The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents’work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.
sleep; fatigue; mothers; fathers; pregnancy; postpartum; naps
Determine whether sleep quality is associated with physical function in older men.
Six U.S. centers
2,862 community dwelling men
Total hours of nighttime sleep [TST], wake after sleep onset [WASO], sleep latency [SL], and sleep efficiency [SE] measured by actigraphy. Sleep stage distribution, respiratory disturbance index (RDI) and hypoxia measured by polysomnography. Measures of physical function including grip strength, walking speed, chair stand and narrow walk were obtained.
In age adjusted models, TST, SE<80%, WASO > 90 min, RDI > 30 and hypoxia were associated with physical function (i.e. mean grip strength was 2.9% and the mean walking speed was 4.3% lower in men with WASO > 90 minutes compared to men with WASO <90 minutes). After adjusting for potential covariates, differences in grip strength and walking speed remained significantly associated with WASO > 90 min, SE < 80% and hypoxia, but not with TST or RDI > 30.
Increased sleep fragmentation and hypoxia is associated with poorer physical function in older men.
sleep; physical function; older men
Sleep disturbance and insomnia are commonly reported by postmenopausal women. However, the relationship between hormone therapy (HT) and sleep disturbances in postmenopausal community-dwelling adults is understudied. Using data from the multicenter Study of Osteoporotic Fractures (SOF), we tested the relationship between HT and sleep-wake estimated from actigraphy.
Sleep-wake was ascertained by wrist actigraphy in 3,123 women aged 84 ± 4 years (range 77-99) from the Study of Osteoporotic Fractures (SOF). This sample represents 30% of the original SOF study and 64% of participants seen at this visit. Data were collected for a mean of 4 consecutive 24-hour periods. Sleep parameters measured objectively included total sleep time, sleep efficiency (SE), sleep latency, wake after sleep onset (WASO), and nap time. All analyses were adjusted for potential confounders (age, clinic site, race, BMI, cognitive function, physical activity, depression, anxiety, education, marital status, age at menopause, alcohol use, prior hysterectomy, and medical conditions).
Actigraphy measurements were available for 424 current, 1,289 past, and 1,410 never users of HT. Women currently using HT had a shorter WASO time (76 vs. 82 minutes, P = 0.03) and fewer long-wake (≥ 5 minutes) episodes (6.5 vs. 7.1, P = 0.004) than never users. Past HT users had longer total sleep time than never users (413 vs. 403 minutes, P = 0.002). Women who never used HT had elevated odds of SE <70% (OR,1.37;95%CI,0.98-1.92) and significantly higher odds of WASO ≥ 90 minutes (OR,1.37;95%CI,1.02-1.83) and ≥ 8 long-wake episodes (OR,1.58;95%CI,1.18-2.12) when compared to current HT users.
Postmenopausal women currently using HT had improved sleep quality for two out of five objective measures: shorter WASO and fewer long-wake episodes. The mechanism behind these associations is not clear. For postmenopausal women, starting HT use should be considered carefully in balance with other risks since the vascular side-effects of hormone replacement may exceed its beneficial effects on sleep.
Most recommendations are that adults should obtain 7–8 hours of sleep per night, although there are individual differences in self-reported sleep need. Chronotype (preference for early or late sleep timing), in combination with social demands, may affect the ability to obtain adequate sleep. This questionnaire study assessed perceived sleep need and self-reported sleep timing and duration during the week and on the weekend with respect to chronotype in visitors to the Museum of Science in Boston. Increasing age was associated with greater morningness. After adjusting for age, we found no significant association between chronotype and self-reported sleep need, or between chronotype and weekday sleep duration. However, we did find that greater eveningness was associated with a larger gap between self-reported sleep need and weekday sleep duration. On weekends, greater eveningness was associated with a longer sleep duration and greater extension of sleep, with the sleep extension achieved by later wake times. Together, these findings suggest that evening types accumulate a sleep debt during the week, despite reporting a similar sleep need and duration as morning types, and evening types then attempt to make up for that lost weekday sleep on the weekends. Studies of sleep need and sleep duration should take chronotype into account, and studies of chronotype may be confounded by the association between age and morningness, and must account for this potential confound in selection criteria and/or analysis.
