Sleep, vigilance, and thermosensitivity

A 90- followed by a 30-min nap reduces fatigue whereas a 30- followed by a 90-min nap maintains cognitive performance in night work: A randomized crossover-pilot study

OBJECTIVE

To investigate the effects of combinations of brief naps (a 90- followed by a 30-min nap vs. a 30- followed by a 90-min nap) on sleep inertia, reducing sleepiness and fatigue, and maintaining performance during night hours.

METHODS

This randomized, comparative, repeated-measure, cross-over study investigated subjective and cognitive performance in 12 healthy females, evaluated in three experimental nap conditions: 1) from 22:30 to 00:00 and 02:30 to 03:00 (Pre90-NAP group), 2) from 23:30 to 00:00 and 02:30 to 04:00 (Pre30-NAP) group, and 3) no naps (NO-NAP group). Participants' body temperature, psychomotor vigilance task (PVT) and Uchida-Kraepelin test (UKT) scores, and subjective feelings of drowsiness and fatigue were evaluated. Sleep state was determined by an actigraphy monitoring device worn by participants.

RESULTS

Regardless of timing, both 90-min naps were associated with sleep inertia, and both 30-min naps with minimal sleep inertia. Reaction times were shorter and fewer errors were committed at 2 h post-nap in the Pre30-NAP and Pre90-NAP groups compared with those at the same time in the NO-NAP group. Adding a 90-min nap to a 30-min nap reduced subjective fatigue and shortened reaction times, and adding a 30-min nap to a 90-min nap was effective in maintaining performance, suggesting a synergistic effect.

CONCLUSIONS

Taking two naps during a night work can mitigate sleepiness and fatigue, and maintain performance. A 90- followed by a 30-min nap reduced fatigue and reaction time, and a 30- followed by a 90-min nap maintained cognitive performance in the early morning.

A comparative study of algorithms detecting differential rhythmicity in transcriptomic data

Rhythmic transcripts play pivotal roles in driving the daily oscillations of various biological processes. Genetic or environmental disruptions can lead to alterations in the rhythmicity of transcripts, ultimately impacting downstream circadian outputs, including metabolic processes and even behavior. To statistically compare the differences in transcript rhythms between two or more conditions, several algorithms have been developed to analyze circadian transcriptomic data, each with distinct features. In this study, we compared the performance of seven algorithms that were specifically designed to detect differential rhythmicity. We found that even when applying the same statistical threshold, these algorithms yielded varying numbers of differentially rhythmic transcripts. Nevertheless, the set of transcripts commonly identified as differentially rhythmic exhibited substantial overlap among algorithms. Furthermore, the phase and amplitude differences calculated by these algorithms displayed significant correlations. In summary, our study highlights a high degree of similarity in the results produced by these algorithms. Furthermore, when selecting an algorithm for analysis, it is crucial to ensure the compatibility of input data with the specific requirements of the chosen algorithm and to assess whether the algorithm's output fits the needs of the user.

Effects of 90- and 30-min naps or a 120-min nap on alertness and performance: reanalysis of an existing pilot study

The aim of this study was to investigate alertness and cognitive performance immediately after and until the end of the night shift after taking a 120-min monophasic nap (One-nap) or a split 90-min and 30-min nap (Two-nap) during a 16-h simulated night shift, and the relationship between sleep quality and both alertness and performance. This study was performed in 41 females. Among them, 15 participants were included in the No-nap group, 14 in the One-nap group (22:00-00:00), and 12 in the Two-nap group (22:30-00:00 and 02:30-03:00). Participants were tested every hour from 16:00 to 09:00 for performance on the Uchida-Kraepelin test, as well as for subjective feelings of fatigue and drowsiness, body temperature, and heart rate variability. The shorter the sleep latency, the worse the alertness immediately after the 90-min nap. The 120-min and 30-min naps also revealed that prolonged total sleep time led to increased fatigue and drowsiness upon awakening. From 04:00 to 09:00, in the No-nap and One-nap groups, fatigue was higher than in the Two-nap group. The One-nap and Two-nap groups did not show improved morning performance. These results suggest that a split nap might improve drowsiness and fatigue during a long night shift.

Catastrophizing and Hypervigilance Influence Subjective Sleep Quality in Painful TMD Patients

Aims: To determine sleep quality and associated factors in a group of patients with painful TMDs. Methods: The medical records of 80 patients with arthralgia and/or myofascial pain were reviewed and compared to a healthy control group. Data about sex, age, subjective pain, physical activity, social activity, subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), and pain catastrophizing (Pain Catastrophizing Scale [PCS]) were collected. Relationships between PSQI, age, pain intensity, PVAQ, and PCS in the TMD group were also analyzed. Data from the control group were used to transform the PSQI results into T-scores, which were then used to divide the TMD group into two subgroups: normal and impaired sleep. Results: TMD patients presented a significantly higher (P < .001) PSQI score than the control group. Also, in the TMD group, there was a low to moderate correlation between PSQI and pain intensity and a significant correlation between PVAQ and PCS. The impaired sleep group presented a significantly higher (P < .001) PSQI T-score than the normal sleep group. Univariate analysis showed that subjective pain, social activity, and the PCS total and subscale scores differed significantly between the different PSQI T-score groups. The comparison between TMD pain patients and control subjects showed a significantly higher prevalence of T-score discordance in almost all PSQI components in TMD patients with impaired sleep. Conclusion: Subjective sleep quality in painful TMD patients could be associated with and influenced by psychosocial factors (catastrophizing and hypervigilance), social activity, and pain intensity.

Development and Initial Validation of the Assessment of Sleep Environment (ASE): Describing and Quantifying the Impact of Subjective Environmental Factors on Sleep

The purpose of this study was to develop and test the reliability and validity of a 13-item self-report Assessment of Sleep Environment (ASE). This study investigates the relationship between subjective experiences of environmental factors (light, temperature, safety, noise, comfort, humidity, and smell) and sleep-related parameters (insomnia symptoms, sleep quality, daytime sleepiness, and control over sleep). The ASE was developed using an iterative process, including literature searches for item generation, qualitative feedback, and pilot testing. It was psychometrically assessed using data from the Sleep and Healthy Activity Diet Environment and Socialization (SHADES) study (N = 1007 individuals ages 22-60). Reliability was determined with an internal consistency and factor analysis. Validity was evaluated by comparing ASE to questionnaires of insomnia severity, sleep quality, daytime sleepiness, sleep control, perceived stress, and neighborhood disorder. The ASE demonstrated high internal consistency and likely reflects a single factor. ASE score was associated with insomnia symptoms (B = 0.09, p < 0.0001), sleep quality (B = 0.07, p < 0.0001), and sleep control (B = -0.01, p < 0.0001), but not daytime sleepiness. The ASE was also associated with perceived stress (B = 0.20, p < 0.0001) and neighborhood disorder (B = -0.01, p < 0.0001). Among sleep environment factors, only smell was not associated with sleep quality; warmth and safety were negatively associated with sleepiness; and of the sleep environment factors, only light/dark, noise/quiet, and temperature (warm/cool) were not associated with insomnia symptoms. The ASE is a reliable and valid measure of sleep environment. Physical environment (light, temperature, safety, noise, comfort, humidity, and smell) was associated with insomnia symptoms and sleep quality but not sleepiness.

