Sleep Initiation and Maintenance Disorders: Spiegelhalder K

Spiegelhalder K, Espie C, Nissen C, Riemann D. · Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany. · J Sleep Res. · Pubmed #18482107 No free full text.

Abstract: Sleep-related attentional bias has been proposed to be an important factor in the development and maintenance of primary insomnia. In this study, a newly introduced mixed modality (visual auditory) task and an emotional Stroop task were used to investigate attentional processes in patients with primary insomnia, sleep experts and healthy controls (n = 20 per group). The sleep expert group served as second control group to control for effects of frequency of concept usage (FOCU). The results of the emotional Stroop task showed a sleep-related attentional bias in the insomnia group in comparison with the expert group. However, no significant differences were detected in the other group comparisons and in the mixed modality task. The difference between insomnia patients and sleep experts in the emotional Stroop task indicates that FOCU is not the underlying process of sleep-related attentional bias. Insomnia patients seem to be more emotionally, cognitively or procedurally affected by sleep-related stimuli than sleep experts. The findings suggest that a desensitization of sleep-related stimuli might be used therapeutically, thus extending the current cognitive behavioral treatments for primary insomnia.

Feige B, Al-Shajlawi A, Nissen C, Voderholzer U, Hornyak M, Spiegelhalder K, Kloepfer C, Perlis M, Riemann D. · Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany. · J Sleep Res. · Pubmed #18482106 No free full text.

Abstract: Primary insomnia (PI) is characterized by low subjective sleep quality which cannot always be verified using polysomnography (PSG). To shed light on this discrepancy, subjective estimates of sleep and PSG variables were compared in patients with PI and good sleeper controls (GSC). 100 patients with PI (age: 42.57 +/- 12.50 years, medication free for at least 14 days) and 100 GSC (41.12 +/- 13.99 years) with a sex distribution of 46 men and 54 women in each group were included. Both PSG and questionnaire variables showed clear impairments of sleep quality in PI compared with GSC. The arousal index within total sleep time was increased, which was mainly because of a strong increase within rapid eye movement (REM) sleep. Subjectively, more PI than GSC subjects estimated wake times longer than obtained from PSG. Linear modeling analysis of subjective wake time in terms of PSG parameters revealed that in addition to PSG defined wake time, REM sleep time contributed significantly to subjective wake time. This REM sleep contribution was larger for PI than for GSC subjects. The findings suggest that REM sleep-related processes might contribute to subjectively disturbed sleep and the perception of waking time in patients with PI.

Riemann D, Voderholzer U, Spiegelhalder K, Hornyak M, Buysse DJ, Nissen C, Hennig J, Perlis ML, van Elst LT, Feige B. · Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstr. 5, D-79104 Germany. · Sleep. · Pubmed #17702263 links to  free full text

Abstract: STUDY OBJECTIVES: Morphometric analysis of magnetic resonance imaging brain scans was used to investigate possible neuroanatomic differences between patients with primary insomnia compared to good sleepers. DESIGN: MRI images (1.5 Tesla) of the brain were obtained from insomnia patients and good sleepers. MRI scans were analyzed bilaterally by manual morphometry for different brain areas including hippocampus, amygdala, anterior cingulate, orbitofron-tal and dorsolateral prefrontal cortex. SETTING: University Hospital Sleep Center and Radiology Department PARTICIPANTS: 8 unmedicated physician-referred patients with chronic primary insomnia (3 males, 5 females; 48.4 + 16.3 years) and 8 good sleepers matched for age, sex, body mass index, and education. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Patients with primary insomnia demonstrated significantly reduced hippocampal volumes bilaterally compared to the good sleepers. None of the other regions of interest analyzed revealed differences between the 2 groups. CONCLUSIONS: These pilot data raise the possibility that chronic insomnia is associated with alterations in brain structure. Replication of the findings in larger samples is needed to confirm the validity of the data. The integration of structural, neuropsychological, neuroendocrine and polysomnographic studies is necessary to further assess the relationships between insomnia and brain function and structure.