Sleep Initiation and Maintenance Disorders: Martin JL

Martin JL, Fung CH. · Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs Greater Los Angeles Healthcare System (BLAHS), Los Angeles, CA 91343, USA. · J Am Geriatr Soc. · Pubmed #17910566 No free full text.

This publication has no abstract.

Ancoli-Israel S, Martin JL. · University of California San Diego, USA. · J Clin Sleep Med. · Pubmed #17561549 No free full text.

Abstract: Insomnia, daytime sleepiness, and napping are all highly prevalent among the elderly, reflecting changes in sleep architecture, sleep efficiency, sleep quality, and circadian sleep-wake cycles. Insomnia is sometimes associated with subjective daytime sleepiness, as well as other clinical and socioeconomic consequences. The daytime sleepiness will at times lead to napping. Although napping is viewed as a common age-related occurrence, little is known about its benefits or consequences. Factors reported to be contributors to daytime napping include sleep-maintenance difficulty and sleep fragmentation with consequent daytime sleepiness, nighttime use of long-acting sedating agents, daytime use of sedating medications, and dementia. However, a correlation between sleep disturbance and daytime napping has not been consistently observed. Whether napping is beneficial, neutral, or detrimental is an important issue, in light of conflicting findings regarding the impact of daytime napping on nighttime sleep and recent reports of an association between napping and adverse clinical outcomes, including increased mortality risk. Further research is needed to determine whether there is a cause-and-effect relationship between napping and insomnia, and between napping and adverse clinical outcomes, and to explore the clinical implications of improving insomnia and reducing daytime napping. Clinical evaluations of hypnotic agents should assess efficacy for both improving insomnia symptoms (particularly sleep-maintenance difficulty, in the case of elderly patients) and reducing daytime sleepiness that would lead to inadvertent napping.

Shimazaki M, Martin JL. · University of California, Los Angeles, Multicampus Program in Geriatric Medicine and Gerontology, Los Angeles, CA, USA. · J Am Med Dir Assoc. · Pubmed #17498609 links to  free full text

Abstract: Sleep disruption is common in the long-term care setting. This article discusses the available literature on 2 herbal approaches to sleep problems in long-term care. The largest body of evidence exists for the use of the dietary/herbal supplements valerian and melatonin. While these agents appear to have a modest positive effect on sleep quality among older adults, most studies were small in size and included only subjective assessments of sleep quality. In addition, it is unclear whether these agents pose risks to long-term care residents because of potential drug interactions. Additional research is needed before making conclusive recommendations about the use of these interventions for sleep in the long-term care setting.

Martin JL, Ancoli-Israel S. · San Diego State University/University of California, Joint Doctoral Program in Clinical Psychology, USA. · Sleep Med Rev. · Pubmed #12531128 No free full text.

Abstract: A number of non-pharmacologic interventions have been developed and studied for the treatment of primary insomnia in adults. Fifty-four non-pharmacological intervention studies published over the last 20 years were reviewed to determine how primary insomnia was assessed and to characterize patients participating in the studies. The main objectives were to inform clinicians who look to the literature for information on the treatment of insomnia about selection and diagnosis of participants, and to examine differences between clinic-based and research-based studies. Mean age for all patients was 47 years; 65% were women. Studies typically used interview procedures to assess participants. The most common exclusion criteria overall was insomnia secondary to medical illness or psychiatric disorder. Methods for assessing these criteria varied widely across studies. Inclusion most commonly required a 6-month duration of insomnia, and sleep difficulty at least 3 nights per week. There were significant differences between clinic- and research-based studies in the screening assessments, exclusion criteria, and participant drop-out rate. The heterogeneity in assessment and diagnosis complicates comparison across studies. Some studies were more likely to include severe insomnia sufferers and/or individuals with secondary insomnia. Comprehensive assessment and complete reporting of research methods is essential to determining the relative efficacy and clinical utility of interventions. Clinicians should be aware of the differences across studies from research vs. clinical settings. To enhance the generalizability of research-based studies to clinical practice, careful screening and description of study participants is essential. When participants are well-described, research-based studies can be useful and informative to clinicians.

Arnedt JT, Martin JL, Posner DA. · Department of Psychiatry and Human Behavior, Box G-BH, Brown University, Providence, RI 02912, USA. · Med Health R I. · Pubmed #11917751 No free full text.

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Martin JL, Marler MR, Harker JO, Josephson KR, Alessi CA. · Multicampus Program in Geriatric Medicine and Gerontology, University of California, Los Angeles, USA. · J Gerontol A Biol Sci Med Sci. · Pubmed #17301040 No free full text.

Abstract: BACKGROUND: Sleep and circadian rhythms are disrupted among many nursing home (NH) residents. We examined the impact of a multicomponent nonpharmacological intervention on 24-hour rest/activity rhythms among long-stay NH residents. METHODS: The study was a randomized controlled trial in which, following a 3-day baseline, participants received 5 days of either usual care (control condition) or the active intervention. The intervention combined increased exposure to outdoor bright light, efforts to keep residents out of bed during the day, structured physical activity, institution of a bedtime routine, and efforts to reduce nighttime noise and light in residents' rooms. For 100 residents with baseline and follow-up wrist actigraphy data (mean age = 87 years; 76% women), rest/activity rhythms were modeled to determine the rhythm acrophase (peak time), nadir (trough time), midline estimating statistic of rhythm (MESOR) (midpoint), amplitude (height of peak), slope, and the rest period/active period ratio (alpha). RESULTS: The intervention led to an increase in the duration of the "active" portion of the rhythm, which was primarily accounted for by a shift in the rest/activity rhythm rise to an earlier time. Findings persisted when analyses were adjusted for age, cognitive functioning, medical comorbidities, and behavioral disturbances. CONCLUSIONS: These findings suggest that the intervention may effectively improve the robustness of rest/activity rhythms in NH residents. Further research is needed to examine the impact of similar interventions on other measures of circadian rhythms (e.g., body temperature, melatonin) among NH residents.

Martin JL, Alessi CA. · No affiliation provided · J Am Geriatr Soc. · Pubmed #16866697 No free full text.

This publication has no abstract.