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Biabani N, Birdseye A, Higgins S, Delogu A, Rosenzweig J, Cvetkovic Z, Nesbitt A, Drakatos P, Steier J, Kumari V, O’Regan D, Rosenzweig I. The neurophysiologic landscape of the sleep onset: a systematic review. J Thorac Dis 2023; 15:4530-4543. [PMID: 37691675 PMCID: PMC10482638 DOI: 10.21037/jtd-23-325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023]
Abstract
Background The sleep onset process is an ill-defined complex process of transition from wakefulness to sleep, characterized by progressive modifications at the subjective, behavioural, cognitive, and physiological levels. To this date, there is no international consensus which could aid a principled characterisation of this process for clinical research purposes. The current review aims to systemise the current knowledge about the underlying mechanisms of the natural heterogeneity of this process. Methods In this systematic review, studies investigating the process of the sleep onset from 1970 to 2022 were identified using electronic database searches of PsychINFO, MEDLINE, and Embase. Results A total of 139 studies were included; 110 studies in healthy participants and 29 studies in participants with sleep disorders. Overall, there is a limited consensus across a body of research about what distinct biomarkers of the sleep onset constitute. Only sparse data exists on the physiology, neurophysiology and behavioural mechanisms of the sleep onset, with majority of studies concentrating on the non-rapid eye movement stage 2 (NREM 2) as a potentially better defined and a more reliable time point that separates sleep from the wake, on the sleep wake continuum. Conclusions The neurophysiologic landscape of sleep onset bears a complex pattern associated with a multitude of behavioural and physiological markers and remains poorly understood. The methodological variation and a heterogenous definition of the wake-sleep transition in various studies to date is understandable, given that sleep onset is a process that has fluctuating and ill-defined boundaries. Nonetheless, the principled characterisation of the sleep onset process is needed which will allow for a greater conceptualisation of the mechanisms underlying this process, further influencing the efficacy of current treatments for sleep disorders.
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Affiliation(s)
- Nazanin Biabani
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Adam Birdseye
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Alessio Delogu
- James Black Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
| | - Jan Rosenzweig
- Department of Engineering, King’s College London, London, UK
| | - Zoran Cvetkovic
- Department of Engineering, King’s College London, London, UK
| | - Alexander Nesbitt
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Neurology, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Joerg Steier
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Veena Kumari
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Centre for Cognitive Neuroscience (CCN), College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - David O’Regan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Basic and Medical Biosciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London, UK
- Sleep Disorders Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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2
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Kavi PC. Conscious entry into sleep: Yoga Nidra and accessing subtler states of consciousness. Prog Brain Res 2023; 280:43-60. [PMID: 37714572 DOI: 10.1016/bs.pbr.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Human sleep is a dynamic and complex process comprising sleep stages with REM and NREM sleep characteristics that come in cycles. During sleep, there is a loss of responsiveness or a perceptual loss of conscious awareness with increasing thresholds for wakefulness as sleep progresses. There are brief bursts of wakefulness or Wake After Sleep Onset (WASO) throughout a nocturnal sleep. Conscious experience during nocturnal sleep is known to occur during lucid dreaming when one is aware during dreams when the dream is occurring. Most cultures have known lucid dreaming since antiquity. However, conscious experience during dreamless sleep is relatively lesser known. Nevertheless, selected Indo-Tibetan meditation literature has documented it since antiquity. Minimal Phenomenal Experience (MPE) research describes lucid dreamless sleep as its target phenomenology. "Conscious entry into sleep" posits tonic alertness is maintained post sleep onset through the sleep stages for sustained durations of time until an eventual loss of conscious awareness. Entering sleep consciously and being aware during dreamless sleep, including Slow Wave Activity, is plausibly to be in the state of "Yoga Nidra" or Yogic sleep. An attentive sleepful state provides access to subtler states of consciousness and significantly deepens the levels of silence. It is phenomenologically distinct from hypnagogic hallucinations and lucid dreaming. Unfortunately, sleep studies validating this phenomenology are yet to be done. Therefore, an experimental methodology akin to those used in lucid dreaming experiments is described.
