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Objective: To assess efficacy of Chinese medicine (CM) on insomnia considering characteristics of treatment based on syndrome differentiation. Methods: A total of 116 participants aged 18 to 65 years with moderate and severe primary insomnia were randomized to the placebo (n=20) or the CM group (n=96) for a 4-week treatment and a 4-week follow-up. Three CM clinicians independently prescribed treatments for each patient based on syndromes differentiation. The primary outcome was change in total sleep time (TST) from baseline. Secondary endpoints included sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency, Pittsburgh Sleep Quality Index (PSQI) and CM symptoms. Results: The CM group had an average 0.6 h more (95% confidence interval (CI): 0.3–0.9, P<0.001) TST and 34.1% (10.3%–58.0%, P=0.005) more patients beyond 0.5 h TST increment than that of the placebo group. PSQI was changed −3.3 (−3.8 to −2.7) in the CM group, a −2.0 (−3.2 to −0.8, P<0.001) difference from the placebo group. The CM symptom score in the CM group decreased −2.0 (−3.3 to −0.7, P=0.003) more than the placebo group. SOL and WASO changes were not significantly different between groups. The analysis of prescriptions by these clinicians revealed blood deficiency and Liver stagnation as the most common syndromes. Prescriptions for these clinicians displayed relative stability, while the herbs varied. All adverse events were mild and were not related to study treatment. Conclusion: CM treatment based on syndrome differentiation can increase TST and improve sleep quality of primary insomnia. It is effective and safe for primary insomnia. In future studies, the long-term efficacy validation and the exploratory of eutherapeutic clinicians' fixed herb formulas should be addressed (Registration No. NCT01613183). [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy for insomnia (CBT-I) is effective for not only primary insomnia (PI) but also comorbid insomnia (CI; insomnia associated with psychiatric/physical diseases or other types of sleep disorders). This study aimed to compare the outcomes of CBT-I implemented in the same manner between patients with PI and CI. In total, 41 adult patients who had completed CBT-I were enrolled in this retrospective analysis and divided into a PI group and a CI group. The authors then examined and compared the significance of changes after therapy between the two groups. The magnitude of improvement on the Japanese version of the Insomnia Severity Index (ISI-J) was analyzed as the primary endpoint. In the PI group (n = 24), both the ISI-J score and the dose of hypnotics decreased significantly following CBT-I. On the other hand, in the CI group (n = 17), only the dose of hypnotics decreased significantly; no statistically significant improvement was seen in the ISI-J score. Sleep onset latency and sleep quality rating in recorded sleep diaries were significantly correlated with improved ISI-J scores in the CI group only. CBT-I was shown to be effective for CI, but its efficacy for CI was inferior to that for PI in terms of impact on sleep and mental condition. These results suggest that in addition to the basic components of CBT-I, treatment for CI, especially when accompanied by severe insomnia symptoms, should include approaches targeting the comorbid disease. [ABSTRACT FROM AUTHOR]

