A self-help book is better than sleep hygiene advice for insomnia: a randomized controlled comparative study

The objective was to compare the effects of two types of written material for insomnia in a randomized trial with follow-up after three months. Insomniacs were recruited through newspaper advertisements to a web-based survey with validated questionnaires about sleep, anxiety, depression, and use of sleep medications. A self-help book focusing on cognitive behavioral therapy for insomnia was compared to standard sleep hygiene advice; 77 and 78 participants were randomized to self-help book or sleep hygiene advice, respectively. The response rate was 81.9%. The self-help book gave significantly better scores on the sleep questionnaires compared to sleep hygiene advice. The proportion using sleep medications was reduced in the self-help book group, whereas it was increased in the sleep hygiene group. Compared to pre-treatment, the self-help book improved scores on the sleep (effect sizes 0.61-0.62) and depression (effect size 0.18) scales, whereas the sleep hygiene advice improved scores on some sleep scales (effect sizes 0.24-0.28), but worsened another (effect size -0.36). In addition, sleep hygiene advice increased the number of days per week where they took sleep medications (effect size -0.50). To conclude, in this randomized controlled trial, the self-help book improved sleep and reduced the proportion using sleep medications compared to sleep hygiene advice. The self-help book is an efficient low-threshold intervention, which is cheap and easily available for patients suffering from insomnia. Sleep hygiene advice also improved sleep at follow-up, but increased sleep medication use. Thus, caution is warranted when sleep hygiene advice are given as a single treatment.     

Use of the Sleep Assessment Device (Kelley and Lichstein, 1980) to validate insomniacs' self-report of sleep pattern

A comparison is presented of insomniacs' self-reported sleep pattern and objectively monitored sleep using the Sleep Assessment Device (SAD; Kelley & Lichstein, 1980). Analysis of 110 subject nights revealed modest but significant subjective overestimates of both sleep latency and sleep duration which were accounted for by the demands of the task (i.e., longer time periods are harder to estimate accurately). Correlations between self-report and SAD measures were, however, consistently high, suggesting that self-report may be a valid index of sleep disturbance. Results are discussed with reference to the clinician's task in evaluating sleep complaints.This research stury was supported by a grant from the Research Fund of Lanarkshire Health Board, Scotland.     

睡眠对恐惧学习的影响及其认知神经机制

睡眠问题可能会诱发恐惧相关情绪障碍(焦虑、创伤性应激障碍、恐怖症等),研究睡眠影响恐惧学习的认知神经机制,有助于增强对恐惧相关情绪障碍的预测、诊断和治疗。以往研究表明睡眠剥夺影响恐惧习得和消退主要是通过抑制vmPFC活动,阻碍其与杏仁核的功能连接,从而导致恐惧习得增强或是消退学习受损。进一步研究发现睡眠不同阶段对恐惧学习相关脑区有独特的影响:剥夺(缺乏)快速眼动睡眠会抑制vmPFC活动、增强杏仁核、海马激活,导致恐惧习得增强,消退学习受损,此外边缘皮层的功能连接减少破坏了记忆巩固(恐惧记忆和消退记忆);而慢波睡眠主要与海马变化有关,慢波睡眠期间进行目标记忆重激活可促进恐惧消退学习。未来研究需要增加睡眠影响恐惧泛化的神经机制研究、及昼夜节律中断对恐惧消退的影响,以及关注动物睡眠研究向人类睡眠研究转化中存在的问题。     

Effects of sleep deprivation on executive functioning,cognitive abilities,metacognitive confidence,and decision making

Performance on many decision‐making tasks is underpinned by metacognitive monitoring, cognitive abilities, and executive functioning. Fatigue‐inducing conditions, such as sleep loss, compromise these factors, leading to decline in decision performance. Using a 40‐hr sleep deprivation protocol, we examined these factors and the resulting decision performance. Thirteen Australian Army male volunteers (aged 20–30 years) were tested at multiple time points on psychomotor vigilance, inhibitory control, task switching, working memory, short‐term memory, fluid intelligence, and decision accuracy and confidence in a medical diagnosis‐making test. Assessment took place in the morning and night over two consecutive days, during which participants were kept awake. Consistent with previous work, cognitive performance declined after a night without sleep. Extending previous findings, self‐regulation and self‐monitoring suffered significantly greater declines immediately after the sleepless night. These results indicate that the known decline in complex decision‐making performance under fatigue‐inducing conditions might be facilitated by metacognitive rather than cognitive mechanisms.     

