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Milena K Pavlova,1 Véronique Latreille,1 Nirajan Puri,1 Jami Johnsen,1 Salma Batool-Anwar,2 Sogol Javaheri,2 Paul G Mathew1 1Department of Neurology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 2Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USACorrespondence: Milena K PavlovaDepartment of Neurology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USATel +1 617 983 7580Fax +1 617 983 7582Email mpavlova@bwh.harvard.eduObjective: The objective of this prospective pilot study was to examine the effects of a novel non-pharmacological device (BioBoosti) on insomnia symptoms in adults.Methods: Subjects with chronic insomnia were instructed to hold the device in each hand for 8 mins for 6 cycles on a nightly basis for 2 weeks. Outcomes tested included standardized subjective sleep measures assessing sleep quality, insomnia symptoms, and daytime sleepiness. Sleep was objectively quantified using electroencephalogram (EEG) before and after 2 weeks of treatment with BioBoosti, and wrist actigraphy throughout the study.Results: Twenty adults (mean age: 45.6±17.1 y/o; range 18–74 y/o) were enrolled in the study. No significant side effects were noted by any of the subjects. After 2 weeks of BioBoosti use, subjects reported improved sleep quality (Pittsburgh Sleep Quality Index: 12.6±3.3 versus 8.5±3.7, p=0.001) and reduced insomnia symptoms (Insomnia Severity Index: 18.2±5.2 versus 12.8±7.0, p

Orfeu M Buxton,1-4 Milena K Pavlova,1,5 Shawn P O’Connor,1 Wei Wang,1,2 John W Winkelman1,6 1Division of Sleep Medicine, Harvard Medical School, 2Department of Medicine, Brigham and Women’s Hospital, 3Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, 4Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, 5Department of Neurology, Brigham and Women’s Hospital, 6Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Study objectives: Primary insomnia (PI) may increase diabetes risk. We tested the hypothesis that the effects of PI on glucose metabolism could be improved by 2 months of pharmacological treatment.Methods: Adult men and women meeting clinical criteria for PI were studied (n=20, body mass index 25.1±2.7 kg/m2, age 39.7±7.9) in a randomized, double-blind, placebo-controlled clinical trial. The study consisted of two 1-day inpatient admissions to a General Clinical Research Center separated by 2 months of at-home treatment with 3 mg eszopiclone or placebo. During inpatient admissions, each subject underwent two intravenous glucose tolerance tests (IVGTTs) pre- and post-treatment. Diet was controlled for micro- and macro-nutrient content and calories on the day prior to pre- and post-treatment IVGTTs. Subjects were randomized following completion of the initial IVGTT to take either placebo or eszopiclone 30 min prior to bedtime at home for 2 months.Results: Two-month eszopiclone treatment did not change insulin sensitivity, glucose tolerance, or any of the sleep measures significantly, compared with placebo. Changes in glycated hemoglobin (HbA1c, clinical measure of glycemic control) were correlated with changes in diary-reported total sleep time in the eszopiclone group (r=0.66, p=0.0360), and in the combined groups’ data (r=0.55, p=0.0125). Changes in polysomnography-measured wake after sleep onset, a hallmark of PI, were positively related to changes in IVGTT-derived glucose effectiveness, or non-insulin-mediated glucose uptake.Conclusion: Treatment with 3 mg eszopiclone for 2 months, compared with placebo, did not significantly influence either sleep or measures of diabetes risk in this preliminary study. Keywords: primary insomnia, sleep duration, metabolism, IVGTT, insulin sensitivity, diabetes, eszopiclone, wake after sleep onset

Objectives: Perceived expectations for active aging (PEAA) reflect subjective exposure to social expectations about staying active and fit in old age, for example, by maintaining health and social engagement. We investigated whether motivational and personality factors were related to PEAA in the domains of physical health, mental health, and social engagement., Method: We used a nationally representative sample of German adults (SOEP-IS) covering the entire adult life span ( N  = 2,007, age range 16-94 years) to test our pre-registered hypotheses., Results: Multiple regression analyses indicated that motivation (i.e. life goals and health-related worries) was consistently associated with PEAA in the matching domains and mediated the effects of openness to experience on PEAA. No other personality trait was associated with PEAA., Conclusion: Our findings suggest that individuals preferentially notice the expectations for active aging whose content relates to their personal concerns and goals.

Internal circadian phase assessment is increasingly acknowledged as a critical clinical tool for the diagnosis, monitoring, and treatment of circadian rhythm sleep-wake disorders and for investigating circadian timing in other medical disorders. The widespread use of in-laboratory circadian phase assessments in routine practice has been limited, most likely because circadian phase assessment is not required by formal diagnostic nosologies, and is not generally covered by insurance. At-home assessment of salivary dim light melatonin onset (DLMO, a validated circadian phase marker) is an increasingly accepted approach to assess circadian phase. This approach may help meet the increased demand for assessments and has the advantages of lower cost and greater patient convenience. We reviewed the literature describing at-home salivary DLMO assessment methods and identified factors deemed to be important to successful implementation. Here, we provide specific protocol recommendations for conducting at-home salivary DLMO assessments to facilitate a standardized approach for clinical and research purposes. Key factors include control of lighting, sampling rate, and timing, and measures of patient compliance. We include findings from implementation of an optimization algorithm to determine the most efficient number and timing of samples in patients with Delayed Sleep-Wake Phase Disorder. We also provide recommendations for assay methods and interpretation. Providing definitive criteria for each factor, along with detailed instructions for protocol implementation, will enable more widespread adoption of at-home circadian phase assessments as a standardized clinical diagnostic, monitoring, and treatment tool., (© 2024 The Author(s). Journal of Pineal Research published by John Wiley & Sons Ltd.)