Insomnia is a common problem, affecting individuals' health and quality of life. Among several therapies used to treat this condition, spiritual interventions are suggested to have beneficial outcomes on sleep disturbances. Nevertheless, a systematic compilation of the evidence available is still needed in the literature in order to scientifically investigate the topic. To examine the most common spiritual interventions proposed to treat sleep disorders and to assess the scientific evidence of these interventions. This is a scoping literature review conducted by independent researchers on the following databases: PubMed, SCOPUS, Web of Science, Cochrane Library and OpenGrey. A boolean expression was used, and all studies published in the last 5 years investigating the role of spiritual or religious interventions on insomnia were included. From a total of 3257 articles retrieved in our search, ten studies were included in the final analysis. There is a wide array of techniques used to treat insomnia or the mental disorders associated with insomnia, such as mantra, yoga, mindfulness, praying/meditation, daily spiritual experiences, psycho-religious training and intervention. The included studies showed a positive influence of spiritual/religious interventions on insomnia directly and indirectly. However, there is a scarcity of clinical trials and most studies have small sample sizes and used only subjective measures, resulting in a low evidence. The results of the present review point to a promising role of spirituality and religion on better sleep outcomes, particularly in the improvement in insomnia. However, the heterogeneity and the quality of these studies suggest caution while interpreting these findings. More clinical trials are needed in this area to provide a recommendation of these methods in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioral therapy for insomnia (CBT-I) is a first-line therapy for insomnia disorders. We assessed changes in discrepancies between subjective and objective sleep measures and correlations between discrepancy changes and clinical insomnia severity for CBT-I in patients with primary insomnia Methods: Fifty-two outpatients (mean age, 60.3 years; 26 women) with primary insomnia were treated by individual CBT-I (50 min, maximum six sessions, once every 1–2 weeks). One week before and after CBT-I, patients recorded a sleep log and wore an actigraphy device. Subjective and objective time in bed (TIB), total sleep time (TST), sleep-onset latency (SOL), wake time after sleep onset (WASO), and sleep efficiency (SE) were evaluated by averaging 1-week records. Relative values of sleep discrepancy in TIB, TST, SOL, WASO, and SE were calculated for estimating effects of CBT-I. The therapeutic effects were also evaluated using psychological scales before and after CBT-I. Results: Subjective and objective discrepancies in sleep measures decreased by 36, 25, and 37 min in TST, SOL, and WASO, respectively, and 7% in SE (all P < 0.001) after CBT-I. Seven patients transitioned from underestimating SE before CBT-I to overestimating SE after CBT-I. Although CBT-I improved relative values of discrepancy in WASO and SE, alongside ISI, the improvement in insomnia severity only correlated with SOL discrepancy. Conclusions: CBT-I may reduce the discrepancy between subjective and objective sleep measures in patients with primary insomnia. However, a greater therapeutic effect of CBT-I was observed in reducing the ISI, which was slightly influenced by improvements in sleep discrepancies. [ABSTRACT FROM AUTHOR]

Dysfunction of the sleep-wake transition is considered to be associated with the pathology of patients with primary insomnia (PI). Previous animal study had reported that brain circuits between the striatum and cortex can regulate sleep-wake transitions. So far, few studies have systematically explored the structural connectivity of the striatum-centered circuits and their potential roles in patients with PI. In this study, we chosen the striatum as the seed and 10 priori target regions as masks to assess the structural connectivity by using seed-based classification with a diffusion tensor imaging (DTI) probabilistic tractography method. Track strengths of the striatum-centered circuits were compared between 22 patients with PI (41.27 ± 9.21 years) and 30 healthy controls (HC) (35.2 ± 8.14 years). Pittsburgh Sleep Quality Index (PSQI) was used to measure the sleep quality in all participants. Lower track strengths (left striatum- anterior cingulate cortex (ACC), left striatum- dorsal anterior cingulate cortex (dACC), left striatum-Hippocampus, and right striatum-Hippocampus) were observed in patients with PI compared to HC. Additionally, the lower track strengths of brain circuits mentioned above were negatively correlated with PSQI. Taken together, our findings revealed the lower tract strength of frontostriatal circuits in patients with PI and HC, which provided the implications of the system-level structural connections of frontostriatal circuits in the pathology of PI. We suggested that the track strengths of the frontostriatal circuits calculated from DTI can be the potential neuroimaging biomarkers of the sleep quality in patients with PI. [ABSTRACT FROM AUTHOR]

Purpose: According to the cognitive processing perspectives, patients with insomnia have insufficient neural management of expressional information. In this study, we compared the pre-attentive processing function of task-irrelevant facial expressions in patients with primary insomnia (PI) and matched healthy controls, with expression-related mismatch negativity (EMMN) elicited by emotional faces as the indicator. Methods: Using three schematic facial expressions (neutral, happy, and sad) as task-irrelevant stimuli, we investigated the visual processing of PI patients (n = 22) and healthy subjects (n = 22) in an expression-related oddball paradigm designed to elicit the visual N170 and EMMN component. After recording and analyzing the electroencephalogram of all participants, amplitude analysis of N170 and EMMN was eventually conducted under corresponding time window. Results: Compared with control group, the amplitude of sad-EMMN component was significantly attenuated in patients with PI, while no remarkable difference was observed under the happy condition. In addition, negative cognitive bias was further validated in the control group, but not presented in the PI group. Conclusion: The current data suggest dysfunctional expressional information processing in PI patients, accompanied by the disorganization of high level perceptual strategy of processing facial emotional expression. [ABSTRACT FROM AUTHOR]