The impact of pre-sleep arousal state and strategy to control unwanted thoughts on sleep quality

Objective: It has been questioned whether elevated pre-sleep cognitive arousal contributes to poor sleep or whether it is the use of maladaptive thought control strategies, used to manage this cognitive arousal, that are responsible. The study aimed to examine how these factors – cognitive arousal (with and without anxiety) and maladaptive thought control strategies contribute to perceived sleep quality (SQ). Design: 129 “healthy adults” (46 males, 83 females) were exposed to picture-stimuli eliciting either anxious cognitive arousal or non-anxious cognitive arousal at bedtime. The groups were then randomly split and briefed to use either a cognitive distraction or cognitive suppression thought control strategy or no instructions were given (controls). Subjective SQ was measured immediately on waking. Results: Induced anxious cognitive arousal was associated with lower SQ compared to non-anxious cognitive arousal. Analyses revealed a significant interaction between arousal and the strategies used to control unwanted thoughts on SQ. When experiencing anxious cognitive arousal, the strategy of distraction was associated with poorer sleep outcomes. Conclusion: The findings suggest that the efficacy of differing thought control strategies vary depending upon whether cognitive arousal elicits anxiety or not. With that in mind, clinical implications in terms of augmenting the treatment of insomnia are discussed.     

睡眠质量对冒险行为影响的证据及解析

睡眠质量影响个体冒险行为已得到许多研究的验证和支持。睡眠缺失既影响大脑前额叶功能的完整性, 也影响杏仁核、纹状体等脑区的激活, 从而降低了个体对危险的知觉和对损失的敏感, 导致冒险意愿和冒险行为增加。已往相关研究多以成人群体为研究对象, 且忽略了个体特质与所处社会环境在睡眠质量与冒险行为关系中的交互影响。由于青少年期睡眠不足和高冒险行为普遍存在, 未来研究应对青少年睡眠质量与冒险行为的关系及其中的影响作用机制, 尤其是神经机制给予更多关注。     

睡眠限制对认知功能的影响及其潜在作用机制

睡眠限制已然成为现代社会人们普遍面临的问题, 其对个体身心机能的影响备受研究者关注。众多研究表明, 睡眠限制会对注意功能、执行功能和长时记忆等不同认知领域的心理加工产生差异化影响, 且影响程度与任务类型、睡眠限制的严重程度、年龄和性别等因素相关。研究者们提出了4种主要的作用假说：唤醒假说、注意控制假说、警觉性假说以及前额皮层易感性假说。未来研究需要从关注个体间差异、使用动脉自旋标记灌注功能磁共振成像技术以及重视轻度睡眠限制的影响等角度进行深化和扩展。     

Infant sleep moderates the effect of infant temperament on maternal depressive symptoms,maternal sensitivity,and family functioning

Observed infant temperamental difficulty and infant sleep efficiency and sleep variability were examined as predictors of maternal depressive symptoms, maternal sensitivity, and family functioning. Eight observations at 8-months postpartum were used to assess infant temperament, and actigraphy was used to measure infant sleep for 1-week at the time of the 8-month assessment. Structured clinical interviews were used to assess maternal depressive symptoms between 5 and 12 months postpartum and at 15 months postpartum, and observational assessments were used to assess maternal sensitivity and family functioning at 15 months postpartum. Variability in infant sleep moderated the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning. Infant temperament was positively associated with maternal depressive symptoms when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Likewise, infant temperament was negatively associated with maternal sensitivity and family functioning when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Results underscore the importance of infant sleep for maternal and family health.     