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Strauss M, Sitt JD, Naccache L, Raimondo F. Predicting the loss of responsiveness when falling asleep in humans. Neuroimage 2022; 251:119003. [PMID: 35176491 DOI: 10.1016/j.neuroimage.2022.119003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/04/2021] [Accepted: 02/13/2022] [Indexed: 11/26/2022] Open
Abstract
Falling asleep is a dynamical process that is poorly defined. The period preceding sleep, characterized by the progressive alteration of behavioral responses to the environment, which may last several minutes, has no electrophysiological definition, and is embedded in the first stage of sleep (N1). We aimed at better characterizing this drowsiness period looking for neurophysiological predictors of responsiveness using electro and magnetoencephalography. Healthy participants were recorded when falling asleep, while they were presented with continuous auditory stimulations and asked to respond to deviant sounds. We analysed brain responses to sounds and markers of ongoing activity, such as information and connectivity measures, in relation to rapid fluctuations of brain rhythms observed at brain onset and participants' capabilities to respond. Results reveal a drowsiness period distinct from wakefulness and sleep, from alpha rhythms to the first sleep spindles, characterized by diverse and transient brain states that come on and off at the scale of a few seconds and closely reflects, mainly through neural processes in alpha and theta bands, decreasing probabilities to be responsive to external stimuli. Results also show that the global P300 was only present in responsive trials, regardless of vigilance states. A better consideration of the drowsiness period through a formalized classification and its specific brain markers such as described here should lead to significant advances in vigilance assessment in the future, in medicine and ecological environments.
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Affiliation(s)
- Mélanie Strauss
- Cognitive Neuroimaging Unit, CEA DSV/I2BM, INSERM, NeuroSpin Center, Université Paris-Sud, Université Paris-Saclay, Gif-sur-Yvette, France; Neuropsychology and Functional Imaging Research Group (UR2NF), Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, B-1050, Brussels, Belgium; Departments of neurology, psychiatry and sleep medicine, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, B-1070, Brussels, Belgium.
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013, Paris, France; Inserm U 1127, F-75013, Paris, France
| | - Lionel Naccache
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013, Paris, France; Department of Neurophysiology, Hôpital de la Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Federico Raimondo
- Institut du Cerveau et de la Moelle épinière, ICM, PICNIC Lab, F-75013, Paris, France; GIGA-Consciousness, Coma Science Group, University of Liège, Liège, Belgium; Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Rao A, Ebelt P, Mallard A, Briskey D. Palmitoylethanolamide for sleep disturbance. A double-blind, randomised, placebo-controlled interventional study. Sleep Sci Pract 2021; 5:12. [PMID: 34522787 PMCID: PMC8428962 DOI: 10.1186/s41606-021-00065-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Background Sleep is essential for wellbeing, yet sleep disturbance is a common problem linked to a wide range of health conditions. Palmitoylethanolamide (PEA) is an endogenous fatty acid amide proposed to promote better sleep via potential interaction with the endocannabinoid system. Methods This double-blind, randomised study on 103 adults compared the efficacy and tolerability of 8 weeks of daily supplemented PEA formulation (350 mg Levagen + ®) to a placebo. Sleep quality and quantity were measured using wrist actigraphy, a sleep diary and questionnaires. Results At week 8, PEA supplementation reduced sleep onset latency, time to feel completely awake and improved cognition on waking. After 8 weeks, both groups improved their sleep quality and quantity scores similarly. There was no difference between groups at baseline or week 8 for sleep quantity or quality as measured from actigraphy or sleep diaries. Conclusion These findings support PEA as a potential sleeping aid capable of reducing sleep onset time and improving cognition on waking. Trial registration Australian
New Zealand Clinical Trials Registry ACTRN12618001339246. Registered 9th
August 2018.
