavioral training was implemented to increase adherence with positive airway pressure (PAP) in 4 preschool children. The training employed distraction, counterconditioning, graduated exposure, differential reinforcement, and escape extinction. A non-concurrent multiple baseline experimental design was used to demonstrate program effects. Initially, the children displayed distress and escape–avoidance behavior when PAP was attempted. With training, all 4 children tolerated PAP while sleeping for age appropriate durations. For the 3 children with home follow-up data, the parents maintained benefits. The results are discussed in relation to behavior principles, child health, and common barriers to PAP adherence.
TL;DR: CPAP exposure therapy may be beneficial in some cases; however, further research is needed to determine types of patients most likely to benefit from this therapy.
Abstract: Continuous positive airway pressure (CPAP) is a safe, effective treatment for obstructive sleep apnea, and yet many patients develop claustrophobic reactions to the CPAP nasal mask and cannot tolerate this treatment. We examined the efficacy of a graded in-vivo exposure therapy for enhancing CPAP adherence using a retrospective, case series design. Objective CPAP adherence data were obtained on clinical patients who attended 1 or more sessions of exposure therapy with a behavioral sleep psychologist. Compared to pre-treatment, patients used CPAP significantly longer after exposure therapy. No predictors of treatment response were identified. CPAP exposure therapy may be beneficial in some cases; however, further research is needed to determine types of patients most likely to benefit from this therapy.
TL;DR: This pilot study supports the use of the 24-Hour SPI as a valid and feasible measure of subjective sleep patterns for research, especially for researchers with limited budgets or who are primarily interested in subjective sleep outcomes.
Abstract: The purpose of this project was to examine the validity and feasibility of the 24-Hour Sleep Patterns Interview (24-Hour SPI) as a measure of sleep continuity (bedtime, wake time, sleep onset latency, total sleep time) and sleep quality. Two studies were completed. The first study (n = 154) compared the 24-Hour SPI with a 2-week sleep diary, and the second study (n = 32) compared the 24-Hour SPI with actigraphy, sleep diary, and the Pittsburgh Sleep Quality Index. Both studies found a significant relation between the 24-Hour SPI and established measures of sleep patterns and sleep quality. The sensitivity and feasibility were also examined by data completion rates, differences in weekday and weekend sleep patterns, and qualitative feedback from participants. This pilot study supports the use of the 24-Hour SPI as a valid and feasible measure of subjective sleep patterns for research, especially for researchers with limited budgets or who are primarily interested in subjective sleep outcomes. Additional research with larger and broader samples is needed to further validate this approach.
TL;DR: The interplay among sleep quality, dysfunctional beliefs and attitudes about sleep, and QoL is discussed, as well as potential clinical implications and ideas for future investigations specific to perimenopausal women.
Abstract: Sleep disturbance is a common complaint among perimenopausal women and is hypothesized to contribute to compromises in their quality of life (QoL). We investigated the degree to which sleep disturbance and QoL were related and whether dysfunctional beliefs and attitudes about sleep were significantly associated with QoL ratings among a community sample of 168 perimenopausal women (88% return rate). Questionnaires included measures of subjective sleep quality, beliefs and attitudes about sleep, and QoL. Subjective sleep quality accounted for a significant amount of variance in both the physical and mental health aspects of QoL. Dysfunctional beliefs and attitudes about sleep significantly accounted for the physical components of QoL but not mental components. The interplay among sleep quality, dysfunctional beliefs and attitudes about sleep, and QoL is discussed, as well as potential clinical implications and ideas for future investigations specific to perimenopausal women.
TL;DR: One versus two nights of CPAP titration did not affect CPAP compliance, but sleep efficiency improved on the second diagnostic night and an extra titration study may be necessary for some patients, especially those with only one diagnostic night.
Abstract: Objective: To investigate continuous positive airway pressure (CPAP) compliance after one versus two nights of CPAP titration. Method: A chart review and a telephone questionnaire interview were conducted in 110 sleep apnea patients who received one or two nights of CPAP titration. Of these patients, 78 followed through with phone interview. Results: There was no difference in CPAP compliance between those who had one or two nights of CPAP titration. The titration pressures on the first and second nights were not significantly different. But there was significant improvement in sleep efficiency from the first to the second diagnostic night. Conclusion: One versus two nights of CPAP titration did not affect CPAP compliance, but sleep efficiency improved on the second diagnostic night and an extra titration study may be necessary for some patients, especially those with only one diagnostic night.
TL;DR: Objective measures of adherence are needed to enhance the accuracy of adherence studies and information technologies should be studied for their reliability and validity in assessing adherence, and for their potential impact on improving adherence.
Abstract: The following four sections identify 30 research issues critical to understanding both the factors essential for effective adherence to treatments for sleep disorders, and the role of sleep factors...
TL;DR: This work presents a novel and scalable approach that combines a beads-based method for quantifying the commitment of patients to a treatment they believe to be safe and effective in the context of long-term sleep disorders.
Abstract: Nearly 20 years ago I (David Dinges) was asked by my sleep medicine colleagues at the University of Pennsylvania School of Medicine if I would join them in developing studies of adherence to contin...