RATIONALE:An increasing body of evidence links the occurrence of sleep continuity disturbances with increased inflammation and both sleep disturbances and inflammation are associated with clinical depression. Typhoid vaccination results in a mild inflammatory response that significantly increases levels of the proinflammatory cytokine, interleukin (IL)-6.

OBJECTIVES:The present exploratory study aimed to enhance our understanding of the link between inflammation, sleep and depression by examining the effects of typhoid vaccine on the sleep polysomnogram.

METHODS:We studied the effects of a single injection of typhoid polysaccharide vaccine and placebo (saline solution) on sleep in 16 healthy male and female participants aged 20-38 years, sleeping at home in a randomized, double-blind, balanced order, crossover design. Subjective measures of mood, sleep and adverse effects were elicited and plasma samples analysed for IL-6 levels.

RESULTS:IL-6 levels (in picogramme per millilitre) significantly increased 2 h post vaccine compared to placebo (0.90 vs 0.53, p = 0.026, r = 0.55). Relative to placebo, typhoid vaccination produced significant impairment in several measures of sleep continuity. Total sleep time (in minute) (426.1 vs 410.7, p = 0.005, r = 0.62) and sleep efficiency percent (94.3 vs91.5, p = 0.007, r = 0.65) were decreased; with increases in wake after sleep onset (in minute) (25.5 vs 38.8, p = 0.007,r = 0.65), total wake (in minute) (34.9 vs 50.3, p = 0.005,r = 0.67), sleep stage transitions (155.9 vs 173.1, p = 0.026, r = 0.56), number of awakenings (27.2 vs36.1, p = 0.007, r = 0.64) and awakening index (3.8 vs 5.3, p = 0.005, r = 0.67) (means, significance level and effect size).

CONCLUSIONS:Inflammatory mechanisms may underlie the impairment in sleep efficiency which is a hallmark of major depression. Because impaired sleep is also a predictor of major depression, there may be a role for suitable anti-inflammatory approaches in strategies designed to prevent the onset of depression. ClinicalTrials.gov ( https://www.clinicaltrials.gov ): NCT02628054.

OBJECTIVE:To observe the effects of hyperbaric oxygen (HBO2) therapy on the treatment of sleep disorders and its safety in children with cerebral palsy (CP).

METHODS:A total of 71 recruited children were divided into two groups based on age: group 1, aged between 2 and 4 years; and group 2, aged between 4 and 6 years. The effects of HBO2 therapy on sleep quality were observed.

RESULTS:The total sleep items (TSIs) were significantly different in the two groups between pre-HBO2, post 10 HBO2 sessions, and post 20 HBO2 sessions (p < 0.01). A total of 15/38 (39.5%) participants in group 1 and 8/21 (38.0%) in group 2 presented difficulty in falling asleep; 17/38 (44.7%) in group 1 and 4/21 (19.0%) in group 2 had a short duration of sleep during the night; and 20/38 (52.6%) in group 1 and 11/21 (52.4%) in group 2 woke up easilyin the night. No significant difference in the average TSIs in 59 participants was found after 10 HBO2 sessions. Eight participants had insomnia after the first 5 sessions, and three in group 2 had nocturnal hyperkinesia after 15 sessions. A seizure during decompression was observed in 2/59 participants (2/419 sessions).

DISCUSSION:These results indicate that HBO2 therapy is beneficial to improve sleep and is safe for children with CP; however, further studies are necessary to explore the mechanisms of HBO2 on sleep.

OBJECTIVES:To assess the benefits of training in mindfulness-based stress reduction (MBSR) or moderate intensity exercise (EX) for improving sleep quality.

DESIGN:Randomized controlled trial.

SETTING:Outpatient, community-based.

PARTICIPANTS:Healthy adults (n = 413) aged 30-69 who did not regularly exercise or practice meditation, and who had no known prior sleep problems.

INTERVENTIONS:1) 8-weeks of MBSR training; 2) matched EX training; or 3) wait-list control.

MEASUREMENTS:The Pittsburgh Sleep Quality Index (PSQI) was administered at baseline and at 1, 3, 5, and 7-month follow-up visits.

