Cognitive-behavioral therapy of insomnia: A clinical case series study of patients with co-morbid disorders and using hypnotic medications

Cognitive-behavioral therapy for insomnia (CBTi) has demonstrated considerable efficacy within randomized clinical trials and case-series designs. This case-series study in a community sleep medicine clinic assessed the effectiveness of an eight-session CBTi protocol chronic insomnia patients who were allowed to continue their use of hypnotics (intent-to-treat n = 48), administered by a clinical psychology doctoral student receiving training and supervision in CBTi by a behavioral sleep medicine certified clinician. Outcome measures included daily sleep diaries, self-report measures on insomnia severity, dysfunctional beliefs and attitudes about sleep, daytime sleepiness, as well as medication usage. Patients showed significant improvements in sleep onset latency, wake time after sleep onset, sleep efficiency, insomnia severity, and dysfunctional sleep beliefs from pre- to post-treatment. No changes were seen in daytime sleepiness - patients were not excessively sleepy either before or after treatment. Use of sleep medication declined significantly from 87.5% pre-treatment to 54% post-treatment, despite no active efforts to encourage patients to withdraw. Results demonstrate that a CBTi conducted in a community sleep medicine clinic with patients not required to discontinue sleep-related medications can have similar effects as therapy delivered among those not on medication.     

拯救肢体畸残患者的“菩萨”——秦泗河从事儿麻后遗症矫治30年的纪念

秦泗河医生30年来坚守于基层乡、区级医院,毕生心血奉献于小儿麻痹后遗症——肢体畸残矫治事业,开创了肢残矫治“前无古人,后无来者”的秦泗河畸代,值得珍惜、尊重和纪念,更是为了记住历史,给这样的事业以应有的地位和尊重。其多重意义,将为医学界带来激励和启迪。     

Changes in processing of masked stimuli across early- and late-night sleep: a study on behavior and brain potentials

Sleep has proven to support the memory consolidation in many tasks including learning of perceptual skills. Explicit, conscious types of memory have been demonstrated to benefit particularly from slow-wave sleep (SWS), implicit, non-conscious types particularly from rapid eye movement (REM) sleep. By comparing the effects of early-night sleep, rich in SWS, and late-night sleep, rich in REM sleep, we aimed to separate the contribution of these two sleep stages in a metacontrast masking paradigm in which explicit and implicit aspects in perceptual learning could be assessed separately by stimulus identification and priming, respectively. We assumed that early sleep intervening between two sessions of task performance would specifically support stimulus identification, while late sleep would specifically support priming. Apart from overt behavior, event-related EEG potentials (ERPs) were measured to record the cortical mechanisms associated with behavioral changes across sleep. In contrast to our hypothesis, late-night sleep appeared to be more important for changes of behavior, both for stimulus identification, which tended to improve across late-night sleep, and for priming, with the increase of errors induced by masked stimuli correlating with the duration of REM sleep. ERP components proved sensitive to presence of target shapes in the masked stimuli and to their priming effects. Of these components, the N2 component, indicating processing of conflict, became larger across early-night sleep and was related to the duration of S4 sleep, the deepest substage of SWS containing particularly high portions of EEG slow waves. These findings suggest that sleep promotes perceptual learning primarily by its REM sleep portion, but indirectly also by way of improved action monitoring supported by deep slow-wave sleep.     

Consolidation of novel word learning in native English-speaking adults

Sleep has been shown to improve the retention of newly learned words. However, most methodologies have used artificial or foreign language stimuli, with learning limited to word/novel word or word/image pairs. Such stimuli differ from many word-learning scenarios in which definition strings are learned with novel words. Thus, we examined sleep's benefit on learning new words within a native language by using very low-frequency words. Participants learned 45 low-frequency English words and, at subsequent recall, attempted to recall the words when given the corresponding definitions. Participants either learned in the morning with recall in the evening (wake group), or learned in the evening with recall the following morning (sleep group). Performance change across the delay was significantly better in the sleep than the wake group. Additionally, the Levenshtein distance, a measure of correctness of the typed word compared with the target word, became significantly worse following wake, whereas sleep protected correctness of recall. Polysomnographic data from a subsample of participants suggested that rapid eye movement (REM) sleep may be particularly important for this benefit. These results lend further support for sleep's function on semantic learning even for word/definition pairs within a native language.     

