Schlaf und zirkadiane Rhythmik im Alter

Zusammenfassung: Mit steigendem Alter nimmt die nächtliche Schlafkonsolidierung ab, kurze Nickerchen über den Tag nehmen zu, und die Schlafzeit verschiebt sich in frühere Stunden. Die Schlafregulation hängt von der Interaktion zwischen einem zirkadianen Schrittmacher (biologische Uhr) und dem Schlafhomöostaten (je länger die Wachphase, desto größer der Schlafdruck) ab. Wir konnten an gesunden älteren Personen zeigen, dass sich die Amplitude zirkadianer Rhythmen (z. B. die Melatonin-Sekretion) und die Tiefschlafdauer verringert. Gleichzeitig nimmt die Müdigkeit am Nachmittag zu, wie auch die Tendenz—im Gegensatz zu jüngeren Personen—am frühen Abend einzuschlafen. Da Licht der Hauptzeitgeber ist, um die biologische Uhr zu stabilisieren, brauchen ältere Menschen tagsüber und am Abend genügend Licht und sollten während des Tages keine oder nur kurze Nickerchen machen, um in der Folge den Schlaf in der Nacht zu verbesser

Schwangerschaftsdepression und deren Behandlung

Zusammenfassung: Etwa 11% aller schwangeren Frauen leiden unter einer behandlungsbedürftigen Depression, welche unbehandelt mit Risiken wie Frühgeburt oder niederem Geburtsgewicht verbunden ist. Da manche Symptome der Depression oft der Schwangerschaft zugeschrieben werden, ist die Diagnose einer Schwangerschaftsdepression nicht immer leicht. Eine weitere Herausforderung ist die Wahl der geeigneten Therapiemaßnahme. Als Behandlungsmöglichkeiten stehen neben Psycho- und Pharmakotherapie auch die Elektrokrampftherapie (EKT) sowie Lichttherapie zur Auswahl. Aktuelle Berichte über Auswirkungen von Antidepressiva auf die Entwicklung des Ungeborenen und postpartale Anpassungsschwierigkeiten führen zu großen Verunsicherungen. Die Entscheidung, welche Therapiemaßnahme ergriffen wird, kann nur mit der werdenden Mutter zusammen getroffen werden; ein sorgfältiges Abwägen der Vor- und Nachteile der Behandlung ist dafür Voraussetzun

Light, Health and Wellbeing: Implications from chronobiology for architectural design

Chronobiology is the science of biological rhythms, more specifically the impact of the 24-hour light-dark cycle and seasonal changes in day length on biochemistry, physiology and behaviour in living organisms. In the last 20 years, chronobiology has moved from its somewhat obscure scientific corner to a high-impact mainstream research field, notably with respect to the discovery of clock genes and peripheral oscillators – and a novel photoreceptor in the eye with specific input to the circadian system. Key discoveries in human chronobiology are related to the impact of light. Recognition of the so-called ‘biological effects of light’ by lighting manufacturers has led to interest in developing new lighting systems that integrate this knowledge. Is it time for the medical mainstream to take notice of what neuroscientists know about the body clock? And is it also time for architects to do so? These questions were explored at a symposium for architects, lighting engineers and manufacturers, initiated by Society for Light Treatment and Biological Rhythms (www. sltbr.org), in order to develop approaches to bridge the gap between these disciplines

Circadian rhythms and sleep regulation in seasonal affective disorder

Seasonal affective disorder (SAD) is characterised by recurrent episodes in autumn and winter of depression, hypersomnia, augmented appetite with carbohydrate craving, and weight gain, and can be successfully treated with bright light. Circadian rhythm hypotheses (summarized in) have stimulated research into the pathophysiology of SAD, postulating that: 1.The illness is a consequence of delayed phase position, 2.It is correlated with diminished circadian amplitude, or 3.It results from changes in the nocturnal duration between dusk and dawn e.g. of low core body temperature or melatonin secretion. Light is considered to act directly on the circadian pacemaker (‘Process C') and not on sleep dependent processes (‘Process S'). Thus successful treatment of SAD must act via mechanisms within known retinohypothalamic pathways. Conversely, emergence of SAD symptoms may reflect inappropriate neurobiological response to decreasing daylengt

Encoding difficulty promotes postlearning changes in sleep spindle activity during napping

