Paula K Schweitzer

St. Luke's Hospital (MO, USA) · Sleep Medicine and Research Center

Study objectives To compare delta spectral power (delta) and odds-ratio-product (ORP) as measures of sleep depth during sleep restriction with placebo or a drug that increases delta. Methods This is a secondary analysis of data from a study of forty-one healthy participants randomized to receive placebo or gaboxadol 15mg during sleep restriction....

Numerous studies have demonstrated that sleep promotes memory consolidation, but there is little research on the effect of hypnotics on sleep-dependent memory consolidation. We compared bedtime administration of zolpidem-ER 12.5 mg (6- to 8-h duration of action), middle-of-the-night administration of zaleplon 10 mg (3- to 4-h duration of action), a...

Study objective: To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). Design, setting, and participants: The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducte...

This chapter describes the current knowledge about the medications used for promotion of sleep, beginning with the benzodiazepines and nonbenzodiazepine agents acting as agonists at the γ-aminobutyric acid type A (GABA A) receptor complex. The chapter focuses on the medications which have a sedating effect, including antidepressants, antihistamines...

To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults. Cross-sectional analyses of polysomnographic and neurocognitive data from 1204 adult participants with a clinical diagnosis of obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES), ass...

Sleep disturbance, daytime sleepiness, and decrements in cognitive function occur in individuals with allergic rhinitis, respiratory disorders, and cardiovascular disease. These impairments may be caused or exacerbated by disease or by treatment with drugs that affect the central nervous system. First-generation H1 antihistamines produce both subje...

Study Objectives To investigate whether enhancement of slow wave sleep (SWS) with sodium oxybate reduces the impact of sleep deprivation. Design Double-blind, parallel group, placebo-controlled design Setting Sleep research laboratory Participants Fifty-eight healthy adults (28 placebo, 30 sodium oxybate), ages 18-50 years. Interventions A 5-da...

To investigate whether enhancement of slow wave sleep (SWS) with sodium oxybate reduces the impact of sleep deprivation. Double-blind, parallel group, placebo-controlled design Sleep research laboratory Fifty-eight healthy adults (28 placebo, 30 sodium oxybate), ages 18-50 years. A 5-day protocol included 2 screening/baseline nights and days, 2 sle...

Drugs currently used for the treatment of insomnia include benzodiazepine receptor agonists (BzRAs), a melatonin receptor agonist, sedating antidepressants, several atypical antipsychotics, sedating antihistamines, and unregulated substances such as valerian and melatonin. Among these compounds substantial evidence of efficacy exists only for the B...

To evaluate the impact of enhanced slow wave sleep (SWS) on behavioral, psychological, and physiological changes resulting from sleep restriction. A double-blind, parallel group, placebo-controlled design was used to compare gaboxadol (GBX) 15 mg, a SWS-enhancing drug, to placebo during 4 nights of sleep restriction (5 h/night). Behavioral, psychol...

To assess the size, time course, and durability of the effects of long-term continuous positive airway pressure (CPAP) therapy on neurocognitive function, mood, sleepiness, and quality of life in patients with obstructive sleep apnea. Randomized, double-blinded, 2-arm, sham-controlled, multicenter, long-term, intention-to-treat trial of CPAP therap...

To evaluate the impact of enhanced slow-wave sleep (SWS) on behavioral, psychological, and physiologic changes resulting from sleep restriction A double-blind, parallel-group, placebo-controlled design was used to compare tiagabine, 8 mg, (a SWS-enhancing drug) to placebo during 4 nights of sleep restriction (time in bed = 5 hours per night). Behav...

To evaluate the effect of tiagabine on sleep and next-morning alertness and performance in adult patients with primary insomnia. Patients with primary insomnia, as defined by Diagnostic and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV), received tiagabine 4, 8, 12, 16 mg, and placebo in a randomized, double-blind, five-period, Lat...