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Affiliation(s)
- Amanda Rao
- RDC Clinical, Brisbane, 4006 Australia.,University of Sydney, School of Medicine, Sydney, Australia
| | | | - Alistair Mallard
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - David Briskey
- RDC Clinical, Brisbane, 4006 Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
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Yardley J, Kärppä M, Inoue Y, Pinner K, Perdomo C, Ishikawa K, Filippov G, Kubota N, Moline M. Long-term effectiveness and safety of lemborexant in adults with insomnia disorder: results from a phase 3 randomized clinical trial. Sleep Med 2021; 80:333-342. [PMID: 33636648 DOI: 10.1016/j.sleep.2021.01.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/07/2020] [Accepted: 01/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE/BACKGROUND Lemborexant is a dual orexin receptor antagonist approved in the United States, Japan, and Canada for the treatment of insomnia in adults. We report effectiveness and safety outcomes in subjects with insomnia who received up to twelve months of continuous lemborexant treatment in Study E2006-G000-303 (Study 303; SUNRISE-2). PATIENTS/METHODS Study 303 was a twelve-month, global, multicenter, randomized, double-blind, parallel-group, Phase 3 study divided into two treatment periods. In Treatment Period 1 (first six months), subjects (n = 949, Full Analysis Set) were randomized to daily placebo, lemborexant 5 mg (LEM5) or lemborexant 10 mg (LEM10). In Treatment Period 2 (second six months), placebo subjects were rerandomized to LEM5 or LEM10, and subjects randomized to lemborexant continued their assigned treatment (LEM5, n = 251; LEM10, n = 226). Sleep onset and sleep maintenance endpoints were analyzed from daily electronic sleep diary data. Treatment-emergent adverse events (TEAEs) were monitored. RESULTS For all sleep parameters, the significant benefits observed with LEM5 and LEM10 versus placebo over six months were maintained at twelve months in subjects who received twelve continuous months of treatment. There was no evidence of rebound insomnia or withdrawal in either lemborexant group following treatment discontinuation. Over twelve months of lemborexant treatment, most TEAEs were mild/moderate; the most common TEAEs were nasopharyngitis, somnolence and headache. CONCLUSIONS LEM5 and LEM10 had significant benefit on sleep onset and sleep maintenance compared with placebo, and importantly, lemborexant effectiveness persisted at twelve months, suggesting that lemborexant may provide long-term benefits for subjects with insomnia. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT02952820; ClinicalTrialsRegister.eu, EudraCT Number 2015-001463-39.
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Affiliation(s)
| | - Mikko Kärppä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | | | - Carlos Perdomo
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA
| | | | - Gleb Filippov
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA
| | | | - Margaret Moline
- Eisai Inc., 100 Tice Boulevard, Woodcliff Lake, NJ 07677, USA.
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Abstract
Tinnitus is a highly prevalent medical disorder occurring in 10-30% of the general population. This disorder often becomes chronic and severe effecting quality of life contributing to significant psychiatric consequences; one that we have written about recently is comorbid insomnia. The latter can predispose effected persons to depressive episodes and a worsening of their total functioning. We have reported in the past that comorbid insomnia occurs in 10-80% of tinnitus patients with most reports finding over a 40% frequency. Unfortunately, these prior studies tended to evaluate only insomnia as a symptom and not as a diagnosis; therefore its seriousness and implications could not be assessed. Furthermore, most studies utilized only open-ended questionnaires with many being sent via the mail. Our study evaluated 72 tinnitus patients who were prospectively evaluated over the telephone for a tinnitus treatment study program at our center focusing on possible co-morbid insomnia symptoms as well as whether the insomnia satisfied a diagnosis with its accompanying dysfunctional state. The interview included questions regard a full range of questions assessing sleep onset, sleep continuity, early morning awakening, sleep duration as well as daytime consequences necessary for a diagnosis of insomnia. We found that not only were insomnia symptoms highly prevalent, but 60% of the tinnitus sample met strict diagnostic criteria (DSM-IV-TR) of insomnia secondary to a general medical condition, i.e., tinnitus. Alarmingly, only 4 % were being treated for their insomnia. In addition, our data suggests that tinnitus patients with co-morbid insomnia have a more severe form of tinnitus and thus, may need further care and treatment.