ANALYSIS:Total PSQI scores and three PSQI factors (perceived sleep quality; daily disturbances, sleep efficiency) were assessed using linear mixed effects regression models for longitudinal data.

RESULTS:Compared to controls, PSQI global scores improved significantly for EX (mean change -0.98 points [95% CI -1.56, -0.41] p = 0.001) and marginally for MBSR (-0.53 [-1.10, 0.04] p = 0.07). The perceived sleep quality factor improved for both EX (-0.18 [-0.30, -0.07] p = 0.002) and MBSR (-0.12 [-0.24, -0.01] p = 0.035). The daily disturbances factor improved slightly more for MBSR (-0.13 [-0.22, -0.033] p = 0.008) than EX (-0.09 [-0.19, 0.004] p = 0.06). The sleep efficiency factor did not improve after MBSR (0.08 [-0.045, 0.21] p = 0.2) or EX (-0.07 [-0.20, 0.06] p = 0.3). Improvements in the sleep quality were sustained over 7 months for both groups.

CONCLUSIONS:Training in MBSR and EX produced small but statistically significant and sustained improvements in sleep quality. For EX participants, this improvement was due primarily to improvements in perceived sleep quality. For MBSR, the decrease in daytime disturbance was more important.

OBJECTIVE: To determine the effects of moderate-intensity exercise training on self-rated (subjective) sleep quality among healthy, sedentary older adults reporting moderate sleep complaints.

DESIGN: Randomized controlled trial of 16 weeks' duration. SETTING: General community.

PARTICIPANTS: Volunteer sample of 29 women and 14 men (of 67 eligible subjects) aged 50 to 76 years who were sedentary, free of cardiovascular disease, and reported moderate sleep complaints. No participant was withdrawn for adverse effects.

INTERVENTION: Randomized to 16 weeks of community-based, moderate-intensity exercise training or to a wait-listed control condition. Exercise consisted primarily of four 30- to 40-minute endurance training sessions (low-impact aerobics; brisk walking) prescribed per week at 60% to 75% of heart rate reserve based on peak treadmill exercise heart rate.

MAIN OUTCOME MEASURE: Pittsburgh Sleep Quality Index (PSQI).

RESULTS: Compared with controls (C), subjects in the exercise training condition (E) showed significant improvement in the PSQI global sleep score at 16 weeks (baseline and posttest values in mean [SD] for C=8.93 [3.1] and 8.8 [2.6]; baseline and posttest values for E=8.7 [3.0] and 5.4 [2.8]; mean posttest difference between conditions=3.4; P<.001; 95% confidence interval, 1.9-5.4), as well as in the sleep parameters of rated sleep quality, sleep-onset latency (baseline and posttest values for C=26.1 [20.0] and 23.8 [15.3]; for E=28.4 [20.2] and 14.6 [13.0]; net improvement=11.5 minutes), and sleep duration baseline and posttest scores for C=5.8 [1.1] and 6.0 [1.0]; for E=6.0 [1.1] and 6.8 [1.2]; net improvement=42 minutes) assessed via PSQI and sleep diaries (P=.05).

CONCLUSIONS: Older adults with moderate sleep complaints can improve self-rated sleep quality by initiating a regular moderate-intensity exercise program.

BACKGROUND: Cyclic meditation (CM) is a technique that combines yoga postures interspersed with supine rest. This combination is based on ancient texts and is considered easier for beginners to practice. MATERIAL/METHODS: Whole-night polysomnographic measures and the self-rating of sleep were studied on the night following a day in which 30 male participants practiced CM twice (ca. 23 minutes each time). This was compared with another night when they had had two sessions of supine rest (SR) of equal duration on the preceding day. The sessions were one day apart and the order of the sessions was randomized. Recordings were from the F4, C4, and O2 electrode sites referenced to linked earlobes and bipolar electroculography and electromyography sites. RESULTS: In the night following CM, the percentage of slow-wave sleep (SWS) was significantly higher than in the night following SR, whereas the percentage of rapid-eye-movement (REM) sleep and the number of awakenings per hour were less. Following CM the self-rating of sleep based on visual analog scales showed an increase in the feeling that the sleep was refreshing, an increase in feeling "good" in the morning, an overall increase in sleep duration, and decreases in the degree to which sleep was influenced by being in a laboratory as well as any associated discomfort. CONCLUSIONS: Practicing cyclic meditation twice a day appeared to improve the objective and subjective quality of sleep on the following night.