To evaluate the effects of napping, caffeine, and napping plus caffeine on performance and alertness in both laboratory and field settings. (1) Laboratory Study: parallel-groups design with random assignment to 1 of 4 experimental conditions. (2) Field Study: crossover design. Sleep laboratory and field settings. (1) Laboratory Study: 68 healthy in...

To evaluate the dose- response effects of tiagabine on sleep and safety measures in healthy older adults. Randomized, double-blind, Latin-square design. Sleep laboratory. Twenty-four healthy older adults (11 men, 13 women; mean age 68.0 +/- 6.2 years) Tiagabine 2, 4, or 8 mg, or placebo, each given on two consecutive nights. Polysomnography reveale...

To assess the effect of 200 mg of modafinil compared to placebo on alertness, neurobehavioral performance, and executive function during 4 consecutive simulated night shifts. Double-blind, randomized, parallel groups. Sleep research facility. 32 male and female volunteers between the ages of 18 and 55 years. 200 mg of modafinil or placebo given nig...

Study Objectives To assess the effect of 200 mg of modafinil compared to placebo on alertness, neurobehavioral performance, and executive function during 4 consecutive simulated night shifts. Design Double-blind, randomized, parallel groups. Setting Sleep research facility. Participants 32 male and female volunteers between the ages of 18 and 55...

Intermittent use (i.e., a few nights per week) of hypnotic medication is often recommended for the treatment of chronic insomnia despite an absence of efficacy and safety data using this regimen. To evaluate the clinical efficacy and safety of intermittent pharmacotherapy for chronic insomnia. Randomized, double-blind, placebo-controlled, parallel...

Objective: To examine the hypnotic efficacy of zaleplon 10 mg, a selective benzodiazepine receptor agonist, over a period of 35 nights in primary insomniacs.Methods: A double-blind, parallel-group, placebo-controlled design was employed. Subjects were 113 men and women, ages 18 to 65 years. Polysomnographic and subjective sleep data were collected...

The present randomized, double-blind, placebo and active-drug controlled, crossover study assessed residual sedation after zaleplon 10 mg, flurazepam 30 mg (as an active control), and placebo, taken during a nocturnal awakening in patients with sleep maintenance insomnia. Twenty-two healthy sleep maintenance insomniacs (11 men; mean age, 42 y) rece...

To assess patterns of pharmacological treatment of insomnia during the period 1987-1996. Data were obtained from the National Disease and Therapeutic Index (NDTI; IMS America, Ltd., Plymouth Meeting, PA) which samples office-based physicians in 24 specialties. Drug mentions, a measure of patient contacts in which drug therapy is recommended, with a...

Various aspects of human performance were assessed in children after sleep loss. Sixteen children (7 males, 9 females) between the ages of 10 and 14 years. Children were randomly assigned to either a control (CTRL) group, with 11 hours in bed, or an experimental sleep restriction (SR) group, with 5 hours in bed, on a single night in the sleep labor...

Study Objectives Various aspects of human performance were assessed in children after sleep loss. Participants Sixteen children (7 males, 9 females) between the ages of 10 and 14 years Design and Interventions Children were randomly assigned to either a control (CTRL) group, with 11 hours in bed, or an experimental sleep restriction (SR) group, w...

To evaluate the effects of triazolam upon insomnia and daytime sleepiness in patients with rheumatoid arthritis (RA). Triazolam or placebo was administered during two 7 night periods to 15 patients with RA in a double blind crossover study. Polysomnographic recordings were conducted on the last 2 nights of each condition, and multiple sleep latency...

SUMMARY  Hypnotic medication reliably improves sleep during the day, in terms of increasing total sleep time (TST) and reducing awakenings and light sleep. Middle-aged individuals may benefit more than young adults. In addition, the time of day during which sleep is attempted may influence the efficacious dose of short-acting drugs. Available data...