Studies have explored brain structural abnormalities in patients with primary insomnia (PI). However, most of them are based on volumetric measures, in a specific region of interest, and have small sample sizes. Here, we investigated changes in cortical morphology (thickness and volume) in PI using an advanced surface-based morphometric method. Sixty-seven patients with PI and 55 matched healthy controls were recruited for this study and underwent a structural magnetic resonance imaging scan. The reconstructed cortical surface was processed by Freesurfer 6.0. A general linear model was used to explore group differences in surface-based morphometric features. Furthermore, the association between these cortical features and clinical characteristics were assessed in the PI group. Compared to controls, PI patients showed cortical thickening in the left orbital frontal cortex (OFC), right rostral anterior cingulate cortex (rACC), left middle cingulate cortex (MCC), bilateral insula, left superior parietal lobule (SPL), and right fusiform area (FFA), and showed increased cortical volume in the left OFC, right rACC, bilateral rostral middle frontal gyrus, and right FFA. Cortical thickness in the right OFC and FFA was positively correlated with the severity of insomnia in the PI group, suggesting a right-lateralized relationship. This study was the first to explore multiple-scale cortical morphometric changes in a relatively large sample of PI patients. Our results suggest that hypertrophic cortical morphology may underlie the neuropathology of primary insomnia. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to obtain consensus statements required for the development of clinical guidelines for the use of benzodiazepines (BZDs) and Z-drugs for the management of primary insomnia in adults in Saudi Arabia. Methods: Three rounds of the e-Delphi technique using a Bristol Online Survey (BOS) were conducted between May and August 2018. The Director of the Saudi Sleep Medicine Group helped recruit the country's sleep medicine experts. Snowballing was used to forward invitation emails, information sheets, and the survey to known sleep medicine experts and physicians deemed to be interested in the field. All participants' details were anonymised except to the researcher. Results: Fifteen experts from four different regions and specialities in Saudi Arabia participated in Round 1. Twenty-one statements originated from participants' responses. In Round 2, there were 17 respondents and 16 of the statements obtained the required consensus of 70% or higher. Eleven experts participated in Round 3 and eight statements received 100% agreement, two received 91%, and six received 82%. Having obtained the required consensus of 80% or higher in Round 3, these 16 statements fulfilled the criteria to be included in future guidelines. The five statements that failed to attain the required consensus were rejected as inappropriate for inclusion in Saudi Arabian clinical guidelines. Conclusions: The items that achieved the required consensus can be included in future guidelines for the use of BZDs and Z-drugs in the treatment of primary insomnia in adults to standardize best practices in sleep medicine in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Previous neuroimaging studies have reported brain morphological alterations and the occurrence of mental disorders in primary insomnia (PI) patients. However, studies of the effect of disrupted sleep on brain structure have showed inconsistent results. In this study, DARTEL-VBM was used to evaluate the changes in gray matter volume from 60 PI patients and 53 controls. Voxel-wise statistics was performed in two ways. One is a more liberal statistical analysis using an uncorrected P < 0. 001 with 25 voxels, and the other one is a more conservative approach using a threshold of P < 0.05, corrected for multiple comparisons using the Gaussian random field (GRF) method. Partial correlation was used to analyze the relationship between abnormal volume and clinical features. PI patients had reduced gray matter volume primarily in the right middle cingulate cortex with correction (P < 0.05). Correlation analysis showed gray matter changes in the left middle cingulate cortex were negatively associated with self-ratings for anxiety and depression. This study showed that gray matter deficits in cingulate cortex in patients with insomnia, and the decreased gray matter volume may be associated with the difficulties in emotional management due to insomnia. Functional roles of the affected regions in emotion and regulation of sleep might provide supplementary evidence and guide further research that may facilitate understanding the mechanisms underlying insomnia. [ABSTRACT FROM AUTHOR]

