CPAP Treatment Adherence in Women with Obstructive Sleep Apnea.

Untreated obstructive sleep apnea (OSA) has numerous negative health-related consequences. Continuous positive airway pressure (CPAP) is generally considered the treatment of choice for OSA, but rates of nonadherence are high. It is believed that OSA is more prevalent among men; therefore understanding how OSA presents among women is limited and treatment adherence has received little research attention. For this study, 29 women were recruited from primary care offices. They completed a questionnaire battery and underwent a night of nocturnal polysomnography (PSG) followed by a visit with a sleep specialist. Women diagnosed with OSA were prescribed CPAP; 2 years later CPAP adherence was evaluated. Results show that approximately half the sample was adherent. There were no significant differences between adherent and nonadherent women on OSA severity; however CPAP adherent women had worse nocturnal and daytime functioning scores at the time of diagnosis. Moreover, when the seven nocturnal and daytime variables were used as predictors in a discriminant analysis, they could predict 87% of adherent and 93% of the nonadherent women. The single most important predictor was nonrefreshing sleep. We discuss the implications of the findings for identifying women in primary care with potential OSA and offer suggestions for enhancing treatment adherence.

Doxepin and cognitive behavioural therapy for insomnia in patients with Parkinson's disease -- a randomized study.

INTRODUCTION: Although a variety of pharmacologic and non-pharmacologic treatments are effective for insomnia in the general population, insomnia in Parkinson's disease differs in important ways and may need different treatments. No studies have conclusively demonstrated effective insomnia treatments in Parkinson's disease. METHODS: We conducted a three-arm six-week randomized pilot study assessing non-pharmacologic treatment (cognitive behavioural therapy with bright light therapy) or doxepin (10 mg daily), compared to an inactive placebo in Parkinson's patients with insomnia. Sleep outcomes included insomnia scales, clinical global impression, sleep diaries and actigraphy. Secondary outcomes included motor severity, fatigue, depression and quality of life. RESULTS: 18 patients were randomized, 6 to each group. Compared to placebo, doxepin improved the Insomnia Severity Index (-9 ± 5.4 vs. -2 ± 3.9, p = 0.03), the SCOPA-night score (-5.2 ± 1.5 vs. -2.3 ± 2.8, p = 0.049), the Pittsburgh Sleep Quality Index-sleep disturbances subscale (-0.5 ± 0.5 vs 0.2 ± 0.4, p = 0.02), and both patient and examiner-rated clinical global impression of change (1.7 ± 0.8 vs. 0.5 ± 0.8, p = 0.03 and 1.4 ± 0.5 vs. 0.3 ± 0.5, p = 0.003). On secondary outcomes doxepin reduced the fatigue severity scale (p = 0.02) and improved scores on the Montreal Cognitive Assessment (p = 0.007). Non-pharmacological treatment reduced the Insomnia Severity Index (-7.8 ± 3.8 vs. -2.0 ± 3.9, p = 0.03), and the examiner-reported clinical global impression of change (p = 0.006), but was associated with decline in Parkinson Disease Questionnaire-39. There were no changes in other primary and secondary outcomes, including actigraphy outcomes. Adverse events were comparable in all groups. CONCLUSION: Doxepin and non-pharmacologic treatment substantially improved insomnia in Parkinson's disease. These potential benefits must be replicated in a full confirmatory randomized controlled trial.

What government, agencies, and organizations can do to improve access to computers for postsecondary students with disabilities: recommendations based on Canadian empirical data.

Computer, information and adaptive computer technologies have the potential to enhance the lives of people with disabilities but also to deny them equality of access to education, jobs, and community life. In a series of three studies we investigated the computer technology needs and concerns of approximately 800 postsecondary students with disabilities. Our data show that the vast majority of college and university students, regardless of sex, age, programme of study, or type of disability, can and do use computer technologies to help them succeed. A variety of government and non-governmental organizations provide computer supports for postsecondary students with disabilities. Here, we describe key aspects of our findings concerning what these organizations can do to improve the availability of technologies to students with disabilities in postsecondary education and formulate recommendations based on an environmental barriers perspective on disability. Although the research is focused on the experiences of Canadians, many of the findings and recommendations are relevant for other countries.

How is good and poor sleep in older adults and college students related to daytime sleepiness, fatigue, and ability to concentrate?

