ArticleLiterature Review

Effects of passive body heating on body temperature and sleep regulation in the elderly: A systematic review

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Abstract

Insomnia in the elderly is associated with circadian body temperature changes. Manipulating body temperature prior to sleep onset may improve sleep quality in the elderly. This systematic review analyzed the effect of passive body heating on body temperature and sleep quality. Three studies related to passive body heating for the elderly identified from a computerized database search were evaluated. All of them used crossover designs to examine effects of passive body heating on sleep quality. Passive body heating such as a warm bath immersed to mid-thorax with 40-41 degrees C water for 30 min in the evening could increase rectal body temperature, delay occurrence of body temperature nadir and increase slow wave sleep (deep sleep) in healthy female elderly with insomnia. The elderly also perceived "good sleep" or "quickness of falling asleep" after the bathing condition. Evening warm bath facilitates nighttime sleep for the healthy elderly with insomnia.

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... Therapeutically, taking a hot or cold bath or shower or hot footbath can reduce a person's nocturnal body temperature and effectively treat sleep impairment [45,46]. For example, body cooling strategies (e.g. ...
... Thus, the application of heat [e.g. warm (38-39 °C) bath for 1-h] can initially cause hyperthermia (e.g. 1 °C increase in body temperature) [46], but after leaving the bath, body temperature rapidly falls [39,46]. This rapid decline in a person's skin temperature (induced by bathing) is thought to accentuate the natural evening drop in body temperature, if the heated stimulus is applied about 2-h prior to planned sleep [21,43]. ...
... Thus, the application of heat [e.g. warm (38-39 °C) bath for 1-h] can initially cause hyperthermia (e.g. 1 °C increase in body temperature) [46], but after leaving the bath, body temperature rapidly falls [39,46]. This rapid decline in a person's skin temperature (induced by bathing) is thought to accentuate the natural evening drop in body temperature, if the heated stimulus is applied about 2-h prior to planned sleep [21,43]. ...
Article
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Purpose: Overweight/obesity, sleep disturbance, night eating, and a sedentary lifestyle are common co-occurring problems. There is a tendency for them to co-occur together more often than they occur alone. In some cases, there is clarity as to the time course and evolution of the phenomena. However, specific mechanism(s) that are proposed to explain a single co-occurrence cannot fully explain the more generalized tendency to develop concurrent symptoms and/or disorders after developing one of the phenomena. Nor is there a clinical theory with any utility in explaining the development of co-occurring symptoms, disorders and behaviour and the mechanism(s) by which they occur. Thus, we propose a specific mechanism-dysregulation of core body temperature (CBT) that interferes with sleep onset-to explain the development of the concurrences. Methods: A detailed review of the literature related to CBT and the phenomena that can alter CBT or are altered by CBT is provided. Results: Overweight/obesity, sleep disturbance and certain behaviour (e.g. late-night eating, sedentarism) were linked to elevated CBT, especially an elevated nocturnal CBT. A number of existing therapies including drugs (e.g. antidepressants), behavioural therapies (e.g. sleep restriction therapy) and bright light therapy can also reduce CBT. Conclusions: An elevation in nocturnal CBT that interferes with sleep onset can parsimoniously explain the development and perpetuation of common co-occurring symptoms, disorders and behaviour including overweight/obesity, sleep disturbance, late-night eating, and sedentarism. Nonetheless, a significant correlation between CBT and the above symptoms, disorders and behaviour does not necessarily imply causation. Thus, statistical and methodological issues of relevance to this enquiry are discussed including the likely presence of autocorrelation. Level of evidence: Level V, narrative review.
... Other studies hypothesized that imposed skin temperature changes within the comfortable range may have causal effects, supposedly mediated by projections of cutaneous thermoreceptors to brain structures involved in the regulation of sleep and arousal. 66 Thermal interventions, applied either passively or actively by physical exercise, can induce significant changes in skin temperatures and CBT, 35,47,63,67,68 while some dedicated interventions managed to alter more specifically proximal or distal skin temperature without affecting CBT. [69][70][71][72] The intensity of a thermal intervention is crucial, as are the skin region selected and the time of application. ...
... 68 When sleep occurs in a warm environmental temperature (31 to 38° C), duration of wakefulness increases and duration of both REM and NREM sleep decreases. 47,63,67,68 Also, cold exposure (21° C) induces more awakenings, less time in sleep stage 2, and less TST but does not affect the duration of the other sleep stages. Marked thermoregulatory effects were induced under such manipulations. ...
... Rewarming of the cool shell after cool bathing leads to a characteristic after-drop in CBT. 80 Several studies showed effects of positive heat load on sleep, 47,67,68 but no study examined effects on sleep after a cold bath. In general, passive body heating (40 to 43° C for 30 to 90 minutes with a CBT increase of 1.4 to 2.6° C) has a positive effect on many aspects of sleep in healthy young adults and in older and sleep-disturbed subjects. ...
Chapter
The human sleep-wake cycle is tightly coupled to the circadian time course of CBT. The evening increase in heat loss through distal skin regions and reduction in heat production is associated with sleepiness and the ease of falling asleep. After sleep initiation, ultradian NREM/REM sleep cycle fluctuations seem to have minor thermoregulatory functions, especially in humans. Sleep deprivation–induced increases in homeostatic sleep pressure may not affect the thermoregulatory system in supine conditions, while effects emerge in upright conditions. The POAH integrates input from brain areas involved in circadian, temperature, and sleep-wake regulation and in turn influences vigilance states and body temperature in response to that input. Experimental data show that mild skin warming, supposedly impinging on the POAH, can increase sleep propensity, sleep consolidation, and the duration of SWS. In animals, the torpid state may be a valuable model to investigate the relationship between thermoregulation and sleep. During daily torpor, similar physiologic processes occur as during normal entrance into sleep, but this is observed in a more extreme way, providing an excellent opportunity to investigate these processes in more detail.
... 52 When sleep occurs in a warm environmental temperature (31 to 38° C), duration of wakefulness increases, and at the opposite, duration of REM and NREM sleep decreases. 15,17,51,52 Also, cold exposure (21° C) induced more awakenings, less time in sleep stage 2, and less TST but did not affect the duration of the other sleep stages. Marked thermoregulatory effects were induced under such manipulations. ...
... Rewarming of the cool shell after cool bathing leads to a characteristic after-drop in CBT. 58 Several studies showed effects of positive heat load on sleep, 15,51,52 but no study examined effects on sleep after a cold bath. In general, passive body heating (40 to 43°C for 30 to 90 minutes; CBT increase of 1.4 to 2.6° C) has a positive effect on many aspects of sleep in healthy young adults and in older and sleep-disturbed subjects. ...
... Bathing performed in the morning or early afternoon had no effect on sleep architecture. 15,51 In principal, actual levels of CBT at sleep onset or the decline in CBT afterward could be related to the amount of SWS after warm bathing. 15,51 Additionally, a phase delay of the CBT nadir during the night sleep episode has been described after evening hot bathing, which correlates with increased SWS. ...
Chapter
The human sleep-wake cycle is usually tightly coupled to the circadian time course of core body temperature. The circadian regulation of heat loss in the evening, via distal skin regions, is intimately associated with sleepiness and the ease to fall asleep, whereas the homeostatic increase in sleep pressure does not influence the thermoregulatory system. The rise in heat loss and reduction in heat production during lying down and relaxing behavior before sleep is hypothesized to be part of the role of sleep as a mechanism for energy conservation and may be a remnant of our evolutionary past. After sleep initiation, non-rapid eye movement (NREM) sleep to rapid eye movement (REM) sleep cycle fluctuations seem to have minor thermoregulatory functions, especially in humans.
... 52 When sleep occurs in a warm environmental temperature (31 to 38° C), duration of wakefulness increases, and at the opposite, duration of REM and NREM sleep decreases. 15,17,51,52 Also, cold exposure (21° C) induced more awakenings, less time in sleep stage 2, and less TST but did not affect the duration of the other sleep stages. Marked thermoregulatory effects were induced under such manipulations. ...
... Rewarming of the cool shell after cool bathing leads to a characteristic after-drop in CBT. 58 Several studies showed effects of positive heat load on sleep, 15,51,52 but no study examined effects on sleep after a cold bath. In general, passive body heating (40 to 43°C for 30 to 90 minutes; CBT increase of 1.4 to 2.6° C) has a positive effect on many aspects of sleep in healthy young adults and in older and sleep-disturbed subjects. ...
... Bathing performed in the morning or early afternoon had no effect on sleep architecture. 15,51 In principal, actual levels of CBT at sleep onset or the decline in CBT afterward could be related to the amount of SWS after warm bathing. 15,51 Additionally, a phase delay of the CBT nadir during the night sleep episode has been described after evening hot bathing, which correlates with increased SWS. ...
... 52 When sleep occurs in a warm environmental temperature (31 to 38° C), duration of wakefulness increases, and at the opposite, duration of REM and NREM sleep decreases. 15,17,51,52 Also, cold exposure (21° C) induced more awakenings, less time in sleep stage 2, and less TST but did not affect the duration of the other sleep stages. Marked thermoregulatory effects were induced under such manipulations. ...
... Rewarming of the cool shell after cool bathing leads to a characteristic after-drop in CBT. 58 Several studies showed effects of positive heat load on sleep, 15,51,52 but no study examined effects on sleep after a cold bath. In general, passive body heating (40 to 43°C for 30 to 90 minutes; CBT increase of 1.4 to 2.6° C) has a positive effect on many aspects of sleep in healthy young adults and in older and sleep-disturbed subjects. ...
... Bathing performed in the morning or early afternoon had no effect on sleep architecture. 15,51 In principal, actual levels of CBT at sleep onset or the decline in CBT afterward could be related to the amount of SWS after warm bathing. 15,51 Additionally, a phase delay of the CBT nadir during the night sleep episode has been described after evening hot bathing, which correlates with increased SWS. ...
... In the current study, we also evaluated the effects of toppers on sleep and sleep-related physiology in the old adult subjects. It is known that sleep quality declines in the elderly, and the temperature changes during sleep are often dysregulated [14][15][16]. We also observed reduced sleep qualities of old adult subjects, including reductions in total sleep time, sleep efficiency, deep sleep (% stage 3&4), and REM sleep (S1 and S2 Tables). ...
