University students' sleep during the COVID-19 pandemic in the State of Hawai'i.

Objectives: This study assessed undergraduates' sleep in Hawai'i during the COVID-19 pandemic and whether demographic characteristics, health locus of control, substance use and campus features related to sleep outcomes. Implications are considered for programs to support students' sleep and health during pandemic conditions. Participants: About 1,288 undergraduate students from six universities in Hawai'i. Methods: Surveys assessing sleep, emotional wellbeing, ethnicity, body mass index, locus of health control, and substance use. Results: Students' reported increased sleep time but decreased sleep quality during the pandemic. Sleep disruption related to anxiety, depression, ethnicity, substance use, BMI, health locus of control, class rank, and whether students lived at home. All campuses were associated with disrupted sleep, regardless of size, location, religious affiliation, term structure, or method of instruction. Conclusions: In response to public health crises, such as the COVID-19 pandemic, all Hawai'i universities should screen students for sleep disruption, emotional adjustment, social isolation and substance misuse. Programs to promote sleep and behavioral health appear particularly warranted for graduating seniors, Pacific Islanders, students with high BMI, and students who commute to college.

Translational Sleep Science in Behavioral Medicine: Introduction to this Special Issue.

The consideration of sleep and circadian rhythms in the context of health is a relatively recent development in the history of the field of behavioral medicine. This special issue of the International Journal of Behavioral Medicine recognizes that sleep and circadian rhythms are fundamental to appreciating physiological, psychological, social, and environmental factors in the health and well-being of the population. The articles included in this issue draw attention to the breadth and saliency of sleep as a marker of health status and as a target of behavioral intervention to promote health. Such research highlights the diversity of participants, research methods, and clinical significance of translational sleep science allowing us to recognize the role of sleep in the context of health in new ways. These studies also illustrate progress in integrating theory, employing prospective and longitudinal designs and multimodal and integrative assessments. This introduction to the special issue concludes by discussing challenges and opportunities in the field of behavioral sleep medicine, including those posed by the coronavirus disease 2019 (COVID-19) pandemic and the need to more effectively provide sleep disorder treatment among underserved populations.

Behavioral medicine challenges in the shadow of a global pandemic.

Health behavior researchers should refocus and retool as it becomes increasingly clear that the challenges of the COVID-19 pandemic surpass the direct effects of COVID-19 and include unique, drastic, and ubiquitous consequences for health behavior. The circumstances of the pandemic have created a natural experiment, allowing researchers focusing on a wide range of health behaviors and populations with the opportunity to use previously collected and future data to study: (a) changes in health behavior prepandemic and postpandemic, (b) health behavior prevalence and needs amidst the pandemic, and (c) the effects of the pandemic on short- and long-term health behavior. Our field is particularly challenged as we attempt to consider biopsychosocial, political, and environmental factors that affect health and health behavior. These realities, while daunting, should call us to action to refocus and retool our research, prevention, and intervention efforts.

Position statement: start middle and high schools at 8:30 am or later to promote student health and learning.

The Society of Behavioral Medicine recommends school officials start middle and high school classes at 8:30 am or later. Such a schedule promotes students' sleep health, resulting in improvements in physical health, psychological well-being, attention and concentration, academic performance, and driving safety. In this position statement, we propose a four-tiered approach to promote later school start times for middle and high schools.

Deactivation of brain areas during self-regulation of slow cortical potentials in seizure patients.

This study investigates the neurophysiological basis of EEG feedback for patients with epilepsy. Brain areas are identified that become hemodynamically deactivated when epilepsy patients, trained in EEG self-regulation, generate positive slow cortical potentials (SCPs). Five patients were trained in producing positive SCPs, using a training protocol previously established to reduce seizure frequency in patients with drug refractory epilepsy. Patients attempted to produce positive SCP shifts in a functional magnetic resonance imaging (fMRI) scanner. Two patients were able to reliably produce positive SCP shifts. When these successful regulators were prompted to produce positive SCPs, blood oxygen level-dependent (BOLD) response indicated deactivation, in comparison to a control state, around the recording electrode, frontal lobe, and thalamus. Unsuccessful regulators' BOLD response indicated no deactivation in cortical areas proximal to the active electrode. No thalamic deactivation was found in poor regulators. Decreased seizure frequency from SCP training may be the result of positively reinforced inhibition in cortical areas proximal to active electrode placement, the frontal cortex, and the thalamus.

