Tag: Sleep Hygiene

What is the REM Sleep Behaviour Disorder Screening Questionnaire?

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Introduction

The REM Sleep Behaviour Disorder Screening Questionnaire (RBDSQ) is a specific questionnaire for rapid eye movement behaviour disorder (RBD) developed by Stiasny-Kolster and team, to assess the most prominent clinical features of RBD.

It is a 10-item, patient self-rating instrument with short questions to be answered by either ‘yes’ or ‘no’.

The validity of the questionnaire was studied by researchers and they have observed it to perform with high sensitivity and reasonable specificity in the diagnosis of RBD.

Refer to Parasomnia.

Use

RBDSQ has the potential to be useful as a screening instrument for neurodegenerative disorder, such as the α-synucleinopathies, Parkinson’s disease or multiple system atrophy which may enable early diagnosis and also recruitment of people with RBD necessary for research studies.

Format

RBDSQ contains a set of 10 items that are to be answered by either ‘yes’ or ‘no’.

  • Items 1 to 4 address the frequency and content of dreams and their relationship to nocturnal movements and behaviour.
  • Item 5 asks about self-injuries and injuries of the bed partner.
  • Item 6 consists of four subitems assessing nocturnal motor behaviour more specifically, e.g. questions about nocturnal vocalisation, sudden limb movements, complex movements, or bedding items that fell down.
  • Items 7 and 8 deal with nocturnal awakenings.
  • Item 9 focuses on disturbed sleep in general.
  • Item 10 focuses on the presence of any neurological disorder.

The maximum total score of the RBDSQ is 13 points.

Book: Make Sense of Sleep: A Guide to Physical and Mental Wellness

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Book Title:

Make Sense of Sleep: A Guide to Physical and Mental Wellness

Author(s): L.J. Simpson.

Year: 2021.

Edition: First (1st).

Publisher: ?.

Type(s): Kindle.

Synopsis:

This book focuses on the importance of achieving a good nights sleep. The book focuses on all of those factors and variables that may impact your sleep, as well as those considerations that can help pave the way for a better nights rest.

This book also focuses on how to achieve and maintain good mental and physical health, while drilling into the impacts this can have on our sleep.

Sleep-Wake Disorders & DSM-5

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Research Paper Title

Sleep-wake disorders and DSM-5.

Background

Most individuals with mental disorders complain about the problems they experience with sleeping and waking. It is becoming evident that careful diagnosis of sleep-wake disorders is of great importance for the prevention and treatment of mental disorders. Since the introduction of the DSM-IV, clinical scientific research has provided important new insights in this field.

Therefore the aim of this research was to find out whether the new classification of sleep-wake disorders in DSM-5 is likely to improve the diagnosis of disorders of this type.

Method

The researchers discuss the main changes in the DSM-5 classification of sleep- wake disorders, comparing the new version with the version in DSM-IV.

Results

Because considerable attention is being given to the symptom-orientated and dimensional approach, the classification of sleep-wake disorders in the DSM-5 is closer to current psychiatric practice and it does justice to the current scientific insights into the dimensional nature of psychiatric disorders.

Conclusions

The DSM-5 classification takes recent scientific insights into account and might help to improve the diagnosis of sleep-wake disorders in psychiatry.

Reference

van Bemmel, A.L. & Kerkhof, G.A. (2020) Sleep-wake disorders and DSM-5. Tijdschrift voor Psychiatrie. 56(3), pp.192-195.

Book: Sleep Medicine and Mental Health

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Book Title:

Sleep Medicine and Mental Health – A Guide for Psychiatrists and Other Healthcare Professionals.

Author(s): Karim Sedky, Racha Nazir, and David Bennett (Editors).

Year: 2020.

Edition: First (1st).

Publisher: Springer.

Type(s): Hardcover and Kindle.

Synopsis:

Advances in sleep medicine research are improving our clinical work for individuals with sleep problems. The aim of this book is to educate psychiatrists and other mental health professionals about the importance of understanding sleep disorders, including their bidirectional relationship with psychiatric conditions.