In the present article, I review theory and evidence on the psychological mechanisms of mind wandering, paying special attention to its relation with executive control. I then suggest applying a dual-process framework (i.e., automatic vs. controlled processing) to mind wandering and goal-directed thought. I present theoretical arguments and empirical evidence in favor of the view that mind wandering is based on automatic processing, also considering its relation to the concept of working memory. After that, I outline three scenarios for an interplay between mind wandering and goal-directed thought during task performance (parallel automatic processing, off-task thought substituting on-task thought, and non-disruptive mind wandering during controlled processing) and address the ways in which the mind-wandering and focused-attention spells can terminate. Throughout the article, I formulate empirical predictions. In conclusion, I discuss how automatic and controlled processing may be balanced in human conscious cognition., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author. Published by Elsevier Inc. All rights reserved.)

Older adults are faced with prescriptions to remain fit and socially engaged (active aging) or limit consumption of social resources (altruistic disengagement), and violations of these may result in backlash and marginalization. Despite such negative consequences that prescriptive views of aging (PVoA) may have for older adults, whether PVoA endorsement is modifiable is still to be examined. Thus, in our study, we investigated the malleability of PVoA endorsement. Further, we explored whether malleability of PVoA endorsement generalizes across specific age norms (active aging and altruistic disengagement), life domains (health and social), and targets (others and self). We conducted two preregistered experiments in which participants reflected on agreeing or disagreeing with PVoA. In Experiment 1, 536 adults (50-89 years) reflected on their personal agreement or disagreement with PVoA. In Experiment 2, 435 adults (50-87 years) reflected on agreement with PVoA in society. Reflecting on agreement changed endorsement of PVoA in both experiments: Participants who reflected on agreement reported higher endorsement of PVoA, whereas participants who reflected on disagreement reported lower endorsement. Our results indicated that the cognitive representation of PVoA is norm and domain specific: The endorsement effect did not transfer from active aging to altruistic disengagement (or vice versa) nor across health and social domains. Further, participants set the same prescriptions for their behavior as they set for others as shown by a transfer between endorsement of other- to self-related PVoA. Our findings attest to the complexity and specificity of PVoA and offer important insights for designing interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Circannual status epilepticus (SE) patterns in communities near Earth's poles best test the hypothesis that SE susceptibility varies with light exposure because these communities are routinely subject to large changes in annual light exposure, which may result in changes to daily sleep time. We compared northern hemispheric circannual SE occurrence in Kivalliq, Canada (latitude-62.8° N) to southern hemispheric Auckland, New Zealand (latitude-36.9° S). Instead of peaking at a similar calendar time, SE peaked at a similar solar time during the increasing daylight phase after each region's respective winter solstice. This demonstrates that cumulative effects of increasing light exposure can mediate SE susceptibility., (© 2023 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

Exposure to expectations for active aging may be modulated by age and individual resources (socioeconomic status, social integration, and health) via multiple pathways. Using a cross-sectional, nationally representative sample of adults aged 17 to 94 ( N  = 2,007), we investigated the relations between age, individual resources, and perceived expectations for active aging (PEAA) in three domains (physical health, mental health, and social engagement). Across domains, young adults and individuals aged 70+ reported slightly lower PEAA than emerging adults did; no other age differences emerged. Multiple regression showed that a higher subjective socioeconomic status, better perceived general health, and partnership (in older adults) predicted higher PEAA (almost) across domains, whereas church attendance, employment status, and occupational prestige yielded domain- and age-specific effects, which were not always positive. We conclude that the effects of individual resources on PEAA are limited in general but vary depending on life domain and age.

Study Objectives: Philips Respironics issued a voluntary recall of positive airway pressure devices used to treat obstructive sleep apnea in June 2021. We surveyed sleep medicine clinicians from the American Academy of Sleep Medicine membership to assess the impact of the recall on clinicians and patients., Methods: One hundred thirty-six clinicians participated between June 2022 and November 2022. Participants reported their treatment recommendations for patients affected by the recall, their patients' behaviors regarding the recall, the recall's impact on them as clinicians and on their patients, and the approximate time their patients were waiting for a replacement device., Results: Clinicians most commonly reported first learning about the recall from Philips (25.0%), and patients most commonly first heard about the recall from news sources (34.5%). Most clinicians (62.4%) reported that they recommended patients continue using a recalled device. In comparison, only 9.3% of clinicians reported encouraging patients to stop using their recalled device. Clinicians reported that 59.9% of patients continued treatment with their recalled device, whereas 26.5% stopped treatment. Clinicians reported that over one-third of their patients were still waiting for a replacement machine. Most (86.8%) clinicians reported their stress levels were affected due to the recall, and 91.5% of clinicians reported the recall affected their patients' health and well-being. Most (83.3%) clinicians reported the recall affected their patients' trust in medicine., Conclusions: Clinicians reported that the Philips recall impaired the vast majority of their patients' health and trust in medicine and that many patients were still waiting for replacement devices., Citation: Robbins R, Epstein LJ, Pavlova MK, et al. Quantifying the impact of the Philips recall on patients with sleep apnea and clinicians. J Clin Sleep Med . 2023;19(9):1677-1683., (© 2023 American Academy of Sleep Medicine.)