... Another aim for including the old adult subjects was to examine if HR aids subjects who have difficulty falling sleep. It has been postulated that dysregulation of body temperature at bedtime, especially in old subjects, may interfere with the sleep occurrence or quality [14,15]. However, the old subjects we evaluated fell asleep with both HR and LR as quickly as the young subjects, and we did not detect a difference in sleep latency between HR and LR. ...
Article
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Recently, several new materials for mattresses have been introduced. Although some of these, such as low rebound (pressure-absorbing/memory foam) and high rebound mattresses have fairly different characteristics, effects of these mattresses on sleep have never been scientifically evaluated. In the current study, we have evaluated effects of a high rebound mattress topper [HR] on sleep and its associated physiology, and the effects were compared to those of a low rebound mattress toppers (LR) in healthy young (n = 10) and old (n = 20) adult males with a randomized, single-blind, cross over design. We found that sleeping with HR compared to LR induced a larger decline in core body temperature (CBT) in the initial phase of nocturnal sleep both in young (minimum CBT: 36.05 vs 36.35°C) and old (minimum CBT: 36.47 vs. 36.55°C) subjects, and declines in the CBT were associated with increases in deep sleep/delta power (+27.8% in young and +24.7% in old subjects between 11:00–01:00). We also found significantly smaller muscle activities during roll over motions with HR (-53.0 to -66.1%, depending on the muscle) during a separate daytime testing. These results suggest that sleeping with HR in comparison to with LR, may facilitate restorative sleep at the initial phase of sleep.
... The sleep recommendation was clarified in light of clinical evidence suggesting that bathing, as part of a specific routine, may improve infant sleep (14). Results of studies in adults support the argument that prebedtime bathing may be soporific through mechanisms involving the temporary modification of core temperature (16,17). ...
... This recommendation was limited to newborns, because older infants may enjoy longer baths, and there is no evidence to suggest that this is likely to be harmful. The frequency-of-bathing recommendation was reworded to state that infants should be bathed at least two to three times per week, because this is the minimum frequency used in clinical studies (16,(21)(22)(23)(24). ...
Article
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Background: European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. Methods: The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. Results: Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. Conclusion: Health care professionals can use these recommendations as the basis of their advice to parents.
... And the final possibility is that the inclusion of a bath as part of the recommended routine, which affects core body temperature, resulted in improved sleep. Studies in adults have found that a bath improves sleep, 14,15 and similar effects may have been found in this study. ...
Article
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Establishment of a consistent bedtime routine is often recommended to parents of young children, especially those with sleep difficulties. However, no studies have investigated the efficacy of such a routine independent of behavioral intervention. Thus, the purpose of this study was to examine the impact of a consistent bedtime routine on infant and toddler sleep, as well as maternal mood. 405 mothers and their infant or toddler (ages 7-18 months, n=206; ages 18-36 months, n=199) participated in 2 age-specific 3-week studies. Families were randomly assigned to a routine or control group. The first week of the study served as a baseline during which the mothers were instructed to follow their child's usual bedtime routine. In the second and third weeks, mothers in the routine group were instructed to conduct a specific bedtime routine, while the control group continued their child's usual routine. All mothers completed the Brief Infant Sleep Questionnaire (BISQ) on a weekly basis and a daily sleep diary, as well as completed the Profile of Mood States. The bedtime routine resulted in significant reductions in problematic sleep behaviors for infants and toddlers. Significant improvements were seen in latency to sleep onset and in number/duration of night wakings, P < 0.001. Sleep continuity increased and there was a significant decrease in the number of mothers who rated their child's sleep as problematic. Maternal mood state also significantly improved. Control group sleep patterns and maternal mood did not significantly change over the 3-week study period. These results suggest that instituting a consistent nightly bedtime routine, in and of itself, is beneficial in improving multiple aspects of infant and toddler sleep, especially wakefulness after sleep onset and sleep continuity, as well as maternal mood.
... Two pathways may explain the association between bathing and older people's health status. First, tub bathing promotes good sleep 26,27 and decreases sympathetic nerve activity. 28 These changes may be beneficial for the mental status of older people and may prevent depression or cognitive function decline. ...
Article
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Background: While bathing styles vary among countries, most Japanese people prefer tub bathing to showers and saunas. However, few studies have examined the relationship between tub bathing and health outcomes. Accordingly, in this prospective cohort study, we investigated the association between tub bathing frequency and the onset of functional disability among older people in Japan. Methods: We used data from the Japan Gerontological Evaluation Study (JAGES). The baseline survey was conducted from August 2010 to January 2012 and enrolled 13,786 community-dwelling older people (6,482 men and 7,304 women) independent in activities of daily living. During a 3-year observation period, the onset of functional disability, identified by new certification for need of Long-Term Care Insurance, was recorded. Tub bathing frequencies in summer and winter at baseline were divided into 3 groups: low frequency (0-2 times/week), moderate frequency (3-6 times/week), and high frequency (≥ 7 times/week). We estimated the risks of functional disability in each group using a multivariate Cox proportional hazards model. Results: Functional disability was observed in a total of 1,203 cases (8.7%). Compared with the low-frequency group and after adjustment for 14 potential confounders, the hazard ratios (95% confidence intervals) of the moderate- and high-frequency groups were 0.91 (0.75-1.10) and 0.72 (0.60-0.85) for summer and 0.90 (0.76-1.07) and 0.71 (0.60-0.84) for winter. Conclusion: High tub bathing frequency is associated with lower onset of functional disability. Therefore, tub bathing might be beneficial for older people’s health.
... As a physiological intervention, bathing at an appropriate temperature and with optimal timing has been reportedly associated with a subjective improvement of sleep initiation and an objective increase in deep EEG sleep, possibly due to general relaxation and/or increased heat loss after such warming interventions [8][9][10]. Warming of the hand or foot skin before bedtime has been reported to improve sleep quality and decrease core body temperature in elderly subjects with or without insomnia [11,12]. ...
Article
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Appropriate warming of the periocular or posterior cervical skin has been reported to induce autonomic or mental relaxation in humans. To clarify the effects of cutaneous warming on human sleep, eight male subjects with mild sleep difficulties were asked to try three experimental conditions at home, each lasting for 5 days, in a cross-over manner: warming of the periocular skin with a warming device for 10 min before habitual bedtime, warming of the posterior cervical skin with a warming device for 30 min before habitual bedtime, and no treatment as a control. The warming device had a heat- and steam-generating sheet that allowed warming of the skin to 40 °C through a chemical reaction with iron. Electroencephalograms (EEGs) were recorded during nocturnal sleep using an ambulatory EEG device and subjected to spectral analysis. All the participants reported their sleep status using a visual analog scale. We found that warming of the periocular or posterior cervical skin significantly improved subjective sleep status relative to the control. The EEG delta power density in the first 90 min of the sleep episode was significantly increased under both warming of the periocular or posterior cervical skin relative to the control. These results suggest that warming of appropriate skin regions may have favorable effects on subjective and objective sleep quality.
... However, studies conducted outside Japan, demonstrated that the bathing style is similar to the characteristics of JSB, are listed in the Table 2 [79][80][81]. Liao [84] reviewed the effects of bathing on body temperature and sleep regulation in the elderly from three studies including our study [54]. The review showed that bathing immersed to mid-thorax with 40-41 °C water for 10-30 min in the evening can increase the duration of slow-wave sleep in healthy elderly women, even in those with insomnia. ...
Article
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Japanese-style bathing (JSB), which involves soaking in hot water up to the shoulders in deep bathtubs for a long time in the evening to night, is unique. Many experimental and epidemiological studies and surveys have shown that JSB improve sleep quality, especially shortens sleep onset latency in winter. In addition, repeated JSB lead the improvement of depressive symptoms. JSB is a simple and low-cost non-pharmacological measure to sleep difficulty in winter and mental disorders, especially for the elderly. On the contrary, drowning, while soaking in a bathtub, is the most common of accidental death at home in Japan. It is estimated that approximately 19,000 Japanese individuals die annually while taking a bath, mostly during winter, and most victims are elderly people. Elderly Japanese people tend to prefer a higher-risk JSB because the temperature inside the house during winter, especially the dressing room/bathroom temperature, is very low. Since the physiological thermal effect of the elderly associated with bathing is relatively lower among the elderly than the young, the elderly prefer to take a long hot bath. This elderly’s favorite style of JSB results in larger increased blood pressure in dressing rooms and larger decreased in blood pressure during hot bathing. A sudden drop in blood pressure while immersed in the bathtub leads to fainting and drowning. Furthermore, elderly people are less sensitive to cold air or hot water, therefore, it is difficult to take appropriate measures to prevent large fluctuations in blood pressure. To ensure a safe and comfortable winter bathing, the dressing room/bathroom temperature needs to be maintained at 20 °C or higher, and several degrees higher would be recommended for the elderly.
... Considering the strong impact that biological factors have on the sleep-wake cycle (e.g. core body temperature, cortisol levels; Joseph et al., 2015;Liao, 2002), and the strong support that wake times are consistent for infants internationally (even for families where primary caregivers are not working; , it can be argued that wake times are more biologically driven than bedtimes. Future research should take into consideration whether the infants woke independently or were awoken by caregivers due to scheduling confines. ...
Article
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The aim of this study was to investigate the development of infant and toddler sleep patterns. Data were collected on 841 children (aged from birth to 36 months) via a free, publicly available, commercially sponsored iPhone app. Analyses were conducted on caregiver recordings of 156 989 sleep sessions across a 19-month period. Detailed visualizations of the development of sleep across the first 3 years of life are presented. In the first 3 months, sleep sessions primarily lasted less than 3.5 h throughout the day. Between 3 and 7 months old, sleep consolidated into two naps of about 1.5 h in length and a night-time sleep session of about 10.5 h. Across age groups, a negative relationship was observed between the start of bedtime and the length of the night-time sleep session (i.e. later bedtime is associated with a shorter night-time sleep period). The length of daytime sleep sessions (naps) varied with age, decreasing between 1 and 5 months old, and then increasing monotonically through 28 months. Morning wake time was observed to be invariant in children aged 5-36 months. Sleep patterns are ever-changing across the first few years with wide individual variability. Sleep patterns start to develop more clearly at 5-6 months, when longer night-time sleep duration begins and sleep consolidation occurs. Daytime sleep patterns appeared to become more consistent and consolidated later in age than night-time sleep. Finally, there is greater variability in bedtimes than wake times, with bedtimes having a greater influence on night-time sleep duration.