BACKGROUND: Cyclic meditation (CM) is a technique that combines yoga postures interspersed with supine rest. This combination is based on ancient texts and is considered easier for beginners to practice. MATERIAL/METHODS: Whole-night polysomnographic measures and the self-rating of sleep were studied on the night following a day in which 30 male participants practiced CM twice (ca. 23 minutes each time). This was compared with another night when they had had two sessions of supine rest (SR) of equal duration on the preceding day. The sessions were one day apart and the order of the sessions was randomized. Recordings were from the F4, C4, and O2 electrode sites referenced to linked earlobes and bipolar electroculography and electromyography sites. RESULTS: In the night following CM, the percentage of slow-wave sleep (SWS) was significantly higher than in the night following SR, whereas the percentage of rapid-eye-movement (REM) sleep and the number of awakenings per hour were less. Following CM the self-rating of sleep based on visual analog scales showed an increase in the feeling that the sleep was refreshing, an increase in feeling "good" in the morning, an overall increase in sleep duration, and decreases in the degree to which sleep was influenced by being in a laboratory as well as any associated discomfort. CONCLUSIONS: Practicing cyclic meditation twice a day appeared to improve the objective and subjective quality of sleep on the following night.

A nine-year-old female with a history of perinatal stroke, seizures, and type-I diabetes was seen for six weeks of Reiki to determine the effects of Reiki on relaxation, and in turn, the prevention of future seizures. The secondary and tertiary aims were to determine the effects of Reiki on sleep patterns and the stress levels of the mother. There was a decrease in stress in both the child and the mother, as measured by a modified Perceived Stress Scale and a Perceived Stress Scale, respectively. There was no change in the child's overall sense of well-being, as measured by a global questionnaire. There was a positive change in sleep patterns on 33.3% of the nights during which the study occurred, as reported on a sleep log kept by the mother. The child and the Reiki Master (a Reiki practitioner who has completed all three levels of Reiki certification training and trains and certifies individuals in the practice of Reiki as well as provides Reiki to individuals) experienced warmth and tingling sensations on the same area of the child during the Reiki sessions. The child relaxed within the first five to seven minutes of each session as reported by the Reiki Master. There were no reports of seizures during this study. Reiki may be a useful adjunct for children with increased stress levels and sleep disturbances secondary to their medical condition. Further research is warranted to evaluate the use of Reiki in children, particularly with a large sample size, and to evaluate the long-term use of Reiki and its effects on adequate sleep.

OBJECTIVES: To determine the effectiveness of tai chi on self-rated sleep quality and daytime sleepiness in older adults reporting moderate sleep complaints. DESIGN: Randomized, controlled trial with allocation to tai chi or exercise control. SETTING: General community. PARTICIPANTS: One hundred eighteen women and men aged 60 to 92. INTERVENTION: Participants were randomized into tai chi or low-impact exercise and participated in a 60-minute session, three times per week, for 24 consecutive weeks. MEASUREMENTS: Primary outcome measures were the seven subscales of the Pittsburgh Sleep Quality Index (PSQI), PSQI global score, and Epworth Sleepiness Scale (ESS). Secondary outcome measures were physical performance (single leg stand, timed chair rise, 50-foot speed walk) and 12-item short form (SF-12) physical and mental summary scores. RESULTS: Tai chi participants reported significant improvements in five of the PSQI subscale scores (sleep quality, sleep-onset latency, sleep duration, sleep efficiency, sleep disturbances) (P<.01), PSQI global score (P=.001), and ESS scores (P=.002) in comparison with the low-impact exercise participants. Tai chi participants reported sleep-onset latency of about 18 minutes less per night (95% confidence interval (CI)=-28.64 to -7.12) and sleep duration of about 48 minutes more per night (95% CI=14.71-82.41) than low-impact exercise participants. Tai chi participants also showed better scores in secondary outcome measures than low-impact exercise participants. Both groups reported improvements in SF-12 mental summary scores. CONCLUSION: Older adults with moderate sleep complaints can improve self-rated sleep quality through a 6-month, low- to moderate-intensity tai chi program. Tai chi appears to be effective as a nonpharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.