Summary: Circadian sleep-wake disorders are common. Because they represent conflict between the timing of the patient's endogenous rhythms and desired timing of sleep, the presenting complaints may include both difficulty of sleep initiation or maintenance and undesired or unplanned daytime or early evening sleepiness. Therefore, circadian disorders may be misdiagnosed as either a primary insomnia or a hypersomnia disorder, depending on which complaint is more troublesome for the patient. Objective information about sleep and wake patterns over long periods is crucial for accurate diagnosis. Actigraphy provides long-term information about the rest/activity pattern about an individual. However, caution should be applied in interpretation of the results because the information provided only includes information of movements, and activity is only an indirect circadian phase marker. Timing of light and melatonin therapy is critical for successful treatment of circadian rhythm disorders. Therefore, results of actigraphy are useful and should be used in conjunction with additional measurements, including 24 hours sleep-wake history, sleep log, and melatonin measurements., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 by the American Clinical Neurophysiology Society.)

Voluntary participation is thought to promote the well-being of engaged individuals, especially in old age, but prior evidence on this link is mixed. In the present studies, we used the cross-sectional data from Round 6 (2012) of the European Social Survey (ESS) to investigate the variation in the associations between voluntary participation and eudaimonic (e.g., sense of direction) and social (e.g., perceived social support) well-being across types of participation (nonpolitical volunteering vs. political participation), age groups, and European countries. Study 1 addressed individual-level associations and age differences therein (preregistered at https://osf.io/2p9sz and https://osf.io/6twqe). Two-level multiple regression with an extensive set of control variables showed that at the within-country level, the associations between voluntary participation and well-being indicators were small on average. Nonpolitical volunteering had significantly more positive effects than did political participation, whereas few significant age differences emerged. Study 2 focused on the country-level variables that might explain the substantial cross-national variation in the main effects of voluntary participation (preregistered at https://osf.io/mq3dx). Only GDP per capita was a significant moderator at the country level: The associations of nonpolitical volunteering with eudaimonic well-being were more positive in the European countries with lower GDP. Other country-level variables (Gini coefficient, social welfare spending, and democracy indices) yielded no consistent moderation effects. Study 3 considered potential country-level explanations for the substantial cross-national variation in whether younger or older adults appeared to benefit more (preregistered at https://osf.io/7ks45). None of the country-level variables considered (effective retirement age in men, life expectancy at 65, average age of members of the national parliament and cabinet, and youth unemployment rate) could account for this variation. We conclude that, given the large cross-national variation in the effects of voluntary participation on well-being and in age differences therein, more attention to national specifics is warranted., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Pavlova, Lühr. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Drawing on the theory of planned behavior (TPB) and the volunteer process model (VPM), we compared proximal (the TPB variables) and distal (general social support and sense of community) antecedents and quality of experience between civic (CP) and political (PP) participation. Outcome variables were future intentions. We used data from a mail survey of 3,231 adults with or without prior CP or PP experience. Both inexperienced and experienced individuals perceived PP more negatively than CP. Quality of experience was also rated substantially more negatively for PP than for CP. Distal antecedents had similar effects for CP and PP, but they were mostly significant for CP only. In line with the VPM, quality of experience was the strongest predictor of future intentions in experienced individuals. Perceived behavioral control was the strongest mediator. Findings corroborate the distinction between CP and PP and suggest that PP is much less attractive on average.

Objectives: Emerging evidence suggests that circadian rhythms affect seizure propensity in addition to, and possibly independent of, sleep-wake states. Subject to extreme seasonal changes in light and dark, the northerly Arctic can serve as a "natural experiment" to assess the real-life impact of environmental influences on seizure severity. Therefore, we evaluated the timing of seizure evacuations over 11.25 years in a well-defined region of the Canadian Arctic., Methods: Retrospective review of EEG database and patient records at the single "bottleneck" hospital to which all patients from the Kivalliq Region in Nunavut, Canada are evacuated for seizure emergencies. We calculated the mean resultant length (MRL) of circular data for circannual analysis, and conducted Rayleigh's test to assess for a statistical departure from circular uniformity., Results: Screening 40,392 EEGs, we found 117 medical evacuations from 99 distinct individuals from September 2009 to November 2020. Most evacuations occurred month-wise in May (19%); week-wise within a 7-day period in February (5%), June (5%), or November (5%); and day-wise within a 24-hour period in June (3%) or November (3%). Maximal MRL clustering occurred in April no matter if analyzed by day (0.16333, p = 0.04), week (0.16296, p = 0.04), or month (0.1736, p = 0.03)., Conclusions: A relative circannual increase in seizure evacuations between the winter and summer solstices may be related to increasing sleep loss when day length grows. Fewer evacuations between the summer and winter solstices may be related to decreased daylight and "catching up" on sleep when night length grows. Additional factors likely also play a role in circannual variation of seizure evacuations in the Arctic, which warrants further research., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Sleep apnea is associated with a broad range of pathophysiology. While electronic health record (EHR) information has the potential for revealing relationships between sleep apnea and associated risk factors and outcomes, practical challenges hinder its use. Our objectives were to develop a sleep apnea phenotyping algorithm that improves the precision of EHR case/control information using natural language processing (NLP); identify novel associations between sleep apnea and comorbidities in a large clinical biobank; and investigate the relationship between polysomnography statistics and comorbid disease using NLP phenotyping., Materials and Methods: We performed clinical chart reviews on 300 participants putatively diagnosed with sleep apnea and applied International Classification of Sleep Disorders criteria to classify true cases and noncases. We evaluated 2 NLP and diagnosis code-only methods for their abilities to maximize phenotyping precision. The lead algorithm was used to identify incident and cross-sectional associations between sleep apnea and common comorbidities using 4876 NLP-defined sleep apnea cases and 3× matched controls., Results: The optimal NLP phenotyping strategy had improved model precision (≥0.943) compared to the use of one diagnosis code (≤0.733). Of the tested diseases, 170 disorders had significant incidence odds ratios (ORs) between cases and controls, 8 of which were confirmed using polysomnography ( n  = 4544), and 281 disorders had significant prevalence OR between sleep apnea cases versus controls, 41 of which were confirmed using polysomnography data., Discussion and Conclusion: An NLP-informed algorithm can improve the accuracy of case-control sleep apnea ascertainment and thus improve the performance of phenome-wide, genetic, and other EHR analyses of a highly prevalent disorder., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Drawing on cumulative advantage/disadvantage and conservation of resources theories, I investigated changes in economic, social, and personal resources and in subjective well-being (SWB) of workers as they stayed continuously employed or continuously unemployed. I considered age, gender, and SES as potential amplifiers of inequality in resources and SWB. Using 28 yearly waves from the German Socio-Economic Panel (SOEP 1985-2012), I conducted multilevel analysis with observations nested within participants. A longer duration of continuous employment predicted slightly higher economic resources and thereby slightly higher SWB over time. A longer organizational tenure had mixed effects on resources and predicted slight reductions in SWB via lower mastery. A longer duration of continuous unemployment predicted marked reductions mainly in economic but also in social resources, which led to modest SWB decreases. Younger workers, women, and workers with higher SES benefited from longer continuous employment and organizational tenure more. At the between-person level, some evidence for self-selection of less resourceful individuals into long-term or repeated unemployment emerged. The highly regulated German labor market and social security system may both dampen the rewards of a strong labor force attachment and buffer against the losses of long-term unemployment., Competing Interests: The author has declared that no competing interests exist.