... The majority of studies confirm an increase in SWS in the half of the night but causes an increase in sleep disruption in the second half of the sleep (34). Totally limiting alcohol intake is preferable as was reported by the Writing Group of the PREMIER Collaborative Group (35).Taking a warm bath in the evening is effective for sleep regulation in elderly (36). In the future, we hope to use wristwatch used in the current study to quantitatively assess the extent to which such behaviors increase deep sleep duration. ...
Article
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This study aimed to examine the associations between home blood pressure (HBP) and sleep and activity assessed using data obtained via a wristwatch-type pulsimeter with accelerometer (Pulsense®) using original software. We recruited 28 elderlies and 40 employees aged 24–81 years who were not on hypotensive agents and sleeping drugs. Sleep, activity, and HBP were measured consecutively over a 5–7-day period. Body mass index (BMI), base heart rate (HR0), and age showed significant correlation with HBP in a simple and multiple linear regression analysis. HR0 was positively, and log deep sleep duration, negatively correlated with HBP in the adjusted multiple linear regression analysis. Physical and mental activities were negatively correlated with systolic blood pressure (SBP) in a simple linear regression, but high physical and mental activities tend to reduce deep sleep duration. Self-recorded sleep duration had no relationship with HBP. In conclusion, HR0, BMI, age, deep sleep duration, and activity showed relationships with HBP. Using this type of wristwatch and observing daily sleep and activity data with HBP measurement may have important clinical implication.
... In adults, body temperatures differ in sleep versus wakefulness (W): skin temperatures (Ts) are lower during W than during sleep, whereas the core temperature is higher during W than during sleep (for a review, see Ref. [2]). Interestingly, when this wakeÀsleep difference is reduced, sleep quality and quantity worsen; conversely, increasing this difference (when it is small) improves sleep [3]. Sleep is preceded by a transition period during which progressive vasodilation occurs. ...
Article
Objectif Chez l’adulte, l’endormissement est favorisé par une vasodilatation cutanée périphérique, notamment au niveau des pieds. Notre objectif est de déterminer si une telle vasodilatation est observée chez le nouveau-né prématuré, et si elle favorise l’endormissement (apprécié par la durée des épisodes de veille intra-sommeil). Méthodes Trente enfants prématurés ont été étudiés (20-8 h à j9 de vie, terme : 208 ± 8 j, poids naissance : 1,3 ± 0,3 kg). Dix températures cutanées locales (thermographie infrarouge, abdomen Tabdo, pectoral, cernes, mains, pieds, cuisses) ont été relevées pour 118 épisodes de veille intra-sommeil spontanée (VIS ; début, fin, toutes les 5 min pendant VIS). Les régressions entre la durée de VIS et les températures ont été analysées. Résultats La durée de l’épisode de VIS est d’autant plus courte que les températures cutanées distales (mains, pieds, cuisses) mesurées à la fin de VIS sont élevées et proches de Tabdo, et qu’elles augmentent pendant VIS, se rapprochant de Tabdo et reflétant une vasodilatation distale. Conclusion Nos résultats mettent en évidence pour la première fois chez des nouveau-nés prématurés de 9 jours que les températures cutanées distales jouent un rôle essentiel dans l’induction du sommeil du nouveau-né : plus la vasodilatation est marquée, plus la VIS est courte. Ceci est particulièrement important au regard du rôle essentiel du sommeil pour le développement et la santé de ces prématurés.
... For example, a hot bath in the afternoon aids night-time sleep for healthy elderly subjects with insomnia. 39 The second major finding of this study is related to a sex difference in the effect of a BP on the analyzed variables. In this study, a differential effect in improving pain was found between the sexes, with significant improvements for men (P < 0.01) after BP, but not for women. ...
Article
Background The main purpose of this study is to analyze the effect of a 12-day balneotherapy programme on pain, mood state, sleep, and depression in older adults.Methods In this study, 52 elderly adults from different areas of Spain participated in a social hydrotherapy programme created by the government's Institute for Elderly and Social Services, known as IMSERSO; participants included 23 men (age, 69.74 ± 5.19 years) and 29 women (age, 70.31 ± 6.76 years). Pain was analyzed using the visual analogue scale. Mood was assessed using the Profile of Mood Status. Sleep was assessed using the Oviedo Sleep Questionnaire. Depression was assessed using the Geriatric Depression Scale. The balneotherapy programme was undertaken at Balneario San Andrés (Jaén, Spain). The water at Balneario San Andrés, according to the Handbook of Spanish Mineral Water, is a hypothermic (≥20°C) hard water of medium mineralization, with bicarbonate, sulfate, sodium, and magnesium as the dominant ions.ResultsBalneotherapy produced significant improvements (P < 0.05) for all variables (pain, mood state, sleep, and depression) in the total sample. A differential effect was found between the sexes regarding pain improvement, with men, but not women, having significantly improvement (P < 0.01) after treatment. With regard to improving mood, sex differences were also shown, with women, but not men, significantly improved (P < 0.05) in both depression and fatigue.Conclusions In conclusion, a 12-day balneotherapy programme has a positive effect on pain, mood, sleep quality, and depression in healthy older people.
... The improvement in sleep following evening thermal manipulation of healthy young adults was confirmed in studies on the elderly (review in Liao, 2002). Sleep quality was improved, SWS duration was increased and wakefulness and body motion were decreased after a 10-30 min bath (at 40-40.5°C, ...
Article
This chapter reviews the thermoregulation–sleep interactions in humans. The chapter considers the various aspects: (1) how thermoregulatory responses can be modified by sleep stages; (2) how skin and internal body temperatures vary according to the sleep–wake cycle; and (3) how manipulation of thermal parameters can influence sleep quantity and structure. The chapter reveals some studies that demonstrate that alterations in one rhythm do not systematically modify the other. This has been found with sleep deprivation, bright light stimulation, and melatonin administration, amongst others. The hypothesis is that, in normal conditions, temperature rhythms are under the control of the circadian clock and act on the sleep–wake cycle by reinforcing circadian control. Sleep onset is facilitated during the declining phase of core temperature. This is mainly obtained by increasing heat loss through peripheral vasodilation. Conversely, it is difficult to maintain sleep when the core temperature is rising. From a practical point of view, it demonstrates that sleep cannot be scheduled no matter when—it needs to be prepared, as suggested by the discrete thermoregulatory changes observed prior to sleep. Having a regular bedtime makes it more likely that sleep onset will occur during the decreasing phase of core body temperature.
... In adults, body temperatures differ in sleep versus wakefulness (W): skin temperatures (Ts) are lower during W than during sleep, whereas the core temperature is higher during W than during sleep (for a review, see Ref. [2]). Interestingly, when this wakeÀsleep difference is reduced, sleep quality and quantity worsen; conversely, increasing this difference (when it is small) improves sleep [3]. Sleep is preceded by a transition period during which progressive vasodilation occurs. ...
Article
Objectif Chez l’adulte, il existe une phase de préparation au sommeil entre la veille (caractérisée par des niveaux faibles de température (T) cutanée et élevé de T interne) et le sommeil (T cutanée élevée et T interne faible). Cette phase transitoire se caractérise par une vasodilatation cutanée, à l’origine de pertes de chaleur corporelle et d’une diminution de la T interne. Notre objectif a été de déterminer si des évolutions similaires de T corporelles existaient chez le nouveau-né prématuré (∼1,3 kg) et d’en calculer l’impact sur le bilan énergétique, très fragile pour ces enfants. Méthodes Les T cutanées ont été mesurées par thermographie infra-rouge, pendant un enregistrement PSG de 12 hrs (20 h–8 h) chez 18 nouveaux-nés prématurés (en incubateur fermé) au 9e jour de vie. L’évolution temporelle des T avant endormissement a été analysée. Résultats Au total, 15 épisodes de veille répondaient aux critères de sélection (éveil et endormissement spontanés, durée > 12 min). Nos résultats mettent en évidence pour la première fois une vasodilatation cutanée principalement au niveau du pied (+0,38 °C, p = 0,008) pendant les 20 min qui précèdent l’endormissement. Cette vasodilatation induit une perte de chaleur corporelle de 0,15 °C.h-1 (T corporelle moyenne). Conclusion La vasodilatation existe chez le nouveau-né prématuré, bien que la plupart des facteurs connus chez l’adulte pour la favoriser n’existent pas chez ces enfants qui sont de plus maintenus dans un environnement quasi-constant. La compensation d’une telle perte de chaleur représente une augmentation de 4 % de la production de chaleur métabolique.
... Another possible, albeit speculative, reason for observing this fast change, particularly in sleep onset latency and sleep consolidation, may be that a bath and/or massage may impact elements of physiology, such as core body temperature or cortisol. Studies in adults have found that a bath improves sleep (Kanda, Tochihara, & Ohnaka, 1999;Liao, 2002) and similar effects may have been found in this study. Furthermore, one recent study investigating the development of circadian rhythms in newborns found that changes in cortisol and core body temperature occur prior to sleep consolidation (Joseph et al., 2015) and another noted an association between cortisol and sleep regulation (Saridjan et al., 2017), thus supporting the role of core body temperature and cortisol as part of the sleep process. ...
Article
Background: Institution of a consistent bedtime routine has been demonstrated to improve sleep in young children within two weeks. However, no studies have investigated the rate of this change and when most change occurs. The purpose of this study was to examine the nightly change in infant sleep and maternal perceptions after implementing a bedtime routine. Methods: Mothers (n=134) and their infant (8-18 months) were randomly assigned to implementation of a bedtime routine intervention for a two-week period. Results: Two-level piecewise linear growth models showed that the intervention resulted in the most rapid change in the first three nights of the intervention across sleep outcomes, including sleep onset latency, the frequency and duration of nighttime awakenings, sleep consolidation, and maternal perceptions of bedtime ease, sleep quality, and infant mood. No significant additional improvement in sleep onset latency emerged after these first three nights, whereas small additional improvements occurred for all other outcomes throughout the remainder of the intervention period. Conclusions: These results indicate that sleep disturbances in infants and toddlers can be quickly ameliorated within just a few nights after implementation of a consistent bedtime routine, including a bath, massage, and quiet activities. Future research should consider the potential mechanisms behind these relatively fast improvements in sleep, such as reduced household chaos or physiological changes (e.g. core body temperature, cortisol).