Heart rate variability, thyroid hormone concentration, and neuropsychological responses in Brazilian navy divers: a case report of diving in Antarctic freezing waters

Open-water diving in a polar environment is a psychophysiological challenge to the human organism. We evaluated the effect of short-term diving (i.e., 10 min) in Antarctic waters on autonomic cardiac control, thyroid hormone concentration, body temperatures, mood, and neuropsychological responses (working memory and sleepiness). Data collection was carried out at baseline, before, and after diving in four individuals divided into the supporting (n=2) and diving (n=2) groups. In the latter group, autonomic cardiac control (by measuring heart rate variability) was also assessed during diving. Diving decreased thyroid-stimulating hormone (effect size = 1.6) and thyroxine (effect size = 2.1) concentrations; these responses were not observed for the supporting group. Diving also reduced both the parasympathetic (effect size = 2.6) and sympathetic activities to the heart (ES > 3.0). Besides, diving reduced auricular (effect size > 3.0), skin [i.e., hand (effect size = 1.2) and face (effect size = 1.5)] temperatures compared to pre-dive and reduced sleepiness state (effect size = 1.3) compared to basal, without changing performance in the working memory test. In conclusion, short-term diving in icy waters affects the hypothalamic-pituitary-thyroid axis, modulates autonomic cardiac control, and reduces body temperature, which seems to decrease sleepiness.

Turn it off and on again: characteristics and control of torpor

Torpor is a hypothermic, hypoactive, hypometabolic state entered into by a wide range of animals in response to environmental challenge. This review summarises the current understanding of torpor. We start by describing the characteristics of the wide-ranging physiological adaptations associated with torpor. Next follows a discussion of thermoregulation, control of food intake and energy expenditure, and the interactions of sleep and thermoregulation, with particular emphasis on how those processes pertain to torpor. We move on to review the evidence for the systems that control torpor entry, including both the efferent circulating factors that signal the need for torpor, and the central processes that orchestrate it. Finally, we consider how the putative circuits responsible for torpor induction integrate with the established understanding of thermoregulation under non-torpid conditions and highlight important areas of uncertainty for future studies.

Median preoptic GABA and glutamate neurons exert differential control over sleep behavior

Previous studies suggest that the median preoptic nucleus (MnPO) of the hypothalamus plays an important role in regulating the wake-sleep cycle and, in particular, homeostatic sleep drive. However, the precise cellular phenotypes, targets, and central mechanisms by which the MnPO neurons regulate the wake-sleep cycle remain unknown. Both excitatory and inhibitory MnPO neurons innervate brain regions implicated in sleep promotion and maintenance, suggesting that both cell types may participate in sleep control. Using genetically targeted approaches, we investigated the role of the MnPO GABAergic (MnPO^Vgat) and glutamatergic (MnPO^Vglut2) neurons in modulating wake-sleep behavior of mice. We found that both neuron populations differentially participate in wake-sleep control, with MnPO^Vgat neurons being involved in sleep homeostasis and MnPO^Vglut2 neurons facilitating sleep during allostatic (stressful) challenges.

Functional links between thermoregulation and sleep in children with neurodevelopmental and chronic health conditions

The bi-directional relationship between sleep and wake is recognized as important for all children. It is particularly consequential for children who have neurodevelopmental disorders (NDDs) or health conditions which challenge their sleep and biological rhythms, and their ability to maintain rhythms of participation in everyday activities. There are many studies which report the diverse reasons for disruption to sleep in these populations. Predominantly, there is focus on respiratory, pharmaceutical, and behavioral approaches to management. There is, however, little exploration and explanation of the important effects of body thermoregulation on children's sleep-wake patterns, and associated behaviors. Circadian patterns of sleep-wake are dependent on patterns of body temperature change, large enough to induce sleep preparedness but remaining within a range to avoid sleep disturbances when active thermoregulatory responses against heat or cold are elicited (to maintain thermoneutrality). Additionally, the subjective notion of thermal comfort (which coincides with the objective concept of thermoneutrality) is of interest as part of general comfort and associated behavioral responses for sleep onset and maintenance. Children's thermoregulation and thermal comfort are affected by diverse biological functions, as well as their participation in everyday activities, within their everyday environments. Hence, the aforementioned populations are additionally vulnerable to disruption of their thermoregulatory system and their capacity for balance of sleep and wakefulness. The purpose of this paper is to present hitherto overlooked information, for consideration by researchers and clinicians toward determining assessment and intervention approaches to support children's thermoregulation functions and promote their subjective thermal comfort, for improved regulation of their sleep and wake functions.

Turn it off and on again: characteristics and control of torpor

Torpor is a hypothermic, hypoactive, hypometabolic state entered into by a wide range of animals in response to environmental challenge. This review summarises the current understanding of torpor. We start by describing the characteristics of the wide-ranging physiological adaptations associated with torpor. Next follows a discussion of thermoregulation, control of food intake and energy expenditure, and the interactions of sleep and thermoregulation, with particular emphasis on how those processes pertain to torpor. We move on to take a critical view of the evidence for the systems that control torpor entry, including both the efferent circulating factors that signal the need for torpor, and the central processes that orchestrate it. Finally, we consider how the putative circuits responsible for torpor induction integrate with the established understanding of thermoregulation under non-torpid conditions and highlight important areas of uncertainty for future studies.

Effects of a snack on performance and errors during a simulated 16-h night shift: A randomized, crossover-controlled, pilot study

BACKGROUND

Night shift workers might not eat due to their busy schedules during the night shift. However, food may not only satisfy hunger, but also affect performance and errors. The aim of this study was to clarify the effect of a snack on performance and errors during 2-day, 16-h, simulated night shifts.

METHODS

A randomized, repeated-measure, crossover study was performed to investigate subjective and cognitive performance in 15 healthy female adults (mean age, 21.7 years) after they consumed a snack (352 kcal) during a simulated night shift (16:00 to 09:00) from October to November 2018. The participants were kept awake from waking up in the morning to the next day at 09:00. Subjects were tested for performance on the Uchida-Kraepelin test, as well as for subjective feeling, body temperature, psychomotor vigilance test, and heart rate variability, before and after they consumed the snack. One day before the experiment, all participants wore an actigraphy monitoring device to determine their sleep state.

RESULTS

There was no difference between having (Snack condition) and not having (Skipping condition) the snack in sleep states the day before the experiment. On the day of the experiment, between 16:00 and 09:00, subjective sleepiness, fatigue, and body temperature were not different between the two conditions. Subjects maintained performance on the Uchida-Kraepelin test and showed a significant improvement in false starts on the psychomotor vigilance test, the primary outcome measure, in the Snack condition compared with the Skipping condition. The Snack condition was also associated with decreased high-frequency power, a decreased low-frequency power/high-frequency power ratio, and increased heart rate in the vagally mediated heart rate variability indices, which may reflect a higher ability to modulate cognitive and behavioral processes.

CONCLUSIONS

These results suggest that providing a snack to shift workers during night shifts might improve work safety and efficiency.

Human thermal perception and time of day: A review

The circadian clock regulates diurnal variations in autonomic thermoregulatory processes such as core body temperature in humans. Thus, we might expect that similar daily fluctuations also characterize human thermal perception, the ultimate role of which is to drive thermoregulatory behaviors. In this paper, we explore this question by reviewing experimental and observational thermal comfort investigations which include the "time of day" variable. We found only 21 studies considering this factor, and not always as their primary analysis. Due to the paucity of studies and the lack of a specific focus on time-of-day effects, the results are difficult to compare and appear on the whole contradictory. However, we observe a tendency for individuals to prefer higher ambient temperatures in the early evening as compared to the rest of the day, a result in line with the physiological decrease of the core body temperature over the evening. By drawing from literature on the physiology of thermoregulation and circadian rhythms, we outline some potential explanations for the inconsistencies observed in the findings, including a potential major bias due to the intensity and spectrum of the selected light conditions, and provide recommendations for conducting future target studies in highly-controlled laboratory conditions. Such studies are strongly encouraged as confirmed variations of human thermal perceptions over the day would have enormous impact on building operations, thus on energy consumption and occupant comfort. List of abbreviations: TSV: Thermal Sensation Vote; TCV: Thermal Comfort Vote; Tpref: Preferred Temperature; TA: Indoor Air Temperature; RH: Indoor Relative Humidity; Tskin: Skin Temperature; Tty: Tympanic Temperature; Tre: Rectal Temperature; Toral: Oral Temperature.