Objective: This study investigated alterations of resting-state networks (RSNs) in primary insomnia patients as well as relationships between these changes and clinical features.Methods: Fifty-nine primary insomnia patients and 53 healthy control subjects underwent a resting-state fMRI scan (rs-fMRI). Ten RSNs were identified using independent component analysis of rs-fMRI data. To assess significant differences between the two groups, voxel-wise analysis of ten RSNs was conducted using dual regression with FSL randomised non-parametric permutation testing and a threshold-free cluster enhanced technique to control for multiple comparisons. Relationships between abnormal functional connectivity and clinical variables were then investigated with Pearson's correlation analysis.Results: Primary insomnia patients showed decreased connectivity in regions of the right frontoparietal network (FPN), including the superior parietal lobule and superior frontal gyrus. Moreover, decreased connectivity in the right middle temporal gyrus and right lateral occipital cortex with the FPN showed significant positive correlations with disease duration and self-rated anxiety, respectively.Conclusions: Our study suggests that primary insomnia patients are characterised by abnormal organisation of the right FPN, and dysfunction of the FPN is correlated with disease duration and anxiety. The results enhance our understanding of neural substrates underlying symptoms of primary insomnia from the viewpoint of resting-state networks.Key Points: • Primary insomnia patients showed altered functional connectivity in the right FPN. • Middle temporal gyrus FC with FPN was significantly correlated with disease duration. • Lateral occipital cortex FC with FPN was significantly correlated with SAS scores. [ABSTRACT FROM AUTHOR]

Objective: To explore the abnormal connectivity patterns between the insular and the voxels of the brain in primary insomnia (PI) with insular-based functional connectivity (FC).Methods: With the resting-state fMRI data acquired from 57 PI patients and 46 healthy controls, a two-sample t test was performed on individual FC correlation maps from two groups. The person correlation analysis was used to evaluate the relationship between the abnormal FC and clinical features.Results: PI patients show enhanced connectivity between the left insula with the right anterior cingulate cortex (p < 0.05 and p < 0.001, AlphaSim-corrected), right frontal sup orb, bilateral thalamus and left precuneus,as well as decreased connectivity with the left middle temporal gyrus and right fusiform (p < 0.05, AlphaSim-corrected). Correlation analysis indicated the enhanced connectivities in the PI patients have significant negative correlations with Self-Rating Depression Scale(SDS)and Self-Rating Anxiety Scale(SAS)scores. In addition, the decreased functional connectivities showed positive correlations with SDS and SAS scores.Conclusion: Our study showed the increased connectivity regions with insula were mainly in the emotional circle and decreased connectivity was in cognitive-related regions. These provide additional evidence from functional integration view to understand the possible underlying neural- mechanisms of PI.Key Points: • The aberrant insular-based connectivity pattern of PI patients was detected. • Regions showing increased connectivity with left insular were mainly in emotional circle. • Significant correlations between changed FC and SDS and SAS score were found. [ABSTRACT FROM AUTHOR]

Purpose: Primary insomnia is a persistent and recurrent disorder as well as a risk factor for depression. The aim of this study was to determine whether the zolpidem combined with paroxetine would be effective in the treatment of patients with primary insomnia. Methods: Ninety patients meeting DSM-IV criteria for primary insomnia were randomly assigned to 8 weeks of treatment with zolpidem combined with paroxetine (the combined treatment group, n = 45) or zolpidem combined with placebo (the control group, n = 45). Patients were assessed with the Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG), and the Treatment Emergent Symptom Scale (TESS). Results: Compared with the control group, the combined treatment group was more significantly improved on wake time after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and total PSQI scores, but not the sleep onset latency (SOL). Conclusions: Eight weeks of the zolpidem combined with paroxetine treatment to patients with primary insomnia is more effective than zolpidem treatment only in sleep maintenance and early morning awakenings. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to explore the regional spontaneous activity changes in primary insomnia (PI) patients.Materials and Methods: Based on the resting-state fMRI datasets acquired from 59 PI patients and 47 healthy controls, a two-sample t-test was performed on individual normalized regional homogeneity (ReHo) maps. Relationships between abnormal ReHo values and the Pittsburgh Sleep Quality Index (PSQI), the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS) were investigated with Pearson correlation analysis.Results: In PI patients, we found increased ReHo in the left insula, right anterior cingulate gyrus, bilateral precentral gyrus and left cuneus, as well as decreased ReHo in the right middle cingulate cortex and left fusiform (p < 0.05, AlphaSim-corrected). We also found a significant positive correlation between increased ReHo in the left insula and SAS scores, decreased ReHo in the right middle cingulated cortex and SDS, SAS scores as well as a negative correlation between increased ReHo in the right precentral gyrus and SDS scores (p < 0.05).Conclusions: Our study found abnormal spontaneous activities in multiple brain regions, especially in emotion-related areas in PI patients. Alterative activities in these regions might contribute to an understanding the intrinsic functional architecture of insomnia and its clinical features.Key Points: • Regional spontaneous activity changes were detected in PI patients. • Decreased or increased ReHo of some regions was identified in PI patients. • Significant correlations between mean ReHo and SDS scores were found. [ABSTRACT FROM AUTHOR]

