Changes in sleep profile on exposure to sodium chloride and artificially carbonated springs: a pilot study.

[Purpose] Herein, we aimed to investigate the effects of bathing in a sodium chloride spring and an artificially carbonated spring on core body temperature and electroencephalograms, to assess whether the springs facilitate sleep. [Participants and Methods] This randomized, controlled, crossover study evaluated the effects of a sodium chloride spring, an artificially carbonated spring, a plain hot bath, and no bath on sleep. The subjective evaluations and recording of temperature were performed before/after bathing at 40 °C for 15 min at 22:00 h, before nocturnal sleep (0:00-7:00 h), and after the participants (n=8) woke up in the morning. [Results] Bathing significantly increased the core body temperature, with significant subsequent declines observed until bedtime. Participants in the sodium chloride spring group had the highest average core body temperature, while participants in the no-bath group had the lowest average core body temperature before bedtime (23:00-0:00 h). During bedtime (1:00-2:00 h), the participants in the no bath group had the highest average core body temperature, while participants in the artificially carbonated spring group had the lowest average core body temperature. The amount of delta power/min in the first sleep cycle significantly increased in the bathing groups, with the highest value during bedtime being recorded in the artificially carbonated spring group, followed by the sodium chloride spring, plain hot bath, and no-bath groups. These sleep changes were associated with significant declines in the elevated core body temperature. Increased heat dissipation and decreased core body temperature were observed in the artificially carbonated spring and sodium chloride spring groups, which increased the delta power during the first sleep cycle compared with that observed in the plain hot bath group, followed by the no-bath group. [Conclusion] An artificially carbonated spring would be the most appropriate given each circumstance because it did not cause fatigue, as observed with the sodium chloride spring.

Testing the sleep hygiene recommendation against nighttime exercise.

PURPOSE: Experts have recommended exercise for improved sleep, but often with the caveat that one should avoid nighttime exercise. The aim of this study was to challenge this recommendation in a sample who might be most prone to sleep impairment after nighttime exercise. The secondary aims were to assess whether or not post-treatment sleep was correlated with anxiolytic effects or downregulation of body temperature. METHODS: Twelve sedentary adults with insomnia completed two treatments (separated by 2-5 days) in counterbalanced order: (1) 30 min of moderate treadmill exercise (60-70% maximum heart rate) + 15 min of moderate resistance exercise and (2) a control treatment (reading). Each treatment was completed 2 h before bedtime and followed by a 10-min shower, a light snack, 8 h of polysomnographic recording, and a sleep questionnaire. State anxiety was assessed before and 30 min after each treatment and 10 min before bedtime. Body temperature was assessed from pre-exercise to wake time. RESULTS: No significant treatment differences in sleep were found, and Hedges g paired comparisons indicated small effect sizes; however, two participants had severely disturbed objective sleep following exercise. Significant correlations were found between change in state anxiety from pre-exercise to bedtime and TST (r = 0.69, p = 0.03). Stage 1 (r = 0.67, p = 0.03), WASO (r = 0.69, p = 0.03), and sleep efficiency (r = 0.66, p = 0.02). No significant correlations were found of sleep with temperature decline. CONCLUSIONS: Profound sleep disturbance after exercise in some participants, and no marked sleep improvement in the others, provides some support for caution regarding late-night exercise for sedentary individuals with insomnia.

Anti-NMDA-receptor antibody detected in encephalitis, schizophrenia, and narcolepsy with psychotic features.

BACKGROUND: Causative role of encephalitis in major psychotic features, dyskinesias (particularly orofacial), seizures, and autonomic and respiratory changes has been recently emphasized. These symptoms often occur in young females with ovarian teratomas and are frequently associated with serum and CSF autoantibodies to the NMDA receptor (NMDAR). METHODS: The study included a total of 61 patients from age 15 to 61 and was carried out between January 1, 2005, and Dec 31, 2010. The patients were divided into the following three clinical groups for comparison. Group A; Patients with typical clinical characteristics of anti-NMDAR encephalitis. Group B; Patients with narcolepsy with severe psychosis. Group C; Patients with schizophrenia or schizo-affective disorders. RESULTS: Ten out of 61 cases were anti-NMDAR antibody positive in typical encephalitis cases (group A: 3 of 5 cases) and cases in a broader range of psychiatric disorders including narcolepsy (group B: 3 of 5 cases) and schizophrenia (group C: 4 of 51 cases). CONCLUSION: In addition to 3 typical cases, we found 7 cases with anti-NMDAR antibody associated with various psychotic and sleep symptoms, which lack any noticeable clinical signs of encephalitis (seizures and autonomic symptoms) throughout the course of the disease episodes; this result suggest that further discussion on the nosology and pathophysiology of autoimmune-mediated atypical psychosis and sleep disorders is required.