Using Theoretical Domains Framework for Exploring Appropriate Sitting Posture Determinants Among Office Workers: A Content Analysis Study

Background: Sedentary occupations frequently expose employees to prolonged periods with poor posture, which has been considered as the cause of musculoskeletal disorder. Objectives: The study set out to identify the related factors of a taking healthy sitting posture in office workers. Methods: This qualitative study aimed to use the theoretical domains framework (TDF) to investigate perceived determinants to taking a proper sitting posture in office workers. Semi-structured interviews with 25 office workers according to purposive sampling was conducted with a convenience sample of university office workers in Iran. Recorded interviews were transcribed into MAXQDA version 10. Directed content analysis and framework analysis were used for drawing the 12 domains of the TDF. Results: Explored themes were mapped onto the TDF domains, including skills, knowledge, behavioral regulation, goals, environmental context and resources, social influences, beliefs about capability, intentions, emotion, beliefs about consequences, memory, and attention and reinforcement. Conclusions: This study is a theoretical starting point in making structured interventions to change improper sitting posture among office workers. Also, the identified factors provide organizational managers with a wide list of factors by which they can encourage their employees to use proper postures in the workplace, leading to a significant reduction in job absenteeism and insurance fees associated with health problems. In addition, this study enriches the literature by providing additional empirical evidence for the TDF theory.

Skin Temperatures of Back or Neck Are Better Than Abdomen for Indication of Average Proximal Skin Temperature During Sleep of School-Aged Children

PURPOSE

The tight association between sleep, body temperature regulation, and patterns of skin temperature change highlights the necessity for accurate and valid assessment of skin temperatures during sleep. With increased interest in this functional relationship in infants and children, it is important to identify where to best measure proximal skin temperature and whether it is possible to reduce the number of sites of measures, in order to limit the experimental effects in natural settings. Thus, the aim of this study was to determine the most suitable single skin temperature sites for representation of average proximal skin temperature during sleep of school aged children.

METHODS

Statistical analyses were applied to skin temperature data of 22 children, aged 6 to 12 years, measured over four consecutive school nights in their home settings, to compare single site measures of abdomen, back, neck, forehead and subclavicular skin temperatures (local temperatures) with average proximal skin temperatures.

RESULTS

Abdomen and forehead skin temperatures were significantly different (respectively higher and lower) to the other local proximal temperatures and to average proximal skin temperatures. Moreover, the time pattern of forehead temperature was very different from that of the other local temperatures.

CONCLUSIONS

Local forehead and abdomen skin temperatures are least suitable as single site representations of average proximal skin temperatures in school aged children when considering both the level and the time course pattern of the temperature across the night. Conversely, back and neck temperatures provide most fitting representation of average proximal skin temperatures.

Brain mechanisms of insomnia: new perspectives on causes and consequences

While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.

Impact of Sleep Disorder as a Risk Factor for Dementia in Men and Women

Sleep is an essential physiological process, especially for proper brain function through the formation of new pathways and processing information and cognition. Therefore, when sleep is insufficient, this can result in pathophysiologic conditions. Sleep deficiency is a risk factor for various conditions, including dementia, diabetes, and obesity. Recent studies have shown that there are differences in the prevalence of sleep disorders between genders. Insomnia, the most common type of sleep disorder, has been reported to have a higher incidence in females than in males. However, sex/gender differences in other sleep disorder subtypes are not thoroughly understood. Currently, increasing evidence suggests that gender issues should be considered important when prescribing medicine. Therefore, an investigation of the gender-dependent differences in sleep disorders is required. In this review, we first describe sex/gender differences not only in the prevalence of sleep disorders by category but in the efficacy of sleep medications. In addition, we summarize sex/gender differences in the impact of sleep disorders on incident dementia. This may help understand gender-dependent pathogenesis of sleep disorders and develop therapeutic strategies in men and women.

Effects of sleep on a high-heat capacity mattress on sleep stages, EEG power spectra, cardiac interbeat intervals and body temperatures in healthy middle-aged men‡

Study Objectives

This study deals with the question whether a slow (non-disturbing) reduction of core body temperature (CBT) during sleep increases sleep stage N3 and EEG slow wave energy (SWE) and leads to a slowing of heart rate in humans.

Participants

Thirty-two healthy male subjects with a mean ± SD age 46 ± 4 years and body mass index 25.2 ± 1.8 kg/m2.

Methods

A high-heat capacity mattress (HM) was used to lower body temperatures in sleep and was compared to a conventional low-heat capacity mattress (LM) in a double-blinded fashion. Polysomnography was performed accompanied by measurements of skin-, core body- and mattress surface-temperatures, and heart rate. EEG power spectral analyses were carried out using Fast Fourier Transform. Interbeat intervals were derived from the electrocardiogram.

Results

The HM led to a larger decline in CBT, mediated through higher heat conduction from the core via the proximal back skin onto the mattress together with reduced heart rate. These effects occurred together with a significant increase in sleep stage N3 and standardized slow wave energy (sSWE, 0.791–4.297 Hz) accumulated in NREM sleep. In the 2nd half of the night sSWE increase was significantly correlated with body temperature changes, for example with CBT decline in the same phase.

Conclusions

A HM subtly decreases CBT, leading to an increased amount of sleep stage N3 and of sSWE, as well as a slowing of heart rate.

Lifestyle Choices and Brain Health

This article is largely based on the recommendations of the AARP's Global Council on Brain Health (GCBH) and aims to provide an overview of evidence from current literature and expert opinion on key elements known to be relevant in preserving brain health as people age. Although we realize that there may be other lifestyle choices of importance to brain health, the GCBH has decided to initially focus on the issues below based on the preferences and concerns of its members. The areas to be discussed are: mental well-being, exercise, cognitively stimulating activities, sleep, nutrition, and social connectedness. Our review concluded that each of these areas offer opportunities for aging individuals to make lifestyle adjustments to positively impact brain health.

The effects of a 120-minute nap on sleepiness, fatigue, and performance during 16-hour night shifts: A pilot study

Objective

To investigate sleepiness, fatigue, and performance following a 120‐minute nap during simulated 16‐hour night shifts based on subjective and objective assessments.

Methods

Fourteen females participated in this crossover comparative study. Three experimental nap conditions were used: naps from 22:00 to 00:00 (22‐NAP), 00:00 to 02:00 (00‐NAP), and 02:00 to 04:00 (02‐NAP), respectively. Measurement items were sleep parameters, sublingual temperature, a Visual Analog Scale for sleepiness and fatigue, a single‐digit mental arithmetic task (for 10 minutes), and heart rate variability. Participants wore an ActiGraph to estimate their sleep state.

Results

There was no difference in the sleep parameters at the time of naps among the three conditions. Immediately following a 120‐minute nap, sleepiness and fatigue increased, and the number of calculations performed in the single‐digit mental arithmetic task decreased in any of the conditions. In particular, immediately after the 02‐NAP, fatigue and high‐frequency power (HF) were higher than after the 22‐NAP. In the early morning (from 05:00 to 09:00), in the 22‐NAP, sleepiness and fatigue increased, and performance and sublingual temperature decreased more than in the 00‐NAP and 02‐NAP. Furthermore, the ratio of errors was significantly lower in the 00‐NAP than in the 22‐NAP in the early morning.

