Data-Driven Analysis of EEG Reveals Concomitant Superficial Sleep During Deep Sleep in Insomnia Disorder

Study Objectives: The subjective suffering of people with Insomnia Disorder (ID) is insufficiently accounted for by traditional sleep classification, which presumes a strict sequential occurrence of global brain states. Recent studies challenged this presumption by showing concurrent sleep- and wake-type neuronal activity. We hypothesized enhanced co-occurrence of diverging EEG vigilance signatures during sleep in ID. Methods: Electroencephalography (EEG) in 55 cases with ID and 64 controls without sleep complaints was subjected to a Latent Dirichlet Allocation topic model describing each 30 s epoch as a mixture of six vigilance states called Topics (T), ranked from N3-related T1 and T2 to wakefulness-related T6. For each stable epoch we determined topic dominance (the probability of the most likely topic), topic co-occurrence (the probability of the remaining topics), and epoch-to-epoch transition probabilities. Results: In stable epochs where the N1-related T4 was dominant, T4 was more dominant in ID than in controls, and patients showed an almost doubled co-occurrence of T4 during epochs where the N3-related T1 was dominant. Furthermore, patients had a higher probability of switching from T1- to T4-dominated epochs, at the cost of switching to N3-related T2-dominated epochs, and a higher probability of switching from N2-related T3- to wakefulness-related T6-dominated epochs. Conclusion: Even during their deepest sleep, the EEG of people with ID express more N1-related vigilance signatures than good sleepers do. People with ID are moreover more likely to switch from deep to light sleep and from N2 sleep to wakefulness. The findings suggest that hyperarousal never rests in ID

Magnesium supplementation for the treatment of restless legs syndrome and periodic limb movement disorder : A systematic review

Magnesium supplementation is often suggested for restless legs syndrome (RLS) or period limb movement disorder (PLMD) based on anecdotal evidence that it relieves symptoms and because it is also commonly recommended for leg cramps. We aimed to review all articles reporting the effects of magnesium supplementation on changes in RLS and/or PLMD. We conducted a systematic search looking for all relevant articles and then two reviewers read all article titles and abstracts to identify relevant studies. Eligible studies were scored for their quality as interventional trials. We found 855 abstracts and 16 of these could not be definitively excluded for not addressing all aspects of our research question. Seven full-text articles were unlocatable and one was ineligible which left eight studies with relevant data. One was a randomised placebo-controlled trial, three were case series and four were case studies. The RCT did not find a significant treatment effect of magnesium but may have been underpowered. After quality appraisal and synthesis of the evidence we were unable to make a conclusion as to the effectiveness of magnesium for RLS/PLMD. It is not clear whether magnesium helps relieve RLS or PLMD or in which patient groups any benefit might be seen. (c) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Genome-wide association analysis of insomnia complaints identifies risk genes and genetic overlap with psychiatric and metabolic traits.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesPersistent insomnia is among the most frequent complaints in general practice. To identify genetic factors for insomnia complaints, we performed a genome-wide association study (GWAS) and a genome-wide gene-based association study (GWGAS) in 113,006 individuals. We identify three loci and seven genes associated with insomnia complaints, with the associations for one locus and five genes supported by joint analysis with an independent sample (n = 7,565). Our top association (MEIS1, P < 5 × 10-8) has previously been implicated in restless legs syndrome (RLS). Additional analyses favor the hypothesis that MEIS1 exhibits pleiotropy for insomnia and RLS and show that the observed association with insomnia complaints cannot be explained only by the presence of an RLS subgroup within the cases. Sex-specific analyses suggest that there are different genetic architectures between the sexes in addition to shared genetic factors. We show substantial positive genetic correlation of insomnia complaints with internalizing personality traits and metabolic traits and negative correlation with subjective well-being and educational attainment. These findings provide new insight into the genetic architecture of insomnia.Netherlands Organization for Scientific Research NWO Brain & Cognition 433-09-228 European Research Council ERC-ADG-2014-671084 INSOMNIA Netherlands Scientific Organization (NWO) VU University (Amsterdam, the Netherlands) Dutch Brain Foundation Helmholtz Zentrum Munchen - German Federal Ministry of Education and Research state of Bavaria German Migraine & Headache Society (DMKG) Almirall AstraZeneca Berlin Chemie Boehringer Boots Health Care GlaxoSmithKline Janssen Cilag McNeil Pharma MSD Sharp Dohme Pfizer Institute of Epidemiology and Social Medicine at the University of Munster German Ministry of Education and Research (BMBF) German Restless Legs Patient Organisation (RLS Deutsche Restless Legs Vereinigung) Swiss RLS Patient Association (Schweizerische Restless Legs Selbsthilfegruppe