First seizures are often perceived as devastating events by patients and their families due to the fear of having a life-long disease. One in 10 people experiences one or more seizures during their lifetime, while 1 in 26 people develops epilepsy. Acute symptomatic seizures are often related to a provoking factor or an acute brain insult and typically do not recur. Careful history and clinical examination should guide clinicians' management plans. Electroencephalography and brain imaging, preferably with epilepsy-specific magnetic resonance imaging, may help characterize both etiology and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision to prescribe drugs depends on individual risk factors for seizure recurrence and possible complications from seizures, which should be discussed with the patient. Counseling about driving and lifestyle modifications should be provided early, often at the first seizure encounter., Competing Interests: None declared., (Thieme. All rights reserved.)

Epilepsy is a chronic disease with multiple, complex comorbidities. Bidirectional relationships exist among seizures, sleep, circadian rhythms, and diseases within and outside of the central nervous system. Seizures fragment sleep and can contribute to development of sleep disorders, which in turn leads to worse overall health and more seizures. Moreover, treatment options are often limited by interactions with anti-seizure medications. Advances in the fields of epilepsy and in sleep medicine have been made separately, and therefore treating patients with these comorbidities necessitates interdisciplinary approach. The focus of this section of the Sleep and Epilepsy Workgroup was to identify methods of collaboration and outline investigational, educational, and treatment priorities to mutually advance what we consider a combined field.

Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in patients with refractory epilepsy. Likely pathophysiological mechanisms include seizure-induced cardiac and respiratory dysregulation. A frequently identified feature in SUDEP cases is that they occur at night. This raises the question of a role for sleep state in regulating of SUDEP. An association with sleep has been identified in a number of studies with patients and in animal models. The focus of this section of the Sleep and Epilepsy Workshop was on identifying and understanding the role for sleep and time of day in the pathophysiology of SUDEP.

Epileptic seizures, sleep, and circadian timing share bilateral interactions, but concerted work to characterize these interactions and to leverage them to the advantage of patients with epilepsy remains in beginning stages. To further the field, a multidisciplinary group of sleep physicians, epileptologists, circadian timing experts, and others met to outline the state of the art, gaps of knowledge, and suggest ways forward in clinical, translational, and basic research. A multidisciplinary panel of experts discussed these interactions, centered on whether improvements in sleep or circadian rhythms improve decrease seizure frequency. In addition, education about sleep was lacking in among patients, their families, and physicians, and that focus on education was an extremely important "low hanging fruit" to harvest. Improvements in monitoring technology, experimental designs sensitive to the rigor required to dissect sleep versus circadian influences, and clinical trials in seizure reduction with sleep improvements were appropriate.

The purpose of the present work is to examine, on a clinically diverse population of older adults (N = 46) sleeping at home, the performance of two actigraphy-based sleep tracking algorithms (i.e., Actigraphy-based Sleep algorithm, ACT-S1 and Sadeh's algorithm) compared to manually scored electroencephalography-based PSG (PSG-EEG). ACT-S1 allows for a fully automatic identification of sleep period time (SPT) and within the identified sleep period, the sleep-wake classification. SPT detected by ACT-S1 did not differ statistically from using PSG-EEG (bias = -9.98 min; correlation 0.89). In sleep-wake classification on 30-s epochs within the identified sleep period, the new ACT-S1 presented similar or slightly higher accuracy (83-87%), precision (86-89%) and F1 score (90-92%), significantly higher specificity (39-40%), and significantly lower, but still high, sensitivity (96-97%) compared to Sadeh's algorithm, which achieved 99% sensitivity as the only measure better than ACT-S1's. Total sleep times (TST) estimated with ACT-S1 and Sadeh's algorithm were higher, but still highly correlated to PSG-EEG's TST. Sleep quality metrics of sleep period efficiency and wake-after-sleep-onset computed by ACT-S1 were not significantly different from PSG-EEG, while the same sleep quality metrics derived by Sadeh's algorithm differed significantly from PSG-EEG. Agreement between ACT-S1 and PSG-EEG reached was highest when analyzing the subset of subjects with least disrupted sleep (N = 28). These results provide evidence of promising performance of a full-automation of the sleep tracking procedure with ACT-S1 on older adults. Future longitudinal validations across specific medical conditions are needed. The algorithm's performance may further improve with integrating multi-sensor information.