morningness–eveningness; diurnal type; circadian
Wrist actigraphy measures sleep activity and circadian rhythm. This study examined nighttime variability in Actiwatch parameters in a sample of breast cancer survivors (BCSs) to determine a minimum number of nights needed to obtain an accurate picture of objective sleep. A descriptive, quantitative, and repeated measures design was used. Consenting participants wore an actigraph and completed a sleep diary across 7 nights. There were no significant differences in wake after sleep onset (WASO), total sleep time (TST), sleep latency, or sleep disturbances across nights of week (Monday to Sunday) or monitoring nights (1st to 7th). Sleep efficiency was significantly better at Night 6 compared with Night 7. The coefficients of variation (CVs) for WASO ranged from 46% to 86%, TST 23%–34%, sleep latency 154%–246%, sleep efficiency 12%–22%, and sleep disturbances 33%–41%. Although the CVs indicated high variability across women, there was little internight variability in WASO or TST during across 7 nights of sleep. This suggests that in BCSs, Actiwatch data could be collected and evaluated from any single night for an accurate measure of usual sleep.
sleep; actigraphy; breast cancer; circadian rhythm; survivors
To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep.
The sleep of 187 adults (41% Black; mean age = 59.5 ± 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, and architecture; self-report was used to assess sleep quality. Psychosocial factors, health behaviors, and environmental factors were also measured.
Blacks had shorter sleep duration and lower sleep efficiency, as measured by actigraphy and PSG, and they spent less time proportionately in Stage 3 to 4 sleep, compared with others (p < .01). Lower SES was associated with longer actigraphy-measured latency, more wake after sleep onset as measured by PSG, and poorer sleep quality on the Pittsburgh Sleep Quality Index (p < .05).
Blacks and perhaps individuals in lower SES groups may be at risk for sleep disturbances and associated health consequences.
race; socioeconomic status; sleep; polysomnography; actigraphy
Sleep disturbances are common in Parkinson's disease (PD). Actigraphy has emerged as an alternative to polysomnography to measure sleep, raising the question of its ability to capture sleep quality in PD patients. Our aim was to compare self-report data with actigraphic data and to examine associations with clinical variables. Thirty non-demented individuals with PD and 14 normal control participants (NC) were included. Sleep was measured using 24-hour wrist actigraphy over a seven-day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the Parkinson's Disease Sleep Scale, and Epworth Sleepiness Scale. Patients with PD presented with more sleep problems than NC. In NC, none of the actigraphic sleep variables were related to any of the self-report measures of sleep. In PD, scores on subjective sleep measures correlated with actigraphy-derived estimates of sleep quality. Our results suggest that actigraphy is an appropriate method of measuring sleep quality in PD.
Parkinson's disease; sleep; actigraphy; subjective sleep ratings
Self-reported short sleep duration is linked to higher blood pressure and incident hypertension in adults. Few studies have examined sleep and blood pressure in younger samples. We evaluated the associations between actigraphy-assessed time spent asleep and ambulatory blood pressure in adolescents. Participants were 246 black and white adolescents (mean age = 15.7) who were free from cardiovascular or kidney disease and were not taking sleep, cardiovascular, or psychiatric medications. Sleep duration and efficiency were assessed with in-home wrist actigraphy and sleep diaries across one week; ambulatory blood pressure monitoring was used to obtain 24-hour, sleep, wake blood pressure, and sleep-wake blood pressure ratios across two full days and nights. Results showed that shorter actigraphy-assessed sleep across one week was related to higher 48-hour blood pressure and higher nighttime blood pressure. Shorter sleep was also related to a higher systolic blood pressure sleep-wake ratio. These results were independent of age, race, sex, and body mass index. Follow-up analyses by race revealed that associations between sleep duration and blood pressure were largely present in white, but not black, adolescents. These data are consistent with the hypothesis that the cardiovascular consequences of short sleep may begin as early as adolescence.
ambulatory blood pressure; sleep duration; actigraphy; adolescent; race
Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.