Absence of multiple sleep-onset rapid eye movement periods (SOREMPs) is not a specific feature of patients with pathological sleep prolongation.

Purpose: Multiple sleep-onset rapid eye movement periods (SOREMPs) are involved in the pathophysiology of narcolepsy, but it is not clear whether the lack of multiple SOREMPs is associated with the pathophysiology of idiopathic hypersomnia or not. We examined the significance of multiple SOREMPs in patients with pathological sleep prolongation. Methods: Participants were consecutive patients complaining of unexplained sleepiness and agreed to a 3-day-sleep studies; 24 h polysomnography (PSG) followed by standard PSG and multiple sleep latency test (MSLT). Forty-one (26 females, 21.9 ± 8.1 years old, BMI 20.4 ± 2.3 kg/m2) of 54 eligible patients without other sleep pathologies showed pathological sleep prolongation. We subdivided them into those with and without multiple SOREMPs on MSLT and compared clinical and PSG variables between groups. Results: Six of 41 (14.6%) patients showed multiple SOREMPs on MSLT. There were almost no differences in sleep variables between those with and without multiple SOREMPs. We only found shorter mean sleep latency on MSLT and more REM cycles on 24 h PSG in those with multiple SOREMPs (adjusted p = 0.016 and 0.031). The frequencies of REM-related phenomena and clinical symptoms related to idiopathic hypersomnia were not different between groups. Conclusion: Our results indicated that patients with pathological sleep prolongation had the same clinical profiles regardless of the status of SOREMPs, suggesting the absence of multiple SOREMPs, prerequisite for the diagnosis of idiopathic hypersomnia, is not a specific feature of pathological sleep prolongation. Confirmation of sleep prolongation alone could be a diagnostic tool for idiopathic hypersomnia.

Effects of transdiagnostic group treatment for sleep disturbances in adult attention-deficit/hyperactivity disorders and autistic spectrum disorder: a pilot study.

Although adult patients with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often have sleep problems, few studies have verified the effect of a psychological approach specific to sleep-wake rhythms on these sleep disturbances. Therefore, the aim of this pilot study was to develop a trans-diagnostic approach with sleep scheduling and regularity of sleep duration as core modules, and to examine the effect of the intervention in adult ADHD and/or ASD subjects with sleep disturbances. This was a within-group pilot study. Ten patients with adult ADHD and/or ASD with sleep disturbances (10 males, age: 27.4 ± 5.6 years) took part in a 90-min weekly group intervention for 5 weeks. All participants were assessed on scales for sleep complaints, anxiety, depression, and symptoms of ADHD and ASD before and after the intervention, and at 3-month follow-up. The results showed that the intervention significantly improved sleep disturbances at post-intervention (p = 0.003, d = 1.30, 95% CI 0.31-2.28) and at the 3-month follow-up (p = 0.035, d = 0.41, 95% CI - 0.48 to 1.30). In addition, attention switching for ASD symptoms was significantly reduced post-intervention (p = 0.031, d = 1.16, 95% CI 0.19-2.13). This is the first pilot study of a trans-diagnostic group approach for adult ADHD and/or ASD with sleep disturbances. The intervention primarily led to an improvement of sleep disturbances, followed by improvement of disease-specific symptoms in adult subjects with ADHD and ASD.

Sleep Debt and Social Jetlag Associated with Sleepiness, Mood, and Work Performance among Workers in Japan.