Conclusions

A 120‐minute nap taken from 22:00 to 02:00 may cause temporary sleepiness after waking, increase fatigue and reduce performance. Greater attention should be given to naps taken at a later time (ie, 02‐NAP). In addition, taking a nap starting at 00:00 might decrease the risks of errors in the morning.

Electroencephalographic and peripheral temperature dynamics during a prolonged psychomotor vigilance task

Attention lapses and fatigue are a main source of impaired performance that can lead to accidents. This study analyzed electroencephalographic (EEG) dynamics and body skin temperature as markers of attentional fluctuations in non-sleep deprived subjects during a 45min Psychomotor Vigilance Task (PVT). Independent Component Analysis and time-frequency analysis were used to evaluate the EEG data. Results showed a positive association between distal and distal-to-proximal gradient (DPG) temperatures and reaction time (RT); increments in EEG power in alpha-, theta- and beta-band frequencies in parieto-occipital, central-medial and frontal components, were associated with poor performance (slower RT) in the task. This generalized power increment fits with an increased activity in the default mode network, associated with attention lapses. This study highlights the potential use of the PVT as a tool to obtain individual physiological indices of vigilance and fatigue that could be applied to other vigilance tasks typically performed in occupational settings.

Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) and R(-) MDMA on actigraphy-based daytime activity and sleep parameters in rhesus monkeys

3,4-Methylenedioxymethamphetamine (MDMA) affects monoaminergic pathways that play a critical role in sleep-wake cycles. Dopaminergic mechanisms are thought to mediate the sleep-disrupting effects of stimulant drugs. However, the mechanisms underlying the effects of MDMA on sleep-wake cycles and the effects of R(-) MDMA, a stereoisomer that lacks dopaminergic activity, on sleep remain unknown. The aim of the present study was to investigate the effects of racemic MDMA and R(-) MDMA on daytime activity and sleep-like parameters evaluated with actigraphy in adult rhesus macaques (Macaca mulatta, n = 6). Actiwatch monitors were attached to the monkeys' collars and actigraphy recording was conducted during baseline conditions and after the administration of acute intramuscular injections of saline (vehicle), racemic MDMA (0.3, 1.0, or 1.7 mg/kg), or R(-) MDMA (0.3, 1.0, or 1.7 mg/kg) at 9 or 16 h (3 h before "lights off"). Morning treatments had no effects on sleep-like parameters. Racemic MDMA decreased general daytime activity during the first hour after injection and increased daytime activity at 3 hr posttreatment. Although afternoon administration of racemic MDMA increased sleep latency, it improved other sleep parameters, decreasing wake time after sleep onset (WASO) and increasing sleep efficiency for subjects with low baseline sleep efficiency. Afternoon treatment with R(-) MDMA improved sleep measures, increasing sleep efficiency and decreasing sleep latency and WASO, while having no effects on daytime activity. The stimulant and sleep-disrupting effects of racemic MDMA are likely mediated by dopaminergic and noradrenergic mechanisms, while serotonergic pathways appear to be involved in the sleep-promoting effects of MDMA. (PsycINFO Database Record

Sustained effects of prior red light on pupil diameter and vigilance during subsequent darkness

Environmental light can exert potent effects on physiology and behaviour, including pupil size, vigilance and sleep. Previous work showed that these non-image forming effects can last long beyond discontinuation of short-wavelength light exposure. The possible functional effects after switching off long-wavelength light, however, have been insufficiently characterized. In a series of controlled experiments in healthy adult volunteers, we evaluated the effects of five minutes of intense red light on physiology and performance during subsequent darkness. As compared to prior darkness, prior red light induced a subsequent sustained pupil dilation. Prior red light also increased subsequent heart rate and heart rate variability when subjects were asked to perform a sustained vigilance task during the dark exposure. While these changes suggest an increase in the mental effort required for the task, it could not prevent a post-red slowing of response speed. The suggestion that exposure to intense red light affects vigilance during subsequent darkness, was confirmed in a controlled polysomnographic study that indeed showed a post-red facilitation of sleep onset. Our findings suggest the possibility of using red light as a nightcap.

A Neuronal Hub Binding Sleep Initiation and Body Cooling in Response to a Warm External Stimulus

Mammals, including humans, prepare for sleep by nesting and/or curling up, creating microclimates of skin warmth. To address whether external warmth induces sleep through defined circuitry, we used c-Fos-dependent activity tagging, which captures populations of activated cells and allows them to be reactivated to test their physiological role. External warming tagged two principal groups of neurons in the median preoptic (MnPO)/medial preoptic (MPO) hypothalamic area. GABA neurons located mainly in MPO produced non-rapid eye movement (NREM) sleep but no body temperature decrease. Nitrergic-glutamatergic neurons in MnPO-MPO induced both body cooling and NREM sleep. This circuitry explains how skin warming induces sleep and why the maximal rate of core body cooling positively correlates with sleep onset. Thus, the pathways that promote NREM sleep, reduced energy expenditure, and body cooling are inextricably linked, commanded by the same neurons. This implies that one function of NREM sleep is to lower brain temperature and/or conserve energy.

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Nitrergic-glutamatergic neurons in the preoptic area are excited by external warmth

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Reactivation of these neurons induced a drop in body temperature and NREM sleep

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This circuitry binds a warm stimulus, NREM sleep, and body cooling

Patterns and reliability of children's skin temperature prior to and during sleep in the home setting

The relationship between patterns of change in skin temperature and sleep is well recognized. In particular, there is a rapid rise in distal skin temperature (T_distal) and slower rise in proximal skin temperature (T_proximal) prior to sleep onset. The difference between T_distal and T_proximal is known as the distal-proximal gradient (DPG). Rise in DPG is known as a measure of distal vasodilation, which contributes to the drop in core body temperature (T_core) that is important to sleep onset and maintenance. Patterns of change in skin temperature before and during sleep are reported for neonates, infants, adults and elderly, however they are not known for school aged children. Therefore, the current observational study aimed to determine the patterns and reliability of skin temperatures (T_skin) and DPG in relation to sleep of school aged children in their home settings. Participants (22 children, aged 6-12) completed the Children's Sleep Habits Questionnaire and used Thermochron iButtons and actigraphy for four school nights in their typical sleep settings. There were evident patterns of T_skin change before and during sleep. In particular, T_distal was lower but rose more rapidly than T_proximal after reported bedtime and prior to sleep onset. This reflected a timely rise in DPG, and shows that distal vasodilation precedes sleep onset in school aged children. The measures of T_skin and sleep were practical for children in their home settings, and the observed patterns were consistent across consecutive school nights. Environmental and behavioural strategies that manage skin temperature before and during sleep should be explored for their potential as valuable components of treatment of childhood insomnia.