A clinical interpretation of shame regulation in maladaptive perfectionism

Maladaptive perfectionism, a transdiagnostic personality trait, is associated with depression. Shame has been associated with depressive disorders and to negatively impact its treatment. Interestingly, maladaptive perfectionism and maladaptive shame regulation strategies might be both expressions of an internalizing personality style. We applied forward and backward stepwise linear regression modeling to explain maladaptive perfectionism by association of shame coping styles in a highly powered cross-sectional study of 1436 participants. Maladaptive perfectionism was shown to have significant positive associations with the two internalizing coping styles attacking the self, and withdrawing, and negative associations with adaptive coping. Furthermore, a significant positive interaction effect was shown for the two internalizing coping styles. Our research shows that participants who adopt maladaptive perfectionism, internalize the pain of shame. Clinically, this is especially relevant during treatment: the patterns of maladaptive perfectionism must come into the open, the client feels exposed and, consistent with his shame regulation style, shame grows. Our research might account for the negative responsiveness of perfectionism to brief therapies for depression: there may not be enough focus on and time for working through the evoked shame

Slow dissolving of distress contributes to hyperarousal

Insomnia is highly prevalent and a major risk factor for depression. Its most consistently reported characteristic is chronic hyperarousal, resembling enduring emotional distress. Understanding its cause would provide opportunities to develop better treatment and prevention of depression. Given recent insights in the role of rapid eye-movement (REM) sleep in emotion regulation, it was hypothesized that fragmented REM sleep interferes with the overnight resolution of emotional distress, contributing to its accumulation which shows as hyperarousal. Participants (N=1,199) completed questionnaires on insomnia, hyperarousal, nocturnal mental content—an indicator of restless REM sleep—and emotional distress after experiencing shame, a relevant self-conscious emotion in psychiatry. Structural equation analyses investigated whether restless REM sleep contributed to hyperarousal by leaving emotional distress unresolved

Wearable technology in sleep medicine: state-of-art of current clinical applications in people with sleep and circadian rhythm disorders

Wearable devices that enable continuous monitoring of behaviors and physiology during daily life have a long and consolidated history in sleep medicine. Over the last few decades, the tremendous advances in biomedical technologies, micro and nanotechnologies and materials engineering, coupled with the "internet of things" revolution, have drastically and rapidly reshaped the core technology behind wearable health devices and, consequently, their application in clinical practice and research. Indeed, from the earliest uniaxial activity trackers (early 1970's) to now, many sleep clinics utilize highly sophisticated wearables among their standard equipment. Nonetheless, despite the widespread use of wearable technologies, the know-how to comprehensively analyze information collected is still rather limited and global guidelines remain broad. The proposed session aims at filling this gap by providing sleep clinicians and researchers practical insights into the interpretation of data collected through these devices within the clinical management of people with sleep and circadian rhythm disorders. The symposium will provide a critical overview of: (i) research that has assessed the validity of wearables in detecting unique sleep/wake patterns associated with specific sleep disorders; (ii) research that has correlated measures collected using wearables with clinical/psychopathological features; and, (iii) how wearables can assess clinical efficacy and adherence to pharmacological and behavioural treatments and the prospective monitoring of clinical trajectories of sleep disorders. We propose examining: Central Disorders of Hypersomnolence (Narcolepsy Type 1 and Type 2, Idiopathic Hypersomnia and Klein-Levin Syndrome), Insomnia, Parasomnias (REM sleep behavior disorder) and Circadian Rhythm Sleep Disorders. Finally, in light of the unprecedented rise of commercially available consumer wearable devices and the introduction of ad-hoc online services to analyze data from the latter, we will critically discuss the rationale and use of consumer wearable devices and their role in research and clinical sleep medicin

Reduced dynamic functional connectivity between salience and executive brain networks in insomnia disorder

International audienceResearch into insomnia disorder has pointed to large-scale brain network dysfunctions. Dynamic functional connectivity is instrumental to cognitive functions but has not been investigated in insomnia disorder. This study assessed between-network functional connectivity strength and variability in patients with insomnia disorder as compared with matched controls without sleep complaints. Twelve-minute resting-state functional magnetic resonance images and T1-weighed images were acquired in 65 people diagnosed with insomnia disorder (21-69 years, 48 female) and 65 matched controls without sleep complaints (22-70 years, 42 female). Pairwise correlations between the activity time series of 14 resting-state networks and temporal variability of the correlations were compared between cases and controls. After false discovery rate correction for multiple comparisons, people with insomnia disorder and controls did not differ significantly in terms of mean between-network functional connectivity strength; people with insomnia disorder did, however, show less functional connectivity variability between the anterior salience network and the left executive-control network. The finding suggests less flexible interactions between the networks during the resting state in people with insomnia disorder

From childhood trauma to hyperarousal in adults: The mediating effect of maladaptive shame coping and insomnia