The impact of post-learning sleep vs. wakefulness on recognition memory for faces with different facial expressions

A beneficial effect of sleep after learning, compared to wakefulness, on memory formation has been shown in many studies using a variety of tasks. However, none of these studies has specifically addressed recognition memory for faces so far. The recognition of familiar faces, together with the extraction of emotional information from facial expression, is a fundamental cognitive skill in human everyday life, for which specific neural systems and mechanisms of processing have been developed. Here, we investigated the role of post-learning sleep for later recognition memory for neutral, happy, and angry faces. Twelve healthy subjects, after judging the emotional valence of the faces in the evening (learning phase), either slept normally in the subsequent night, with sleep recorded polysomnographically (sleep condition), or remained awake (wake condition) according to a cross-over design. Recognition testing took place in the second evening after learning, i.e. after a further night of regular sleep spent at home. Sleep after learning, compared to wakefulness, enhanced memory accuracy in recognition memory. This effect was independent of the emotional valence of facial expression. The response criterion at recognition testing did not differ between sleep and wake conditions. The amount of non rapid eye movement (NonREM) sleep during post-learning sleep correlated positively with memory accuracy at recognition testing, while time in REM sleep was associated with a speeded responding to the learned faces. Results suggest that face recognition, despite its dependence on specialized brain systems, nevertheless relies on the general neural mechanisms of sleep-associated memory consolidation.     

A Multimethod Examination of the Effect of Insomnia Symptoms on Anxious Responding to a Social Stressor

A growing number of studies identify insomnia symptoms as a potential risk factor for the development of anxiety disorders. However, little research has examined potential mechanisms through which insomnia could confer increased risk for anxiety. A separate line of literature suggests sleep is necessary for adaptive emotional and behavioral responding to stressors, a potential mechanism linking insomnia symptoms to anxiety risk. To test whether insomnia symptoms affect emotional and behavioral responding to an anxiety-relevant stressor, the current study recruited a sample of 99 undergraduates with varying levels of insomnia symptoms. Participants completed self-report and psychophysiological measures before, during, and after an impromptu speech task. Results indicated that, after covarying for negative affectivity, increased insomnia symptoms were significantly associated with elevated anticipatory anxiety and skin conductance response prior to the speech, and increased skin conductance response, emotion regulation difficulties, and safety aid use during the speech. Taken together, results provide evidence for the notion that insomnia symptoms are associated with maladaptive emotional and behavioral responding to an anxiety-relevant stressor.     

原发性失眠患者的主客观睡眠特征研究

目的：了解原发性失眠患者的睡眠特点,探讨其主客观睡眠的异同点。方法：对15例原发性失眠患者、20例正常人的主观睡眠（PSQI）和客观睡眠（PSG）特点进行比较,对原发性失眠患者进行主观睡眠（PSQI）和客观睡眠（PSG）的比较。结果：原发性失眠的PSG多项指标（睡眠总时间、睡后觉醒次数、觉醒总时间、睡眠潜伏期、睡眠效率、觉睡比、睡眠维持率、REM睡眠时间和REM百分比、REM睡眠潜伏期和REM活动密度）等方面与正常对照有显著差异（p〈0.05或p〈0.01）;原发性失眠的PSQI多项指标（PSQI总分、睡眠效率、睡眠时间、睡眠潜伏期）方面与正常组对照差异显著（p〈0.01）。原发性失眠的PSQI和PSG在睡眠效率、实际睡眠时间、睡眠潜伏期方面存在显著差异（p〈0.01）。结论：原发性失眠患者的PSQI和PSG均存在一定程度的异常,原发性失眠患者有高估自己睡眠障碍的倾向。     

Adaptive memory: The influence of sleep and wake delay on the survival-processing effect

Processing items in terms of their survival value leads to superior memory relative to many deep (semantic) processing tasks. To date, such survival processing has been investigated with short delay intervals only, ignoring possible effects of longer wake and sleep delay. In this study, subjects performed orienting tasks that induced survival or deep (semantic) processing of single items. A surprise memory test was administered after a short delay or a delay of 12 hours that included either sleep or wake; a cued-recall test was conducted in Experiment 1, and an item-recognition test in Experiment 2. Survival-processing effects were present regardless of delay, and their size was not influenced by delay interval. While wake delay reduced memory for both item types, sleep compared to wake enhanced their memory. These results suggest that the survival-processing effect is fully maintained across longer delay, regardless of whether the interval is filled with wake or sleep.     