... Another study by Liao, Chui & Landis (2004) did not show changed and perceived sleep outcomes. Also, a study by Liao (2002) stated that there was no significant change in sleep efficiency and sleep maintenance. ...
Article
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It is important to understand the physiologic changes during the aging process as well as the problems brought about it so that it can be managed effectively. Effects of aging include deterioration of sleep quality. Since sleep is essential to promote well-being, this study aims to determine the effectiveness of footbath among Filipino elderly. A one group- pretest post-test design was utilized. In this design, comparisons were made before and after the administration of footbath. Purposive sampling technique was used to select the 20 female Filipino elderly participants aged 65-86 years old from a home-for-the-aged institution in NCR Philippines. Depression Stress and Anxiety Scale and Mini-mental State Exam were utilized to assess their mental capacity and condition. A pretest using the Pittsburgh Sleep Quality Index (PSQI) was given to determine their quality of sleep.This study showed the effectiveness of warm footbath as an intervention in the sleep quality among Filipino elderly. Footbath initiated an increase in peripheral blood flow and DPG promoting sleep quality which is evidenced by the improvement in all of the seven domains namely: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction.
... Bewegung in Form von Lauftraining, Yoga oder anderer körperlichen Aktivität, ist erwiesenermaßen hilfreich bei Schlafstörungen(Reid et al., 2010;Yang et al., 2012). Dass Wärmeanwendungen, in Form von heißen Bädern oder Sauna, bei Schlafstörungen helfen, wurde schon von Medizinern der Antike festgehalten und im Laufe der Zeit mehrfach bestätigt(Liao, 2002;Silva et al., 2013).Deshalb formulierten wir die Annahme, dass ÜWB bei depressionstypischen Schlafstörungen wirksam sind und prüften eine Überlegenheit gegenüber der BT. Diese konnte bestätigt werden, der Unterschied zwischen ÜWB und BT war jedoch nur zum ersten Messzeitpunkt signifikant (p = 0.036). ...
Thesis
Die Volkskrankheit Depression nimmt in Deutschland an Häufigkeit zu und führt nicht nur zu enormen Kosten im Gesundheitssystem, sondern bedeutet vor allem für jeden einzelnen Patienten eine Bürde im alltäglichen Leben. Trotz verschiedener evidenzbasierter Therapieoptionen bleibt die Depression oft schwer behandelbar und häufig setzt die Wirkung erst verzögert nach einigen Wochen ein. Deswegen werden neue Therapien gebraucht, die eine kurzfristige bzw. ergänzende Wirkung haben und einfach selbstständig durchzuführen sind. Überwärmungsbäder (ÜWB) werden schon seit langer Zeit bei der Therapie der Depression in der Naturheilkunde angewandt - es fehlen jedoch Studien, die ihre Wirkung beweisen. Das Ziel dieser Studie war es, die Wirksamkeit von ÜWB, mit der von Bewegungstherapie (BT), einer komplementären Standardtherapie, bei Patienten mit Depressionen zu vergleichen. Es handelte sich um eine randomisierte, kontrollierte, monozentrische, achtwöchige Pilotstudie im Parallelgruppendesign. Beide Gruppen durchliefen 16 Anwendungen (zweimal/Woche), die je ca. 50min dauerten und aus einem 40°C heißen Bad und einer Nachruhezeit bzw. einem Training mit Lauf- und Krafteinheit bestanden. Der Becks Depressions Inventar (BDI II) und der Pittsburgh Schlaf Qualitäts Index (PSQI) wurden zu Beginn, nach zwei Wochen (T1) und nach acht Wochen (T2) gemessen. Außerdem wurden die subjektive Wirksamkeit und Verträglichkeit, sowie die Nebenwirkungen erfragt und die Körpertemperaturen gemessen. Es wurden 45 Probanden (ÜWB=22, BT=23) eingeschlossen. In der ÜWB-Gruppe stieg die Körperkerntemperatur im Mittel um 1,9°C an, in der BT Gruppe kam es zu keinem Anstieg. In der ÜWB-Gruppe besserten sich BDI und PSQI zu T1 signifikant gegenüber Baseline und der BT Gruppe (BDI: p=0,002, PSQI: p=0,036, ITT-Analyse). An T2 fand sich kein signifikanter Unterschied zwischen den Gruppen. Die Verträglichkeit und Wirksamkeit wurden in beiden Gruppen als gut eingeschätzt, es traten keine schweren Nebenwirkungen auf. In der BT-Gruppe kam es zu einer deutlich höheren Zahl an Drop-outs als in der ÜWB Gruppe (14 versus 4), was als Hinweis auf eine bessere Umsetzbarkeit der ÜWB gewertet werden kann. Zusammenfassend stellen ÜWB eine vielversprechende, einfach anwendbare Behandlungsmöglichkeit bei Depressionen dar. Sie wirkten kurzfristig besser als eine leitliniengemäße Therapie mit Bewegung.
... Taking a bath before going to bed, according to the daily schedule, mobilizes babies' nervous system to sleep [14,26]. ...
... High bedroom temperatures can lead to inability of the body to dissipate heat into the environment (Lack et al. 2008) which has a detrimental affect on ability to engage in sleep, achieve deep sleep, increasing wakefulness and decreasing slow-wave sleep (Murphy and Campbell 1997;van Someren 2006;Gradisar et al. 2006;Kräuchi 2007;Lack and Lushington 1996;van den Heuvel et al. 2006;Jordan et al. 1990;Okamoto-Mizuno and Mizuno 2012;Valham et al. 2012;Romeijn et al. 2002;Liao 1996;Van Someren 2000;Raymann et al. 2007Raymann et al. , 2008Leung and Ge 2013). ...
Thesis
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Overheating in homes is a problem because high indoor temperatures present a risk to occupant health and well-being. Overheating in the UK is already a problem and is expected to increase in the future as the climate warms, homes become better insulated, and the population ages and urbanises. Air-conditioning could be used, but would increase electricity demand at a time when climate change targets require the UK to reduce its carbon emissions. Strategies are needed to help keep UK homes cool in summer and prevent the uptake of air-conditioning. Occupant-controlled strategies for cooling could make use of existing features of the homes: operable windows, internal shading, internal doors, or a combination of these. Occupants influence the indoor temperature of homes, but there is a gap in knowledge about what occupants should do, and when, to reduce indoor temperatures in summer and what effect these interventions might have in typical UK homes. This thesis aims to examine the effect of occupant-controlled cooling strategies on ventilation rate and indoor temperature through measurement and modelling of a matched pair of test houses. The two houses are a nominally identical pair of adjoining 1930s semi-detached two-storey houses located in the East Midlands of England. The houses are thermally as-built, except for the addition of double-glazing and loft insulation. Measurements assured that the houses had similar heat loss coefficients and air permeability. The houses were instrumented with sensors to measure indoor temperatures, ventilation rates, and the weather conditions. Synthetic occupancy devices operated windows, internal shading, internal doors and mimicked the internal heat gains of occupants and appliances. Three main experiments were conducted. Experiment~1 evaluated the effect of window opening with curtains open and closed on ventilation rates. The experiment used tracer gas in side-by-side simultaneous tests in single rooms with the internal doors closed (i.e. single-sided ventilation). In one house the room being tested had windows and curtains open, in the corresponding room in the other house the windows were also open, but the curtains were closed. Other tracer gas tests were also done to measure whole house infiltration with internal doors and curtains open, but windows closed. Measured infiltration was compared to infiltration derived from calculation methods. Results showed that keeping the curtains open in bedrooms allowed for higher ventilation rates compared to when curtains were closed. Measured infiltration was lower than predicted by all calculation methods. Experiment~2 evaluated the effect of occupant-controlled strategies on indoor temperatures and overheating, which was assessed using the CIBSE TM59 protocol. The experiment used a series of side-by-side tests using synthetic occupancy to directly compare different strategies including windows always closed, windows open in response to indoor temperature and occupancy (the TM59 protocol), or windows open according to time of day; daytime closing of curtains; varying the use of internal doors; or a combination of these. The houses were monitored for an entire summer period (May-September 2017) which featured a heatwave in June (as defined by the UK Met Office) when outdoor temperatures reached a maximum of 30.5\,\degree C, exceeded 30\,\degree C on two consecutive days, and were above 28.5\,\degree C on two other days within a 5-day period. Analysis of temperatures and overheating in all seven tests focused on rooms pertinent to the TM59 overheating assessment: living rooms, kitchens, and bedrooms. It was found that night ventilation of bedrooms and a ground floor room with internal doors open was the most effective occupant-controlled strategy to keep homes cool in summer. However, neither of the strategies trialled during the June heatwave prevented the houses from overheating, and so alternative strategies are needed. Experiment~3 evaluated the ability of dynamic thermal models to accurately predict overheating. The experiment used the data gathered in Experiment~2 to empirically validate models in a two-phase multi-model exercise. This involved four experienced, industry practitioners using two different dynamic thermal modelling programs. Models were first constructed in a blind phase where modellers received information about the test houses, the occupancy profiles, and weather conditions. Models were then modified in an open phase where modellers received the test house temperature measurements and, with the other modellers, adjusted their models to try and improve the predictions. The models' predicted hours of overheating were compared with the measured hours using the BS~EN~15251 Category II threshold for living rooms during occupied hours and the CIBSE static threshold of 26\,\degree C for bedrooms during sleeping hours. The models developed in each phase were also used to predict the hours of overheating using the TM59 procedure, which allowed for inter-model comparison. All four dynamic thermal models predicted higher maximum temperatures and lower minimum temperatures than were measured, especially during the June heatwave when predictive accuracy was most needed. Overheating hours were predicted higher than measured in living rooms and predicted lower than measured in bedrooms. Even when the modellers had access to the measured temperatures they could not eliminate the over- and under-prediction of temperatures. The inter-model variability in predictions, which is due to the differences in the models and the way they were used, was quantified as the Simulation Resolution. This work has demonstrated the value of matched pair houses for understanding the effect that different occupant-controlled cooling strategies had on ventilation rates and indoor temperature in summer. It has also demonstrated and quantified the unreliability of the overheating predictions of dynamic thermal models. These and other results will be valuable to house builders, those concerned with assuring the health and well-being of UK citizens, and the academics, engineers, and consultants that use dynamic thermal models to assess summertime overheating.