Patients and methods
Eighty five women with Stages I–IIIA breast cancer who were scheduled to begin adjuvant or neo-adjuvant anthracycline-based chemotherapy participated. Each had sleep/wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.
On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01).
The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.
Fatigue; Sleep; Circadian rhythms; Quality of life; Breast cancer; CES-D: Center for Epidemiological Studies-Depression scale; CI: Confidence Intervals; FACT-B: Functional Assessment of Cancer Therapy-Breast; FOSQ: Functional Outcome of Sleep Questionnaire; MFSI-SF: Multidimensional Fatigue Symptom Inventory-Short Form; PSQI: Pittsburgh Sleep Quality Index
A survey on sleep schedule, sleep health, school performance and school start times was conducted in 1,941 adolescents. A high level of early and circadian-disadvantaged sleep/wake schedules during weekdays was observed. Shorter sleep duration on weekdays was reported, especially in upper classmen. Complaints of inadequate sleep and sleepiness during weekdays, alarm clock use, and napping were prevalent. Night awakening and prolonged sleep onset were common and associated with poor school performance. Students with a sleep length of less than 7 hours on both weekdays and weekends exhibited poorer performance, while those who made up this sleep loss on weekends did not. The total number of poor sleep factors in an individual also correlated with poor school performance. Earlier school start times were associated with a perception of poor sleep quality, shorter sleep duration and more sleep health problems. We conclude that sleep inadequacies and sleep health problems were prevalent in this population, especially in those who started school earlier in the morning, and that these poor sleep factors were associated with school performance.
sleep deprivation; sleep health problem; adolescents; performance; school start time
To test the effects of walking, light exposure, and a combination intervention (walking plus light plus sleep education) on the sleep of persons with Alzheimer’s disease (AD).
Randomized, controlled trial with blinded assessors.
Independent community living.
132 AD patients and their in-home caregivers.
Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control. Participants received three or six in-home visits.
Primary outcomes were patient total wake time based on wrist actigraphy, and caregiver ratings of patient sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of patient sleep percent, number of awakenings, and total sleep time.
Patients in walking (p<.05), light (p<.04), and combination treatment (p<.01) had significant improvements in total wake time at post-test (effect size 0.51 – 0.63) compared to control subjects, but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percent were also observed in active treatment subjects. There were no significant differences between active treatment groups, and no group differences for any sleep outcomes at six months. Patients with greater adherence (4+ days/week) to walking and light exposure recommendations had significantly (p<.05) less total wake time and better sleep efficiency at post-test than those with lesser adherence.
Walking, light exposure and the combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.
Sleep; Alzheimer’s disease; walking; light; adherence
To examine whether sleep duration and quality are associated with fasting glucose, fasting insulin, or estimated insulin resistance in a community-based sample of early middle-aged adults.
RESEARCH DESIGN AND METHODS
This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Habitual sleep duration and fragmentation were estimated from 6 days of wrist actigraphy collected in 2003–2005. Insomnia was defined as self-reported difficulty falling asleep or waking up in the night three or more times per week plus average sleep efficiency of <80% based on actigraphy. Fasting blood samples to measure glucose and insulin were collected after the sleep measures during the CARDIA clinical examination in 2005–2006. Insulin resistance was estimated using the homeostatic model assessment (HOMA) method. Analyses were cross-sectional and stratified by the presence of diabetes.
There was no association between sleep measures and fasting glucose, insulin, or HOMA in the 115 subjects without diabetes. Among the 40 subjects with diabetes, after adjustment for covariates, 10% higher sleep fragmentation was associated with a 9% higher fasting glucose level, a 30% higher fasting insulin level, and a 43% higher HOMA level. Insomnia was associated with a 23% higher fasting glucose level, a 48% higher fasting insulin level, and an 82% higher HOMA level.
The observed association between poor sleep quality and higher glucose, insulin, and estimated insulin resistance among subjects with diabetes warrants further examination of the effect of sleep disturbances on glucose control in type 2 diabetes.
