Tag: Sleep

Are Alterations in Alpha Synchrony Discriminatory of PTSD?

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Research Paper Title

Alterations in Sleep EEG Synchrony in Combat-Exposed Veterans With PTSD.

Background

The researchers assessed whether the synchrony between brain regions, analysed using electroencephalography (EEG) signals recorded during sleep, is altered in subjects with post-traumatic stress disorder (PTSD) and whether the results are reproducible across consecutive nights and sub-populations of the study.

Methods

Seventy-eight combat-exposed veteran men with (n = 31) and without (n = 47) PTSD completed two consecutive laboratory nights of high-density EEG recordings. They computed a measure of synchrony for each EEG channel-pair across three sleep stages [rapid eye movement (REM) and non-REM stages 2 and 3] and six frequency bands.

The researchers examined the median synchrony in nine region-of-interest (ROI) pairs consisting of six bilateral brain regions (left and right frontal, central, and parietal regions) for ten frequency-band and sleep-stage combinations.

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

Results

In the discovery analysis, five alpha-band synchrony pairs during non-REM sleep were consistently larger in PTSD subjects compared to controls (effect sizes ranging from 0.52 to 1.44) across consecutive nights: two between the left-frontal and left-parietal ROIs, one between the left-central and left-parietal ROIs, and two across central and parietal bilateral ROIs.

These trends were preserved in the replication set.

Conclusions

PTSD subjects showed increased alpha-band synchrony during non-REM sleep in the left fronto-parietal, left centro-parietal, and inter-parietal brain regions.

Importantly, these trends were reproducible across consecutive nights and sub-populations. Thus, these alterations in alpha synchrony may be discriminatory of PTSD.

Reference

Laximinarayan, S., Wang, C., Ramakrishnan, S., Oyama, T., Cashmere, J.D., Germain, A. & Reifman, J. (2020) Alterations in Sleep EEG Synchrony in Combat-Exposed Veterans With PTSD. Sleep. doi: 10.1093/sleep/zsaa006. Online ahead of print.

Can Adverse Childhood Experiences have an Affect on Mental Health Outcomes through Disrupted Sleep?

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Research Paper Title

Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers.

Background

Adverse childhood experiences (ACEs) can have long-term impacts on a person’s mental health, which extend into adulthood.

There is a high prevalence of ACEs among service members.

Further, service members also report frequently experiencing disrupted sleep.

Methods

The researchers hypothesised that disrupted sleep may serve a mechanistic function connecting ACEs to functional impairment and poorer mental health.

Results

In a cross-sectional sample (n = 759), the researchers found evidence for an indirect effect of ACEs on mental health outcomes through disrupted sleep.

In a different sample using two time-points (n = 410), they found evidence for an indirect effect of ACEs on changes in mental health outcomes and functional impairment during a reset period, through changes in disrupted sleep during the same period.

Conclusions

Implications, limitations and future research directions are discussed.

Reference

Conway, M.A., Cabrera, O.A., Clarke-Walper, K., Dretsch, M.N., Holzinger, J.B., Riviere, L.A. & Quartana, P.J. (2020) Sleep disturbance mediates the association of adverse childhood experiences with mental health symptoms and functional impairment in US soldiers. Journal of Sleep Research. e13026. doi: 10.1111/jsr.13026. [Epub ahead of print].

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?

Published on by Andrew MarshallLeave a comment

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.

Treatment of Anxiety Disorders

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When treating anxiety disorders, there are a number of things to consider:

  • Treatment of the cause if appropriate;
  • Psychotherapy;
  • Drug therapy; and/or
  • Treatment of other active disorders.

Accurate diagnosis is important because treatment varies from one anxiety disorder to another.

Additionally, anxiety disorders must be distinguished from anxiety that occurs in many other mental health disorders, which involve different treatment approaches.

If the cause is another medical disorder or a drug, medical professionals aim to correct the cause rather than treat the symptoms of anxiety.

Anxiety should subside after the physical disorder is treated or the drug has been stopped long enough for any withdrawal symptoms to abate.

If anxiety remains, anti-anxiety drugs or psychotherapy (such as behavioural therapy) is used.

For individuals who are dying, certain strong pain relievers, such as morphine, may relieve both pain and anxiety.

If an anxiety disorder is diagnosed, drug therapy or psychotherapy (such as behavioral therapy), alone or in combination, can significantly relieve the distress and dysfunction for most individuals.

Benzodiazepines (such as diazepam) are commonly prescribed for acute anxiety.

For many individuals, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), work as well for anxiety disorders as they do for depression.

Specific treatments depend on which anxiety disorder is diagnosed.

All of the anxiety disorders can occur along with other psychiatric conditions.

For example, anxiety disorders often occur along with an alcohol use disorder.

It is important to treat all of these conditions as soon as possible.

Treating the alcohol use disorder without treating the anxiety is unlikely to be effective since the individual may be using alcohol to treat the anxiety.

On the other hand, treating the anxiety without addressing the alcohol disorder may be unsuccessful because daily changes in the amount of alcohol in the blood can cause levels of anxiety to fluctuate.

Diagnosis of Anxiety Disorders

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A diagnosis of anxiety disorder is via a medical professional’s evaluation, based on specific criteria.

Deciding when anxiety is severe enough to be considered a disorder can be complicated.

Individual ability to tolerate anxiety varies, and determining what constitutes abnormal anxiety can be difficult.

Medical professionals usually use the following specific established criteria:

  • Anxiety is very distressing.
  • Anxiety interferes with functioning.
  • Anxiety is long-lasting or keeps coming back

Medical professionals look for other disorders that may be causing anxiety, such as depression or a sleep disturbance.

They may also ask whether relatives have had similar symptoms, because anxiety disorders tend to run in families.

Medical professionals also do a physical examination. Blood and other tests may be done to check for other medical disorders that can cause anxiety.

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].