Rationale: Patients with epilepsy experience frequent episodes of fragmented sleep which may contribute to chronic sleep loss. Enhancing sleep patterns might lead to improved quality of life in these patients. Currently, unlike some other antiepileptic drugs (AEDs), there are no data on the effects of clobazam, a novel AED on sleep. Therefore, we tested the hypothesis that patients with epilepsy will have longer, more consolidated sleep after treatment with clobazam., Methods: In this prospective study, we included adults with drug-resistant epilepsy who were being considered for treatment with clobazam. Patients with known untreated moderate/severe sleep apnea or with major circadian rhythm disorders were excluded. We tested a set of the following subjective sleep measures: Pittsburgh Sleep Quality Inventory (PSQI), Epworth Sleepiness Scale (ESS), Karolinska Sleepiness Scale (KSS), Insomnia Severity Index (ISI), and Quality of Life in Epilepsy (QOLIE) prior to starting the treatment, as well as after achieving a stable clobazam dose. We also measured sleep pattern using wrist actigraphy - before starting therapy and after achieving stable dose., Results: A total of 12 participants completed all parts of the study. After treatment, a lower number of awakenings and less wake after sleep onset (WASO) were seen, as well as a lower number of seizures. Average pretreatment bedtime was 23:45, and average wake time was 8:24. A higher seizure frequency significantly correlated with all subjective sleep measures, as well as with a higher amount actigraphy measured WASO and less total sleep time (TST) measured both by sleep log and by actigraphy. Those with higher baseline WASO by actigraphy also had more depressive symptoms, worse quality of life, longer duration of epilepsy, and a higher seizure frequency., Conclusion: Both objective and subjective sleep metrics correlate with depressive symptoms and quality of life. After treatment, there were fewer awakenings as well as fewer seizures., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Seizures often exhibit striking circadian-like (~24-h) rhythms. While chronotherapy has shown promise in treating epilepsy, it is not widely used, in part because the patterns of seizure rhythmicity vary considerably among patients and types of epilepsy. A better understanding of the mechanisms underlying rhythmicity in epilepsy could be expected to result in more effective approaches which can be tailored to each individual patient. The excitatory neurotransmitter glutamate is an essential modulator of circadian rhythms, and changes in the extracellular levels of glutamate likely affect the threshold to seizures. We used a reverse translational rodent model of mesial temporal lobe epilepsy (MTLE) combined with long-term intracerebral microdialysis to monitor the hourly concentrations of glutamate in the seizure onset area (epileptogenic hippocampus) over several days. We observed significant 24-h oscillations of extracellular glutamate in the epileptogenic hippocampus ( n = 4, JTK&#95;CYCLE test, p < 0.05), but not in the hippocampus of control animals ( n = 4). To our knowledge, circadian glutamate oscillations have not been observed in a seizure onset region, and we speculate that the oscillations contribute to the rhythmicity of seizures in MTLE., (Copyright © 2020 Sandhu, Dhaher, Gruenbaum, Raaisa, Spencer, Pavlova, Zaveri and Eid.)

Objective: We sought to assess the prevalence, correlates, and consequences of periodic limb movements of sleep (PLMS) in persons with obstructive sleep apnea (OSA) and the effect (worsening or improvement) of continuous positive airway pressure (CPAP) therapy on PLMS in a large prospective multicenter randomized controlled trial., Methods: We performed retrospective analyses of data from the Apnea Positive Pressure Long-term Efficacy Study, a prospective multicenter randomized controlled trial. A total of 1,105 persons with OSA enrolled in this study underwent a polysomnographic investigation at baseline, another one for CPAP titration, and another study 6 months after randomization to either active CPAP or sham CPAP., Results: Of all participants, 19.7% had PLM index (PLMI) ≥10/hour, 14.8% had PLMI ≥15/hour, 12.1% had PLMI ≥20/hour, 9.3% had PLMI ≥25/hour, and 7.5% had PLMI ≥30/hour. The odds of having a PLMI ≥10 were higher in older participants (odds ratio [OR] 1.03, p < 0.001), men (OR 1.63. p = 0.007), those using antidepressants (OR 1.48. p = 0.048), and those with higher caffeine use (OR 1.01, p = 0.04). After controlling for OSA and depression, PLMS were associated with increased sleep latency, reduced sleep efficiency, and reduced total sleep time. No significant relationships were noted between PLMS frequency and subjective sleepiness (Epworth Sleepiness Scale score) or objective sleepiness (Maintenance of Wakefulness Test). There was no differential effect of CPAP in comparison to sham CPAP on PLMS after 6 months of therapy., Conclusions: PLMS are common in patients with OSA and are associated with a significant reduction in sleep quality over and above that conferred by OSA. Treatment with CPAP does not affect the severity of PLMS., (© 2019 American Academy of Neurology.)