The sedative effects of cetirizine (10 mg once daily), diphenhydramine (50 mg three times daily), and placebo, each administered during a 3-day period, were compared with objective measures of sleepiness and performance. Twelve atopic subjects received each of the three treatments for 3 consecutive days in a double-blind Latin square design. Subjec...

The effect of two durations of bright light upon sleepiness and performance during typical night shift hours was assessed. Thirty normal, healthy young adults participated in a 2-night protocol. On the 1st night subjects were exposed to bright or dim light beginning at 2400 hours, under one of the following three conditions: bright light for 4 hour...

SUMMARY  Slow-wave sleep (SWS) has been theorized to be an intense form of nonREM sleep, but selective deprivation of SWS or Stage 4 sleep has not been shown to cause greater decrements in alertness or performance, compared to deprivation or disruption of the other stages of sleep. The present experiment examined the effects of marked SWS deprivati...

This study examined the influence of morningness-eveningness on night shift sleepiness in 15 subjects. Sleepiness was assessed during a five-night protocol involving the multiple sleep latency test (MSLT), repeated test of sustained wakefulness (RTSW) and the Stanford Sleepiness Scale (SSS). Daytime sleep was estimated by sleep diaries and wrist ac...

Twelve healthy subjects participated in three daytime work periods, in a double-blind repeated measures Latin square design. Subjects received cetirizine (10 mg), hydroxyzine (25 mg), or placebo at 0800. Performance was measured each day during eight 50-minute test periods on a simulated assembly line task between 0830 and 1700. Before entry into t...

Napping and caffeine consumption, two common strategies for improving alertness and performance on the night shift, were investigated in two separate studies. Performance was measured with a simulated assembly line task (SALT) during a single night work shift. Both strategies proved beneficial. Performance and subjective alertness were improved fol...

The sedative effect of 0.7 g/kg of 100% ethanol, ingested at 9:30 PM, was investigated to examine the combined effects of ethanol and circadian sleepiness/alertness levels. Fourteen healthy young adults participated in a placebo-controlled, double-blind crossover design. Each subject, on two separate occasions (placebo or ethanol), completed multip...

Forty-eight healthy volunteers with a normal sleep/wake history participated in a two-centre, double-blind, parallel group study comparing the effects of estazolam 2.0 mg, triazolam 0.25 mg, and placebo on sleep, performance and alertness following 180 degree reversal in sleep/wake schedule. Sleep-phase reversal produced decreased sleep time, prima...

Nasal continuous positive airway pressure (CPAP) effectively treats obstructive sleep apnea by providing a pneumatic splint in the supraglottic airway. This treatment involves administration of a constant positive end-expiratory pressure (PEEP) within the range of 2.5 to 17.5 cm H2O. The optimal PEEP not only eliminates apneas and hypopneas, but al...

Physiological sleep tendency during a simulated night shift schedule was examined in 15 middle-aged subjects following daytime sleep after administration of triazolam or placebo. A double-blind, counterbalanced, crossover design involving two tours of five laboratory nights and four daytime home sleep periods was used. Triazolam lengthened daytime...

A 3-hour phase advance of sleep time was employed to produce a model of transient insomnia. The degree to which this manipulation was effective varied substantially among young, healthy normal sleepers. Zolpidem, an imidazopyridine hypnotic compound, was effective in reversing the sleep disruption in those individuals displaying transient insomnia...

Marked sleepiness occurs during typical night shift work hours and this reduced alertness is associated with marked performance deficits. The effect of caffeine (versus placebo) upon sleepiness at night was studied using objective measures of physiological sleep tendency and ability to sustain wakefulness. Both measures show caffeine to reduce slee...

A 3-hour phase advance of sleep time was employed to produce a model of transient insomnia. The degree to which this manipulation was effective varied substantially among young, healthy normal sleepers. Zolpidem, an imidazopyridine hypnotic compound, was effective in reversing the sleep disruption in those individuals displaying transient insomnia...