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Affiliation(s)
- Gregory M Asnis
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, New York USA
| | - Henderson Ma
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, New York USA
| | - Sylvester C
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, New York USA
| | - Thomas M
- Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine/Montefiore Medical Center, New York USA
| | - Kiran M
- Department of Psychiatry, Temple University, School of Medicine, New York, USA
| | - Richard De La G
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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7
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Gibbings A, Ray LB, Berberian N, Nguyen T, Shahidi Zandi A, Owen AM, Comeau FJE, Fogel SM. EEG and behavioural correlates of mild sleep deprivation and vigilance. Clin Neurophysiol 2020; 132:45-55. [PMID: 33248433 DOI: 10.1016/j.clinph.2020.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The current study investigated the behavioral, cognitive, and electrophysiological impact of mild (only a few hours) and acute (one night) sleep loss via simultaneously recorded behavioural and physiological measures of vigilance. METHODS Participants (N = 23) came into the lab for two testing days where their brain activity and vigilance were recorded and assessed. The night before the testing session, participants either slept from 12am to 9am (Normally Rested), or from 1am to 6am (Sleep Restriction). RESULTS Vigilance was reduced and sleepiness was increased in the Sleep Restricted vs. Normally Rested condition, and this was exacerbated over the course of performing the vigilance task. As well, sleep restriction resulted in more intense alpha bursts. Lastly, EEG spectral power differed in Sleep Restricted vs. Normally Rested conditions as sleep onset progressed, particularly for frequencies reflecting arousal (e.g., delta, alpha, beta). CONCLUSIONS The findings of this study suggest that only one night of mild sleep loss significantly increases sleepiness and, importantly, reduces vigilance. In addition, this sleep loss has a clear impact on the physiology of the brain in ways that reflect reduced arousal. SIGNIFICANCE Understanding the neural correlates and cognitive processes associated with loss of sleep may lead to important advancements in identifying and preventing deleterious or potentially dangerous, sleep-related lapses in vigilance.
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Affiliation(s)
- A Gibbings
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - L B Ray
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - N Berberian
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - T Nguyen
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - A Shahidi Zandi
- Alcohol Countermeasures Systems Corp (ACS), Toronto M9W 6J2, Canada
| | - A M Owen
- The Brain & Mind Institute, Western University, London N6A 5B7, Canada
| | - F J E Comeau
- Alcohol Countermeasures Systems Corp (ACS), Toronto M9W 6J2, Canada
| | - S M Fogel
- Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; The Brain & Mind Institute, Western University, London N6A 5B7, Canada; University of Ottawa Brain & Mind Research Institute, Ottawa K1H 8M5, Canada.
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Haar Horowitz A, Cunningham TJ, Maes P, Stickgold R. Dormio: A targeted dream incubation device. Conscious Cogn 2020; 83:102938. [PMID: 32480292 DOI: 10.1016/j.concog.2020.102938] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/27/2022]
Abstract
Information processing during sleep is active, ongoing and accessible to engineering. Protocols such as targeted memory reactivation use sensory stimuli during sleep to reactivate memories and demonstrate subsequent, specific enhancement of their consolidation. These protocols rely on physiological, as opposed to phenomenological, evidence of their reactivation. While dream content can predict post-sleep memory enhancement, dreaming itself remains a black box. Here, we present a novel protocol using a new wearable electronic device, Dormio, to automatically generate serial auditory dream incubations at sleep onset, wherein targeted information is repeatedly presented during the hypnagogic period, enabling direct incorporation of this information into dream content, a process we call targeted dream incubation (TDI). Along with validation data, we discuss how Dormio and TDI protocols can serve as tools for controlled experimentation on dream content, shedding light on the role of dreams in the overnight transformation of experiences into memories.