... An increased risk of dementia was associated with frequent sleep disturbances in a study of middle-aged men from Finland during a 20-year follow-up (Luojus et al., 2017). Findings from experiments which used warm water baths for passive body heating suggest that an increase in the body core temperature beneficially affects sleep, depending on the increase in body core temperature and the proximity to sleep (Horne and Reid, 1985;Bunnell et al., 1988;Liao, 2002). Potentially sauna bathing affects sleeping similarly. ...
Article
Full-text available
Repeated heat exposure like sauna bathing is suggested to beneficially affect against dementia development. The epidemiological evidence is, however, scarce. Therefore, we studied the association between heat exposure during sauna bathing (i.e., the frequency of sauna bathing, frequency of heat sessions, length of stay in heat, sauna temperature) and the subsequent risk of dementia. A prospective cohort study was conducted based on 13,994 men and women aged 30–69 and free from dementia diagnosis from the Finnish Mobile Clinic Follow-up Survey. During a follow-up of 39 years, a total of 1805 dementia patients were diagnosed. The sauna bathing data was gathered from a questionnaire. Analyses based on the Cox model included the sauna bathing variables and the potential confounding factors. Sauna bathing frequency was related to a reduced risk of dementia after adjustment for the potential sociodemographic, lifestyle, and metabolic risk factors of dementia considered. The hazard ratio of dementia between individuals sauna bathing 9–12 times per month in comparison with those not sauna bathing or sauna bathing less than four times per month was 0.47 (95% CI = 0.25–0.88) during the first 20 years of follow-up and 0.81 (95% CI = 0.69–0.97) during the whole follow-up. The results are in line with the hypothesis that sauna bathing provides protection against dementia. Further studies are required to verify the suggested benefits of sauna bathing.
... ). Eine weitere Übersichtsarbeit[41] identifizierte zwei Studien, die anhand polysomnografischer Daten zeigten, dass ein warmes Bad über 30 min vor dem Zubettgehen bei Personen mit einer Insomnie den Tiefschlaf signifikant erhöhen kann, jedoch keinen Einfluss auf die Schlafeffizienz oder auf das Durchschlafen nimmt[14,15]. Weiterhin gibt es aus einer Laboruntersuchung mit 16 Studienteilnehmer*innen Hinweise darauf, dass das Erwärmen der Haut vor dem Zubettgehen bei älteren Insomniepatient*innen die Einschlafdauer signifikant verkürzen kann[58]. ...
Article
In order to better understand sleep initiation and maintenance disorders research into human chronobiology is necessary. Some patients suffering from insomnia seem to show abnormal circadian rhythms of core body temperature and melatonin onset. These circadian rhythm angles are associated with difficulties falling asleep and with complaints of early morning awakenings. Chronobiological treatments aim to enhance appropriately timed input to the circadian timing system to support its role in sleep regulation. Nevertheless, the evidence of their effects remains unclear in patients with insomnia. Moreover, future research should examine the effects of cognitive behavioral therapy for insomnia on circadian factors.
... A decrease in blood glucose does not seem to contribute, as the non-fasting blood glucose was not significantly altered by ATRF in the db/db mice. In addition, ATRF-associated changes in the body temperature oscillation (Szentirmai et al., 2009) may also contribute to the improvement of sleep-wake cycle as body temperature modifies the sleep behavior (Liao, 2002). However, future studies are required to test this possibility. ...
Article
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People with diabetes are more likely to experience sleep disturbance than those without. Sleep disturbance can cause daytime sleepiness in diabetic patients, which may impair their daytime performance or even lead to workplace injuries. Therefore, restoring the normal sleep-wake cycle is critical for diabetic patients who experience daytime sleepiness. Previous data on a diabetic mouse model, the db/db mice, have demonstrated that the total sleep time and sleep fragmentation are increased and the daily rhythm of the sleep-wake cycle is attenuated. Accumulating evidence has shown that active time-restricted feeding (ATRF), in which the timing of food availability is restricted to the active-phase, is beneficial to metabolic health. However, it is unknown whether ATRF restores the normal sleep-wake cycle in diabetes. To test that, we used a non-invasive piezoelectric system to monitor the sleep-wake profile in the db/db mice with ad libitum feeding (ALF) as a baseline and then followed with ATRF. The results showed that at baseline, db/db mice exhibited abnormal sleep-wake patterns: the sleep time percent during the light-phase was decreased, while during the dark-phase it was increased with unusual cycling compared to control mice. In addition, the sleep bout length during both the light-phase and the full 24-h period was shortened in db/db mice. Analysis of the sleep-wake circadian rhythm showed that ATRF effectively restored the circadian but suppressed the ultradian oscillations of the sleep-wake cycle in the db/db mice. In conclusion, ATRF may serve as a novel strategy for treating diabetes-induced irregularity of the sleep-wake cycle.
Article
The circadian distribution of vigilance states and body temperature changes are tightly coupled. The increase in heat loss at the end of the day is associated with increased ease to fall asleep. Experimental data show that warming the skin or the brain can increase sleep propensity, sleep consolidation, and the duration of sleep. Anatomical and neurophysiological studies show that the pre-optic-anterior-hypothalamus (POAH) is the main integrator of sleep and thermoregulatory information. It integrates information on vigilance states, body temperature, and environmental temperature and influences vigilance states and body temperature in response. Animals that display daily torpor may be a valuable model to investigate the relationship between sleep and thermoregulation. During torpor these animals seem to apply similar strategies and physiological processes as humans during entrance into sleep, but in a more extreme way, providing an excellent opportunity to investigate these processes in more detail. More systematic investigations are needed to further our understanding of the relationship between sleep and thermoregulation, and may provide the basis to treat sleep disturbances with thermal strategies.
Article
Objective: To answer the question: Is there scientific evidence with the techniques of hydrotherapy? Methods: Bibliographic search of evidence-based medicine in clinical trials published until February 2008. To this end, use the Tripdatabase, which links to databases of medical quality. It also search the clinical trials indexed by PubMed. The degrees of evidence are classified according to the table of the Agency for Healthcare Research and Quality USA; grades in this recommendation are: A (high evidence: at least obtained from a randomized clinical trial), B (moderate evidence: from quasi-experimental studies) and C (low evidence: clinical experience or opinions of experts). Main results: The balneology is recommended with the Grade A: chronic low back pain, arthrosis, rheumatoid arthritis and fibromyalgia; and with the grade B: Ankylosing spondylitis, respiratory infections tracks high, hypertension, hypercholesterolemia, heart failure, venous insufficiency, periferic arteriopathy and atopic dermatitis. The cure hydroponic, with the grade A: nephrolithiasis; and with the grade B: postural hypotension, osteoporosis, hypertension, dyslipidemia and iron-deficiency anemia. The thalassotherapy with de grade B: Psoriasis, artrosis and fibromyalgia. The thermotherapy, grade A: Fibromyalgia; and grade B: Newborns, labour, anal fissure, insect bites, chronic low back pain, arthrosis, spasticity, neuromotor pathology, insomnia, infections tracks high. Cryotherapy, with the grade A: Fever; and the grade B: Prevention of heatstroke and wounds. The hydrotherapy temperature alternating, with the grade B: muscle pain after exercise, heart failure. The exercises in the aquatic environment, with Grade A: Arthrosis, fibromyalgia; and with the grade B: Quality of life and balance, chronic obstructive pulmonary disease, heart failure and rheumatoid arthritis. Conclusions: There are already indications of hydrotherapy with high and moderate grades of evidence. Objetivo: Responder a la pregunta: ¿Existe evidencia científica con las técnicas hidroterápicas? Material y métodos: Búsqueda bibliográfica de la medicina basada en la evidencia de los ensayos clínicos publicados hasta febrero de 2008. Para este fin se utiliza el buscador Tripdatabase, que enlaza con bases médicas de calidad. También se recogen los ensayos clínicos indexados por el PubMed. Los grados de evidencia se clasifican según la tabla de la Agency for Healthcare Research and Quality de USA; en ésta los grados de recomendación son: A (evidencia alta: obtenida al menos a partir de un ensayo clínico aleatorio), B (evidencia media: a partir de estudios cuasi experimentales) y C (evidencia baja: experiencias clínicas u opiniones de expertos). Resultados principales: La balneoterapia está recomendada con el grado A en: lumbalgia crónica, artrosis y artritis reumatoide y fibromialgia; y con el grado B en: Espondilitis anquilopoyética, infecciones respiratorias de vías altas, hipertensión arterial, hipercolesterolemia, insuficiencia cardiaca, insuficiencia venosa, arteriopatia periférica y dermatitis atópica. La cura hidropínica, con el grado A en: Litiasis renal; y con el grado B en: Hipotensión postural, osteoporosis, hipertensión arterial, dislipemia y anemia ferropénica, e hidratación de la piel. La talasoterapia, con grado B en: Psoriasis, artrosis y fibromialgia. La termoterapia, con grado A en: Fibromialgia; y con grado B en: Recién nacidos, parto, fisura anal, picadura de insectos, lumbalgia crónica, artrosis, espasticidad, patología neuromotora, insomnio, infecciones de vías altas. La crioterapia, con el grado A en: Fiebre; y con el grado B en: Prevención del golpe de calor; y heridas. La hidroterapia de temperatura alterna, con el grado B en: Dolor muscular posterior al ejercicio, insuficiencia cardiaca. Los ejercicios en medio acuático, con grado A en: Artrosis, fibromialgia; y con el grado B en: Calidad de vida y equilibrio, enfermedad pulmonar obstructiva crónica, insuficiencia cardiaca y artritis reumatoide. Conclusiones: Actualmente ya existen indicaciones de la hidroterapia con grados altos y medios de evidencia.
Article
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Changing times and advancements in technology have taken a toll on human health. Poor sleep quality is rampant in every age group thus an apharmacological cure is slowly becoming a necessity of the times. Exercises/physical activities are a strong contender in the race. But still a lot work has to be done to finally conclude about its efficacy as the treatment. This article aims at reviewing the relation between sleep quality and exercise. This article reviews the experimental and epidemiological work done on the topic along with the reviews published on the same. The emphasis here is on the studies done and the possible mechanisms underlying the relationship. The article also talks about the lacunae in research and future directions for research.