The quantification of interdependencies within autonomic nervous system has gained increasing importance to characterise healthy and psychiatric disordered subjects. The present work introduces a biosignal processing approach, suggesting a computational resource to estimate coherent or synchronised interactions as an eventual supportive aid in the diagnosis of primary insomnia and schizophrenia pathologies. By deploying linear, nonlinear and statistical methods upon 25 electroencephalographic and electrocardiographic overnight sleep recordings, the assessment of cross-correlation, wavelet coherence and [Formula: see text]:[Formula: see text] phase synchronisation is focused on tracking discerning features amongst the clinical cohorts. Our results indicate that certain neuronal oscillations interact with cardiac power bands in distinctive ways responding to standardised sleep stages and patient groups, which promotes the hypothesis of subtle functional dynamics between neuronal assembles and (para)sympathetic activity subject to pathophysiological conditions. [ABSTRACT FROM AUTHOR]

Primary insomnia ( PI) is one of the most prevalent sleep disorders. For this reason, over the last decades, several comprehensive and etiological theories have been proposed. In this paper we review some of the main theoretical models of insomnia and discuss the two most studied processes for comprehension of insomnia: the hyperarousal and the failure to inhibit wakefulness or psychobiological inhibition hypotheses. Some clinical implications of the models are described. In the end, we propose that the two processes are complementary and both are relevant to the understanding of clinical insomnia. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the efficacy of individual and group cognitive behavioral therapy for insomnia ( CBT-I) in outpatients with primary insomnia diagnosed by DSM-IV-TR. The participants were 20 individually treated ( I-CBT-I) and 25 treated in a group therapy format (three to five patients per group) ( G-CBT-I), which showed no significant difference regarding demographic variables between groups. The same components of CBT- I stimulus control therapy, sleep restriction therapy, cognitive therapy, and sleep hygiene education were applied on both groups. The short-term outcome (4 weeks after treatment) was measured by sleep logs, actigraphy, the Pittsburgh Sleep Quality Index ( PSQI), and the Dysfunctional Beliefs and Attitudes about Sleep Scale ( DBAS), and was compared between I-CBT-I and G-CBT-I. The results indicated that CBT-I was effective in improving subjective and objective sleep parameters and subjective sleep evaluations for both individual and group treatment. However, I-CBT-I resulted in significantly better improvements over G-CBT-I, in (i) objective and subjective sleep onset latency time, (ii) objective sleep efficacy and moving time during sleeping, (iii) overall sleep quality and duration of actual sleep time in PSQI, (iv) consequences of insomnia, control and predictability of sleep, sleep requirement expectation, and sleep-promoting practices in DBAS. The present study suggested the superiority of I-CBT-I over G-CBT-I in clinical settings, and further evaluations are necessary. [ABSTRACT FROM AUTHOR]