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Scott H, Lack L, Lovato N. A systematic review of the accuracy of sleep wearable devices for estimating sleep onset. Sleep Med Rev 2019; 49:101227. [PMID: 31901524 DOI: 10.1016/j.smrv.2019.101227] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/13/2019] [Accepted: 10/31/2019] [Indexed: 12/19/2022]
Abstract
The accurate estimation of sleep onset is required for many purposes, including the administration of a behavioural treatment for insomnia called Intensive Sleep Retraining, facilitating power naps, and conducting objective daytime sleepiness tests. Specialised equipment and trained individuals are presently required to administer these applications in the laboratory: a costly and impractical procedure which limits their utility in practice. A wearable device could be used to administer these applications outside the laboratory, increasing accessibility. This systematic review aimed to identify practical wearable devices that accurately estimate sleep onset. The search strategy identified seventy-one articles which compared estimations of sleep onset latency from wearable devices against polysomnography (PSG). Actigraphy devices produced average estimations of sleep onset latency that were often not significantly different from PSG, but there was large inter-individual variability depending on participant characteristics. As expected, electroencephalography-based devices produced more accurate and less variable estimates. Devices that measured behavioural aspects of sleep onset consistently overestimated PSG-determined sleep onset latency, but to a comparatively low degree. This sleep measurement method could be deployed in a simple wearable device to accurately estimate sleep onset and administer Intensive Sleep Retraining, power naps, and objective daytime sleepiness tests outside the laboratory setting.
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Affiliation(s)
- Hannah Scott
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5001, Australia.
| | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide 5001, Australia; College of Medicine and Public Health, Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Adelaide 5001, Australia
| | - Nicole Lovato
- College of Medicine and Public Health, Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Adelaide 5001, Australia
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10
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McCabe SM, Elliott C, Langdon K, Abbiss CR. Patterns and reliability of children's skin temperature prior to and during sleep in the home setting. Physiol Behav 2018; 194:292-301. [PMID: 29885918 DOI: 10.1016/j.physbeh.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/13/2023]
Abstract
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 (Tdistal) and slower rise in proximal skin temperature (Tproximal) prior to sleep onset. The difference between Tdistal and Tproximal 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 (Tcore) 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 (Tskin) 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 Tskin change before and during sleep. In particular, Tdistal was lower but rose more rapidly than Tproximal 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 Tskin 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.
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Affiliation(s)
- Susan M McCabe
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Bentley, Australia
| | - Katherine Langdon
- Department of Paediatric Rehabilitation, Princess Margaret Hospital, Subiaco, Australia
| | - Chris R Abbiss
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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11
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Speth J, Schloerscheidt AM, Speth C. Mental time travel to the future might be reduced in sleep. Conscious Cogn 2017; 48:180-9. [PMID: 27951414 DOI: 10.1016/j.concog.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 10/31/2016] [Accepted: 11/13/2016] [Indexed: 01/06/2023]
Abstract
We present a quantitative study of mental time travel to the future in sleep. Three independent, blind judges analysed a total of 563 physiology-monitored mentation reports from sleep onset, REM sleep, non-REM sleep, and waking. The linguistic tool for the mentation report analysis is based on established grammatical and cognitive-semantic theories and has been validated in previous studies. Our data indicate that REM and non-REM sleep must be characterized by a reduction in mental time travel to the future, which would support earlier physiological evidence at the level of brain function.
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12
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Spruyt K, Braam W, Smits M, Curfs LM. Sleep Complaints and the 24-h Melatonin Level in Individuals with Smith-Magenis Syndrome: Assessment for Effective Intervention. CNS Neurosci Ther 2016; 22:928-935. [PMID: 27743421 DOI: 10.1111/cns.12653] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS Individuals with Smith-Magenis syndrome (SMS) are reported to have a disrupted circadian rhythm. Our aim was to examine problematic sleeping in those attending our sleep clinic for the first time. METHODS At intake, caregivers of 50 children and nine adults with SMS were surveyed about the sleep pattern and potential melatonin administration. Sampling of salivary melatonin levels was performed. RESULTS At intake, exogenous melatonin was used by 16 children (27.1% of sample; 56.3% male) with mean age 6.8 ± 2.8 years, whereas 34 children (57.6%; 7.5 ± 4.8 years old; 64.7% male) and nine adults (15.3%; 36.8 ± 15.3 years old; 44.4% male) were not taking melatonin at intake. Participants were reported to have problems with night waking and early awakenings regardless of melatonin administration. Overall, moderate to high levels of salivary melatonin at noon were found in individuals with SMS. In particular, children with SMS showed a disrupted melatonin pattern. Furthermore, the endogenous melatonin level, age, and gender may potentially interact, yielding the severity range of sleep disturbances reported in SMS. CONCLUSION Treatment of sleep problems in SMS is complex, and our findings may support person-centered sleep and medication management. Future clinical trials including larger groups may shed light on such approaches.