Article
Usually, the bed is where the day ends and a new day begins. During sleep, people are mostly unaware of the things that happen in the environment, and therefore psychologically, sleep separates one day from the next. For many, an “ideal” night of sleep consists of quickly falling asleep, sleeping through the night, and waking up refreshed and ready to face the day (e.g., Taylor et al., 2008). However, some nights are not that ideal. Not only people with clinical conditions or sleep disorders, but also healthy people might sometimes have difficulties falling asleep and staying asleep, and wake up too early or unrefreshed (e.g., NSF, 2008; Cuartero and Estivill, 2007; Bixler, 2009). Many people without chronic sleep complaints also sometimes feel the need to be assured that the upcoming night will be a refreshing one, without troubles. Therefore, this chapter focuses on the sleep of healthy individuals.
The prevalence of insomnia, SDB, circadian rhythm disorders, and sleep-related movement disorders increases substantially in late-life. In addition, normal age-related changes in sleep architecture create a fragmented and light sleep pattern that sets the stage for sleep complaints in this population. Sleep disturbance in older adults may be associated with poorer quality of life, dependence on hypnotic medication, increased risk of falls, increased morbidity, impaired cognitive performance, and daytime somnolence. A thorough evaluation of a sleep complaint includes assessment of contributing medical, psychiatric, medication, behavioral, and environmental factors. Once identified, sleep disorders can be effectively treated. Treatments include medically-based interventions such as mechanical devices for SDB and medications for movement disorders as well as behavioral and environment interventions (e.g., behavioral treatments for insomnia and bright light therapy for circadian disturbances). However, more information on the application and effectiveness of these treatments specific to elderly populations is needed and will only increase in importance as the population of older adults grows. Uncited items.
Article
Although exercise clearly offsets aging effects on the body, its benefits for the aging brain are likely to depend on the extent that physical activity (especially locomotion) facilitates multisensory encounters, curiosity, and interactions with novel environments; this is especially true for exploratory activity, which occupies much of wakefulness for most mammals in the wild. Cognition is inseparable from physical activity, with both interlinked to promote neuroplasticity and more successful brain aging. In these respects and for humans, exercising in a static, featureless, artificially lit indoor setting contrasts with exploratory outdoor walking within a novel environment during daylight. However, little is known about the comparative benefits for the aging brain of longer-term daily regimens of this latter nature including the role of sleep, to the extent that sleep enhances neuroplasticity as shown in short-term laboratory studies. More discerning analyses of sleep electroencephalogram (EEG) slow-wave activity especially 0.5-2-Hz activity would provide greater insights into use-dependent recovery processes during longer-term tracking of these regimens and complement slower changing waking neuropsychologic and resting functional magnetic resonance imaging (fMRI) measures, including those of the brain's default mode network. Although the limited research only points to ephemeral small sleep EEG effects of pure exercise, more enduring effects seem apparent when physical activity incorporates cognitive challenges. In terms of "use it or lose it," curiosity-driven "getting out and about," encountering, interacting with, and enjoying novel situations may well provide the brain with its real exercise, further reflected in changes to the dynamics of sleep.
Article
Nocturia is a bothersome symptom that increases with age, resulting in sleep disruption, an increased risk of falls, and a greater likelihood of rating one's health as poor. It is often a symptom of conditions that cause low volume voiding, overproduction of urine across the day or only at night and a symptom of a sleep disorder. Nocturia affects quality of life and has an impact on aging in place, thus assessment and treatment are essential. Behavioral treatments should be explored first, keeping in mind what the affected older adult defines as the desired outcomes of treatment.
Article
Development of the skin barrier continues up to 12 months after birth; therefore, care must be taken when cleansing and bathing infants' skin. Available guidelines for skin care in newborns are, however, limited. In 2007, the 1st European Round Table meeting on 'Best Practice for Infant Cleansing' was held, at which a panel of expert dermatologists and paediatricians from across Europe aimed to provide a consensus on infant bathing and cleansing. Based on discussions at the meeting and a comprehensive literature review, the panel developed a series of recommendations relating to several aspects of infant skin care, including initial and routine bathing, safety while bathing, and post-bathing procedures. The panel also focused on the use of liquid cleansers in bathing, particularly relating to the benefits of liquid cleansers over water alone, and the criteria that should be used when choosing an appropriate liquid cleanser for infants. Alkaline soaps have numerous disadvantages compared with liquid cleansers, with effects on skin pH and lipid content, as well as causing skin drying and irritation. Liquid cleansers used in newborns should have documented evidence of their mildness on skin and eyes, and those containing an emollient may have further benefits. Finally, the panel discussed seasonal differences in skin care, and issues relating to infants at high risk of atopic dermatitis. The panel further discussed the need of clinical studies to investigate the impact of liquid cleansers on skin physiology parameters on newborns' and infants' skin. Bathing is generally superior to washing, provided basic safety procedures are followed, and has psychological benefits for the infant and parents. When bathing infants with a liquid cleanser, a mild one not altering the normal pH of the skin surface or causing irritation to skin or eyes should be chosen.
Article
Purpose: To determine the type and degree of effect that a hot footbath has on sleep quality and fatigue level in older Korean adults. Methods: A non-equivalent control group quasi-experimental design was used. Fifty participants from a long-term care facility in Kwangju, South Korea, were randomly selected and assigned to two groups: experimental group (27 participants) and control group (23 participants). The participants in the experimental group received hot footbaths in a temperature-controlled water tub of . They soaked their feet up to 20cm above the ankles for 30 minutes before going to bed for 3 nights. Actigraphy was used to measure their sleep patterns. The data were analyzed using the SAS program. Results: After the intervention, the total sleep satisfaction rate of the participants increased, while sleep latency and fatigue decreased significantly in the experimental group compared to the control group. Conclusion: The study results suggest that hot footbaths are beneficial for older Korean adults in enhancing sleep quality as well as reducing fatigue. Therefore, hot footbaths are recommended as a nursing intervention to improve sleep quality and to reduce fatigue in older Korean adults.
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Bed interface material can affect the person's temperature characteristics. This article is based on ergonomics principle and method, paralyzedgroup for the audience to carry the mattress temperature sensation characteristic experiments. Through the subjective survey, found that paralyzed sponge mattress material local temperature influence the human body, through the objective experiment, it is pointed out that different sponge mattress different effects on human body temperature; correlation between subjective and objective analysis found: Waist temperature on the maximum total thermal comfort; the best waves sponge thermal comfort; consistent with the results of subjective and objective analysis.
Article
Water-based passive body heating (PBHWB) as a warm shower or bath before bedtime is often recommended as a simple means of improving sleep. We searched PubMed, CINAHL, Cochran, Medline, PsycInfo, and Web of Science databases and extracted pertinent information from publications meeting predefined inclusion and exclusion criteria to explore the effects of PBHWB on sleep onset latency (SOL), wake after sleep onset, total sleep time, sleep efficiency (SE), slow wave sleep, and subjective sleep quality. The search yielded 5322 candidate articles of which 17 satisfied inclusion criteria after removing duplicates, with 13 providing comparable quantitative data for meta-analyses. PBHWB of 40 to 42.5oC was associated with both improved self-rated sleep quality and SE, and when scheduled 1-2 hours before bedtime for little as 10 min significant shortening of SOL. These findings are consistent with the mechanism of PBHWB effects being the extent of core body temperature decline achieved by increased blood perfusion to the palms and soles that augments the distal-to-proximal skin temperature gradient to enhance body heat dissipation. Nonetheless, additional investigation is required because the findings regarding PBHWB are limited by the relative scarcity of reported research, especially its optimal timing and duration plus exact mechanisms of effects.
Chapter
Sleep and pain are strongly connected. Sleep disturbance is reported by 67%–88% of patients with chronic pain, and 50% of patients with insomnia suffer from chronic pain. Patients with chronic pain may have difficulty implementing strategies of traditional CBT-I, such as stimulus control or sleep restriction, due to physical limitations (e.g., unable to get in-and-out of bed easily) or behavioral strategies of pain management (e.g., “sleeping off” headaches). This chapter is a guide to modifications to CBT-I that may help patients with chronic pain adhere to and benefit more from treatment.
Chapter
Integrative oncology provides patients with the best of conventional medicine such as surgery and chemotherapy alongside the best herbal, nutritional, and energetic treatments. Research has made clear that the best outcomes in cancer treatment occur when the patient completes the prescribed treatment within the prescribed timeline. Nutritional approaches help patients complete treatment protocols with fewer symptoms and better outcomes (Ravasco, J Clin Med 8(8):1211, 2019). Age is the greatest risk factor for developing cancer (Cancer.net Editorial Board. Aging and Cancer [Internet]. Cancer.net. 2019 [cited 2021 Feb 17]. Available from: https://www.cancer.net/navigating-cancer-care/older-adults/aging-and-cancer#:~:text=Age%20is%20the%20greatest%20risk,are%2060%25%20of%20cancer%20survivors). With over 70% of adults over 65 experiencing some form of cancer, providing nutritional guidance is the key to supporting a better quality of life in our older patients (Berger et al., Trans Am Clin Climatol Assoc 117:147–55, 2006). Recurrence rates vary greatly across different cancer types, ranging anywhere from 5% to 85% (Blevins Primeau A. Cancer Recurrence Statistics [Internet]. Cancer Therapy Advisor. 2018 [cited 2021 Feb 19]. Available from: https://www.cancertherapyadvisor.com/home/tools/fact-sheets/cancer-recurrence-statistics/) To be clear, using nutritional approaches in the absence of conventional medical treatment is outside the scope of this book and not endorsed by its authors. The National Cancer Institute has identified over 160 types of cancer, all of which require individualized approaches; while this book will not address these details, cancer prevention, treatment, and recovery are all well supported by nutritional interventions and are discussed thoroughly (NIH. Cancer Types [Internet]. NIH National Cancer institute. 2020 [cited 2021 Feb 17]. Available from: https://www.cancer.gov/types).