Introduction: A new line of insomnia research focuses on the developmental trajectories from early live stress to insomnia in adulthood. Adverse childhood experiences (ACE’s) might create a vulnerability for later maladaptive coping with distress, as seen in chronic hyperarousal or insomnia. In an functional magnetic resonance imaging (fMRI) study, failure to dissociate the neurobiological components of shame from autobiographical shameful memories in insomnia was reflected by continued activation of the dorsal anterior cingulate cortex (dACC), which may be a result of maladaptive coping in the wake of ACE’s. Following up on that study, the current pilot study explores the relation between ACE’s, shame coping-styles, adult insomnia, hyperarousal, and neurobiology of autobiographical memory. Methods: We used existing data (N = 57) from individuals with insomnia (N = 27) and controls (N = 30), and asked these participants to complete the childhood trauma questionnaire (CTQ). Two structural equation models were used to test the hypotheses that shame-coping styles and insomnia symptom severity mediate the association between ACE’s and (1) self-rated hyperarousal symptoms and (2) dACC activation to recall of autobiographical memories. Results: For the association between ACE’s and hyperarousal, there was a significant mediation of shame-coping style (p < 0.05). This model also indicated worse shame coping with more ACE’s (p < 0.05) and worse insomnia symptoms with more ACES’s (p < 0.05), but no association between shame coping and insomnia symptoms (p = 0.154). In contrast, dACC activation to recall of autobiographical memories could only be explained by its direct association with ACE’s (p < 0.05), albeit that in this model more ACE’s were also associated with worse insomnia symptoms. Discussion: These findings could have an implication for the approach of treatment for insomnia. It could be focused more on trauma and emotional processing instead of conventional sleep interventions. Future studies are recommended to investigate the relationship mechanism between childhood trauma and insomnia, with additional factors of attachment styles, personality, and temperament

From childhood trauma to hyperarousal in adults: The mediating effect of maladaptive shame coping and insomnia

Introduction: A new line of insomnia research focuses on the developmental trajectories from early live stress to insomnia in adulthood. Adverse childhood experiences (ACE’s) might create a vulnerability for later maladaptive coping with distress, as seen in chronic hyperarousal or insomnia. In an functional magnetic resonance imaging (fMRI) study, failure to dissociate the neurobiological components of shame from autobiographical shameful memories in insomnia was reflected by continued activation of the dorsal anterior cingulate cortex (dACC), which may be a result of maladaptive coping in the wake of ACE’s. Following up on that study, the current pilot study explores the relation between ACE’s, shame coping-styles, adult insomnia, hyperarousal, and neurobiology of autobiographical memory. Methods: We used existing data (N = 57) from individuals with insomnia (N = 27) and controls (N = 30), and asked these participants to complete the childhood trauma questionnaire (CTQ). Two structural equation models were used to test the hypotheses that shame-coping styles and insomnia symptom severity mediate the association between ACE’s and (1) self-rated hyperarousal symptoms and (2) dACC activation to recall of autobiographical memories. Results: For the association between ACE’s and hyperarousal, there was a significant mediation of shame-coping style (p < 0.05). This model also indicated worse shame coping with more ACE’s (p < 0.05) and worse insomnia symptoms with more ACES’s (p < 0.05), but no association between shame coping and insomnia symptoms (p = 0.154). In contrast, dACC activation to recall of autobiographical memories could only be explained by its direct association with ACE’s (p < 0.05), albeit that in this model more ACE’s were also associated with worse insomnia symptoms. Discussion: These findings could have an implication for the approach of treatment for insomnia. It could be focused more on trauma and emotional processing instead of conventional sleep interventions. Future studies are recommended to investigate the relationship mechanism between childhood trauma and insomnia, with additional factors of attachment styles, personality, and temperament

Overnight worsening of emotional distress indicates maladaptive sleep in insomnia

Study Objectives Mechanisms underlying the distress of hyperarousal in people with insomnia remain enigmatic. We investigated whether insomnia impedes the overnight adaptation to emotional distress. Methods We induced the distressful self-conscious emotion of shame four times across three consecutive days by exposing 64 participants to their often embarrassingly out-of-tune singing, recorded earlier during a Karaoke session. Perceived physical, emotional, and social distress was assessed with the Experiential Shame Scale. Results Compared to exposures followed by wakefulness, exposures followed by sleep resulted in overnight relief of physical component of shame in normal sleepers, but in a striking opposite overnight worsening in people with insomnia. Conclusions Our findings are the first to experimentally show that the benefits of sleep are not only lost when sleep is poor; people with insomnia experience a maladaptive type of sleep that actually aggravates physically perceived distress. Maladaptive sleep could shed new light on posttraumatic stress disorder (PTSD) and on diurnal mood fluctuation and the counterintuitive favorable effects of sleep deprivation in depression