Brain Reactivity and Selective Attention to Sleep-Related Words in Patients With Chronic Insomnia.

OBJECTIVE/BACKGROUND: Sleep-related attentional bias has been suggested to represent an important factor for the maintenance of chronic insomnia. However, little is known about potentially underlying psychological mechanisms such as threat or craving. As these are associated with distinguishable brain activation patterns, we performed a functional neuroimaging study. PARTICIPANTS/METHODS: Functional magnetic resonance imaging was used to investigate brain reactivity to sleep-related words in 20 patients with primary insomnia according to DSM-IV criteria and 35 good sleeper controls according to Research Diagnostic Criteria. In addition, an emotional Stroop task was performed in all participants outside the scanner to investigate sleep-related attentional bias. RESULTS: Contrary to the hypotheses, patients with chronic insomnia did not differ from good sleeper controls in terms of threat- or craving-related brain reactivity to sleep-related words. In addition, the emotional Stroop task did not reveal any significant group difference in sleep-related attentional bias. Exploratory analyses did not show any significant correlations between brain reactivity/selective attention to sleep-related words and questionnaire scores/PSG parameters. CONCLUSIONS: The results from the present study call into question that attentional bias to sleep-related stimuli is a core feature of chronic insomnia. Future studies may use pictorial stimuli and larger sample sizes for investigating sleep-related information processing in insomnia.

[Insomnia]. / Schlafstörungen.

Insomnia is a highly prevalent disorder with consequences for the patient's physical and mental health, daily function, and job performance. This paper gives an overview on current and new pharmacological treatments of insomnia. Additionally, some evidence based treatment options with regard to cognitive behavioral therapy are presented.

Different Endocrine Effects of an Evening Dose of Amitriptyline, Escitalopram, and Placebo in Healthy Participants.

OBJECTIVE: The primary aim of this study was to further characterize the acute effects of amitriptyline (AMI) and escitalopram (ESC) on serum levels of ghrelin, leptin, cortisol and prolactin in healthy humans. METHODS: Eleven healthy male participants received a single dose of AMI 75 mg, ESC 10 mg, or placebo (PLA) at 9:00 PM in a double blind, randomized, controlled, repeated measures study separated by one week. Fasting morning serum levels (7:00 AM) of ghrelin, leptin, cortisol and prolactin were assessed. RESULTS: A repeated measures multivariate analysis of variance revealed a significant main effect for the factor condition (AMI, ESC, PLA). Subsequent univariate analyses demonstrated significant condition effects for ghrelin and cortisol. Post-hoc analyses demonstrated a significant reduction of ghrelin levels after AMI in comparison to PLA, and a significant reduction of cortisol levels after AMI in comparison to both ESC and PLA. Other contrasts did not reach statistical significance. CONCLUSION: Administration of a single dose of AMI, but not of ESC, leads to a significant reduction in morning serum ghrelin and cortisol levels. No effects on leptin and prolactin levels were observed. The differential impact of AMI and ESC on hormones might contribute to different adverse effect profiles of both substances.

Insomnia-perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia.

Study Objectives: Insomnia disorder (ID) is a frequent sleep disorder coupled with increased risks for somatic and mental illness. Although subjective complaints are severe, polysomnography (PSG) parameters show only modest differences between groups. Rapid eye movement (REM) sleep as the most aroused sleep state may be especially vulnerable to be perceived as wake. To directly assess possible differences, we determined auditory waking thresholds and sleep perception in patients with ID and healthy control participants (good sleeper controls [GSC]) in N2 and REM sleep. Methods: In case-control study, 27 patients with ID and 27 age- and gender-matched controls were included. Four consecutive nights were assessed in the sleep laboratory, with nights 3 and 4 each containing three awakenings either from stable N2 or REM sleep. Awakening thresholds in patients with ID did not differ from GSC, but decreased over the course of the night. Patients with ID indicated significantly more frequently than GSC having been awake when woken from REM sleep but not from N2 and were less sure when indicating they had been asleep. Additionally, participants with ID rated their REM sleep mentation as more emotionally negative compared with GSC. Conclusions: This study presents direct evidence that the subjective experience of insomnia might be specifically coupled to the REM sleep state. Assuming chronic hyperarousal as a central pathophysiologically relevant pathway for insomnia, this might become especially evident during REM sleep, thus reflecting a hybrid sleep state in insomnia being coupled with altered sleep perception.

Sleep restriction over several days does not affect long-term recall of declarative and procedural memories in adolescents.

OBJECTIVES: There is broad evidence that sleep as opposed to waking facilitates the consolidation of both declarative and procedural memory. The current study addressed the question whether different extents of sleep restriction after learning would impair long-term memory consolidation in adolescents. METHODS: Eighty-eight healthy adolescents were randomized to five different sleep protocols with 9, 8, 7, 6 or 5 h of time in bed for four consecutive nights under controlled conditions that excluded daytime sleep. Declarative (word-pair task) and procedural memory (mirror tracing task) encoding was assessed prior to the sleep restriction protocol. Recall was assessed after two recovery nights following the sleep protocol and 4 weeks later. RESULTS: Sleep diaries and actigraphy data demonstrated that the participants closely followed the sleep protocols. There were no differences in demographic parameters or memory encoding at baseline. In contrast to the initial prediction, restriction of nocturnal sleep over four consecutive nights had no significant impact on declarative or procedural memory consolidation. Polysomnographic monitoring after sleep restriction demonstrated a high preservation of the amount of slow wave sleep in the restricted conditions. CONCLUSIONS: The results suggest that adolescents show a high resilience of memory consolidation to substantial sleep curtailment across four nights that might be promoted by increased sleep intensity under conditions of sleep restriction.