The coupling of short sleep duration and high sleep need predicts riskier decision making

Abstract

Objective: To examine how risk-related decision making might be associated with habitual sleep variables, including sleep variability, sleep duration and perceived sleep need in young adults cross-sectionally and longitudinally.

Design: 166 participants completed a 7-day protocol with sleep and risk-related decision-making measures at baseline (T1) and 12 months later (T2).

Results: Habitual short sleep duration (averaging < 6?h nightly) was identified in 11.0% in our sample. After controlling for baseline demographic factors and risk-taking measures, self-reported sleep need at T1 interacted with habitual short sleep in predicting risk taking at follow-up (F_8,139=9.575, adjusted R²=.431, p<.001). T1 greater perceived sleep need predicted more risk taking among short sleepers, but decreased risk taking among normal sleepers at T2. Variable sleep timing was cross-sectionally correlated with making more Risky choices at baseline and fewer Safe choices after loss at follow up.

Conclusions: Young adults with variable sleep timing and those with short sleep duration coupled with high perceived sleep need were more likely to take risks. The moderating effects of perceived sleep need suggest that individual differences may alter the impact of sleep loss and hence should be measured and accounted for in future studies.     

睡眠剥夺对风险决策的影响机制探讨

许多行业的决策者必须在睡眠不足的状态下做出选择与判断。睡眠剥夺是睡眠不足的实验室模型, 被证明能显著影响风险决策, 但内在机制不明。基于前人研究基础提出假设模型, 即睡眠剥夺通过影响个体的反馈加工、风险感知、抑制控制、决策理性, 进而影响风险决策。拟通过实验室研究与现场研究, 采用简单赌博任务、概率折扣任务、双选择Oddball任务等研究范式, 对比睡眠剥夺前后被试在执行上述实验任务时的行为差异, 同时比较执行控制网络、奖赏网络等脑功能网络连接强度, 以及任务诱发的FRN等脑电成分在睡眠剥夺前后的变化, 进而论证上述反应被试反馈加工等心理过程的行为-脑电-脑成像指标的变化与睡眠剥夺后被试风险决策变化的关系。研究结果将科学地解释睡眠剥夺影响风险决策的内在机制, 为进一步探讨如何规避睡眠不足导致的决策失误提供理论与实证依据。     

Three consecutive nights of sleep loss: Effects of morning caffeine consumption on subjective sleepiness/alertness,reaction time and simulated driving performance

Caffeinated products are often consumed as a popular countermeasure to the effects of sleep loss. However, the efficacy of caffeine to exert these effects after consecutive nights of sleep loss is poorly understood. The aim of this study was to investigate the effects of three consecutive nights of restricted sleep and morning caffeine consumption on subjective ratings of sleepiness/alertness, reaction time, and simulated driving performance. Twenty healthy, habitual caffeine consumers (11 females; age: 23.3 ± 5.7 y; BMI: 22.3 ± 3.5 kg⋅m⁻²; caffeine intake: 204 ± 89 mg⋅day⁻¹; Mean ± SD) who had normal sleeping patterns (≥8 h⋅night⁻¹) participated in this double-blind, placebo-controlled, randomised study. Following one night of normal sleep (≥8 h time in bed (TIB)), participants underwent three consecutive nights of restricted sleep (5 h TIB). Participants received caffeine (200 mg; n = 10) or placebo (n = 10) capsules each morning and all participants received caffeine (100 mg) capsules each afternoon. Subjective ratings of alertness, concentration and tiredness were measured before and 1 h after morning capsule administration. Choice Reaction Time (CRT) was examined 1 h after morning capsule administration, with response speed and accuracy as outcome variables. Driving performance was assessed using a 30 min simulated driving task, with lateral (standard deviation of lane position [SDLP]; total number of line crossings [LC]) and longitudinal (standard deviation of speed [SDSP]) measures of vehicle control as outcome variables. Alertness and concentration significantly decreased, and tiredness increased across the three days of sleep loss. Caffeine only marginally alleviated these effects. No differences were observed between treatments or across trial days for response speed and accuracy on the CRT task. Likewise, no significant differences were observed between groups or across trial days for any measures of simulated driving performance. Overall, results from this study indicate that three consecutive days of sleep loss influence subjective ratings of alertness, concentration and tiredness, but does not alter CRT or simulated driving performance. Caffeine may alleviate some of the negative subjective effects imposed by restricted sleep, but the efficacy of caffeine to attenuate performance changes in CRT and driving performance were unable to be observed.     