Daytime sleep and nocturnal sleepiness were examined in 18 normal sleepers (9 young adults, 9 middle-age adults) for 5.5 days following acute sleep/wake schedule inversion. Triazolam and placebo were compared in a counterbalanced, crossover design. Triazolam improved daytime sleep, but did not produce significant changes in sleep tendency at night....

From July, 1982 through March, 1986, 253 patients with moderate to severe sleep apnea (OSA) were treated and had polysomnographic assessment of treatment. The treatment modalities were: 1. uvulopalatopharyngoplasty (UPP), 2. nasal continuous positive airway pressure (CPAP), 3. tracheostomy, 4. medication (tricyclic antidepressants), 5. tongue retai...

Since its introduction in 1981 uvulopalatopharyngoplasty (UPPP) has become an alternative surgical approach to permanent tracheostomy in treating obstructive sleep apnea (OSA). However, the criteria for selecting candidates for this procedure are unclear and the prediction of a positive response remains an enigma. This article presents the experien...

Since its introduction in 1981 uvulopalatopharyngoplasty (UPPP) has become an alternative surgical approach to permanent tracheostomy in treating obstructive sleep apnea (OSA). However, the criteria for selecting candidates for this procedure are unclear and the prediction of a positive response remains an enigma. This article presents the experien...

Systematic cineradiographic observation of the upper airway with simultaneous polysomnography, termed somnofluoroscopy, was performed for a relatively large sample of obstructive sleep apnea patients. These observations suggest that (a) the site of upper airway occlusion may be oropharyngeal, hypopharyngeal, or both; (b) upper airway dynamics appea...

Ten rotating shift workers, who changed shifts every 1 to 4 weeks, slept in the laboratory during the first four daytime sleep periods of two consecutive tours of night shift. Prior to the first two sleep periods of one tour, the subjects were given 0.5 mg triazolam. Placebo was administered prior to sleep periods one and two of the other night shi...

The effects of 3 mg lorazepam on polysomnographic recordings, performance, anxiety, and perceived sleep were examined. Six insomniac subjects slept in the sleep laboratory for 18 consecutive nights after having taken placebo or lorazepam. Polysomnographic data and subjective reports indicated hypnotic efficacy in terms of sleep initiation and maint...

The development, clinical course, and electrophysiologic characteristics of narcolepsy were evaluated in 50 adults who had a current complaint of sleep attacks and cataplexy. In most of the patients, the first symptoms, usually excessive daytime sleepiness and sleep attacks, developed during childhood or adolescence. The condition was invariably ch...

Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and related parameters were assessed. Placebo was given on baseline nights 1 to 4, lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12 to 18. Subjective and objective...

Quazepam, an investigational benzodiazepine, was evaluated in doses of 7.5, 15, and 30 mg in a 12-night protocol including four nights of drug trial. All three doses were effective in inducing and maintaining sleep, with the highest degree of effectiveness after the first drug night. Carry-over effectiveness, which was seen after withdrawal of all...

Fifty adults with either a present or past complaint of somnambulism were evaluated to determine the development and clinical course of their disorder as well as their personality patterns. Generally, when sleepwalking was outgrown, its onset was before age 10 years and its termination before age 15 years. Current sleepwalkers, compared with past s...

The families of 25 probands with sleepwalking and 27 probands with night terrors were studied. Eighty per cent of the sleepwalking pedigrees and 96 per cent of the night terror pedigrees included one or more individuals, other than the proband, who were affected by sleepwalking, night terrors, or both. Our data appear to fit a 'two threshold' multi...

This is the first controlled study to show a lack of relation between a positive history of sleepwalking or night terrors in adults and daytime EEG abnormalities. We recorded a standard clinical EEG on 35 adult sleepwalkers (SW), 35 adult night terror patients (NT), and 35 control subjects (CS). Three subjects in the SW group showed abnormalities:...