This book consists of six major sections with seventeen chapters. It is led off by an introduction on the function of sleep, its neurophysiology, and types of sleep problems. Since insomnia represents a common and significant challenge for patients with psychiatric disorders, its clinical presentation and treatments are reviewed in the second section. Cognitive behavioural therapy for insomnia (CBT-I), mindfulness-based CBT, acceptance and commitment therapy (ACT), and the medication management of insomnia are reviewed.

A third section addresses sleep related breathing disorders. The pathology of sleep apnea, its treatments, and therapeutic modalities to address non-compliance with positive pressure ventilation are reviewed. Other sleep disorders such as hypersomnia, circadian rhythm disorders, movement disorders and parasomnias are discussed in the fourth section.

Since features of sleep disorders can vary by age, gender, and trauma history, a fifth section discusses the unique sleep problems associated with children, women, older adults, and veterans. The book concludes with a final section discussing how sleep disorders and psychiatric conditions overlap.

We hope this book highlights the importance of understanding and addressing comorbid sleep disorders among individuals with psychiatric conditions. We are confident that this book will be valuable in helping clinicians improve the management of sleep disorders in their clinical practice.

Is there a Link between Sleeplessness and Alzheimer’s?

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Just one sleepless night raises levels of a protein linked to Alzheimer’s disease in the blood of young men (Benedict et al., 2020).

This suggests getting into good sleep habits at an early age may help ward off the illness.

People with Alzheimer’s have clumps of two sticky proteins –
beta-amyloid and tau – in their brains. Previous work has found that one night of sleep deprivation raises beta-amyloid levels in our brains, but less is known about tau.

Jonathan Cedernaes at Uppsala University in Sweden and his team
recruited 15 healthy young men. They measured tau levels in the
men’s blood after a full night’s sleep and after a night of no sleep.

After the sleepless night, tau levels in blood rose by 17%. After
the good night, the rise was 2%.

While it is a small study that looked only at men, the finding adds to growing evidence that people with poor sleep are more likely to develop Alzheimer’s decades later, says Cedernaes.

More research is needed to confirm that sleep deprivation increases tau in the brain, since blood levels are not necessarily indicative of amounts in the brain, says Cedernaes. And higher blood levels of tau after sleep deprivation could be a sign that the brain is clearing out the protein rather than accumulating it, he says.

The role tau plays in Alzheimer’s is unclear – it may be a side effect, not a cause. Similarly, while lack of sleep has been linked to Alzheimer’s disease, it is possible that this is an early sign of
the condition, rather than a contributing factor.

References

Benedict, C., Blennow, K., Zetterberg, H. & Cedarnaes, J. (2020) Effects of acute sleep loss on diurnal plasma dynamics of CNS health biomarkers in young men. Neurology. 94(11). DOI: https://doi.org/10.1212/WNL.0000000000008866.

Klein, A. (2020) Alzheimer’s Protein Rise Without Sleep. New Scientist. 18 January 2020, pp.17.

Is There a Link between Elevated Spindle Oscillatory Frequency in PTSD & Sleep Continuity?

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Research Paper Title

Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder.

Background

Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified.

Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation.

The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and sub-samples of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory.

The researchers identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights.

To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited:

  1. Higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights; and
  2. Higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night.

The first finding was preserved in the replication analysis.

The researchers found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusions

The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity.

The findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.

Reference

Wang, C., Laxminarayan, S., Ramakrishnan, S., Dovzhenok, A., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder. Sleep. pii: zsaa064. doi: 10.1093/sleep/zsaa064. [Epub ahead of print].

Could an Elevated Spindle Oscillatory Frequency in PTSD Indicate a Deficient Sensory-gating Mechanism is Responsible For Preserving Sleep Continuity?

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Research Paper Title

Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder.

Background

Sleep disturbances are core symptoms of post-traumatic stress disorder (PTSD), but reliable sleep markers of PTSD have yet to be identified.

Sleep spindles are important brain waves associated with sleep protection and sleep-dependent memory consolidation.

The present study tested whether sleep spindles are altered in individuals with PTSD and whether the findings are reproducible across nights and sub-samples of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive nights of high-density EEG recordings in a laboratory.

The researchers identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep stages and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights.

To assess reproducibility, they used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to non-PTSD participants, PTSD participants exhibited 1) higher slow-spindle oscillatory frequency over the antero-frontal regions on both nights and 2) higher fast-spindle oscillatory frequency over the centro-parietal regions on the second night.