One night of sleep deprivation affects reaction time, but not interference or facilitation in a Stroop task

The Stroop color-naming task is one of the most widely studied tasks involving the inhibition of a prepotent response, regarded as an executive function. Several studies have examined performance on versions of the Stroop task under conditions of acute sleep deprivation. Though these studies revealed effects on Stroop performance, the results often do not differentiate between general effects of sleep deprivation on performance and effects specifically on interference in the Stroop task. To examine the effect of prolonged wakefulness on performance on the Stroop task, we studied participants in a 40-h "constant routine" protocol during which they remained awake in constant conditions and performed a Stroop color-naming task every two hours. We found that reaction time was slowest when the color and word did not match (incongruent), fastest when the color and word did match (congruent), and intermediate when participants named the color of the non-word stimulus (neutral). Performance on all three trial types degraded significantly as a function of time awake. Extended wakefulness did not significantly change the additional time needed to respond when the color and word did not match (Stroop interference), nor did it change the amount of facilitation when color and word matched. These results indicate that one night of sleep deprivation influences performance on the Stroop task by an overall increase in response time, but does not appear to impact the underlying processes of interference or facilitation. The results suggest that the degree to which an "executive function" is affected by sleep deprivation may depend on the particular executive function studied and the degree to which it is subserved by the prefrontal cortex.     

The effects of total sleep deprivation on recognition memory processes: A study of event-related potential

This study examined the memorization of information after a night of normal sleep and total sleep deprivation (TSD) by means of event-related potentials (ERPs). We expected a disfacilitatory effect of TSD on memory processing. Eighteen subjects were tested twice in a counterbalanced fashion. During the study session, subjects were presented with unfamiliar face stimuli and asked to memorize them for a subsequent memory test. At the test session, the subjects were presented with the studied faces intermixed with “new” faces and asked to indicate the previously presented stimuli. The N100 was used as a covariate to control for the differences in level of vigilance between the two sessions. Sleep deprivation decreased subjects’ ability to discriminate new from previously studied stimuli and decreased the peak amplitude of the early component (N200) to the decrement of performance. In addition, following TSD the amplitude of the late frontal component (LFC), which is thought to reflect contextual processing, was decreased in covariance with the N100 vigilance component. The amplitude of the late posterior component (LPC/P600) was also reduced but was unrelated to the vigilance component of the ERP. Based on prior studies, this LPC reduction can be interpreted to indicate a decrease in information retrieved after TSD. In summary, a night of TSD decreased the amplitude of the ERPs associated with complex episodic memory task stimuli, affected the frontal cortex during episodic retrieval, and prevented the elaboration process. Furthermore, there was an inability to discriminate what is and what is not in memory, possibly due to less local processing of details.     

Stress perçu et santé physique des doctorants dans les universités françaises

Few studies have focused on PhD students in France despite the fact that this population appears to be particularly vulnerable to stress and often faces precariousness. This research investigated associations between socio-demographic factors, health behaviours, perceived stress and physical health in a wide sample of PhD students (n = 1923) in order to have a better understanding of this population's specificities. Our results indicated that stress is a critical issue among PhD candidates. Predictors of perceived stress were: gender, age, satisfaction with supervision, sleep quality and sports practice. Findings from this study confirm the relevance of the transactional model to investigate students’ health issues and suggest that physical activity and stress management should be encouraged through health promotion programs.     

How professional pilots perceive interactions of working conditions,rosters, stress,sleep problems,fatigue and mental health. A qualitative content analysis

IntroductionSo far, no qualitative content analysis (QCA) has analysed pilots’ experiences and perceptions regarding weaknesses of fatigue risk management (FRM), flight time limitations (FTL), rosters, fatigue-severity, sleep problems, and how they relate to pilots’ mental health and well-being.ObjectiveThis research analyses pilots’ described perceptions of stress, fatigue, aviation safety and how regulations like FTL can affect their health and well-being.MethodIn total, 119 international pilots described their perceptions of FTL, rosters, aviation safety, and how they relate to fatigue and health. The QCA was conducted to analyse interactions of working conditions, stressors, fatigue, sleep problems and mental health of EASA-based and Australian pilots.ResultsAlthough pilots were rostered for only 60.8% to 62.5% of the legally allowed duty and flight hours/month, 78.6% reported severe or very high fatigue, 22.8% significant depression, 12.3% significant anxiety symptoms, 10.5% reported significant depression and anxiety symptoms. Pilots uttered severe concerns about FTL, sleep restrictions associated with early starts, minimum rest, etc. Pilots also expressed distinct fears regarding more fatigue-related crashes, and how adverse working conditions, work-related and psychosocial stress could impair their health.ConclusionsThis QCA provided valuable insights into interactions of working conditions, fatigue, sleep restrictions, physical and mental health. Progressive health impairment due to lack of sleep and accumulated fatigue promote burnout, mental and physical health problems, which not only threaten flight safety, but also sustainability of aviation.