Drawing on the literature that posits heterogeneous influences of social networks on health behaviors, we tested whether different forms of participation in voluntary organizations predicted more or less alcohol and tobacco consumption over time. (Access preregistration at https://osf.io/guzem/) We used panel data from younger (aged 14-29 at baseline), middle-aged (aged 40-50), and older (aged 65-75) UK adults, N s = 1280-9073, followed from 1991 to 2014. Annual measures of smoking included status and intensity. Frequency of pub attendance was assessed biennially between 1996 and 2008. In 2010 and 2013, more precise measures of alcohol consumption were available. We conducted two-level regression analyses for the outcomes measured more than twice and residual change analyses for other outcomes. Over time (within persons), there were no significant effects on smoking. Activity in voluntary organizations predicted slightly less frequent pub attendance in younger adults. In residual change analyses, activity in voluntary organizations decreased last-week ethanol consumption and risk of heavy episodic drinking in younger women. These effects pertained mainly to service-orientated organizations. In middle-aged adults, membership and attendance at meetings of voluntary organizations predicted slightly more frequent pub attendance. Residual change analyses showed volunteering to reduce the risk of heavy episodic drinking in middle-aged men. In older adults, few significant effects emerged. Between persons, all indicators of participation were associated with less smoking, whereas membership was associated with more and activity with less frequent pub attendance. Thus, most associations between participation in voluntary organizations and substance use reflected interindividual differences.

Background: It is unclear whether specific components of individual social capital promote or protect against substance use and whether such effects vary across the life course. In this study, we investigated the effects of voluntary memberships and volunteering on alcohol and tobacco consumption in age comparison., Methods: Preregistration is accessible at https://osf.io/qhkrn/. We used data from the German Socio-Economic Panel (1984-2015), where alcohol consumption was assessed in 2006, 2008, and 2010 and smoking was assessed at least biennially since 1998. We divided participants into three age groups (14-29, 40-50, and 65-75 years of age at baseline). To disentangle intraindividual change over time and interindividual differences (potential selection effects), we employed multilevel analysis., Results: At the within level, voluntary memberships at one occasion predicted higher alcohol consumption a year later in middle-aged and older adults, but memberships had no significant longitudinal effects on smoking. Several positive effects of volunteering on alcohol and tobacco use one year later were found in males. No significant differences in the longitudinal effects between age groups or between nonpolitical and political volunteering emerged. At the between level, voluntary memberships and volunteering were usually associated with more alcohol consumption at low and moderate levels but with less smoking., Discussion: Over time, voluntary memberships and volunteering in Germany appear to promote, rather than to protect against, alcohol and tobacco use. On average, more engaged individuals drink more (at moderate levels) and smoke less, which may be due to selection effects., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: Taking into account the regional context, we investigated whether social comparison in coping with occupational uncertainty served self-improvement (i.e., adaptive coping) or self-enhancement (i.e., subjective well-being)., Method: Respondents were 620 German adults aged 16 to 43, 59% female, who participated in three yearly follow-ups of a larger survey. The number of observations was 1,309 for contemporaneous and 1,079 for longitudinal analyses. Participants reported on perceived occupational uncertainty (e.g., risk of losing a job and difficulties with career planning), strategies for coping with it, and whether, and in which direction, they made social comparisons in coping with occupational uncertainty., Results: Making social comparisons (vs. not) was associated with higher goal engagement and lower goal disengagement. Upward (as opposed to downward) comparison prospectively predicted higher goal engagement. Under high regional unemployment, upward comparison prospectively predicted lower goal disengagement, whereas making social comparisons was contemporaneously associated with higher subjective well-being. Higher regional unemployment rates predicted more frequent comparison, whereas comparison direction was predicted only by situational variables, especially personal control over the outcomes., Conclusions: When operationalized as a conscious mental action and put in the context of coping with occupational uncertainty, social comparison serves primarily self-improvement., (© 2017 Wiley Periodicals, Inc.)

It is widely believed that warm and supportive parenting fosters all kinds of prosocial behaviors in the offspring, including civic engagement. However, accumulating international evidence suggests that the effects of family support on civic engagement may sometimes be negative. To address this apparent controversy, we identified several scenarios for the negative effects of supportive parenting on youth civic engagement and tested them using four waves of data from the Finnish Educational Transitions Studies. They followed 1549 students (55 % female) from late adolescence into young adulthood, included both maternal (n = 231) and offspring reports of parental support, and assessed civic engagement in young adulthood. Control variables included socioeconomic status, other sociodemographic indicators, church belonging, personality traits, and earlier civic engagement. Higher maternal warmth and support and a stronger identification with the parental family in adolescence predicted offspring's lower political activism up to 10 years later. Perceived parental support in young adulthood predicted lower volunteering 2 years later. There were no significant effects on general organizational involvement (e.g., in student and hobby associations). None of the a priori scenarios that we identified from the literature appeared to explain the pattern of results satisfactorily. We put forth cultural and life stage explanations of our findings.

Objective: We sought to examine whether patients with focal epilepsy exhibit sleep dependent memory consolidation, whether memory retention rates correlated with particular aspects of sleep physiology, and how the process was affected by seizures., Methods: We prospectively recruited patients with focal epilepsy and assessed declarative memory using a task consisting of 15 pairs of colored pictures on a 5×6 grid. Patients were tested 12h after training, once after 12h of wakefulness and once after 12h that included sleep. EMG chin electrodes were placed to enable sleep scoring. The number and density of sleep spindles were assessed using a wavelet-based algorithm., Results: Eleven patients were analyzed age 21-56years. The percentage memory retention over 12h of wakefulness was 62.7% and over 12h which included sleep 83.6% (p=0.04). Performance on overnight testing correlated with the duration of slow wave sleep (SWS) (r=+0.63, p<0.05). Three patients had seizures during the day, and 3 had nocturnal seizures. Day-time seizures did not affect retention rates, while those patients who had night time seizures had a drop in retention from an average of 92% to 60.5%., Conclusions: There is evidence of sleep dependent memory consolidation in patients with epilepsy which mostly correlates with the amount of SWS. Our preliminary findings suggest that nocturnal seizures likely disrupt sleep dependent memory consolidation., Significance: Findings highlight the importance of SWS in sleep dependent memory consolidation and the adverse impact of nocturnal seizures on this process., (Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