The first finding was preserved in the replication analysis.

The researchers found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusions

The elevated spindle oscillatory frequency in PTSD may indicate a deficient sensory-gating mechanism responsible for preserving sleep continuity.

The findings, if independently validated, may assist in the development of sleep-focused PTSD diagnostics and interventions.

Reference

Wang, C., Laxminarayan, S., Ramakrishnan, S., Dovzhenok, A., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Increased Oscillatory Frequency of Sleep Spindles in Combat-Exposed Veteran Men with Post-Traumatic Stress Disorder. Sleep. pii: zsaa064. doi: 10.1093/sleep/zsaa064. [Epub ahead of print].

Sleeplessness & Anxiety, Get Some NREM

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While a sleepless night can result in a 30% rise in anxiety levels, deep sleep could actually be a remedy against anxiety according to researchers at the University of California.

The researchers found that when the brain is in deep sleep (aka non-rapid eye movement or NREM) it has a calming effect on individuals with anxiety disorders.

MRI scans and other methods were used to measure brain activity in participants.

The results revealed that sleeplessness shuts down the brain’s medial prefrontal cortex – this helps to keep emotions in check.

However, a full night of slumber helps to restore prefrontal changes.

A Technique to Help Military Veterans with Nightmares

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Introduction

Justin Havens, a former British Army officer and an Eye Movement Desensitisation and Reprocessing (EMDR) trained psychotherapist has been testing a novel approach to helping veterans resolve traumatic nightmares.

Background

Insomnia, anxiety, and the sheer misery associated with night terrors is a huge problem for many of the people with post-traumatic stress disorder (PTSD).

Consequently, Justin has been testing, since approximately 2014, an approach with veteran groups across the UK as part of a PhD at the Veterans and Families Institute of Anglia Ruskin University.

Early results, in 2016, demonstrated that it had been successful for 16 out of 24 veterans who had completed the programme. They had not only seen dramatic improvements to sleep, but also seen an average 50% reduction in PTSD symptoms, according to Justin’s findings.

What is the Technique?

  • The technique works by helping people imagine a different outcome to their bad dreams.
  • While awake, the individual asks themselves ‘what would I like to happen next in my nightmare that feels good and puts me in control?’
  • For example, a burns victim might have nightmares about being burned.
  • They might imagine a new ending to their dream: standing under a waterfall laughing as all the scabs get washed away.

The idea is that the individual does not wake up, the dream continues and they are able to experience the rapid eye movement (REM) sleep vital for feeling fully rested.

Although not a ‘cure’ for PTSD, the approach – known as Planned Dream Intervention (PDI) – can make life more bearable for people with PTSD, and help stabilise them ahead of further therapy.

The concept was originally developed by a former US Navy psychologist called Beverley Dexter, who has taught this skill to several hundred US service personnel and veterans, though no formal research has been undertaken.

Further Information

Useful Publications

Battling Bad Dreams – How a New Technique helps Veterans Confront their Nightmares (2017) xDownload
No More Nightmares – Testing a Novel Intervention for UK Veterans (Havens, 2018)Download
Planned Dream Interventions – A Pragmatic RCT to Evaluate a Psychological Treatment for Traumatic Nightmares in UK Military Veterans (Havens et al., 2018)Download

Useful Links

Dexter, B.A. (2018) No more nightmares: how to use planned dream intervention to end nightmares? International Conference on Psychiatric & Geriatrics Nursing and Stroke. 19-20 November, 2018. Available from World Wide Web: https://www.longdom.org/proceedings/no-more-nightmares-how-to-use-planned-dream-intervention-to-end-nightmares-45944.html. [Accessed: 20 November, 2019].

Havens, J. (2015) No More Nightmares – A Revolution for Sleep/PTSD. Available from World Wide Web: https://www.crowdfunder.co.uk/no-more-nightmares. [Accessed: 20 November, 2019].

King, H. (2016) The New Treatment Hoping To End PTSD Nightmares. Available from World Wide Web: https://www.forces.net/services/tri-service/new-treatment-hoping-end-ptsd-nightmares. [Accessed: 20 November, 2019].