Foot cooling does not improve vigilance but may transiently reduce sleepiness

Temperature of the skin (T_Sk ) and core (T_C ) play key roles in sleep-wake regulation. The diurnal combination of low T_Sk and high T_C facilitates alertness, whereas the transition to high T_Sk and low T_C correlates with sleepiness. Sleepiness and deteriorating vigilance are induced with peripheral warming, whereas peripheral cooling appears to transiently improve vigilance in narcolepsy. This study aimed to test the hypothesis that foot cooling would maintain vigilance during extended wakefulness in healthy adults. Nine healthy young adult participants with habitually normal sleep completed three constant-routine trials in randomized crossover order. Trials began at 22:30 hours, and involved continuous mild foot cooling (30°C), moderate foot cooling (25°C) or no foot cooling, while undertaking six × 10-min Psychomotor Vigilance Tasks and seven × 7-min Karolinska Drowsiness Tasks, interspersed with questionnaires of sleepiness and thermal perceptions. Foot temperatures in control, mild and moderate cooling averaged 34.5 ± 0.5°C, 30.8 ± 0.2°C and 26.4 ± 0.1°C (all p < .01), while upper-limb temperatures remained stable (34-35°C) and T_C declined (approximately -0.12°C per hr) regardless of trial (p = .84). Foot cooling did not improve vigilance (repeated-measures-ANOVA interaction for response speed: p = .45), but transiently reduced subjective sleepiness (-0.8 ± 0.8; p = .004). Participants felt cooler throughout cooling trials, but thermal comfort was unaffected (p = .43), as were almost all Karolinska Drowsiness Tasks' encephalographic parameters. In conclusion, mild or moderate cooling of the feet did not attenuate declines in vigilance or core temperature of healthy young adults during the period of normal sleep onset and early sleep, and any effect on sleepiness was small and transient.

Body temperature and sleep

Sleep in mammals is accompanied by a decrease in core body temperature (CBT). The circadian clock in the hypothalamic suprachiasmatic nucleus regulates daily rhythms in both CBT and arousal states, and these rhythms are normally coupled. Reductions in metabolic heat production resulting from behavioral quiescence and reduced muscle tone along with changes in autonomic nervous system activity and thermoeffector activity contribute to the sleep-related fall in CBT. Reductions in sympathetic tone to the peripheral vasculature resulting in heat loss through the skin are reflected in a sleep-related increase in distal skin temperature that is a prominent feature of sleep onset in humans. Within a sleep episode, patterns of autonomic nervous system and thermoeffector activity and the ability to defend against heat and cold exposure differ during nonrapid eye movement (NREM) and rapid eye movement sleep. Anatomic and functional integration of the control of arousal states and thermoregulation occur in the preoptic/anterior hypothalamus. Subsets or warm-sensing neurons in the preoptic/anterior hypothalamus implicated in CBT regulation are spontaneously activated during sleep onset and NREM sleep compared to waking and may underlie sleep-related changes in autonomic nervous system and thermoeffector activity.

Skin temperature, sleep, and vigilance

A large number of studies have shown a close association between the 24-hour rhythms in core body temperature and sleep propensity. More recently, studies have have begun to elucidate an intriguing association of sleep with skin temperature as well. The present chapter addresses the association of sleep and alertness with skin temperature. It discusses whether the association could reflect common underlying drivers of both sleep propensity and skin vasodilation; whether it could reflect efferents of sleep-regulating brain circuits to thermoregulatory circuits; and whether skin temperature could provide afferent input to sleep-regulating brain circuits. Sleep regulation and concomitant changes in skin temperature are systematically discussed and three parallel factors suggested: a circadian clock mechanism, a homeostatic hourglass mechanism, and a third set of sleep-permissive and wake-promoting factors that gate the effectiveness of signals from the clock and hourglass in the actual induction of sleep or maintenance of alert wakefulness. The chapter moreover discusses how the association between skin temperature and arousal can change with sleep deprivation and insomnia. Finally it addresses whether the promising laboratory findings on the effects of skin temperature manipulations on vigilance can be applied to improve sleep in everyday life.

Abnormalities in the 24-hour rhythm of skin temperature in cirrhosis: Sleep-wake and general clinical implications

BACKGROUND & AIMS

Sleep preparation/onset are associated with peripheral vasodilatation and a decrease in body temperature. The hyperdynamic syndrome exhibited by patients with cirrhosis may impinge on sleep preparation, thus contributing to their difficulties falling asleep. The aim of this study was the assessment of skin temperature, in relation to sleep-wake patterns, in patients with cirrhosis.

METHODS

Fifty-three subjects were initially recruited, and 46 completed the study. Of the final 46, 12 were outpatients with cirrhosis, 13 inpatients with cirrhosis, 11 inpatients without cirrhosis and 10 healthy volunteers. All underwent baseline sleep-wake evaluation and blood sampling for inflammatory markers and morning melatonin levels. Distal/proximal skin temperature and their gradient (DPG) were recorded for 24 hours by a wireless device. Over this period subjects kept a sleep-wake diary.

RESULTS

Inpatients with cirrhosis slept significantly less well than the other groups. Inpatients and outpatients with cirrhosis had higher proximal temperature and blunted rhythmicity compared to the other groups. Inpatients with/without cirrhosis had higher distal temperature values and blunted rhythmicity compared to the other groups. Inpatients and outpatients with cirrhosis had significantly lower DPG values compared to the other groups, and DPG reached near-zero values several hours later. Significant correlations were observed between temperature and sleep-wake variables and inflammatory markers.

CONCLUSIONS

Alterations of distal/proximal skin temperature, their gradient and their time-course were observed in patients with cirrhosis, which may contribute to their sleep disturbances.

Sociality Affects REM Sleep Episode Duration Under Controlled Laboratory Conditions in the Rock Hyrax, Procavia capensis

The rock hyrax, Procavia capensis, is a highly social, diurnal mammal. In the current study several physiologically measurable parameters of sleep, as well as the accompanying behavior, were recorded continuously from five rock hyraxes, for 72 h under solitary (experimental animal alone in the recording chamber), and social conditions (experimental animal with 1 or 2 additional, non-implanted animals in the recording chamber). The results revealed no significant differences between solitary and social conditions for total sleep times, number of episodes, episode duration or slow wave activity (SWA) for all states examined. The only significant difference observed between social and solitary conditions was the average duration of rapid eye movement (REM) sleep episodes. REM sleep episode duration was on average 20 s and 40 s longer under social conditions daily and during the dark period, respectively. It is hypothesized that the increase in REM sleep episode duration under social conditions could possibly be attributed to improved thermoregulation strategies, however considering the limited sample size and design of the current study further investigations are needed to confirm this finding. Whether the conclusions and the observations made in this study can be generalized to all naturally socially sleeping mammals remains an open question.

The impact of morning light intensity and environmental temperature on body temperatures and alertness

Indoor temperature and light exposure are known to affect body temperature, productivity and alertness of building occupants. However, not much is known about the interaction between light and temperature exposure and the relationship between morning light induced alertness and its effect on body temperature. Light intensity and room temperature during morning office hours were investigated under strictly controlled conditions. In a randomized crossover study, two white light conditions (4000K, either bright 1200lx or dim 5lx) under three different room temperatures (26, 29 and 32°C) were investigated. A lower room temperature increased the core body temperature (CBT) and lowered skin temperature and the distal-proximal temperature gradient (DPG). Moreover, a lower room temperature reduced the subjective sleepiness and reaction time on an auditory psychomotor vigilance task (PVT), irrespective of the light condition. Interestingly, the morning bright light exposure did affect thermophysiological parameters, i.e. it decreased plasma cortisol, CBT and proximal skin temperature and increased the DPG, irrespective of the room temperature. During the bright light session, subjective sleepiness decreased irrespective of the room temperature. However, the change in sleepiness due to the light exposure was not related to these physiological changes.

Orexins and the cardiovascular events of awakening

This brief review aims to provide an updated account of the cardiovascular events of awakening, proposing a testable conceptual framework that links these events with the neural control of sleep and the autonomic nervous system, with focus on the hypothalamic orexin (hypocretin) neurons. Awakening from non-rapid-eye-movement sleep entails coordinated changes in brain and cardiovascular activity: the neural "flip-flop" switch that governs state transitions becomes biased toward the ascending arousal systems, arterial blood pressure and heart rate rise toward waking values, and distal skin temperature falls. Arterial blood pressure and skin temperature are sensed by baroreceptors and thermoreceptors and may positively feedback on the brain wake-sleep switch, thus contributing to sharpen, coordinate, and stabilize awakening. These effects may be enhanced by the hypothalamic orexin neurons, which may modulate the changes in blood pressure, heart rate, and skin temperature upon awakening, while biasing the wake-sleep switch toward wakefulness through direct neural projections. A deeper understanding of the cardiovascular events of awakening and of their links with skin temperature and the wake-sleep neural switch may lead to better treatments options for patients with narcolepsy type 1, who lack the orexin neurons.