Night work is associated with disturbed sleep and wakefulness, particularly in relation to the night shift. Circadian rhythm sleep disorders are characterized by complaints of insomnia and excessive daytime sleepiness that are primarily due to alterations in the internal circadian timing system or a misalignment between the timing of sleep and the 24-h social and physical environment.
We evaluated the effect of oral intake of 5 mg melatonin taken 30 minutes before night time sleep on insomnia parameters as well as subjective sleep onset latency, number of awakenings, and duration of sleep. A double-blind, randomized, placebo-controlled crossover study with periods of 1 night and washouts of 4 days comparing melatonin with placebo tablets was conducted. We tried to improve night-time sleep during recovery from night work. Participants were 86 shift-worker nurses aged 24 to 46 years. Each participant completed a questionnaire immediately after awakening.
Sleep onset latency was significantly reduced while subjects were taking melatonin as compared with both placebo and baseline. There was no evidence that melatonin altered total sleep time (as compared with baseline total sleep time). No adverse effects of melatonin were noted during the treatment period.
Melatonin may be an effective treatment for shift workers with difficulty falling asleep.
To describe sleep characteristics in high-risk antepartum inpatients.
Prospective descriptive design.
Tertiary hospital in southern California.
A convenience sample of 39 antepartum women.
Data were collected from participants' medical records, questionnaires (General Sleep Disturbance Scale [GSDS]), actigraphy on days 3-4 after admission, and a sleep diary that included reasons for awakening and morning and evening fatigue ratings.
Weeks gestation ranged from 24-35 weeks. Sleep time varied from 310-492 minutes and averaged 6.7 hours/night. The women were awakened 9-32 times/night and averaged 18 awakenings. They napped an average of 124 minutes throughout the day. Women averaged 3.9 on the GSDS when retrospectively considering 7 days prior to hospitalization and scored 4.1 when considering the current 3 days of hospitalization. In the diary, most rated their sleep quality as Fairly Good or Very Good (62-71%), but 29% said Very Bad on night 2, and 38% said Very Bad on night 3.
Frequent interruptions during the night do not allow for mothers to receive the restorative sleep they need.
Sleep; Antepartum; Hospitalized
Sleep disturbances in late pregnancy are common. This study aimed to survey sleep problems in third trimester pregnant women and to compare sleep in the pre-pregnancy period with the third trimester.
Third-trimester women (n=650) were sent a postal survey containing questions relating to sleep experience, including perceived sleep quality, sleep difficulties, night waking, sleep environment, snoring, daytime tiredness and daytime napping. Time periods reported on were before pregnancy and in the last week.
Respondents numbered 244 (38%). Before pregnancy, the mean reported duration of night-time sleep was 8.1 (SD 1.1) hours; in the last week this had decreased to 7.5 (SD 1.8) hours (p<.0001). Only 29% rated their sleep quality in the last week as very good or fairly good, compared with 82% rating their sleep this way before the pregnancy. The main reasons for sleeping difficulties were discomfort (67%) and pain (36%). Snoring increased significantly over the course of the pregnancy, with 37% reporting snoring often or every night in the last week. Those with a pre-pregnancy body mass index of greater than 25 were significantly more likely to snore (p=.01). Only 4% of women had an abnormal Epworth Sleepiness Scale score (i.e. >10) prior to pregnancy, whereas in the last week 33% scored in the abnormal range. Likewise, 5% had regularly napped during the daytime before pregnancy, compared with 41% in the last week.
Sleep problems are common in women in late pregnancy, and increase markedly compared with before pregnancy.