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SWS seems to be important for the ageing cortex in maintaining ‘use it or lose it’, helping to create new connections to offset ageing effects. Although physical activity is thought to promote this cortical rewiring, the real benefit to the cortex, especially for the frontal region, is the extent to which physical activity provides for novel and interesting sensory and cognitive encounters with one’s surroundings and people, thus eliciting new thoughts, emotions, and experiences to be assimilated and remembered. Thus, cognition is inseparable from physical activity, and within the context of human ageing both processes are intrinsically linked to each other to increase cortical plasticity, leading to more SWS. All one really needs to ‘exercise the cortex’ are a comfortable pair of walking shoes, curiosity, and a desire to explore.
Article
Objectives Passive body heating can have an antidepressant effect by activating warm-sensitive neural pathways associated with affective functions. Interventional studies showed that patients with depression had reduced depressive symptoms after passive body heating. However, the effect of hot water bathing at home on depressive symptoms in the general population remains unclear. Thus, we evaluated the association between objectively measured hot water bathing and depressive symptoms among older adults. Design Cross-sectional analysis. Setting A baseline survey of community-based cohort study in Japan. Participants Community-dwelling older volunteers (n = 1,103; mean age: 72.0 years). Measurements We evaluated bathing conditions and distal skin temperature for two consecutive days. Depressive symptoms were defined as the 15-item Geriatric Depression Scale score of ≥6. Results Logistic regression showed that the no bathing group (adjusted odds ratio [OR] 2.60, 95% confidence interval [CI] 1.36–4.95, χ² = 8.40, degrees of freedom [df] = 1) and the either-day bathing group (adjusted OR 1.68, 95% CI 1.11–2.56, χ² = 5.89, df = 1) had higher odds of depressive symptoms than the both-day bathing group independent of potential confounders including age, sex, body mass index, alcohol intake, income, living alone, hypnotic use, diabetes, and physical activity. Shorter interval from bathing to bedtime was significantly associated with lower odds of depressive symptoms and higher nighttime distal skin temperature after adjusting for water temperature and duration. Conclusions A higher frequency of hot water bathing and shorter interval from bathing to bedtime were associated with lower odds of depressive symptoms.
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Studies in adult humans and animals have demonstrated that sleep and body thermoregulation are closely linked. In a cool or warm environment, there is a functional conflict between the need for sleep and the maintenance of body homeothermia. This conflict might be especially harmful in infants. This chapter reviews sleep-thermoregulation interactions in neonates and infants, together with the implications of these interactions: thermoregulatory responses can differ according to the sleep stage, and sleep can be deteriorated or improved by a non-thermoneutral environment or by slight manipulations of body temperatures. In contrast to adults, the neonate’s thermoregulatory system is fully operational during rapid eye movement (REM) sleep, which protects him/her from long periods of poikilothermy. The lack of data on this aspect in older infants or adolescents means that we do not currently know when the switch from neonatal characteristics (greater thermoregulatory efficiency and a greater amount of REM sleep when exposed to a cool environment) to adult characteristics (i.e., poor thermoregulatory efficiency and partial REM sleep deprivation in cool or warm conditions) occurs. In adults, sleep is regulated in parallel with the circadian rhythm in body temperatures. Similarly, distal skin vasodilation before sleep can be observed as a part of “sleep preparedness” in infants (from preterm neonates to older children). This vasodilation is observed despite age-related differences in sleep structure, rhythm and maturation, and thermoregulatory functions and centers. These observations raise the question of whether thermal or nonthermal manipulation could improve infants’ sleep by inducing distal cutaneous vasodilation.
Article
To investigate the relieving effects of hot spring balneotherapy on mental stress, sleep disorder, general health problems, and women’s health problems in sub-healthy people, we recruited 500 volunteers in sub-health in Chongqing, and 362 volunteers completed the project, including 223 in the intervention group and 139 in the control group. The intervention group underwent hot spring balneotherapy for 5 months, while the control group did not. The two groups took questionnaire investigation (general data, mental stress, emotional status, sleep quality, general health problems, as well as some women’s health problems) and physical examination (height, weight, waist circumference, blood pressure, blood lipid, blood sugar) 5 months before and after the intervention, respectively. After intervention, sleep disorder (difficulty in falling asleep (P = 0.017); dreaminess, nightmare suffering, and restless sleep (P = 0.013); easy awakening (P = 0.003) and difficulty in falling into sleep again after awakening(P = 0.016); and mental stress (P = 0.031) and problems of general health (head pain (P = 0.026), joint pain(P = 0.009), leg or foot cramps (P = 0.001), blurred vision (P = 0.009)) were relieved significantly in the intervention group, as compared with the control group. While other indicators (fatigue, eye tiredness, limb numbness, constipation, skin allergy) and women’s health problems (breast distending pain; dysmenorrhea, irregular menstruation) were relieved significantly in the self-comparison of the intervention group before and after intervention (P < 0.05), but showed no statistically significant difference between two groups (P > 0.05). All indications (except bad mood, low mood, and worry or irritability) in the intervention group significantly improved, with effect size from 0.096 to 1.302. Multiple logistic regression analysis showed that the frequency, length, and location of balneotherapy in the intervention group were the factors influencing emotion, sleep, and health condition (P < 0.05). Relief of insomnia, fatigue, and leg or foot cramps was greater in old-age group than in young-aged group (P < 0.05). Physical examination found that waist circumferences in women of various ages under 55 years were significantly reduced in the intervention group (P < 0.05), while that in men did not significantly change (P > 0.05). Spa therapy (balneotherapy) relieves mental stress, sleep disorder, general health, and reduces women’s waist circumferences in sub-healthy people.
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Comorbidity is common, affecting one-third or more of the global population; and recent co-prevalence estimates suggest that its presence is increasing. It is associated with substantial chronic illness burden, disability, high mortality, and high ongoing costs to the individual and the community, reflecting its substantial impact within and beyond the health care system. Thus, unravelling the causes of comorbidity currently ranks among the top priorities in clinical practice. However, there are currently few protocols and clinical practice guidelines that can be used to assist clinicians in treating comorbid conditions in a coordinated way. Instead, the guidelines and protocols have tended to focus on single disorders and they generally fail to take comorbidities into account. This has resulted in the comorbid disorders being treated as if they are isolated clinical entities, with each condition managed separately, often by different clinicians. Therefore, there is a clear need to develop new clinical practice guidelines and therapeutic approaches that do take comorbidity into account; especially in patients with highly prevalent and highly comorbid disorders.
Article
Objective: Prior to sleep onset in human adults, distal body temperatures change progressively from wakefulness levels (low skin temperatures and a high core temperature) to sleep levels (high skin temperatures and a low core temperature) due to distal skin vasodilation and greater body cooling. It is not known whether this sleep preparedness exists in preterm neonates, even though sleep has a key role in neonatal health and neurodevelopment. The present study's objectives were to determine whether sleep preparedness (as observed in adults) can be evidenced in preterm neonates, and to assess repercussions on thermal stress. Methods: During a 12-h night-time polysomnography session, skin temperatures (recorded with an infrared camera), sleep, and wakefulness episodes were measured in 18 nine-day-old preterm neonates. Results: Fifteen wakefulness episodes were considered. Our results highlighted significant pre-sleep distal skin vasodilation (mainly at the foot: an increase of 0.38 °C in the 20 min preceding sleep onset) for the first time in preterm neonates. This vasodilation occurred even though (1) most factors known to influence pre-sleep vasodilation in adults were not present in these neonates, and (2) the neonates were nursed in a nearly constant thermal environment. The vasodilatation-related increase in body heat loss corresponded to a 0.15°C/h fall in mean body temperature (calculated using partitional calorimetry). Conclusion: Compensation for this body heat loss and the maintenance of body homeothermia would require a 4% increase in metabolic heat production. In neonates, this type of energy expenditure cannot be maintained for a long period of time.
Article
Lifestyle-related chronic illnesses, such as metabolic syndrome, type 2 diabetes, cancer, and dementia are rising at an alarming, epidemic rate. In this modern world of increasing lifespan, we are actually decreasing our health span, placing an undue burden on healthcare costs to society. Modern medicine has largely gotten away from addressing key issues to prevent or even reverse some of these chronic conditions. Yet the evidence for successful interventions in four key areas – nutrition, sleep, physical activity and stress management – to manage and control our health are mounting. Lifestyle medicine as a part of personalized treatment and prevention of chronic illnesses is a necessary cornerstone of disease management as we look to the future. In this review, I discuss various key studies demonstrating the impact of lifestyle on epigenetic, endocrine, immunologic, and inflammatory changes which contribute to chronic disease and our overall health.
Article
Purpose: This systematic review investigated the effects of non-pharmacological interventions to improve the sleep of the Korean elderly at home and in facilities.Methods: A literature search was performed using electronic databases (RISS, KISS, KMbase, KoreaMed, DBpia) from 2010 to 2021. Participants’ characteristics, intervention characteristics, and measured sleep outcomes were systematically reviewed. A qualitative appraisal of studies was performed using the RoB 2.0 and ROBINS-I tools.Results: Of 954 publications identified, 23 met the inclusion criteria. Two studies were randomized controlled trials and 21 studies were quasi-experimental designs with a non-equivalent control group. The contents of 23 intervention studies that aimed to improve sleep included massage, auricular acupressure therapy, laughter therapy, heat therapy, exercise, and aromatherapy. The Korean Sleep Scale A was the most frequently used sleep instrument, in 18 studies. Most interventions were effective in improving sleep, but some inconsistent results were reported.Conclusion: Non-pharmacological interventions for the improvement of sleep in the elderly are useful as therapeutic interventions as part of nursing care, because they are simple and easy to apply. However, to draw clear conclusions about the effect of interventions, it will be necessary to gather results from intervention studies using rigorous methodologies in the future.
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Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm reported to range from 13 to 65 hours (median 25.2 hours) and the period of the body temperature rhythm reported to average 25 hours in adulthood, and to shorten with age. However, those observations were based on studies of humans exposed to light levels sufficient to confound circadian period estimation. Precise estimation of the periods of the endogenous circadian rhythms of melatonin, core body temperature, and cortisol in healthy young and older individuals living in carefully controlled lighting conditions has now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. These findings have important implications for understanding the pathophysiology of disrupted sleep in older people.