Thermoregulation as a disease tolerance defense strategy

Physiological responses that occur during infection are most often thought of in terms of effectors of microbial destruction through the execution of resistance mechanisms, due to a direct action of the microbe, or are maladaptive consequences of host-pathogen interplay. However, an examination of the cellular and organ-level consequences of one such response, thermoregulation that leads to fever or hypothermia, reveals that these actions cannot be readily explained within the traditional paradigms of microbial killing or maladaptive consequences of host-pathogen interactions. In this review, the concept of disease tolerance is applied to thermoregulation during infection, inflammation and trauma, and we discuss the physiological consequences of thermoregulation during disease including tissue susceptibility to damage, inflammation, behavior and toxin neutralization.

Insomnia heterogeneity: Characteristics to consider for data-driven multivariate subtyping

Meta-analyses and systematic reviews have reported surprisingly few consistent insomnia-characteristics with respect to cognitions, mood, traits, history of life events and family history. One interpretation of this limited consistency is that different subtypes of insomnia exist, each with its own specific multivariate profile of characteristics. Because previously unrecognized subtypes will be differentially represented in individual studies and dilute effect sizes of subtype-dependent characteristics of importance, they are unlikely to be reported consistently in individual studies, let alone in meta-analyses. This review therefore aims to complement meta-analyses by listing previously reported psychometric characteristics of insomnia, irrespective of the degree of consistency over studies. The review clearly indicates that characteristics of insomnia may not be limited to sleep. Reports suggest that at least some individuals with insomnia may deviate from people without sleep complaints with respect to demographics, mental and physical health, childhood trauma, life events, fatigue, sleepiness, hyperarousal, hyperactivity, other sleep disorders, lifetime sleep history, chronotype, depression, anxiety, mood, quality of life, personality, happiness, worry, rumination, self-consciousness, sensitivity, dysfunctional beliefs, self-conscious emotion regulation, coping, nocturnal mentation, wake resting-state mentation, physical activity, food intake, temperature perception and hedonic evaluation. The value of this list of characteristics is that 1) internet has now made it feasible to asses them all in a large sample of people suffering from insomnia, and 2) statistical methods like latent class analysis and community detection can utilize them for a truly bottom-up data-driven search for subtypes. The supplement to this review provides a blueprint of this multivariate approach as implemented in the Sleep registry platform (www.sleepregistry.nl), that allows for bottom-up subtyping and fosters cross-cultural comparison and worldwide collaboration on insomnia subtype finding - and beyond.

The Central Control of Energy Expenditure: Exploiting Torpor for Medical Applications

Autonomic thermoregulation is a recently acquired function, as it appears for the first time in mammals and provides the brain with the ability to control energy expenditure. The importance of such control can easily be highlighted by the ability of a heterogeneous group of mammals to actively reduce metabolic rate and enter a condition of regulated hypometabolism known as torpor. The central neural circuits of thermoregulatory cold defense have been recently unraveled and could in theory be exploited to reduce energy expenditure in species that do not normally use torpor, inducing a state called synthetic torpor. This approach may represent the first steps toward the development of a technology to induce a safe and reversible state of hypometabolism in humans, unlocking many applications ranging from new medical procedures to deep space travel.

Exploration of Circadian Rhythms in Patients with Bilateral Vestibular Loss

BACKGROUND

New insights have expanded the influence of the vestibular system to the regulation of circadian rhythmicity. Indeed, hypergravity or bilateral vestibular loss (BVL) in rodents causes a disruption in their daily rhythmicity for several days. The vestibular system thus influences hypothalamic regulation of circadian rhythms on Earth, which raises the question of whether daily rhythms might be altered due to vestibular pathology in humans. The aim of this study was to evaluate human circadian rhythmicity in people presenting a total bilateral vestibular loss (BVL) in comparison with control participants.

METHODOLOGY AND PRINCIPAL FINDINGS

Nine patients presenting a total idiopathic BVL and 8 healthy participants were compared. Their rest-activity cycle was recorded by actigraphy at home over 2 weeks. The daily rhythm of temperature was continuously recorded using a telemetric device and salivary cortisol was recorded every 3 hours from 6:00AM to 9:00PM over 24 hours. BVL patients displayed a similar rest activity cycle during the day to control participants but had higher nocturnal actigraphy, mainly during weekdays. Sleep efficiency was reduced in patients compared to control participants. Patients had a marked temperature rhythm but with a significant phase advance (73 min) and a higher variability of the acrophase (from 2:24 PM to 9:25 PM) with no correlation to rest-activity cycle, contrary to healthy participants. Salivary cortisol levels were higher in patients compared to healthy people at any time of day.

CONCLUSION

We observed a marked circadian rhythmicity of temperature in patients with BVL, probably due to the influence of the light dark cycle. However, the lack of synchronization between the temperature and rest-activity cycle supports the hypothesis that the vestibular inputs are salient input to the circadian clock that enhance the stabilization and precision of both external and internal entrainment.

Control of the Cutaneous Circulation by the Central Nervous System

The central nervous system (CNS), via its control of sympathetic outflow, regulates blood flow to the acral cutaneous beds (containing arteriovenous anastomoses) as part of the homeostatic thermoregulatory process, as part of the febrile response, and as part of cognitive-emotional processes associated with purposeful interactions with the external environment, including those initiated by salient or threatening events (we go pale with fright). Inputs to the CNS for the thermoregulatory process include cutaneous sensory neurons, and neurons in the preoptic area sensitive to the temperature of the blood in the internal carotid artery. Inputs for cognitive-emotional control from the exteroceptive sense organs (touch, vision, sound, smell, etc.) are integrated in forebrain centers including the amygdala. Psychoactive drugs have major effects on the acral cutaneous circulation. Interoceptors, chemoreceptors more than baroreceptors, also influence cutaneous sympathetic outflow. A major advance has been the discovery of a lower brainstem control center in the rostral medullary raphé, regulating outflow to both brown adipose tissue (BAT) and to the acral cutaneous beds. Neurons in the medullary raphé, via their descending axonal projections, increase the discharge of spinal sympathetic preganglionic neurons controlling the cutaneous vasculature, utilizing glutamate, and serotonin as neurotransmitters. Present evidence suggests that both thermoregulatory and cognitive-emotional control of the cutaneous beds from preoptic, hypothalamic, and forebrain centers is channeled via the medullary raphé. Future studies will no doubt further unravel the details of neurotransmitter pathways connecting these rostral control centers with the medullary raphé, and those operative within the raphé itself. © 2016 American Physiological Society. Compr Physiol 6:1161-1197, 2016.

Wake High-Density Electroencephalographic Spatiospectral Signatures of Insomnia

STUDY OBJECTIVES

Although daytime complaints are a defining characteristic of insomnia, most EEG studies evaluated sleep only. We used high-density electroencephalography to investigate wake resting state oscillations characteristic of insomnia disorder (ID) at a fine-grained spatiospectral resolution.