Pregnancy; Sleep disturbances; Sleep quality; Snoring; Daytime sleepiness
BACKGROUND--The combined use of wrist actigraphic assessment and self assessment of sleep in the screening of obstructive sleep apnoea syndrome was evaluated in a community based sample. METHODS--One hundred and sixteen community based subjects clinically suspected of having obstructive sleep apnoea (syndrome) were evaluated by means of simultaneous ambulatory recording of respiration (oronasal flow thermistry), motor activity (wrist actigraphy), and subjective sleep (sleep log) during one night of sleep. RESULTS--The subjects were distributed according to their apnoea index (AI); AI < 1 (non-apnoeic snorers) 44%; AI 1- < 5 39%; and AI > or = 5 17%. High apnoea index values were associated with self reported disturbed sleep initiation and more fragmented and increased levels of motor activity and decreased duration of immobility periods, particularly in those with an apnoea index of > or = 5. Across subjects the duration of immobility periods was the only predictor of the apnoea index, explaining 11% of its variance. Use of the multiple regression equation to discriminate retrospectively between those with an apnoea index of < 1 and > or = 5 resulted in sensitivity and specificity values of 75% and 43%, and 5% and 100%, respectively. CONCLUSIONS--The combined use of a sleep log and actigraphic assessment of sleep failed to identify reliably those subjects who suffered from obstructive sleep apnoea (syndrome) in a sample of community based subjects reporting habitual snoring combined with excessive daytime sleepiness and/or nocturnal respiratory arrests.
Test the hypothesis that sleep disturbances are independently associated with greater evidence of frailty in older men.
Cross-sectional analysis of prospective cohort study
Six U.S. centers
3133 men ≥67 years
Self reported sleep parameters (questionnaire); objective parameters of sleep wake patterns (actigraphy data collected for an average of 5.2 nights); and objective parameters of sleep disordered breathing, nocturnal hypoxemia, and periodic leg movements with arousals (PLMA) (in-home overnight polysomnography). Frailty status classified as robust, intermediate stage or frail using criteria similar to those used in the Cardiovascular Health Study frailty index.
The prevalence of sleep disturbances including poor sleep quality, excessive daytime sleepiness, short sleep duration, reduced sleep efficiency, prolonged sleep latency, sleep fragmentation (greater nighttime wakefulness and frequent long wake episodes), sleep disordered breathing, nocturnal hypoxemia and frequent PLMA was lowest among robust men, intermediate among men in the intermediate stage group, and highest among frail men (p-for-trend ≤0.002 for all sleep parameters). After adjusting for multiple potential confounders, self-reported poor sleep quality (Pittsburgh Sleep Quality Index <5, multivariable odds ratio (MOR) 1.28, 95%CI 1.09–1.50), sleep efficiency <70% (MOR 1.37, 95% CI 1.12–1.67), sleep latency ≥60 minutes (MOR 1.42, 95% CI 1.10–1.82), and sleep disordered breathing (respiratory disturbance index ≥15, MOR 1.38, 95% CI 1.15–1.65) were each independently associated with an increased odds of greater frailty status.
Sleep disturbances including poor self-reported sleep quality, reduced sleep efficiency, prolonged sleep latency and sleep disordered breathing are independently associated with greater evidence of frailty.
sleep disturbances; frailty; aging
A limited body of evidence suggests that sleep problems are common in prostate cancer patients undergoing androgen deprivation therapy, yet little is known about sleep characteristics and the effects of poor sleep on daily functioning in this population. This study assessed sleep in 60 prostate cancer patients taking androgen deprivation therapy with wrist actigraphy and daily diaries for 7 days. The Epworth Sleepiness Scale and the general version of the Functional Assessment of Cancer Therapy scale were also administered. On average, total sleep time was 5.9 (SD = 1.4) hours, and sleep efficiency was 75.0 percent (SD = 12.0) as assessed by actigraphy. There was generally poor concordance between actigraphy and daily diary for most sleep metrics. Subjects reported awakening, on average, 2.7 times per night, most commonly for nocturia and hot flashes. Assessment of daily functioning showed that participants had mild daytime sleepiness, which was predicted by total sleep time (F(1,47) = 4.5, p = .04). General quality of life was not impaired. This study supports more research on the predictors of poor sleep in order to identify effective interventions.
Prostate cancer; hormonal therapy; sleep; actigraphy; nocturia
Goals of Work
To characterize sleep quality and quantity prior to and in the first 3 nights after initial chemotherapy for breast cancer.