We investigated how older adults' perceptions of societal expectations for active aging, or activation demands (e.g., to stay fit and to contribute to the public good), relate to their involvement in paid work and formal volunteering and psychological adjustment. We used two waves of survey data on young-old Germans (aged 56-75, N(T1) = 1,508, N(T2) = 602). With the exception of several items on perceived activation demands, paid work and volunteering were not significant longitudinal predictors of such demands. In females, perceived activation demands increased the likelihood to work for pay a year later. Finally, among nonworking individuals, perceived activation demands predicted a better physical self-concept and a higher positive affect, whereas among nonvolunteers, such demands predicted fewer depressive symptoms a year later. We conclude that the policy debate on active aging may benefit some older German adults but is of little consequence for most of them., (© The Author(s) 2015.)

Psychogenic nonepileptic seizures (PNES), a form of functional neurological symptom disorder (FNSD), are very rarely seen in genuine, electroencephalography (EEG)-confirmed sleep. However, they are more commonly reported as a nocturnal occurrence, likely from a state that is misidentified as sleep (termed by some as "pseudosleep"). Sleep state can be helpful to distinguish FNSD from other neurological disorders. Pseudo-cataplexy, a form of "psychogenic" narcolepsy, "pseudo-parasomnia" and PNES can have a similar presentation. PNES and posttraumatic stress disorder (PTSD) frequently share previously experienced psychological trauma, and therefore the sleep abnormalities found in PTSD may be similarly present in PNES. Future research should use EEG monitoring to evaluate the sleep physiology of patients with FNSD such as PNES, as insights into sleep abnormalities may enable further understanding of the etiology and manifestations of PNES., (© EEG and Clinical Neuroscience Society (ECNS) 2014.)

Purpose: Standard polysomnography (PSG) typically utilizes 4-6 channels of electroencephalography (EEG), which is inadequate to evaluate focal epileptiform activity. Though technical capability has long existed for more extensive EEG recording, few sleep laboratories have utilized this technique. The objective of this study was to determine the utility of combining PSG with 18-channel EEG in select patients with paroxysmal nocturnal events or other symptoms concerning for sleep disorders, nocturnal seizures or both., Methods: Consecutive combined PSG-EEG studies (n=237) were performed between 10/1/2005 and 8/1/2009. Demographics, referral source, indications, and results were reviewed and analyzed., Results: Of the 237 consecutive combined PSG-EEG studies performed, 93% revealed the presence of a primary sleep disorder, 38% were shown to have abnormal EEGs, and 37% had both. Among the 221 subjects (93%) shown to have sleep disorders, the majority of these cases were obstructive sleep apnea (OSA) 89%, followed by periodic limp movements of sleep (PLMS) 22% and rapid eye movement behavior disorder (RBD) 6%. Significantly more patients with known epilepsy were diagnosed with OSA then were patients without a seizure history., Conclusions: Combined PSG-EEG, utilizing 18-channel EEG, is an under-utilized technique which can assist in diagnosing paroxysmal nocturnal events, and differentiate between the presence of a primary sleep disorder, seizure activity, or both. Our study further illustrates the importance of considering sleep disorders in epilepsy patients., (Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Objective: We investigated the relationship between dispositional optimism and coping with growing occupational uncertainty, drawing on the life span theory of control to assess coping., Method: Participants were 606 German adults with various sociodemographic backgrounds, aged 16-43. They were interviewed at the end of 2005 (Time 1) and at the beginning of 2007 (Time 2). We regressed each control strategy at Time 2 on its scores at Time 1, optimism at Time 1, three moderating variables, and their interactions with optimism., Results: Dispositional optimism predicted an increase in both goal engagement strategies (selective primary and compensatory primary control) only under favorable conditions (low regional unemployment rate, low perceived growth in occupational uncertainty, and high perceived controllability of this stressor). Specific conditions moderating the effects of optimism differed between the two engagement strategies. In addition, an unfavorable labor market situation as such prompted an increase in goal engagement. No effects of optimism on goal disengagement (compensatory secondary control) at Time 2 were found., Conclusions: The effects of dispositional optimism on the change in control strategies were contingent on the labor market situation, which supports the view that optimists are better able to tailor their coping responses to available opportunities., (© 2012, Wiley Periodicals, Inc.)

Globalization and economic change are translated into a variety of changes in the proximal contexts of youth development, which are perceived and tackled differently by different individuals., (Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company.)

Objectives: We tested whether formal volunteering, in terms of its associations with mental health, compensates for the absence of major work and family roles among older adults or rather complements such roles among both younger and older adults., Method: Two cross-sectional samples of younger (aged 18-42 years, N = 2,346) and older (aged 56-75 years, N = 1,422) German adults were used. We regressed mental health indicators on control variables, 2 indicators of formal volunteering (participation in voluntary organizations and volunteer work), and their interactions with employment/partnership status., Results: Participation in voluntary organizations was associated with higher positive affect, higher life satisfaction, and fewer depressive symptoms in younger adults. In older adults, it was related to higher life satisfaction only among working individuals, although the difference from nonworking individuals was not significant. Volunteer work was associated with higher positive affect in both age groups. In younger adults, it had no relation to life satisfaction and depressive symptoms. In older adults, it was related to higher life satisfaction among nonworking individuals and to fewer depressive symptoms among those without a steady partner., Discussion: Volunteer work but not participation in voluntary organizations yielded compensatory effects on mental health among older adults.