Although sleep debt and social jetlag (SJL) influence daytime dysfunctions, the effects of both sleep debt and SJL on them have not been analyzed. The aim of this study was to examine the mutual relationship between sleep debt and SJL on daytime sleepiness, mood, and work performance. This study was a cross-sectional study on sleep health conducted on the Japanese general population. A total of 4505 general workers (30% female, aged 43.57 ± 11.63 years) were selected and analyzed. Sleep debt was defined by sleep debt index (SDI), which is the discrepancy between desired and real sleep duration. SJL and SDI scores exhibited a positive but weak coefficient (r = 0.19). In a 4 (SJL) × 3 (SDI) two-way ANOVA, the interaction effects were notable for sleepiness and depression scores, while the group effects were notable for the work performance score. For sleepiness and depression scores, SDI >2 h was not significantly different from SJL. In addition, the impact of SDI was higher than that of SJL on sleepiness (ß = 0.17), depression (ß = 0.16), and work performance (ß = -0.10). The impact of sleep debt was more pronounced than SJL on daytime dysfunctions, although both sleep debt and SJL have negative impacts on them.

Development and validation of the hypersomnia-specific beliefs scale.

OBJECTIVE/BACKGROUND: Patients with Central hypersomnia, especially Narcolepsy type 1 and Idiopathic Hypersomnia (NT1 and IHS) often have psychological frustration in their daily lives. We aimed to develop the first scale of hypersomnia-specific beliefs (HSB). PATIENTS/METHODS: We developed the HSB scale consisting of three factors ("aversion toward doze", "hypersensitivity toward others" reactions about my doze", and "sense of defeat caused by doze") with 12 items through interviews to 11 patients with NT1 and IHS. Validity and reliability of the HSB were evaluated cross-sectionally with 166 patients with NT1 and IHS and 375 controls. Simultaneously, scores of patient health questionnaire -2(PHQ-2), mini-Social Phobia Inventory (mini-SPIN), and Epworth Sleepiness Scale (ESS) were obtained. RESULTS: This 3-factor model had enough fitness (χ2 = 60.25, df = 51, p = 0.18, TLI = 0.99, CFI = 0.99, RMSEA = 0.03), Cronbach's α coefficient being 0.90. The intraclass correlation coefficient was 0.76. Also, the area under the receiver operating characteristic curve (AUC = 0.88) confirmed good discrimination ability. A cut-off score of 38 resulted in a sensitivity of 90% and a specificity of 75%. Multiple linear regression analyses showed that these scales were independently associated with the HSB score; the PHQ-2 (ß = 0.24, p = 0.002), mini-SPIN (ß = 0.29, p < 0.001) and ESS (ß = 0.15, p = 0.048). CONCLUSIONS: Our data suggest that the HSB scale measured beliefs in NT1 and IHS patients with good validity, reliability, and discrimination ability. The HSB scale assesses the negative beliefs specific to patents with NT1 and IHS. This scale could be applied to the development of novel psychotherapeutic approach to patients with NT1 and IHS.

The effect of short or long sleep duration on quality of life and depression: an internet-based survey in Japan.

BACKGROUND: To date, no previous studies have evaluated the relationship between sleep duration and quality of life (QOL) or depression in the general population after controlling for daytime sleepiness and sleep disturbances. METHODS: A web-based cross-sectional survey was conducted with 8698 subjects aged 20-69 years. We examined the relationships between weekday sleep duration and daytime sleepiness, sleep disturbance, QOL and depression, using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (without the item for sleep duration), 8-item Short Form and Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: Daytime sleepiness tended to increase in proportion to shorter weekday sleep durations. Sleep disturbances, physical and mental QOL, and CES-D scores were worse in both the shorter and longer sleep groups compared with the group with 7-8 h of sleep. Hierarchical logistic regression analyses revealed that short sleep duration but not long sleep duration was significantly associated with reduction of both physical and mental QOL, even after controlling for the presence of daytime sleepiness and sleep disturbance. Both short and long sleep duration were independently and significantly correlated with depression after controlling for daytime sleepiness; however, there was no statistically significant association after adjusting for the effects of sleep disturbance. CONCLUSIONS: The results suggested adverse effects of short sleep but not long sleep on both physical and mental QOL. In addition, the negative impact of specific types of sleep disturbance on depression may be greater than the impact of shortening of sleep duration.

Excessive daytime sleepiness in adults with possible attention deficit/hyperactivity disorder (ADHD): a web-based cross-sectional study.