Learning-dependent increases in sleep spindle density have been reported during nocturnal sleep immediately after the learning session. Here, we investigated experience-dependent changes in daytime sleep EEG activity after declarative learning of unrelated word pairs. At weekly intervals, 13 young male volunteers spent three 24 h sessions in the laboratory under carefully controlled homeostatic and circadian conditions. At approximately midday, subjects performed either one of two word-pair learning tasks or a matched nonlearning control task, in a counterbalanced order. The two learning lists differed in the level of concreteness of the words used, resulting in an easier and a more difficult associative encoding condition, as confirmed by performance at immediate cued recall. Subjects were then allowed to sleep for 4 h; afterward, delayed cued recall was tested. Compared with the control condition, sleep EEG spectral activity in the low spindle frequency range and the density of low-frequency sleep spindles (11.25-13.75 Hz) were both significantly increased in the left frontal cortex after the difficult but not after the easy encoding condition. Furthermore, we found positive correlations between these EEG changes during sleep and changes in memory performance between pre-nap and post-nap recall sessions. These results indicate that, like during nocturnal sleep, daytime sleep EEG oscillations including spindle activity are modified after declarative learning of word pairs. Furthermore, we demonstrate here that the nature of the learning material is a determinant factor for sleep-related alterations after declarative learning

Daylight: What Makes a Difference

Light is necessary for vision; it enables us to sense and perceive our surroundings and in many direct and indirect ways, via eye and skin, affects our physiological and psychological health. The use of light in built environments has comfort, behavioural, economic and environmental consequences. Daylight has many particular benefits including excellent visual performance, permitting good eyesight, effective entrainment of the circadian system as well as a number of acute non-image forming effects and the important role of vitamin D production. Some human responses to daylight seem to be well defined whilst others require more research to be adequately understood. This paper presents an overview of current knowledge on how the characteristics of daylight play a role in fulfilling these and other functions often better than electric lighting as conventionally delivered

Circadian-Related Sleep Disorders and Sleep Medication Use in the New Zealand Blind Population: An Observational Prevalence Survey

STUDY OBJECTIVES: To determine the prevalence of self-reported circadian-related sleep disorders, sleep medication and melatonin use in the New Zealand blind population. DESIGN: A telephone survey incorporating 62 questions on sleep habits and medication together with validated questionnaires on sleep quality, chronotype and seasonality. PARTICIPANTS: PARTICIPANTS WERE GROUPED INTO: (i) 157 with reduced conscious perception of light (RLP); (ii) 156 visually impaired with no reduction in light perception (LP) matched for age, sex and socioeconomic status, and (iii) 156 matched fully-sighted controls (FS). SLEEP HABITS AND DISTURBANCES: The incidence of sleep disorders, daytime somnolence, insomnia and sleep timing problems was significantly higher in RLP and LP compared to the FS controls (p<0.001). The RLP group had the highest incidence (55%) of sleep timing problems, and 26% showed drifting sleep patterns (vs. 4% FS). Odds ratios for unconventional sleep timing were 2.41 (RLP) and 1.63 (LP) compared to FS controls. For drifting sleep patterns, they were 7.3 (RLP) and 6.0 (LP). MEDICATION USE: Zopiclone was the most frequently prescribed sleep medication. Melatonin was used by only 4% in the RLP group and 2% in the LP group. CONCLUSIONS: Extrapolations from the current study suggest that 3,000 blind and visually impaired New Zealanders may suffer from circadian-related sleep problems, and that of these, fewer than 15% have been prescribed melatonin. This may represent a therapeutic gap in the treatment of circadian-related sleep disorders in New Zealand, findings that may generalize to other countries

Quality of sleep in patients with schizophrenia is associated with quality of life and coping

BACKGROUND: While sleep disturbance is widespread in schizophrenia it is less clear whether sleep disturbance is uniquely related to impaired coping and perceived quality of life. METHODS: We simultaneously assessed sleep quality, symptoms, and coping in 29 persons with schizophrenia or schizoaffective disorder in a post acute phase of illness. Assessment instruments included the Pittsburgh Sleep Quality Index; the Positive and Negative Symptom Scale; the Heinrichs Quality of Life Scale; and the Ways of Coping Scale. Multiple regressions were performed predicting quality of life and coping from sleep quality controlling for age and symptom severity. On a subset of seven subjects non-dominant wrist actigraphy was used as an objective check of their self-reported poor sleep. RESULTS: Analyses revealed that poor sleep quality predicted low quality of life (r = -0.493; p = .022) and reduced preference for employing positive reappraisal when facing a stressor (r = -0.0594; p = 0.0012). Actigraphy confirmed poor sleep quality in a subset of subjects. They had shorter sleep duration (p < .0005), shorter average sleep episodes (p < .005) and more episodes of long awakening (p < 0.05) than community norms. CONCLUSION: The results are consistent with the hypotheses that poor sleep may play a unique role in sustaining poor quality of life and impaired coping in patients with schizophrenia. These associations may hold for community controls as well