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Affiliation(s)
- Karen Spruyt
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands. .,Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wiebe Braam
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,'s Heeren Loo Zuid-Veluwe, Wekerom, Netherlands
| | - Marcel Smits
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Neurology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Leopold Mg Curfs
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
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13
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Tan X, Alén M, Wiklund P, Partinen M, Cheng S. Effects of aerobic exercise on home-based sleep among overweight and obese men with chronic insomnia symptoms: a randomized controlled trial. Sleep Med 2016; 25:113-121. [PMID: 27823703 DOI: 10.1016/j.sleep.2016.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the effect of a six-month aerobic exercise program on home-based sleep quality among overweight and obese men with chronic insomnia symptoms. METHODS Participants were 45 Finnish men (93% had body mass index ≥25) aged 30-65 years, with chronic (≥3 months) insomnia symptoms as classified by the DSM-IV criteria. Participants were randomized into an exercise (n = 24) or control group (n = 21). The exercise group received six-month aerobic exercise intervention with one to five sessions per week of 30-60 minutes duration. The control group was instructed to maintain habitual lifestyle behaviors during the study period. Seven-night home sleep was measured with a piezoelectric bed sensor and sleep diary. Other assessments included the modified Basic Nordic Sleep Questionnaire, a health and behavior questionnaire, physical activity and diet diaries, anthropometry, fat mass, and physical fitness. Analysis of covariance controlling for baseline values, and repeated-measures analysis of variance were implemented for time-by-group comparisons and within-group comparisons, respectively. RESULTS At six months, the exercise group showed reduced objective sleep onset latency (p = 0.010) and lowered frequency of difficulty initiating sleep (p = 0.021) than controls. Although a time-by-group difference was not significant, exercisers showed shorter objective wake after sleep onset (p = 0.004), reduced subjective nocturnal awakenings (p = 0.010), improved objective sleep efficiency (p <0.001), and improved morning-rated subjective sleep quality (p = 0.042) at six months than baseline. CONCLUSIONS A six-month aerobic exercise can improve sleep, mainly by mitigating difficulty of initiating sleep among overweight and obese men with chronic insomnia symptoms.
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Affiliation(s)
- Xiao Tan
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alén
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Petri Wiklund
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Partinen
- Vitalmed Research Center, Helsinki Sleep Clinic and Department of Neurosciences, University of Helsinki, Helsinki, Finland
| | - Sulin Cheng
- Exercise Health and Technology Center, Shanghai Jiao Tong University, Shanghai, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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14
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Reid KJ, Baron KG, Zee PC. Meal timing influences daily caloric intake in healthy adults. Nutr Res 2014; 34:930-5. [PMID: 25439026 DOI: 10.1016/j.nutres.2014.09.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 09/17/2014] [Accepted: 09/25/2014] [Indexed: 11/16/2022]
Abstract
The role that meal pattern plays in weight regulation is a popular topic of scientific and common debate. The goal of this study was to evaluate the relationship between meal timing with caloric intake and body mass index (BMI). We hypothesized that late meal timing and eating closer to sleep onset time would be associated with greater energy intake and higher BMI. Participants included 59 individuals recruited from the community. Rest/activity patterns were assessed using 7 days of wrist actigraphy, and caloric intake was evaluated using 7 days of diet logs. Results demonstrated that the timing of meals was associated with overall energy intake but not with BMI. In multivariate analyses controlling for age, sex, sleep duration, and timing, eating more frequently, later timing of the last meal, and a shorter duration between last meal and sleep onset predicted higher total caloric intake. In a mediational model, eating frequency explained the relationship between eating closer to sleep onset and total caloric intake. Results suggest that later relative timing of meals, particularly eating close to sleep, could lead to weight gain due to a greater number of eating occasions and higher total daily caloric intake. These findings have important implications for the development of novel, time-based interventions for weight management.