Fatigue and excessive daytime sleepiness are common symptoms in patients with neurological injury. Modafinil has been shown to ameliorate these symptoms, but its use in patients with seizures has been limited because of safety concerns. Using a large centralized clinical registry, we performed a retrospective chart review of patients with a diagnosis of epilepsy who were given modafinil over a 10-year period. A total of 205 patients were analyzed. There were 91 patients who had seizures while taking modafinil; there was no relationship between modafinil dosage and whether the patient had seizures. There were 6 patients in whom modafinil was discontinued because of concern for seizure exacerbation, and 4 patients had de novo seizures after starting modafinil. In 29 patients with epilepsy only, no major seizure exacerbation was seen. Modafinil is potentially safe in patients with epilepsy, but further prospective studies are needed to fully determine its safety and efficacy., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The negative impact of unemployment on subjective well-being (SWB) is well known, but the role of age in this relationship remains unclear. We suggest that cumulative advantage (or disadvantage) associated with the duration of current employment status may produce an age-related divergence in SWB between employed and unemployed individuals. We used cross-sectional data on employed (n = 1382) and unemployed (n = 254) Germans (age 18-42) surveyed in 2005. We found that, among currently employed individuals, relatively older age predicted longer employment duration (tenure), which was related to higher SWB via higher income and higher perceived occupational security. Among currently unemployed individuals, age predicted longer unemployment duration, which was associated with lower SWB via lower perceived social support. Thus, age was indirectly related to higher SWB in employed individuals and to lower SWB in unemployed individuals. In this way, cumulative advantage of long-term employment and cumulative disadvantage of long-term unemployment contributed to the age-related divergence in SWB between employed and unemployed Germans already in the first half of working life.

Drawing on two nationally representative German studies (N(1) = 1744, N(2) = 759), we examined correlates of early, on-time, and late curfew autonomy, a retrospective indicator of behavioural autonomy, in young and middle adulthood (19-37 years of age). Adjustment in four domains was considered: educational attainment, externalizing problem behaviour, subjective well-being, and interpersonal relationships. The early group showed lower adjustment in multiple domains across young and middle adulthood. The late group reported a mixed pattern of adjustment at younger ages (lower externalizing problems, but lower positive affect, lower importance of peers, and lower likelihood to have a partner) and positive adjustment in all domains at older ages. Timing effects were controlled for sociodemographic characteristics and retrospective measures of early adversities, pubertal timing, disclosure to parents, and peer group affiliation in adolescence. Findings show that late behavioural autonomy in its correlates is not simply the opposite of early behavioural autonomy., (Copyright © 2010 The Association for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Epileptiform abnormalities often occur at specific times of day or night, possibly attributable to state of consciousness (sleep vs. wake) and/or influences from the endogenous circadian pacemaker. In this pilot study we tested for the existence of circadian variation of interictal epileptiform discharges (IEDs), independent of changes in state, environment, or behavior. Five patients with generalized epilepsy underwent a protocol whereby their sleep/wake schedule was evenly distributed across the circadian cycle while undergoing full-montage electroencephalography and hourly plasma melatonin measurements. Light was <8 lux to prevent circadian entrainment. All patients completed the protocol, testifying to its feasibility. All patients had normal circadian rhythmicity of plasma melatonin relative to their habitual sleep times. In the three patients with sufficient IEDs to assess variability, most IEDs occurred during non-rapid eye movement (NREM) sleep (ratio NREM:wake=14:1, P<0.001). In both patients who had NREM at all circadian phases, there was apparent circadian variation in IEDs but with different phases relative to peak melatonin.

Purpose: In many patients with epilepsy seizures occur with a day/night pattern. Our aims were to compare day/night patterns in seizure frequency among patients with different epileptogenic regions., Methods: We analyzed video-EEG recordings in 15 patients with temporal lobe (TLE) and 11 with extratemporal lobe epilepsy (XTLE). Each seizure was classified according to subject group (TLE vs XTLE), sleep/wake state, and time of day of seizure occurrence (grouped into 6 x 4-hour "bins")., Results: Of 90 seizures, 41 occurred in TLE and 49 in XTLE patients. There were day/night patterns of seizure occurrence in each group, with differences in the patterns between groups. In TLE, 50% of seizures occurred between the hours of 15:00 and 19:00 (17% would be expected by chance in each 4-hour "bin": F=3.59, P<0.006). In XTLE, there was a peak between 19:00 and 23:00 (47%: F=4.72, P<0.0018). The effect of time on seizures was least pronounced in the XTLE patients who had more than one epileptogenic region. The proportion of seizures occurring from sleep was significantly less in TLE (19%) than in XTLE patients (41%) [P<0.04, Fisher's exact test]., Conclusions: There are clear day/night patterns of seizure occurrence in epilepsy, with differences in the patterns between TLE and XTLE. There is an additional interaction with sleep/wake state, with relatively few seizures occurring from sleep in TLE compared with XTLE. Thus, it appears that both sleep/wake state and day/night or circadian rhythms may affect seizure proclivity, with different effects depending on the location of the epileptogenic region.

There is a close and complex relation between the value of the initial density of the Dunaliella salina Teod. culture and its growth on basic nutrient medium. An increase of the initial density decreases the effect of substrate inhibition in the lag-phase and considerably increases the asymptotic density of the culture without changing the true growth rate. A factorial experiment led to a significant improvement of the composition of the nutrient medium, this allowing to double the asymptotic density of the culture.