We compared good sleepers with minimally and highly distressed poor sleepers on three measures of daytime functioning: self-reported fatigue, sleepiness, and cognitive inefficiency. In two samples (194 older adults, 136 college students), we tested the hypotheses that (1) poor sleepers experience more problems with daytime functioning than good sleepers, (2) highly distressed poor sleepers report greater impairment in functioning during the day than either good sleepers or minimally distressed poor sleepers, (3) daytime symptoms are more closely related to psychological adjustment and to psychologically laden sleep variables than to quantitative sleep parameters, and (4) daytime symptoms are more closely related to longer nocturnal wake times than to shorter sleep times. Results in both samples indicated that poor sleepers reported more daytime difficulties than good sleepers. While low- and high-distress poor sleepers did not differ on sleep parameters, highly distressed poor sleepers reported consistently more difficulty in functioning during the day and experienced greater tension and depression than minimally distressed poor sleepers. Severity of all three daytime problems was generally significantly and positively related to poor psychological adjustment, psychologically laden sleep variables, and, with the exception of sleepiness, to quantitative sleep parameters. Results are used to discuss discrepancies between experiential and quantitative measures of daytime functioning.

What do older good and poor sleepers do during periods of nocturnal wakefulness? The Sleep Behaviors Scale: 60+.

To determine whether older good and poor sleepers with and without insomnia complaints differ in the nature of activities they engage in during periods of nocturnal wakefulness, the authors developed and evaluated the Sleep Behaviors Scale: 60+. Good sleepers (n = 163), low-distress poor sleepers (n = 49), and high-distress poor sleepers (n = 28) were compared on this measure as well as on sleep parameters, personality, lifestyle, and cognitive-affective variables. Findings indicate good psychometric properties for the new measure, offer a rationale for examining the frequency of the nocturnal behaviors reflected by the measure's 4 subscales (Active Behaviors, Relaxation, Cognitive Arousal, and Medication), and suggest a possible role for these behaviors in the etiology and treatment of insomnia.

Poor sleepers who do not complain of insomnia: myths and realities about psychological and lifestyle characteristics of older good and poor sleepers.

Psychological adjustment, lifestyle, and sleep parameters were investigated in 634 older community residents. Participants were divided into three categories: good sleepers, poor sleepers experiencing high distress, and poor sleepers experiencing minimal distress. Results indicate that (1) highly distressed poor sleepers manifested an anxious, depressed, negative cognitive-affective set; (2) many coped well with age related changes in sleep quality--they resembled good sleepers in the relative absence of psychological maladjustment they displayed; (3) the three groups had similar lifestyles, but they differed in the cognitive-affective evaluation of their activities, (4) the insomnia complaint is itself multifaceted and is comprised of three distinct elements--difficulty sleeping, distress, and daytime fatigue; (5) sleep practices (e.g., naps, bedtimes) are not implicated in chronic poor sleep; and (6) many commonly held assumptions about sleep disruptions in older individuals are myth rather than reality. Implications for better understanding and treating insomnia in older individuals are discussed.

[Insomnia and its treatment in aged persons: a new approach]. / L'insomnie et son traitement chez les personnes âgées: une nouvelle approche.

Existing hypotheses regarding psychological mediation of disorders in initiating and maintaining sleep only partially explain the phenomenon of insomnia, particularly in aging individuals. In this article we review existing nonpharmacological treatments of insomnia and propose a new way of conceptualizing and treating disorders of initiating and maintaining sleep. The model, based on cognitive and information processing factors, is then used to propose novel approaches to intervention. Because of the prevalence of sleep disruptions in older adults and the limitations of existing pharmacological and psychological treatments with this population, the assumptions of the model and the proposed intervention are explored with particular reference to aging individuals.

Evaluation of the sexual consequences of surgery: retrospective and prospective strategies.

To assess the impact of a stressor, it is desirable to evaluate affected individuals' status both prior to and following a stressful event. Because of the difficulties inherent in prospective designs, investigators often ask people who have experienced an aversive event to evaluate their prestressor adjustment retrospectively. Do such retrospective evaluations provide a reasonable alternative to prospective assessment? To answer this question we compared retrospective and prospective data gathering procedures in the evaluation of sexual adjustment after prostate surgery. One hundred fifty-two married males who had undergone prostatectomy for benign prostatic enlargement completed a battery of measures which evaluated pre- and postsurgical sexual adjustment either prospectively (i.e., before and after surgery) or retrospectively (i.e., ratings made after surgery of both pre- and postsurgical adjustment). Retrospective assessment indicated considerable sexual deterioration pre- to postsurgery. In subjects tested prospectively, however, the results showed that surgery had little impact on sexual adjustment. Moreover, direct comparisons of retrospective and prospective methodologies reveal that discrepancies are due to differences in evaluations of presurgery status, with retrospective evaluation yielding more favorable ratings than prospective assessment. The results highlight a variety of biases which may affect self-ratings of pre- and post-stressor adaptation and show that discrepancies associated with the two methodologies have important implications for understanding the impact of a stressor on adjustment.