Patients and Methods
Secondary analysis of data from two separate randomized clinical trials (RCT) of behavioral interventions to improve fatigue and sleep. Patients came from two comprehensive cancer centers, three clinical cancer centers, and 10 community clinics in five states. Participants were women with stage I-IIIA breast cancer treated with anthracycline and/or cyclophosphamide based regimens.
Baseline data from each RCT were used in the analysis. Sixty-five percent of women self-reported poor sleep in the month preceding chemotherapy using the Pittsburgh Sleep Quality Index (PSQI) score >5. Three nights of actigraphy data indicated a wide range of sleep experience with an average of 10 awakenings and time (minutes) awake after sleep onset (WASO-M) averaging 61 minutes per night. The first night’s sleep was the worst. There was no statistically significant relationship between self-reported poor sleep and sleep measures obtained by actigraphy. Women with poor sleep at baseline (global PSQI >5) had significantly lower (p<.001) physical (MOS PCS) and mental (MOS MCS) health status. However neither the PCS nor MCS was associated with any of the average actigraphy sleep parameters or Night 1 parameters in the aggregated sample. Increasing age was also associated with poorer sleep.
A high percent of women with breast cancer begin chemotherapy with disturbed sleep and the initial nights after chemotherapy are characterized by sleep fragmentation that disrupts sleep maintenance. Interventions should focus on strategies to decrease the number and duration of night awakenings. Further research is needed to identify predictors of poor sleep during this time.
sleep; chemotherapy; breast cancer; actigraphy; neoplasm; function
Sleep was studied in nine patients for two to four days after major non-cardiac surgery by continuous polygraphic recording of electroencephalogram, electrooculogram, and electromyogram. Presumed optimal conditions for sleep were provided by a concerted effort by staff to offer constant pain relief and reduce environmental disturbance to a minimum. All patients were severely deprived of sleep compared with normal. The mean cumulative sleep time (stage 1 excluded) for the first two nights, daytime sleep included, was less than two hours a night. Stages 3 and 4 and rapid eye movement sleep were severely or completely suppressed. The sustained wakefulness could be attributed to pain and environmental disturbance to only minor degree. Sleep time as estimated by nursing staff was often grossly misjudged and consistently overestimated when compared with the parallel polygraphic recording. The grossly abnormal sleep pattern observed in these patients may suggest some fundamental disarrangement of the sleep-wake regulating mechanism.
Abrupt discontinuation of heavy marijuana (MJ) use is associated with self-reports of sleep difficulty. Disturbed sleep is clinically important because MJ users experiencing sleep problems may relapse to MJ use to improve their sleep quality. Few studies have used polysomnography (PSG) to characterize changes in sleep architecture during abrupt abstinence from heavy MJ use.
We recorded PSG measures on Nights 1, 2, 7, 8, and 13 after abrupt MJ discontinuation in 18 heavy MJ users residing in an inpatient unit.
Across abstinence, Total Sleep Time (TST), Sleep Efficiency (SEff), and amount of REM sleep declined, while Wake after Sleep Onset (WASO) and Periodic Limb Movements (PLM) increased. Furthermore, quantity (joints/week) and duration (years) of MJ use were positively associated with more PLMs.
The treatment of sleep disturbance is a potential target for the management of cannabis use disorders since poor sleep could contribute to treatment failure in heavy MJ users.
sleep; polysomnography; periodic leg movements; marijuana; abstinence; substance abuse; withdrawal
Elevated night time/daytime blood pressure (BP) ratios are associated with cardiovascular morbidity and mortality. We evaluated the associations between sleep/awake BP ratios and sleep disturbances.
Sleep disturbances were assessed by in-home actigraphy and diary measures for nine nights, and polysomnography (PSG) for two nights; ambulatory BP was measured for at least 48 h. Participants were 186 middle-aged African-American and Caucasian men and women who were free from prevalent myocardial infarction, stroke, history of interventional cardiology procedures, diabetes, and diagnosed apnea or other sleep disorders.