PURPOSE:Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment.

PARTICIPANTS:Older adults with cognitive impairment who complain of sleep disturbance.

METHODS:A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese.

RESULTS:Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group.

CONCLUSION:TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment.

CLINICAL TRIAL REGISTRATION:CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

INTRODUCTION: Sleep disturbances are very common in elderly people and Traditional Chinese acupressure a noninvasive technique that promotes health and comfort recently has been used in this regard. The purpose of the present study was to evaluate the potential beneficial effects of acupressure on a group of institutionalized elders experiencing sleep disturbances. METHOD: A randomized controlled clinical trial was conducted to test the effectiveness of acupressure on quality of sleep of elderly residing in a Nursing home. The Pittsburgh Sleep Quality index (PSQI) questionnaire was used as a screening tool to select 90 residents with moderate to marked sleep disturbances. The elders were randomly assigned to an acupressure group, a sham acupressure group and a control group by Balanced randomization method. RESULTS: There were significant differences between the acupressure group and the control group in subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and sleep disturbance. But no significant differences were found in sleep indices between the sham acupressure group and the control group. Sleep log data showed a significant decrease in nocturnal awakenings in acupressure group compared to other two groups. CONCLUSION: The findings of this study indicated that acupressure has an effect on improvement of sleep quality and endorsed it as a non-pharmacological and complementary therapy for sleep-disturbed elderly people.

INTRODUCTION:Menopause is the termination of menstruation and fertility. Women commonly experience sleeping problems during the menopausal period. Aromatherapy is among the complementary therapies used to remedy sleeping problems.

METHODS:This study aims to investigate the effects of lavender oil on sleep and quality of life of menopausal women through steam inhalation. This study was quasi-experimental with pre-test/post-test placebo control groups. It was conducted with 57 women, 27 of whom were subject to aromatherapy and 30 to a placebo. Data were collected using the Questionnaire Form, the Pittsburgh Sleep Quality Index (PSQI) and the Menopause-Specific Quality of Life Questionnaire (MENQOL).

RESULTS:For the intervention group, the PSQI median scores after the administration of aromatherapy were found to be significantly lower than those before the administration (p<0.001) and those of the placebo group (p<0.001). Similarly, for the intervention group, the total median MENQOL scores after the administration of the aromatherapy were found to be significantly lower than the scores prior to the administration (p<0.001) as well as the scores of the placebo group (p<0.001).

CONCLUSION:It was found that aromatherapy involving lavender-scented steam inhalation increased sleep quality and quality of life in women with sleep deprivation problems during menopause.

OBJECTIVES:To evaluate the existing data on aromatherapy interventions for improvement of sleep quality.

DESIGN:Systematic literature review and meta-analysis on the effects of aromatherapy. Study Sources: Electronic databases, including the Korea Education and Research Information Service (KERIS), Korean studies Information Service System (KISS), National Assembly Library, and eight academies within the Korean Society of Nursing Science, were searched to identify studies published between 2000 and August 2013.

STUDY SELECTION:Randomized controlled and quasi-experimental trials that included aromatherapy for the improvement of sleep quality. Of the 245 publications identified, 13 studies met the inclusion and exclusion criteria, and 12 studies were used in the meta-analysis.

RESULTS:Meta-analysis of the 12 studies using a random-effects model revealed that the use of aromatherapy was effective in improving sleep quality (95% confidence interval [CI], 0.540-1.745; Z=3.716). Subgroup analysis revealed that inhalation aromatherapy (95% CI, 0.792-1.541; Z=6.107) was more effective than massage therapy (95% CI, 0.128-2.166; Z=2.205) in unhealthy (95% CI, 0.248-1.100; Z=3.100) and healthy (95% CI, 0.393-5.104; Z=2.287) participants, respectively.

CONCLUSION:Readily available aromatherapy treatments appear to be effective and promote sleep. Thus, it is essential to develop specific guidelines for the efficient use of aromatherapy.

SCOPE:The study investigates the effects of pterostilbene (PTE) on exercise endurance and circadian rhythm in sleep-restricted (SR) mice.