Prostatectomy and inguinal hernia repair: a comparison of the sexual consequences.

This study investigated whether psychosexual changes found after surgery for benign prostatic enlargement relate specifically to the prostatectomy procedure or to the stresses of surgery in general. The sexual adjustment of 91 married men (ranging in age from 51 to 77) who had undergone either transurethral prostatectomy or inguinal hernia repair was compared using the same measures and experimental design. Results show that both surgeries appeared to result in relatively minor but widespread negative consequences for sexual adjustment and expression. Findings on both individual and couple sexual adjustment suggest that the psychosexual consequences of the two procedures do not differ substantially. As expected, the one exception was retrograde ejaculation, which was more likely to be experienced by men who had undergone prostate surgery. The results illustrate the necessity of conducting comparative studies when evaluating the sexual consequences of surgical procedures and highlight the importance of taking age into consideration when conducting research on the effects of surgery on older men.

Transurethral prostatectomy: differential effects of age category and presurgery sexual functioning on postprostatectomy sexual adjustment.

Sexual functioning and adjustment of 72 aging married males who had undergone transurethral prostatectomy were examined retrospectively according to their pre- and postsurgery status. Results indicate that although transurethral prostatectomy was generally associated with deterioration in various aspects of sexual expression, grouping subjects according to age and presurgery sexual adjustment qualified these general findings dramatically. For example, more younger than older males retained or attained good sexual adjustment after surgery. Furthermore, while older males with good presurgery sexual adjustment maintained good couple sexual functioning, they manifested greater loss of sexual self-confidence and individual sexual capacity than did their younger counterparts. In addition, the findings suggest that the question "Does transurethral prostatectomy affect sexual function?" must be rephrased to take into account changes in the cognitive, capacity, and affective domains as well as in the couple behavior and adjustment dimensions of sexual expression.

Self-monitoring and self-focus in erectile dysfunction.

Self-focused attention can cause anxiety and poor performance in those with low self-efficacy expectations. Self-monitoring is frequently used in sex therapy assessment. If self-monitoring is conceptualized as a self-focusing manipulation, it would be expected to cause "spectatoring," anxiety and deterioration in individuals with erectile dysfunction. Therefore, this investigation explored the relationship between the dispositional tendency to focus attention on the self (self-consciousness) and sexual behavior in males with erectile dysfunction, and evaluated the effects of self-monitoring on erectile dysfunctional males who differed in dispositional self-consciousness. Results indicate that (a) individuals with erectile dysfunction were less dispositionally self-conscious than nondysfunctional individuals, (b) self-monitoring had no adverse effects on any aspect of sexuality investigated, and (c) manipulated and dispositional self-focus had no interactive effects. Implications of these results for sex therapy and for a better understanding of etiological and maintaining factors in sexual dysfunction are discussed.

Client attributions for sexual dysfunction.

This investigation examined attributions for sexual dysfunctions made by 63 individuals and 21 of their partners who presented at a sex therapy service for the following problems: erectile dysfunction, premature ejaculation, and female orgasmic dysfunctions. All participants completed measures of marital adjustment, locus of control, depression and a questionnaire which assessed: attributions of responsibility for the sexual problem, perceived control over sexual functioning, distress, effort made to improve the sexual relationship, and expectations about the efficacy of sex therapy for the problem. Results indicate that both identified patients and their partners, regardless of the dysfunction, blamed the sexual problem on the "dysfunctional individual" rather than on the circumstances or the partner. With respect to the partners, husbands of women with orgasmic dysfunction were more likely to blame themselves than the circumstances, while the opposite was true for wives of males with erectile difficulties. Individuals experiencing the dysfunction perceived themselves and their partners as having little, but equal control over the identified patient's sexuality. Correlational analyses indicate that in identified patients, the better the quality of the marital relationship, the greater the self-blame and the lower the partner blame. Those with happy marriages also made greater efforts to improve their sexual relationship and had higher expectations of success with therapy. The implications of the results for research on the role of attributions in sexual dysfunction and for assessment of cognitive factors in sexually dysfunctional individuals and their partners is discussed.

Determining what patients should know about transurethral prostatectomy.