METHODS

A case-control assessment during eyes open (EO) and eyes closed (EC) was performed in a laboratory for human physiology. Participants (n = 94, 74 female, 21-70 y) were recruited through www.sleepregistry.nl: 51 with ID, according to DSM-5 and 43 matched controls. Exclusion criteria were any somatic, neurological or psychiatric condition. Group differences in the spectral power topographies across multiple frequencies (1.5 to 40 Hz) were evaluated using permutation-based inference with Threshold-Free Cluster-Enhancement, to correct for multiple comparisons.

RESULTS

As compared to controls, participants with ID showed less power in a narrow upper alpha band (11-12.7 Hz, peak: 11.7 Hz) over bilateral frontal and left temporal regions during EO, and more power in a broad beta frequency range (16.3-40 Hz, peak: 19 Hz) globally during EC. Source estimates suggested global rather than cortically localized group differences.

CONCLUSIONS

The widespread high power in a broad beta band reported previously during sleep in insomnia is present as well during eyes closed wakefulness, suggestive of a round-the-clock hyperarousal. Low power in the upper alpha band during eyes open is consistent with low cortical inhibition and attentional filtering. The fine-grained HD-EEG findings suggest that, while more feasible than PSG, wake EEG of short duration with a few well-chosen electrodes and frequency bands, can provide valuable features of insomnia.

Effects of mobile phone exposure (GSM 900 and WCDMA/UMTS) on polysomnography based sleep quality: An intra- and inter-individual perspective

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 900MHz 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.

The experienced temperature sensitivity and regulation survey

Individuals differ in thermosensitivity, thermoregulation, and zones of thermoneutrality and thermal comfort. Whereas temperature sensing and -effectuating processes occur in part unconsciously and autonomic, awareness of temperature and thermal preferences can affect thermoregulatory behavior as well. Quantification of trait-like individual differences of thermal preferences and experienced temperature sensitivity and regulation is therefore relevant to obtain a complete understanding of human thermophysiology. Whereas several scales have been developed to assess instantaneous appreciation of heat and cold exposure, a comprehensive scale dedicated to assess subjectively experienced autonomic or behavioral thermoregulatory activity has been lacking so far. We constructed a survey that specifically approaches these domains from a trait-like perspective, sampled 240 volunteers across a wide age range, and analyzed the emergent component structure. Participants were asked to report their thermal experiences, captured in 102 questions, on a 7-point bi-directional Likert scale. In a second set of 32 questions, participants were asked to indicate the relative strength of experiences across different body locations. Principal component analyses extracted 21 meaningful dimensions, which were sensitive to sex-differences and age-related changes. The questions were also assessed in a matched sample of 240 people with probable insomnia to evaluate the sensitivity of these dimensions to detect group differences in a case-control design. The dimensions showed marked mean differences between cases and controls. The survey thus has discriminatory value. It can freely be used by anyone interested in studying individual or group differences in thermosensitivity and thermoregulation.

Natural sleep and its seasonal variations in three pre-industrial societies

How did humans sleep before the modern era? Because the tools to measure sleep under natural conditions were developed long after the invention of the electric devices suspected of delaying and reducing sleep, we investigated sleep in three preindustrial societies [1-3]. We find that all three show similar sleep organization, suggesting that they express core human sleep patterns, most likely characteristic of pre-modern era Homo sapiens. Sleep periods, the times from onset to offset, averaged 6.9-8.5 hr, with sleep durations of 5.7-7.1 hr, amounts near the low end of those industrial societies [4-7]. There was a difference of nearly 1 hr between summer and winter sleep. Daily variation in sleep duration was strongly linked to time of onset, rather than offset. None of these groups began sleep near sunset, onset occurring, on average, 3.3 hr after sunset. Awakening was usually before sunrise. The sleep period consistently occurred during the nighttime period of falling environmental temperature, was not interrupted by extended periods of waking, and terminated, with vasoconstriction, near the nadir of daily ambient temperature. The daily cycle of temperature change, largely eliminated from modern sleep environments, may be a potent natural regulator of sleep. Light exposure was maximal in the morning and greatly decreased at noon, indicating that all three groups seek shade at midday and that light activation of the suprachiasmatic nucleus is maximal in the morning. Napping occurred on <7% of days in winter and <22% of days in summer. Mimicking aspects of the natural environment might be effective in treating certain modern sleep disorders.

Post-illumination pupil response after blue light: Reliability of optimized melanopsin-based phototransduction assessment

Melanopsin-containing retinal ganglion cells have recently been shown highly relevant to the non-image forming effects of light, through their direct projections on brain circuits that regulate alertness, mood and circadian rhythms. A quantitative assessment of functionality of the melanopsin-signaling pathway could be highly relevant in order to mechanistically understand individual differences in the effects of light on these regulatory systems. We here propose and validate a reliable quantification of the melanopsin-dependent Post-Illumination Pupil Response (PIPR) after blue light, and evaluated its sensitivity to dark adaptation, time of day, body posture, and light exposure history. Pupil diameter of the left eye was continuously measured during a series of light exposures to the right eye, of which the pupil was dilated using tropicamide 0.5%. The light exposure paradigm consisted of the following five consecutive blocks of five minutes: baseline dark; monochromatic red light (peak wavelength: 630 nm, luminance: 375 cd/m(2)) to maximize the effect of subsequent blue light; dark; monochromatic blue light (peak wavelength: 470 nm, luminance: 375 cd/m(2)); and post-blue dark. PIPR was quantified as the difference between baseline dark pupil diameter and post-blue dark pupil diameter (PIPR-mm). In addition, a relative PIPR was calculated by dividing PIPR by baseline pupil diameter (PIPR-%). In total 54 PIPR assessments were obtained in 25 healthy young adults (10 males, mean age ± SD: 26.9 ± 4.0 yr). From repeated measurements on two consecutive days in 15 of the 25 participants (6 males, mean age ± SD: 27.8 ± 4.3 yrs) test-retest reliability of both PIPR outcome parameters was calculated. In the presence of considerable between-subject differences, both outcome parameters had very high test-retest reliability: Cronbach's α > 0.90 and Intraclass Correlation Coefficient > 0.85. In 12 of the 25 participants (6 males, mean age ± SD: 26.5 ± 3.6 yr) we examined the potential confounding effects of dark adaptation, time of the day (morning vs. afternoon), body posture (upright vs. supine position), and 24-h environmental light history on the PIPR assessment. Mixed effect regression models were used to analyze these possible confounders. A supine position caused larger PIPR-mm (β = 0.29 mm, SE = 0.10, p = 0.01) and PIPR-% (β = 4.34%, SE = 1.69, p = 0.02), which was due to an increase in baseline dark pupil diameter; this finding is of relevance for studies requiring a supine posture, as in functional Magnetic Resonance Imaging, constant routine protocols, and bed-ridden patients. There were no effects of dark adaptation, time of day, and light history. In conclusion, the presented method provides a reliable and robust assessment of the PIPR to allow for studies on individual differences in melanopsin-based phototransduction and effects of interventions.

Effectiveness of internet-supported cognitive behavioral and chronobiological interventions and effect moderation by insomnia subtype: study protocol of a randomized controlled trial

BACKGROUND

DSM-V criteria for insomnia disorder are met by 6 to 10% of the adult population. Insomnia has severe consequences for health and society. One of the most common treatments provided by primary caregivers is pharmacological treatment, which is far from optimal and has not been recommended since a 2005 consensus report of the National Institutes of Health. The recommended treatment is Cognitive Behavioral Therapy for Insomnia. Effectiveness, however, is still limited. Only a few studies have evaluated the effectiveness of chronobiological treatments, including the timed application of bright light, physical activity and body warming. Another opportunity for optimization of treatment is based on the idea that the people suffering from insomnia most likely represent a heterogeneous mix of subtypes, with different underlying causes and expected treatment responses. The present study aims to evaluate the possibility for optimizing insomnia treatment along the principles of personalized and stratified medicine. It evaluates the following: 1. The relative effectiveness of internet-supported cognitive behavioral therapy, bright light, physical activity and body warming; 2. Whether the effectiveness of internet-supported cognitive behavioral therapy for insomnia can be augmented by simultaneous or prior application of bright light, physical activity and body warming; and 3. Whether the effectiveness of the interventions and their combination are moderated by the insomnia subtype.