Insomnia is frequently comorbid with psychiatric conditions, mostly depression and anxiety disorders. Because disturbed sleep is a symptom of most major mental disorders, it has been traditionally assumed that effective treatment of the psychiatric condition will resolve the coincident insomnia also. However, insomnia often persists after successful treatment of the comorbid mental disorder, suggesting that insomnia often warrants separate treatment attention. Cognitive-behavioral therapy (CBT) is a well established and efficacious treatment for insomnia. Most evidence supporting the efficacy of CBT comes from studies conducted with patients suffering from primary insomnia, yet over the past 20 years there has been growing support for the use of cognitive-behavioral insomnia intervention for patients with comorbid psychiatric conditions. Overall, promising results have been obtained from these studies, not only with regard to insomnia improvement but also concurrent improvements in comorbid psychiatric conditions. In this article we review recent studies in this area with particular focus on treatment of insomnia in the context of depression, post-traumatic stress disorder, and alcohol dependence. [ABSTRACT FROM AUTHOR]

Insomnia, defined as difficulty in falling asleep and/or staying asleep, short sleep duration, or poor quality sleep, is a common sleep disorder affecting 30-40% of adult population. We have conducted a randomized, double-blind, placebo-controlled study to test if anesthesia is therapeutically beneficial in patients with refractory chronic primary insomnia. We have assessed the efficacy and safety of propofol-induced sleep in these patients. This study comprised of 103 patients with refractory chronic primary insomnia (including 59 non-pregnant, non-lactating women; 28-60 years) and the participants were randomized to receive either physiological saline (placebo) ( n = 39) or 3.0 g/l propofol ( n = 64) in a 2-h continuous intravenous infusion for five consecutive nights. The Leeds Sleep Evaluation Questionnaire was used for the subjective assessment of sleep, and polysomnography was used for the objective measurement of sleep architecture and patterns. The assessments were done prior to and at the end of the 5-day treatment and 6 months after treatment period. The adverse effects of the treatment were also recorded. A 2-h continuous intravenous infusion of 3.0 g/l propofol for five consecutive nights improved the subjective and objective assessments of sleep in 64 patients with refractory chronic primary insomnia. This improvement occurred immediately after the therapy and persisted for 6 months. No serious adverse events were noticed during the period of drug administration or 6 months after the treatment. Propofol therapy is an efficacious and safe choice for restoring normal sleep in patients with refractory chronic primary insomnia. [ABSTRACT FROM AUTHOR]

Insomnia has been linked to cardiovascular disease and among these especially hypertension and changes in autonomic function. One marker for cardiovascular risk is baroreflex sensitivity (BRS). We investigate daytime BRS in patients with primary insomnia in order to assess cardiovascular risk. Twenty-one patients (18 females/3 males) with primary insomnia according to DSM-IV were recruited. Careful investigations excluded confounding sleep disorders such as sleep-disordered breathing and periodic limb movements. An age-matched control group with 21 healthy subjects (18 females/3 males) underwent the same investigations. To assess BRS, an experimental protocol with paced breathing during daytime was performed. ECG and continuous non-invasive blood pressure were recorded to obtain spontaneous BRS by calculating the α index (BRS-α) and also by transfer function analysis (TF-BRS). There were no differences at daytime between insomnia patients and controls neither in BRS-α (8.1 ms/mmHg, range 5.8-14.7 vs. 9.6 ms/mmHg, range 6.9-15.8) nor in TF-BRS (5.8 ms/mmHg, range 2.4-16.8 vs. 5.4 ms/mmHg, range 2.3-11.4). Also there were no differences in absolute, low or high frequency bands of heart rate or blood pressure variability between the two groups. We could show that primary insomnia may be not associated with daytime parameters of autonomic imbalance (e.g., baroreflex sensitivity) which are known as non-classical risk markers of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Insomnia is a sleeping disorder, usually studied from a behavioural perspective, with a focus on somatic and cognitive arousal. Recent studies have suggested that an impairment of information processes due to the presence of cortical hyperarousal might interfere with normal sleep onset and/or consolidation. As such, a treatment modality focussing on CNS arousal, and thus influencing information processing, might be of interest. Seventien insomnia patients were randomly assigned to either a tele-neurofeedback ( n = 9) or an electromyography tele-biofeedback ( n = 8) protocol. Twelve healthy controls were used to compare baseline sleep measures. A polysomnography was performed pre and post treatment. Total Sleep Time (TST), was considered as our primary outcome variable. Sleep latency decreased pre to post treatment in both groups, but a significant improvement in TST was found only after the neurofeedback (NFB) protocol. Furthermore, sleep logs at home showed an overall improvement only in the neurofeedback group, whereas the sleep logs in the lab remained the same pre to post training. Only NFB training resulted in an increase in TST. The mixed results concerning perception of sleep might be related to methodological issues, such as the different locations of the training and sleep measurements. [ABSTRACT FROM AUTHOR]