OBJECTIVES: Arousal dysregulation has been speculated to be involved in the pathological mechanism of attention deficit/hyperactivity disorder (ADHD). However, there has been no epidemiological study assessing the real condition of excessive daytime sleepiness (EDS) in adults with ADHD. This study investigated the prevalence of EDS and the relationship between sleepiness and ADHD symptoms in adults with possible ADHD. METHODS: An observational, cross-sectional, web-based study was performed. Participants were 9822 Japanese adults aged 20-69 years who completed an Internet-based questionnaire that assessed ADHD symptoms, autistic traits, depressive symptoms, chronotype, sleepiness, and sleep disturbances. RESULTS: Participants with possible ADHD were more likely than non-ADHD participants to have an evening chronotype and experience depressive symptoms, sleepiness, and sleep disturbances. The rates of having moderate and severe sleepiness in the possible ADHD group were higher than those in the non-ADHD group. Hierarchical logistic regression analyses revealed that the presence of ADHD symptoms was independently associated with EDS even after adjusting for factors related to the presence of sleepiness. When examining inattention and hyperactivity scores among participants with possible ADHD, the inattention score was significantly higher in the severe EDS group compared with the moderate and non-EDS groups. CONCLUSIONS: EDS was relatively common in adults with possible ADHD. ADHD symptoms, especially inattentiveness, were associated with the formation of EDS in this population.

Relationship Between Mobility and Arousal Level After Waking Up.

BACKGROUND AND PURPOSE: Falling is an unexpected event for older adults, but few studies have investigated falls related to arousal levels and mobility immediately after waking up in the morning. Therefore, the purpose of this study was to clarify the possible relationship of arousal level and mobility with falls in the early morning hours. METHODS: We investigated both arousal levels and mobility of 14 community-dwelling older adults after waking up, from 4:00 AM until 2:00 PM. Mobility and arousal levels were evaluated through the following tests: Timed Up and Go, Functional Reach, postural sway, and critical frequency of fusion. Baseline of mobility and arousal levels were measured before sleep and after 5 hours of sleep. Immediately after waking up, each participant's mobility and arousal levels were remeasured and then also remeasured 2 hours later, 6 hours later, and 10 hours later, respectively. Stanford Sleepiness Scale was also chosen to measure the internal state of subjective sleepiness and it was measured 7 times at 2-hour intervals after the participants woke up from sleep. RESULTS: Significant differences were found between before sleep and after awakening in the score of Timed Up and Go test and Stanford Sleepiness Scale. The speed of Timed Up and Go test after awaking was slower than that before sleep. The Stanford Sleepiness Scale showed high states of sleepiness. CONCLUSION: We found that the decrease in arousal level in the early morning may affect mobility. The awareness of the degree of arousal levels may increase fall prevention in older adults in the early morning hours.

Residual effects of zolpidem, triazolam, rilmazafone and placebo in healthy elderly subjects: a randomized double-blind study.

With current hypnotic agents, next-day residual effects are a common problem. The purpose of the present study was to evaluate the residual effects of the commercially available hypnotics - zolpidem, triazolam, and rilmazafone - on the physical and cognitive functions of healthy elderly people in the early morning and the day following drug administration. In this study, the next-day residual effects of zolpidem, triazolam, and rilmazafone, following bedtime dosing in elderly subjects, were evaluated. Women (n = 11) and men (n = 2) aged 60-70 years received a single dose (at 23:00) of one of these, zolpidem 5 mg, triazolam 0.125 mg, rilmazafone 1 mg and placebo in a randomized, double-blind, crossover design. Measures of objective parameters and psychomotor performances (Timed up and Go test, Functional Reach Test, body sway test, critical flicker fusion test, simple discrimination reaction test, short-term memory test) and subjective ratings were obtained at 04:00, 07:00, and the next time of the day. All hypnotics were generally well tolerated; there were no serious adverse side effects and no subjects discontinued the evaluations. Compared to placebo, zolpidem and rilmazafone had good results on the Functional Reach Test. Although subjective assessments tended to be poor in the early morning, rilmazafone significantly improved the body sway test in the other hypnotics. A single dose of zolpidem 5 mg and triazolam 0.125 mg did not have any next-day residual effects on healthy elderly subjects. Residual effects appeared to be related to the compound's half-life and the dose used. Rilmazafone 1 mg exhibited steadiness in static and dynamic balance and seemed to be more favorable for the elderly with early morning awakening.