Sleep Initiation and Maintenance Disorders: Drake CL

Drake CL, Roehrs T, Roth T. · Henry Ford Hospital Sleep Disorders and Research Center, CFP3, Detroit, Michigan 48202, USA. · Depress Anxiety. · Pubmed #14661186 No free full text.

Abstract: There is growing interest in insomnia both from the perspective of recent advances in clinical management as well as research aimed at elucidating its pathophysiology. This theoretical overview of insomnia describes the negative impact, etiological considerations, and pharmacological and behavioral treatments for the disorder, with an emphasis on areas receiving increased research attention. Insomnia, the most prevalent sleep disorder, affects 10-15% of the general population. In population-based studies severe insomnia has been shown to last for a median of 4 years. In addition, insomnia has a significant negative impact on an individual's work, physical, and social performance as well as overall quality of life. Furthermore, the economic cost of insomnia related to lost productivity, work-related accidents, absenteeism, and health-care costs are enormous. There is increasing evidence linking the precipitation of insomnia to stress, and converging evidence from cognitive, endocrine, neurological, and behavioral domains provide clear evidence for hyper-arousal in insomnia. However, there remains no consensus regarding the specific etiological mechanisms of this disorder. Although the pathophysiology of primary insomnia remains an enigma, numerous treatments both pharmacological and behavioral have been developed and found to be efficacious in controlled studies. Despite the wide availability of pharmacological treatments and increased knowledge of behavioral interventions, the vast majority of individuals with insomnia do not appear to be receiving adequate treatment. The inadequate treatment of insomnia leads to several important and under-recognized consequences including subsequent development of psychiatric disease and increased substance use.

Drake CL, Scofield H, Roth T. · Sleep Disorders and Research Center, Henry Ford Hospital, 2799 West Grand Blvd, CFP3, Detroit, MI 48202, USA. · Sleep Med. · Pubmed #17825612 links to  free full text

Abstract: BACKGROUND: The goal of this study was to determine the degree of familial aggregation in vulnerability to stress-related sleep disturbance among siblings. One approach to investigating a potential "familial" predisposition to sleep disturbance is to examine the relationship between siblings on a standard measure of vulnerability to stress-related sleep disturbance. DESIGN: Cross-sectional data on insomnia, vulnerability to stress-related sleep disturbance, sleepiness, habitual sleep, and additional demographic variables was collected separately from pairs of biological siblings. Data were collected during a 15-20min phone assessment. PARTICIPANTS: Interviews on a total of 62 individuals (31 sibling pairs) were completed. A total of 8 individuals and their respective siblings were excluded after meeting conservative criteria for Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV)-based insomnia. The mean age of the sample was 51.1+/-12.1 years (range 18-70) and habitual nightly total sleep time averaged 6.91+/-1.42h/night. RESULTS: Individuals completed the Ford Insomnia Response to Stress Test (FIRST), a standardized measure of individual vulnerability to stress-induced sleep disturbance. The intraclass correlation coefficient (ICC) was r =0.61, df=23, p =0.001 for the relationship between siblings in FIRST scores. This indicated that 37.2% of the variance in vulnerability to stress-related sleep disturbance can be accounted for by familial aggregation. This relationship remained after controlling for potential confounds including age, gender, shift schedule, and psychiatric history. CONCLUSIONS: Our data support the notion that vulnerability to stress-related sleep disturbance has a strong familial aggregation. Additional studies are needed to determine the genetic or environmental origins of this relationship and its underlying biological substrates.

Drake CL, Jefferson C, Roehrs T, Roth T. · Henry Ford Hospital Sleep Disorders and Research Center, and Department of Psychiatry and Behavioral Neurosciences, Wayne State College of Medicine, Detroit, MI 48202, USA. · Sleep Med. · Pubmed #16996309 links to  free full text

Abstract: BACKGROUND AND PURPOSE: To determine the sleep response to caffeine in individuals vulnerable to stress-related sleep disturbance as measured by polysomnography. PATIENTS AND METHODS: Eleven healthy individuals without insomnia scoring low (4 women, mean age=32.64+/-15.46 years) and 10 healthy individuals also without insomnia scoring high (6 women, mean age=34.20+/-13.73 years) on a measure of vulnerability to stress-related sleep disturbance were studied in a laboratory protocol. A moderate-low dose of caffeine (3 mg/kg) was administered 1h prior to lights-out and compared to a counterbalanced control night with each condition separated by 1 week. Standard polysomnographic measures were assessed (i.e. total sleep time, sleep efficiency, latency to persistent sleep, and sleep stage percentages) for both control and caffeine nights. RESULTS: There were no between-group differences in sleep on the control night. Importantly, individuals reporting vulnerability to stress-related sleep disturbance had significantly prolonged latency to persistent sleep in response to the caffeine challenge (interaction; P<0.05). CONCLUSION: Normal sleepers with an identified vulnerability to stress-induced sleep disturbance exhibited greater objectively verifiable sleep-reactivity in response to a caffeine challenge compared to non-vulnerable individuals. These results suggest that the construct of individual differences in vulnerability to sleep disturbance applies to a pharmacological 'stressor' (i.e. caffeine) as well as to previously assessed stressors such as a first-night effect. This finding provides further support for generalized trait vulnerability by demonstrating a sleep disturbance to a wake-promoting pharmacological challenge in specific a priori identified individuals.

Jefferson CD, Drake CL, Scofield HM, Myers E, McClure T, Roehrs T, Roth T. · Henry Ford Hospital Sleep Disorders and Research Center, Detroit, MI, USA. · Sleep. · Pubmed #16171275 No free full text.

Abstract: STUDY OBJECTIVES: The present study was designed to assess selected aspects of sleep hygiene from a population-based sample of individuals with insomnia compared to age- and sex-matched controls. DESIGN: A random-sample phone survey of 258 individuals meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based criteria for insomnia was compared to age- and sex-matched normal sleepers on specific measures of sleep hygiene. Sleep hygiene practices measured included cigarette smoking, smoking near bedtime, alcohol use, caffeine use, napping, time in bed, and reported likelihood of sleeping in on weekends. SETTING: Detroit tricounty population. PARTICIPANTS: 258 individuals 18 to 65 years old with insomnia and 258 age- and sex-matched controls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Insomniacs reported poorer sleep hygiene, as evidenced by an increase in prevalence of smoking close to bedtime and increased use of alcohol. They also reported more naps per week and sleeping in on days not worked. Caffeine use did not differ between groups. Time in bed was also comparable between insomniacs and controls. CONCLUSION: Insomniacs do engage in specific poor sleep hygiene practices, such as smoking and drinking alcohol just before bedtime. These particular aspects of sleep hygiene may be important components that exacerbate or perpetuate insomnia.