Air travel and seizure frequency for individuals with epilepsy.

This study investigated whether air travel is associated with an increase in seizures for individuals with epilepsy. Thirty-seven participants monitored their seizure frequency for one week prior to flying and for one week after flying. For the sample as a whole, seizures were significantly more common after flying (p=.02). No seizures were reported as occurring during flight. Participants who experienced an increase in seizures after flying compared to those who did not (a) had a higher baseline of seizure frequency (p=.004), (b) were more likely to have previously experienced an increase in seizures after flying (p=.001), (c) were more worried about having a seizure while flying (p=.001) and (d) were more likely to avoid air travel (p=.02). Participants with complete seizure control prior to flying did not experience seizures after flying. Distance traveled, time zones crossed, duration of flight and direction of flight were not significantly different for those with seizure increase than for those without such an increase. This study suggests that air travel promotes an increase in seizures for those with a prior history of flight related seizures and a relatively high baseline seizure frequency.

Predictors of seizure reduction after self-regulation of slow cortical potentials as a treatment of drug-resistant epilepsy.

Variables were identified that predict seizure reduction following self-regulation of slow cortical potentials (SCPs) as part of a behavioral self-management program. A sequence analysis across 52 weeks determined 14 patients to have greater than 50% seizure reduction, 8 patients with less than 50% reduction, and 12 patients without improvement. Three variables accounted for 70% of treatment success: (1) cortical excitability at the beginning of training, (2) epileptic focus, and (3) personality variables. Reduction of complex partial and secondary generalized seizures covaried with SCP control attained in the last training session. EEG spectral parameters and cognitive function appeared unrelated to treatment outcome. Successful patients may be those without large negative SCP amplitudes at the beginning of training, without a left temporal epileptic focus, and who score low on life satisfaction and are highly reactive to stress. Patients with complex partial and secondarily generalized seizures may be more likely to experience seizure reduction if they demonstrate good SCP control at the end of their training.

Brain areas activated in fMRI during self-regulation of slow cortical potentials (SCPs).

In humans, surface-negative slow cortical potentials (SCPs) originating in the apical dendritic layers of the neocortex reflect synchronized depolarization of large groups of neuronal assemblies. They are recorded during states of behavioural or cognitive preparation and during motivational states of apprehension and fear. Surface positive SCPs are thought to indicate reduction of cortical excitation of the underlying neural networks and appear during behavioural inhibition and motivational inertia (e.g. satiety). SCPs at the cortical surface constitute summated population activity of local field potentials (LFPs). SCPs and LFPs may share identical neural substrates. In this study the relationship between negative and positive SCPs and changes in the BOLD signal of the fMRI were examined in ten subjects who were trained to successfully self-regulate their SCPs. FMRI revealed that the generation of negativity (increased cortical excitation) was accompanied by widespread activation in central, pre-frontal, and parietal brain regions as well as the basal ganglia. Positivity (decreased cortical excitation) was associated with widespread deactivations in several cortical sites as well as some activation, primarily in frontal and parietal structures as well as insula and putamen. Regression analyses revealed that cortical positivity was predicted with high accuracy by pallidum and putamen activation and supplementary motor area (SMA) and motor cortex deactivation, while differentiation between cortical negativity and positivity was revealed primarily in parahippocampal regions. These data suggest that negative and positive electrocortical potential shifts in the EEG are related to distinct differences in cerebral activation detected by fMRI and support animal studies showing parallel activations in fMRI and neuroelectric recordings.