Previous work suggests that people with poor sleep quality, especially patients with primary insomnia, show an attentional preference for sleep-related stimuli (sleep-related attentional bias). Studies investigating this effect have generally used standardised reaction time experiments, in which the effects of a large number of sleep-related stimuli were averaged. Here, we analysed the data of two studies in order to investigate the contribution of single sleep-related stimuli (words) to sleep-related attentional bias. Results showed that effect sizes of the stimuli were relatively stable between the two studies. Knowing effect sizes of individual stimuli is important for the construction of future attentional paradigms, as well as providing a better understanding of the magnitude and content of sleep-related attentional bias. [ABSTRACT FROM AUTHOR]

Gaboxadol is a selective extrasynaptic GABAA agonist, previously in development for the treatment of insomniac patients. To evaluate the acute efficacy and safety of gaboxadol in primary insomnia (PI). This was a randomised, double-blind, four-way crossover, polysomnograph study comparing gaboxadol 10 and 20 mg (GBX20) to placebo in 40 adults with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria for PI. Zolpidem 10 mg was used as an active reference. Treatment was administered on two consecutive nights in each treatment session. Next-day residual effects were evaluated 2 and 9 h after lights on. Efficacy analysis included the per-protocol population ( n = 38) from night 2. GBX20 reduced wake after sleep onset ( p < 0.01). Both doses of gaboxadol, but not zolpidem, reduced the number of night awakenings ( p < 0.001). GBX20 and zolpidem increased total sleep time ( p < 0.05). Neither dose of gaboxadol nor zolpidem significantly reduced sleep onset latency, although a trend was seen for zolpidem. Gaboxadol enhanced slow wave sleep (SWS) dose-dependently (gaboxadol 10 mg: p < 0.01, GBX20: p < 0.001). Patients reported improved sleep quality following GBX20 ( p < 0.05). Both doses of gaboxadol were generally well tolerated with almost exclusively mild to moderately severe adverse events (AEs). More frequent and severe AEs followed GBX20. No serious AEs were reported. No drug treatment was associated with next-day residual effects. Acute administration of gaboxadol improves sleep maintenance and enhances SWS in a dose-dependent manner in adult patients with PI. Gaboxadol was not associated with next-day residual effects. Gaboxadol was generally well tolerated, although gaboxadol showed a dose-dependent increase in incidence and severity of AEs. [ABSTRACT FROM AUTHOR]

This review article focusses on the state of the art of research and clinical work with respect to primary insomnia. The ICSD-2 is a new diagnostic classification system encompassing a separate chapter on insomnias. Furthermore, the research diagnostic criteria (RDC) for insomnia, having been recently published, will be of relevance for future research in the field of insomnia. The focus of etiological and pathophysiological theories is the hyperarousal concept. This concept is based on the assumption that patients with chronic primary insomnia display a psychophysiological arousal, manifested for example in increased cortisol secretion or enhanced fast frequencies in the sleep EEG. On a molecular genetic level alterations in the adenosine system could be at the core of the hyperarousal. New psychological concepts of primary insomnia focus on attention processes which might play a role for the chronic course of insomnias. Also in detail discussed will be psychotherapeutic concepts, especially cognitive behavioural strategies for the treatment of primary insomnia. These concepts have been subjected to rigorous evidence based testing and can claim a high degree of scientific evidence. [ABSTRACT FROM AUTHOR]

The article presents abstracts on applied psychopathology and biofeedback, presented at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. These include "The Use of Biofeedback and Relaxation Model of Costochrondritis in Childhood: A Clinical Case Examination," "The Effects of Ampliture Training on Measures of Coherence in QEEG," "Paradoxes in Biofeedback and Neurofeedback," and "Biofeedbak Treatment of Severe Psychogenic Cough."