Results showed that the greater the sleep/wake ratios of BP, the more fragmented the sleep, the greater the proportion in stage 1 (light) sleep and the smaller the proportion in rapid eye movement (REM) sleep, and the greater the number of arousals from sleep. These results were independent of age, race, gender, Framingham Risk status, cardiovascular medications, body mass index, and apnea/hypopnea index. Indicators of psychosocial stress were not greater among those with higher sleep/wake BP ratios.
Findings are consistent with the hypothesis that elevated night time/daytime pressure may be a consequence of poor sleep.
To test the effects of nightly valerian (Valeriana officinalis) extract to improve sleep of older women with insomnia.
Participants in this phase 2 randomized, double-blind, cross-over controlled trial were 16 older women (mean age = 69.4 ± 8.1 years) with insomnia. Participants took 300 mg of concentrated valerian extract or placebo 30 minutes before bedtime for two weeks. Sleep was assessed in the laboratory by self-report and polysomnography (PSG) at baseline and again at the beginning and end of each treatment phase (total of 9 nights in the laboratory) and at home by daily sleep logs and actigraphy.
There were no statistically significant differences between valerian and placebo after a single dose or after two weeks of nightly dosing on any measure of sleep latency, wake after sleep onset (WASO), sleep efficiency, and self-rated sleep quality. In comparing each treatment to baseline in separate comparisons, WASO significantly increased (+17.7 ± 25.6 min, p=.02) after two weeks of nightly valerian, but not after placebo (+6.8 ± 26.4 min, NS). Side effects were minor and did not differ significantly between valerian and placebo.
Valerian did not improve sleep in this sample of older women with insomnia. Findings from this study add to the scientific evidence that does not support use of valerian in the clinical management of insomnia.
Valerian; women; aging; phytotherapy; sleep; insomnia; complementary therapies; alternative medicine
It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call.
Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons.
Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p < 0.001). Scores for mental fatigue and feeling well rested were poorer post-call, but returned to Sunday morning levels after two nights' sleep.
Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.
Sleep restriction, leading to deprivation of sleep, is common in modern 24-h societies and is associated with the development of health problems including cardiovascular diseases. Our objective was to investigate the immunological effects of prolonged sleep restriction and subsequent recovery sleep, by simulating a working week and following recovery weekend in a laboratory environment.
Methods and Findings
After 2 baseline nights of 8 hours time in bed (TIB), 13 healthy young men had only 4 hours TIB per night for 5 nights, followed by 2 recovery nights with 8 hours TIB. 6 control subjects had 8 hours TIB per night throughout the experiment. Heart rate, blood pressure, salivary cortisol and serum C-reactive protein (CRP) were measured after the baseline (BL), sleep restriction (SR) and recovery (REC) period. Peripheral blood mononuclear cells (PBMC) were collected at these time points, counted and stimulated with PHA. Cell proliferation was analyzed by thymidine incorporation and cytokine production by ELISA and RT-PCR. CRP was increased after SR (145% of BL; p<0.05), and continued to increase after REC (231% of BL; p<0.05). Heart rate was increased after REC (108% of BL; p<0.05). The amount of circulating NK-cells decreased (65% of BL; p<0.005) and the amount of B-cells increased (121% of BL; p<0.005) after SR, but these cell numbers recovered almost completely during REC. Proliferation of stimulated PBMC increased after SR (233% of BL; p<0.05), accompanied by increased production of IL-1β (137% of BL; p<0.05), IL-6 (163% of BL; p<0.05) and IL-17 (138% of BL; p<0.05) at mRNA level. After REC, IL-17 was still increased at the protein level (119% of BL; p<0.05).
5 nights of sleep restriction increased lymphocyte activation and the production of proinflammatory cytokines including IL-1β IL-6 and IL-17; they remained elevated after 2 nights of recovery sleep, accompanied by increased heart rate and serum CRP, 2 important risk factors for cardiovascular diseases. Therefore, long-term sleep restriction may lead to persistent changes in the immune system and the increased production of IL-17 together with CRP may increase the risk of developing cardiovascular diseases.