Sleep Initiation and Maintenance Disorders: Bliwise DL

Huang W, Kutner N, Bliwise DL. · VA Medical Center at Atlanta, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, 1670 Clairmont Road, Decatur, GA 30033, USA. · Sleep Med Rev. · Pubmed #19097814 No free full text.

Abstract: To examine the extent to which research supports the use of acupuncture in treating insomnia, a systematic review was conducted that included not only clinical trials, but also case series in both English and Chinese literature. Thirty studies were included in the review, 93% of which showed positive treatment effects of acupuncture in improving various aspects of sleep. Although acupuncture has been demonstrated to be safe and holds great potential to be an effective treatment modality for insomnia, the evidence is limited by the quality of these studies and mixed results from those with sham (or unreal treatment) controls. Of the thirty studies, twelve were clinical trials with only three double-blinded. Only five used sham controls, and of these, four showed statistically significant differences favoring real treatments; however, none evaluated the adequacy of sham assignment. Three studies used actigraphy or polysomnography as objective outcome measures. The considerable heterogeneity of acupuncture techniques and acupoint selections among all studies made the results difficult to compare and integrate. High-quality randomized clinical trials of acupuncture in treating insomnia, with proper sham and blinding procedures will be required in the future. This review highlights aspects of acupuncture treatments important to guide future research and clinical practice.

Parker KP, Bailey JL, Rye DB, Bliwise DL, Van Someren EJ. · Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322, USA. · J Nephrol. · Pubmed #18446736 No free full text.

Abstract: BACKGROUND: Hemodialysis (HD) induces physiological changes that may affect the ability to dissipate heat and adversely affect sleep on the nights following treatment. We studied the effects of altering dialysate temperature on polysomnographic measures of nocturnal sleep and the time course of proximal skin temperature. METHODS: The sample included seven stable HD patients. The three-phase randomized trial was conducted in a research facility. After one acclimatization night, subjects were readmitted in the evening on two additional occasions for 42 hours and received HD the next morning in the warm condition (dialysate--37 degrees C) and cool condition (dialysate--35 degrees C) in random order. Continuous proximal skin temperature (axillary, Tax) and polysomnographic measures of sleep were recorded the nights before and after HD was administered. RESULTS: Highly significant findings included that the course of Tax was markedly affected by the interaction of time and condition. In addition, there was a greater drop of Tax in the early morning following the warm condition than during the baseline nights or in the cool condition. Logistic regression indicated that the odds for the occurrence of sleep and its deeper stages were strongly and positively associated with Tax. Time of sleep onset was earlier in the cool condition (p = 0.032) with trends toward longer total sleep times (p = 0.090) and shorter REM latencies (p = 0.088). CONCLUSIONS: These observations suggest that the use of cool dialysate during HD may improve nocturnal sleep the night following treatment by decreasing sympathetic activation and sustaining the normally elevated nocturnal skin temperature until later into the morning hours.

Friedman L, Benson K, Noda A, Zarcone V, Wicks DA, O'Connell K, Brooks JO, Bliwise DL, Yesavage JA. · Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California 94305-5548, USA. · J Geriatr Psychiatry Neurol. · Pubmed #10753003 No free full text.

Abstract: We compared the efficacy of sleep restriction therapy combined with sleep hygiene, nap modification of sleep restriction therapy combined with sleep hygiene, and sleep hygiene alone as treatments for insomnia in 39 community-dwelling men and women 55 years and older. We used the wrist actigraph as an objective outcome measure for all subjects at baseline, end of treatment, and 3-month follow-up; polysomnography (PSG) was conducted in a subgroup of subjects. Although subjects appeared to follow restriction instructions through follow-up, we found few between-group differences in treatment efficacy. Lack of treatment effect might be explained by the efficacy of HYG as a treatment in itself and the relatively low symptom level in these healthy older poor sleepers. At baseline, actigraphic results were found to correlate more highly than sleep log data with PSG in our sample. Actigraphic total sleep time, in particular, was highly correlated with PSG.

Bliwise DL, Ansari FP. · Program in Sleep, Aging and Chronobiology, Department ofNeurology, Emory University Medical School, Atlanta, GA 30329, USA. · Sleep. · Pubmed #17682659 links to  free full text

Abstract: STUDY OBJECTIVE: Many people use dietary supplements or herbal products to help them sleep. We analyzed the associations between melatonin use and insomnia and between valerian use and insomnia in a representative sample of the United States population. DESIGN AND PARTICIPANTS: The data reported upon here were collected in the 2002 Alternative Health/Complementary and Alternative Medicine (CAM) Supplement to the National Health Interview Survey. This was a survey of 31,044 personal interviews that constituted an age-representative and socioeconomically representative sample of the civilian noninstitutionalized population of the United States. RESULTS: Of the survey sample, 5.9% used valerian and 5.2% used melatonin. Of those using valerian, 29.9% endorsed insomnia as 1 reason for CAM use, and, of melatonin users, 27.5% endorsed insomnia as 1 reason for CAM use. Relatively greater use occurred in individuals under age 60 years. The decision to use such substances was made in consultation with a health care provider less than half of the time. CONCLUSIONS: Large segments of the United States population used valerian or melatonin for insomnia within the year preceding the survey, and usage typically fell outside the purview of the health care system.

Kutner NG, Zhang R, Huang Y, Bliwise DL. · Rehabilitation/Quality of Life Special Studies Center, United States Renal Data System, Emory University, CRM-1441 Clifton Rd. NE, Atlanta, GA 30322, USA. · Int Urol Nephrol. · Pubmed #17342449 No free full text.

Abstract: BACKGROUND: Research in the general population indicates that sleep fragmentation is detrimental for cognitive function, but little attention has been given to this issue in dialysis patients. We hypothesized that patients with self-reported persistent sleep difficulty would have an increased risk of scoring lower on a cognitive function measure at follow-up compared to their score at baseline. METHODS: Sleep difficulty and cognitive function were reported by a large national patient cohort near the start of dialysis and at a 9- to 12-month follow-up. Logistic regression was used to investigate the risk of scoring lower on a cognitive function measure at follow-up as a function of self-reported sleep difficulty, controlling for patients' sociodemographic, clinical and treatment characteristics, including depressed mood. RESULTS: At follow-up, cognitive function scores were lower among 35.8% of the cohort. Patients with self-reported persistent sleep difficulty had the lowest average cognitive function score. Men with reported persistent sleep difficulty, regardless of presence of depressed mood, had a significantly increased risk of a lower cognitive function score at follow-up. Women with reported persistent sleep difficulty as well as depressed mood had significantly increased risk of a lower cognitive function score. CONCLUSION: The potential impact of sleep difficulty and depressed mood on the cognitive function of dialysis patients emphasizes the importance of evaluating and treating these risks and highlights the value of continued research to improve our understanding and management of these issues.