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Affiliation(s)
- Kathryn J Reid
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Kelly G Baron
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Phyllis C Zee
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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15
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Putilov AA. When does this cortical area drop off? Principal component structuring of the EEG spectrum yields yes-or-no criteria of local sleep onset. Physiol Behav 2014; 133:115-21. [PMID: 24878318 DOI: 10.1016/j.physbeh.2014.05.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/26/2014] [Accepted: 05/07/2014] [Indexed: 11/26/2022]
Abstract
The traditional sleep scoring approach has been invented long before the recognition of strictly local nature of the sleep process. It considers sleep as a whole-organism behavior state, and, thus, it cannot be used for identification of sleep onset in a separate brain region. Therefore, this paper was aimed on testing whether the practically useful, simple and reliable yes-or-no criterion of sleep onset in a particular cortical region might be developed through applying principal component analysis to the electroencephalographic (EEG) spectra. The resting EEG was recorded with 2-hour intervals throughout 43-61-hour prolongation of wakefulness, and during 12 20-minute attempts to nap in the course of 24-hour wakefulness (15 and 18 adults, respectively). The EEG power spectra were averaged on 1-min intervals of each resting EEG record and on 1-min intervals of each napping attempt, respectively. Since we earlier demonstrated that scores on the first and second principal components of the EEG spectrum exhibit dramatic changes during the sleep onset period, a zero-crossing buildup of the first score and a zero-crossing decline of the second score were examined as possible yes-or-no markers of regional sleep onsets. The results suggest that, irrespective of electrode location, sleep onset criterion and duration of preceding wakefulness, a highly significant zero-crossing decline of the second principal component score always occurred within 1-minute interval of transition from wakefulness to sleep. Therefore, it was concluded that such zero-crossing decline can serve as a reliable, simple, and practically useful yes-or-no marker of drop off event in a given cortical area.
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Affiliation(s)
- Arcady A Putilov
- Research Institute for Molecular Biology and Biophysics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.
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Kinreich S, Podlipsky I, Jamshy S, Intrator N, Hendler T. Neural dynamics necessary and sufficient for transition into pre-sleep induced by EEG neurofeedback. Neuroimage 2014; 97:19-28. [PMID: 24768931 DOI: 10.1016/j.neuroimage.2014.04.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/31/2014] [Accepted: 04/12/2014] [Indexed: 11/16/2022] Open
Abstract
The transition from being fully awake to pre-sleep occurs daily just before falling asleep; thus its disturbance might be detrimental. Yet, the neuronal correlates of the transition remain unclear, mainly due to the difficulty in capturing its inherent dynamics. We used an EEG theta/alpha neurofeedback to rapidly induce the transition into pre-sleep and simultaneous fMRI to reveal state-dependent neural activity. The relaxed mental state was verified by the corresponding enhancement in the parasympathetic response. Neurofeedback sessions were categorized as successful or unsuccessful, based on the known EEG signature of theta power increases over alpha, temporally marked as a distinct "crossover" point. The fMRI activation was considered before and after this point. During successful transition into pre-sleep the period before the crossover was signified by alpha modulation that corresponded to decreased fMRI activity mainly in sensory gating related regions (e.g. medial thalamus). In parallel, although not sufficient for the transition, theta modulation corresponded with increased activity in limbic and autonomic control regions (e.g. hippocampus, cerebellum vermis, respectively). The post-crossover period was designated by alpha modulation further corresponding to reduced fMRI activity within the anterior salience network (e.g. anterior cingulate cortex, anterior insula), and in contrast theta modulation corresponded to the increased variance in the posterior salience network (e.g. posterior insula, posterior cingulate cortex). Our findings portray multi-level neural dynamics underlying the mental transition from awake to pre-sleep. To initiate the transition, decreased activity was required in external monitoring regions, and to sustain the transition, opposition between the anterior and posterior parts of the salience network was needed, reflecting shifting from extra- to intrapersonal based processing, respectively.
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Affiliation(s)
- Sivan Kinreich
- Department of Psychology, Tel Aviv University, Tel Aviv 6997801, Israel; Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ilana Podlipsky
- Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Shahar Jamshy
- School of Computer Science, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Nathan Intrator
- School of Computer Science, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Talma Hendler
- Department of Psychology, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Physiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Functional Brain Center, Wohl Institute for Advanced Imaging, Tel-Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.
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