Many hospitals have developed patient education materials for individuals about to undergo surgery. Information in these educational packages varies in quality and is generally based on 'common sense' beliefs concerning what patients wish and need to know. Since such interventions vary greatly in their effectiveness, the present investigation was undertaken to assess empirically the concerns and needs of patients undergoing a specific procedure, transurethral prostatectomy. Data from 73 men who had undergone transurethral prostatectomy for benign enlargement of the prostate and 32 of their wives indicate that patients would have wanted more information concerning the consequences of surgery, both medical and sexual. In addition, written information, clear instructions concerning the do's and don'ts during the recovery period, and reassurance about what is 'normal' and to be expected contributed to feeling positive about the prostatectomy experience. Results concerning helpful and distressing aspects of the surgery experience and patients' recommendations for improvement are presented. The necessary components of patient education materials are discussed and a synthesis of information needed for patient education related to prostatectomy is provided.

Measurement of therapy outcome and maintenance of gains in the behavioral treatment of secondary orgasmic dysfunction.

Choice of therapeutic goals and criteria used for evaluation of therapeutic outcome represent fundamental conceptual and methodological issues. The present investigation examined the relationship between how data were obtained (by retrospective questionnaire or ongoing daily self-monitoring), what outcome criteria were used (behavioral or cognitive-affective), whose data were being analyzed (the female or male partner), and when measurements were taken (at posttherapy or follow-up) in a sample of 23 couples with the problem of secondary orgasmic dysfunction in the wife. The results indicate that retrospective measurement was more optimistic than ongoing; cognitive-affective changes were twice as likely to occur as changes in behaviors; females benefited more than males; and there were considerable losses of therapeutic gains at follow-up. These results underscore the need for multiple measurement techniques and highlight the multidimensional quality of the sexual experience.

Public awareness of physically disabled persons.

Promoting public awareness that disabled people can function independently within society is seen by many as a necessary precursor to widespread changes in accessibility, housing, and social and economic opportunities for physically disabled people. The goal of the present investigation was to empirically assess the effectiveness of a major Canadian publicity campaign which was designed to sensitize people to the needs and concerns of physically disabled people and to promote favorable attitude change. Results indicate that while the visibility of the publicity campaign can be considered a modest success, the campaign was ineffective in promoting positive attitude change. The implications of the findings for the integration of disabled people into the larger community are discussed.

The SSES-E: a measure of sexual self-efficacy in erectile functioning.

The purpose of this study was to develop and validate the Sexual Self-Efficacy Scale (SSES-E) for erectile disorder. The subjects consisted of 15 heterosexual couples with nonproblematic sexual functioning (normal group) and a sexually dysfunctional sample consisting of nine heterosexual couples and eight heterosexual single males (dysfunctional group). Most of the males in the dysfunctional sample were diagnosed as suffering from erectile disorder. Reliability of the SSES-E, based on test-retest and split-half correlations and on item analyses, appears to be reasonable. Validity, measured in three different ways, is also acceptably high. Suggestions for the use of this instrument in clinical practice and for future research are made.

A comparison of three therapeutic formats in the treatment of secondary orgasmic dysfunction.

The goal of the present study was to compare the effectiveness of three therapeutic formats: Standard Couple Therapy, Group Therapy, and Minimal Contact Bibliotherapy (self-help) in the treatment of 23 couples in which the wife was suffering from secondary orgasmic dysfunction. The results indicate that a cognitive-behavioral sex therapy program is clearly effective in changing a wide range of subjective satisfaction and behavioral measures, with concurrence of the husbands' and wives' data providing further strength to these findings. Differences in outcome which were elicited in the three experimental treatment conditions were mainly in favor of the Standard Couple condition. Since such differences were neither frequent nor great, practical issues related to increasing the effectiveness of less time-consuming treatment formats are discussed. In addition, the theoretical implications of using global versus specific therapy outcome criteria are explored.

Problem-solving skills in happy and distressed couples: effects of videotape and verbal feedback.

Investigated communication in happy and distressed married couples, in two studies. Fifty-eight couples' problem-solving behaviors were evaluated by the spouses themselves and by trained observers. Some distressed couples viewed their own videotape; others received a placebo intervention. Half of the distressed couples received written feedback before a second discussion. Results indicated that (a) distressed and happy couples differed on some behavioral measures; (b) both happy and distressed wives engaged in more negative behaviors than husbands; (c) videotape and written feedback were ineffective in altering behaviors; (d) husbands' and wives' negative behaviors were correlated highly; and (e) spouses' and observers' ratings were independent. Implications for research on marriage and for behavioral couple therapy are discussed.

Videotape and verbal feedback in behavioral couple therapy: a review.

Reviewed the experimental evidence for the efficacy of videotape and verbal feedback in behavioral couple therapy; it is concluded that research to date does not permit definitive conclusions concerning the efficacy of either procedure. Studies on behavioral differences between happy and distressed couples also were summarized. The evidence indicates that it is, as yet, difficult to ascertain just how the communication behaviors of happy and distressed couples differ.