Effects of sleep on positive,negative and neutral valenced story and image memory

During sleep, emotional memories are preferentially strengthened. However, most studies on sleep and emotional memory focus on comparing negative valence with neutral valence stimuli. This study compared the sleep-dependent memory effects for stories and images, each comprising negative, neutral, and positive stimuli. It was hypothesized that a sleep effect would be seen for negatively and positively valenced stimuli. A novel story memory task (comprising three stories), and photographs from the Nencki Affective Picture database were presented for learning to 61 healthy adults (ages 18–25). They were tested for memory on the two tasks immediately, and then again after either a 2-hr nap (n = 31; 17 women, 14 men) or 2-hr wake period (n = 30; 13 women, 17 men). At second testing, the sleep condition had significantly better recall compared to the wake condition on both tasks. There was a relationship with valence only for the story task, with better performance for the sleep condition on the negatively and positively valenced texts, but not on the neutral text. There were no significant relationships between memory measures and sleep-stage duration and EEG power variables. The story memory findings support the hypothesis that memory consolidation prioritizes emotional memory, whether positively or negatively valenced.     

黎明模拟光照对晨起睡眠惰性的影响

本研究采用单因素被试内设计对清晨唤醒后睡眠惰性对个体主观情绪、警觉性和认知加工的影响，以及利用动态黎明模拟光照能否对睡眠惰性产生有效的对抗作用进行了考察。结果发现：（1）被试的积极情绪、主观警觉性在刚唤醒时显著低于基线水平，之后随时间推移逐渐提升。（2）被试醒后立即进行测试的认知加工成绩最差，随后逐渐提高，且主要表现在加工速度的回升上。（3）黎明模拟光照对被试醒后在积极情绪、主观警觉性、持续性注意和抑制功能的缓解上产生了明显的促进作用。这表明睡眠惰性会对个体的主客观活动产生显著的负性影响，而使用黎明模拟光照可在一定程度上对抗睡眠惰性带来的负性影响。     

Absorbed in sleep: Dissociative absorption as a predictor of sleepiness following sleep deprivation in two high-functioning samples

In recent years, a labile sleep-wake cycle has been implicated as a cause for dissociative experiences, and studies show that dissociation is elevated following sleep deprivation. Dissociative individuals may find it harder to regulate sleepiness in the face of sleep disruption. Although there is significant variability in reactions to sleep deprivation, research on trait predictors is scarce. The present study examined the ability of trait dissociation to prospectively predict sleepiness following sleep loss and recovery sleep. Two high-functioning samples, namely, Remotely Piloted Aircraft officers (N = 29) and Air Force jet pilots (N = 57) completed state and trait questionnaires assessing sleep and dissociation before and after full or partial sleep loss. Dissociative absorption was a consistent predictor of an increase in sleepiness following sleep loss and following recovery sleep, controlling for baseline sleepiness levels. We discuss the findings in light of a difficulty to regulate and monitor consciousness states.     

睡眠剥夺影响风险决策的双系统模型探讨

睡眠剥夺是指由于环境或自身原因无法满足正常睡眠时间的情况。大量实证研究发现, 睡眠剥夺会导致个体在风险决策中更倾向于风险寻求, 同时也有研究表明睡眠剥夺会导致个体风险规避, 而目前尚无统一结论。睡眠剥夺从风险感知、风险容忍、风险决策策略三个方面影响了风险决策, 其心理机制可由认知和情绪双路径模型进行解释, 且脑神经生理学研究也提供了相关证据。未来的研究应该进一步关注：(1)现实工作生活中的睡眠不足对风险决策的影响; (2)睡眠剥夺影响风险决策的理论模型建构。     

The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.