METHODS AND RESULTS:The SR model is established by keeping mice awake during the first 8 h of light period for 5 d and PTE (100 mg kgd) is given once a day. PTE improves endurance in SR mice by significantly prolonging the exhaustive swimming time and ameliorating exercise fatigue biochemical parameters, including creatine kinase and lactate dehydrogenase. It is observed that PTE effectively regained mitochondrial function by improving mitochondrial swelling and maintaining oxidative phosphorylation system-related genes expression, and inhibited the decrease of mitochondrial biogenesis-related genes expression. Furthermore, PTE restores rhythms of AMP-activated protein kinase (AMPK) phosphorylation activity, silent information regulator 1 (SIRT1) deacetylation activity, and SIRT1-mediated peroxisome proliferator-activated receptor coactivator 1α (PGC-1α) deacetylation in SR mice. Finally, the results demonstrate that the AMPK/SIRT1/PGC-1α pathway may be correlated with the relationships between mitochondrial function and circadian rhythms, markedly regulating the expression of skeletal muscle clock genes, circadian locomotor output cycles kaput, and brain and muscle arnt-like 1.

CONCLUSIONS:PTE ameliorates SR-induced exercise intolerance associated with circadian misalignment and mitochondrial dysfunction through AMPK/SIRT1/PGC-1α pathway.

STUDY OBJECTIVES:Despite considerable evidence supporting cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia, it remains untested within the context of acute insomnia. This study examined the efficacy of a single session of CBT-I, with an accompanying self-help pamphlet, for individuals with acute insomnia.

DESIGN:A pragmatic parallel group randomized controlled trial.

SETTING:Community.

PARTICIPANTS:Forty adults (mean age 32.9± 13.72 y) with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defined insomnia disorder, except a self-reported duration of less than 3 mo (i.e., acute insomnia), who reported no previous exposure to CBT-I and were not currently taking medication for sleep.

INTERVENTIONS:A single 60- to 70-min session of CBT-I (n = 20), with an accompanying self-help pamphlet, or wait list control group (n = 20). All subjects were offered a full individual course of CBT-I on completion of the study, regardless of group allocation.

MEASUREMENTS AND RESULTS:Subjects completed sleep diaries and the Insomnia Severity Index (ISI) pretreatment and 1 mo following treatment. There were no between-group differences on baseline ISI scores or subjective sleep continuity. The intervention group reported significantly lower ISI scores than controls (t(38) 2.24, P<0.05) at follow-up. Further, using proposed ISI scores for identifying insomnia caseness (i.e.,≥ 10), 60% of those in the CBT-I group had remitted by 1 mo compared to 15% of those in the control group.

CONCLUSIONS:This single session of cognitive behavioral therapy for insomnia (CBT-I) is sufficiently efficacious for a significant proportion of those with acute insomnia. The results are discussed in terms of integrating this brief form of CBT-I into the"stepped care"model of insomnia.

TRIAL REGISTRATION:Testing the efficacy of an early intervention for acute insomnia (SRCTN05891695) http://www.controlled-trials.com/ISRCTN05891695.

It has been recently discovered that blue wavelengths form the portion of the visible electromagnetic spectrum that most potently regulates circadian rhythm. We investigated the effect of blue light-blocking glasses in subjects with delayed sleep phase disorder (DSPD). This open-label trial was conducted over 4 consecutive weeks. The DSPD patients were instructed to wear blue light-blocking amber glasses from 21:00 p.m. to bedtime, every evening for 2 weeks. To ascertain the outcome of this intervention, we measured dim light melatonin onset (DLMO) and actigraphic sleep data at baseline and after the treatment. Nine consecutive DSPD patients participated in this study. Most subjects could complete the treatment with the exception of one patient who hoped for changing to drug therapy before the treatment was completed. The patients who used amber lens showed an advance of 78 min in DLMO value, although the change was not statistically significant (p = 0.145). Nevertheless, the sleep onset time measured by actigraph was advanced by 132 min after the treatment (p = 0.034). These data suggest that wearing amber lenses may be an effective and safe intervention for the patients with DSPD. These findings also warrant replication in a larger patient cohort with controlled observations.