METHODS/DESIGN

In a repeated measures, placebo-controlled, randomized clinical trial that included 160 people diagnosed with insomnia disorder, we are evaluating the relative effectiveness of 4 intervention weeks. Primary outcome is subjective sleep efficiency, quantified using a sleep diary. Secondary outcomes include other complaints of sleep and daytime functioning, health-related cost estimates and actigraphic objective sleep estimates. Compliance will be monitored both subjectively and objectively using activity, light and temperature sensors. Insomnia subtypes will be assessed using questionnaires. Mixed effect models will be used to evaluate intervention effects and moderation by insomnia subtype ratings.

DISCUSSION

The current study addresses multiple opportunities to optimize and personalize treatment of insomnia disorder.

TRIAL REGISTRATION

Netherlands National Trial Register NTR4010, 4 June 2013.

The effects of sodium oxybate on core body and skin temperature regulation in narcolepsy

Patients suffering from narcolepsy type 1 show altered skin temperatures, resembling the profile that is related to sleep onset in healthy controls. The aim of the present study is to investigate the effects of sodium oxybate, a widely used drug to treat narcolepsy, on the 24-h profiles of temperature and sleep-wakefulness in patients with narcolepsy and controls. Eight hypocretin-deficient male narcolepsy type 1 patients and eight healthy matched controls underwent temperature measurement of core body and proximal and distal skin twice, and the sleep-wake state for 24 h. After the baseline assessment, 2 × 3 g of sodium oxybate was administered for 5 nights, immediately followed by the second assessment. At baseline, daytime core body temperature and proximal skin temperature were significantly lower in patients with narcolepsy (core: 36.8 ± 0.05 °C versus 37.0 ± 0.05 °C, F = 8.31, P = 0.01; proximal: 33.4 ± 0.26 °C versus 34.3 ± 0.26 °C, F = 5.66, P = 0.03). In patients, sodium oxybate administration increased proximal skin temperature during the day (F = 6.46, P = 0.04) to a level similar as in controls, but did not affect core body temperature, distal temperature or distal-proximal temperature gradient. Sodium oxybate administration normalised the predictive value of distal skin temperature and distal-proximal temperature gradient for the onset of daytime naps (P < 0.01). In conclusion, sodium oxybate administration resulted in a partial normalisation of the skin temperature profile, by increasing daytime proximal skin temperature, and by strengthening the known relationship between skin temperature and daytime sleep propensity. These changes seem to be related to the clinical improvement induced by sodium oxybate treatment. A causal relationship is not proven.

Somatic influences on subjective well-being and affective disorders: the convergence of thermosensory and central serotonergic systems

Current theories suggest that the brain is the sole source of mental illness. However, affective disorders, and major depressive disorder (MDD) in particular, may be better conceptualized as brain-body disorders that involve peripheral systems as well. This perspective emphasizes the embodied, multifaceted physiology of well-being, and suggests that afferent signals from the body may contribute to cognitive and emotional states. In this review, we focus on evidence from preclinical and clinical studies suggesting that afferent thermosensory signals contribute to well-being and depression. Although thermoregulatory systems have traditionally been conceptualized as serving primarily homeostatic functions, increasing evidence suggests neural pathways responsible for regulating body temperature may be linked more closely with emotional states than previously recognized, an affective warmth hypothesis. Human studies indicate that increasing physical warmth activates brain circuits associated with cognitive and affective functions, promotes interpersonal warmth and prosocial behavior, and has antidepressant effects. Consistent with these effects, preclinical studies in rodents demonstrate that physical warmth activates brain serotonergic neurons implicated in antidepressant-like effects. Together, these studies suggest that (1) thermosensory pathways interact with brain systems that control affective function, (2) these pathways are dysregulated in affective disorders, and (3) activating warm thermosensory pathways promotes a sense of well-being and has therapeutic potential in the treatment of affective disorders.

Sleep deprivation leads to a loss of functional connectivity in frontal brain regions

Background

The restorative effect of sleep on waking brain activity remains poorly understood. Previous studies have compared overall neural network characteristics after normal sleep and sleep deprivation. To study whether sleep and sleep deprivation might differentially affect subsequent connectivity characteristics in different brain regions, we performed a within-subject study of resting state brain activity using the graph theory framework adapted for the individual electrode level.

In balanced order, we obtained high-density resting state electroencephalography (EEG) in 8 healthy participants, during a day following normal sleep and during a day following total sleep deprivation. We computed topographical maps of graph theoretical parameters describing local clustering and path length characteristics from functional connectivity matrices, based on synchronization likelihood, in five different frequency bands. A non-parametric permutation analysis with cluster correction for multiple comparisons was applied to assess significance of topographical changes in clustering coefficient and path length.

Results

Significant changes in graph theoretical parameters were only found on the scalp overlying the prefrontal cortex, where the clustering coefficient (local integration) decreased in the alpha frequency band and the path length (global integration) increased in the theta frequency band. These changes occurred regardless, and independent of, changes in power due to the sleep deprivation procedure.

Conclusions

The findings indicate that sleep deprivation most strongly affects the functional connectivity of prefrontal cortical areas. The findings extend those of previous studies, which showed sleep deprivation to predominantly affect functions mediated by the prefrontal cortex, such as working memory. Together, these findings suggest that the restorative effect of sleep is especially relevant for the maintenance of functional connectivity of prefrontal brain regions.

The circadian rhythm in adult attention-deficit/hyperactivity disorder: current state of affairs

Adults with ADHD often have sleep problems that are caused by a delay of their internal circadian rhythm system. Such individuals are often typified as 'evening' or 'night' persons. This review focuses on the link between ADHD symptoms and the evening typology through multiple pathways. Etiology of the internal circadian rhythm system, the genetic basis for evening typology, overlap between ADHD symptoms and evening preference and risk factors for various chronic health conditions, including metabolic syndrome and cancer, are discussed. The treatment perspectives to reset the delayed rhythm in adults with ADHD involve psychoeducation on sleep hygiene, melatonin in the afternoon or evening and bright light therapy in the morning.

The effect of body posture on cognitive performance: a question of sleep quality

Nearly all functional magnetic resonance imaging (fMRI) studies are conducted in the supine body posture, which has been discussed as a potential confounder of such examinations. The literature suggests that cognitive functions, such as problem solving or perception, differ between supine and upright postures. However, the effect of posture on many cognitive functions is still unknown. Therefore, the aim of the present study was to investigate the effects of body posture (supine vs. sitting) on one of the most frequently used paradigms in the cognitive sciences: the N-back working memory paradigm. Twenty-two subjects were investigated in a randomized within-subject design. Subjects performed the N-back task on two consecutive days in either the supine or the upright posture. Subjective sleep quality and chronic stress were recorded as covariates. Furthermore, changes in mood dimensions and heart rate variability (HRV) were assessed during the experiment. Results indicate that the quality of sleep strongly affects reaction times when subjects performed a working memory task in a supine posture. These effects, however, could not be observed in the sitting position. The findings can be explained by HRV parameters that indicated differences in autonomic regulation in the upright vs. the supine posture. The finding is of particular relevance for fMRI group comparisons when group differences in sleep quality cannot be ruled out.