In order to effectively study the population experiencing insomnia, it is important to identify reliable and valid tools to measure sleep that can be administered in the home setting. The purpose of this study was to assess psychometric properties for the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in community-dwelling adults with primary insomnia. The CPSQI had an overall reliability coefficient of 0.82 –0.83 for all subjects. ‘Subjective sleep quality’ was the component most highly correlated with the global score. Overall, the CPSQI showed acceptable test–retest reliability over a 14- to 21-day interval with a coefficient of 0.85 for all subjects and 0.77 for primary insomniacs. The two contrasting groups had significantly different global and component scores. A CPSQI of greater than 5 yielded a sensitivity and specificity of 98 and 55% in primary insomniacs vs. controls. A CPSQI of greater than 6 resulted in a sensitivity and specificity of 90 and 67%. Results suggest that the CPSQI is a psychometrically sound measure of sleep quality and disturbance for patients with primary insomnia. It may not be an effective screening tool because of its low specificity, but it can be a sensitive, reliable, and valid outcome assessment tool for use in community-based studies of primary insomnia [ABSTRACT FROM AUTHOR]

Question of the study As sedating antidepressants have been used increasingly in the treatment of insomnia, the question whether they elicit periodic leg movements in sleep (PLMS) and thereby disturb sleep patterns may be clinically relevant. PLMS are generally supposed to play a role in eliciting and maintaining sleep disturbances in patients with otherwise unexplained insomnia or daytime sleepiness. We evaluated the PLMS data from a double-blind, placebo-controlled polysomnographic treatment study with doxepin in patients with primary insomnia. The aim of the study was to investigate the influence of low-dose doxepin on PLMS. Patients and methods PLMS recordings from the first diagnostic nights were scored in all 40 patients. PLMS scores from each of the 10 polysomnographic (PSG) nights were however available only in a subset of subjects, because PLMS data were originally not considered as a study objective. The PLMS data of 13 patients over 10 nights (2 baseline nights, 3 treatment nights, 3 withdrawal nights, 2 follow-up nights) were assessed. Patients were treated either with doxepin (six patients 50 mg, one patient 25 mg) or with placebo (six patients) 1 h prior to bed time. Results Comparing the doxepin and the placebo group for the different days of the study, we found no significant differences in PLMS parameters. In the doxepin group, the discontinuation of doxepin was however associated with a significant (P < 0.05) decrease in the PLMS-arousal index (PLMS associated with arousal per hour of sleep), indicating a possible relationship between doxepin medication and the presence of PLMS. Conclusions Treatment with low-dose doxepin appears to exert only a weak influence on PLMS in patients with primary insomnia. [ABSTRACT FROM AUTHOR]

Zusammenfassung Bei auffallend vielen Patienten mit Schlafstörungen kam es durch Nadelung einer bisher unbekannten Zone, die jeweils auch als tastbare Verquellung lateral der von Yamamoto beschriebenen Gehirnpunkte zu lokalisieren ist, zu schneller Ermüdung. Die meisten Patienten fielen schon während der Akupunktur in einen leichten Schlaf. Die Verbesserung des Nachtschlafs trat nach drei bis fünf Sitzungen ein und hielt über einen Beobachtungszeitraum von zwölf Monaten an. Anhand von kurzen Fallberichten über die Erfahrungen von zehn Patienten soll diese neue Zone vorgestellt werden. Remarkably often, patients suffering from sleep disorders tired rapidly after needling of a hitherto not recognized zone, which will be localized as a palpable maceration laterally situated from the brain points described by Yamamoto. The majority of patients dozed off even during acupuncture. Onset of improvement of night's sleep occurred after three to five sessions and was sustained through an observation period of twelve months. Based on brief case reports of ten patients, this newly detected zone will be depicted. [ABSTRACT FROM AUTHOR]

Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of β-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion, and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders. [ABSTRACT FROM AUTHOR]