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The frequencies of five common sleep complaints--trouble falling asleep, waking up, awaking too early, needing to nap and not feeling rested--were assessed in over 9,000 participants aged 65 years and older in the National Institute on Aging's multicentered study entitled "Established Populations for Epidemiologic Studies of the Elderly" (EPESE). Less than 20% of the participants in each community rarely or never had any complaints, whereas over half reported at least one of these complaints as occurring most of the time. Between 23% and 34% had symptoms of insomnia, and between 7% and 15% percent rarely or never felt rested after waking up in the morning. In multivariate analyses, sleep complaints were associated with an increasing number of respiratory symptoms, physical disabilities, nonprescription medications, depressive symptoms and poorer self-perceived health. Sleep disturbances, particularly among older persons, oftentimes may be secondary to coexisting diseases. Determining the prevalence of specific sleep disorders, independent of health status, will require the development of more sophisticated and objective measures of sleep disturbances.
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Seven healthy men were studied in a 34-h constant routine protocol to investigate whether the daily rhythm of heat production and heat loss has an endogenous circadian component. Under these unmasking conditions (constant bed rest, no sleep allowed, regular food and fluid intake), a significant circadian rhythm could be demonstrated for heat production, heart rate, and skin temperatures but not for the respiratory quotient. Heat production and heart rate were phase locked with a maximum at 1100-1200 h. Proximal skin temperatures (infraclavicular region, thigh, and forehead) followed the same circadian rhythm as rectal temperature, whereas distal skin temperatures (hands and feet) were opposite in phase. These physiological circadian rhythm parameters, as well as biochemical parameters (urinary sodium, potassium, urea, and urine flow), were phase advanced by 25-180 min with respect to the circadian rhythm in rectal temperature. Our findings under unmasking conditions show that the circadian variation in rectal temperature is a consequence of endogenous circadian rhythms in both heat production and heat loss.
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Previous studies have inferred a relationship between core temperature and sleep disruption from manipulations of core temperature such as heating prior to sleep or administration of hyperthermic substances. To examine the relationship more directly, this study aimed to produce a direct increase in core temperature during the sleep period. Following an adaptation night, 16 subjects underwent counter-balanced baseline and experimental conditions, on non-consecutive nights between 1900 and 0800h. In the experimental condition, subjects were heated between 0230h and wake up, which significantly increased mean core temperature from baseline levels between 0400 and 0700h by 0.18 +/- 0.03 degree C (mean +/- SEM, p < 0.05). This increase in core temperature was associated with a significant decrease in sleep efficiency between 0330 and 0730h of 5.5 +/- 0.9% (mean +/- SD, p < 0.05). Polysomnographic measures indicated a significant increase in the number of stage changes and the amounts of stage 0 and stage 1 sleep (p < 0.05). Other stages of sleep and the number and duration of arousals were not significantly effected by heating. There was a strong trend toward and increase in the number of arousals (p = 0.054), however, core body temperature did not increase across arousals. Also, melatonin output was not effected by heating. Taken together, these results suggest that increased nocturnal core temperature alone may disrupt sleep. Additionally, the results support evidence suggesting that the circadian regulation of the sleep/wake cycle may be mediated via core temperature.
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The purpose of this study was to investigate the relationship between core body temperature and sleep in older female insomniacs and changes in that relationship as a result of passive body heating (PBH). An increase in body temperature early in the evening by way of PBH in older female insomniacs increased SWS in the early part of the sleep period and improved sleep continuity. Fourteen older female insomniacs (60-73 years old) participated in at least two consecutive nights of PBH involving hot (40-40.5 degrees C) baths 1.5-2 hours before bedtime. Hot baths resulted in a significant delay in the phase of the core body temperature rhythm compared to baseline nights. This delay in temperature phase paralleled the improvements in sleep quality.
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The study examined the prevalence and correlates of insomnia in a representative sample (n=3030) from the general population of Japan. Using a structured questionnaire, we found that the overall prevalence of insomnia during the preceding month was 21.4%, including difficulty initiating sleep (DIS: 8.3%), difficulty maintaining sleep (DMS: 15.0%), and early morning awakening (EMA: 8.0%). Multiple logistic regression analysis showed that older age, being unemployed, lack of habitual exercise, poor perceived health, psychological stress, and being unable to cope with stress were associated with an increased prevalence of insomnia. These findings indicate that the prevalence of insomnia in the general population of Japan is comparable to that reported in Western countries, and that insomnia is associated with multiple psychosocial factors.
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The neurobiological mechanisms of both sleep and circadian regulation have been unraveled partly in the last decades. A network of brain structures, rather than a single locus, is involved in arousal state regulation, whereas the suprachiasmatic nucleus (SCN) has been recognized as a key structure for the regulation of circadian rhythms. Although most models of sleep regulation include a circadian component, the actual mechanism by which the circadian timing system promotes--in addition to homeostatic pressure--transitions between sleep and wakefulness remains to be elucidated. Little more can be stated presently than a probable involvement of neuronal projections and neurohumoral factors originating in the SCN. This paper reviews the relation among body temperature, arousal state, and the circadian timing system and proposes that the circadian temperature rhythm provides an additional signaling pathway for the circadian modulation of sleep and wakefulness. A review of the literature shows that increased brain temperature is associated with a type of neuronal activation typical of sleep in some structures (hypothalamus, basal forebrain), but typical of wakefulness in others (midbrain reticular formation, thalamus). Not only local temperature, but also skin temperature are related to the activation type in these structures. Warming of the skin is associated with an activation type typical of sleep in the midbrain reticular formation, hypothalamus, and cerebral cortex (CC). The decreasing part of the circadian rhythm in core temperature is mainly determined by heat loss from the skin of the extremities, which is associated with strongly increased skin temperature. As such, alterations in core and skin temperature over the day could modulate the neuronal activation state or "preparedness for sleep" in arousal-related brain structures. Body temperature may thus provide a third signaling pathway, in addition to synaptic and neurohumoral pathways, for the circadian modulation of sleep. A proposed model for the effects of body temperature on sleep appears to fit the available data better than previous hypotheses on the relation between temperature and sleep. Moreover, when the effects of age-related thermoregulatory alterations are introduced into the model, it provides an adequate description of age-related changes in sleep, including shallow sleep and awakening closer to the nocturnal core temperature minimum. Finally, the model indicates that appropriately timed direct (passive heating) or indirect (bright light, melatonin, physical activity) manipulation of the nocturnal profile of skin and core temperature may be beneficial to disturbed sleep in the elderly. Although such procedures could be viewed by researchers as merely masking a marker for the endogenous rhythm, they may in fact be crucial for sleep improvement in elderly subjects.
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This review summarizes the current knowledge on changes of the circadian system in advanced age, mainly for rodents. The first part is dedicated to changes of the overt rhythms. Possible causes are discussed, as are methods to treat the disturbances. In aging animals and humans, all rhythm characters change. The most prominent changes are the decrease of the amplitude and the diminished ability to synchronize with a periodic environment. The susceptibility to photic and nonphotic cues is decreased. As a consequence, both internal and external temporal order are disturbed under steady-state conditions and, even more, following changes in the periodic environment. Due to the high complexity of the circadian system, which includes oscillator(s), mechanisms of external synchronization and of internal coupling, the changes may arise for several reasons. Many of the changes seem to occur within the SCN itself. The number of functioning neurons decreases with advancing age and, probably, so does the coupling between them. As a result, the SCN is unable, or at least less able, to produce stable rhythms and to transmit timing information to target sites. Initially, only the ability to synchronize with the periodic environment is diminished, whereas the rhythms themselves continue to be well pronounced. Therefore, the possibility exists to treat age-dependent disturbances. This can be done pharmacologically or by increasing the zeitgeber strength. So, some of the rhythm disturbances can be reversed, increasing the magnitude of the light-dark (LD) zeitgeber. Another possibility is to strengthen feedback effects, for example, by increasing the daily amount of activity. By this means, the stability and synchronization of the circadian activity rhythm of old mice and men were improved.
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The suprachiasmatic nucleus (SCN) of the hypothalamus is implicated in the timing of a wide variety of circadian processes. Since the environmental light-dark cycle is the main zeitgeber for many of the rhythms, photic information may have a synchronizing effect on the endogenous clock of the SCN by inducing periodic changes in the biological activity of certain groups of neurons. By studying the brains obtained at autopsy of human subjects, marked diurnal oscillations were observed in the neuropeptide content of the SCN. Vasopressin, for example, one of the most abundant peptides in the human SCN, exhibited a diurnal rhythm, with low values at night and peak values during the early morning. However, with advancing age, these diurnal fluctuations deteriorated, leading to a disrupted cycle with a reduced amplitude in elderly people. These findings suggest that the synthesis of some peptides in the human SCN exhibits an endogenous circadian rhythmicity, and that the temporal organization of these rhythms becomes progressively disturbed in senescence.
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This issue of Chronobiology International is dedicated to the age-related changes in circadian rhythms as they occur in humans. It seems timely to give an overview of the knowledge and hypotheses on these changes now that we enter a century in which the number and percentage of elderly in the population will be unprecedented. Although we should take care not to follow the current tendency to think of old age as a disease--ignoring the fine aspects of being old--there is definitely an age-related increase in the risk of a number of conditions that are at least uncomfortable. Circadian rhythms have been attributed adaptive values that usually go unnoticed, but can surface painfully clear when derangements occur. Alterations in the regulation of circadian rhythms are thought to contribute to the symptoms of a number of conditions for which the risk is increased in old age (e.g., sleep disturbances, dementia, and depression). A multidisciplinary approach to investigate the mechanisms of age-related changes in circadian regulation eventually may result in treatment strategies that will improve the quality of life of the growing number of elderly. Although diverse topics are addressed in this issue, the possible mechanisms by which a deranged circadian timing system may be involved in sleep disturbances receives the most attention. This seems appropriate in view of the numerous studies that have addressed this relation in the last decade and also because of the high frequency and strong impact of sleep disturbances in the elderly. This introduction to the special issue first briefly addresses the impact of disturbed sleep in the elderly to show that the development of therapeutic methods other than the currently available pharmacological treatments should be given high priority. I believe that chronobiological insights may play an important role in the development of rational therapeutical methods.
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Recent work indicates that cardiac sympathetic activity is not influenced by the circadian system and instead decreases after sleep onset. However, little is known about the pattern of change in cardiac sympathetic activity during NREM/REM sleep cycles and whether this is associated with alterations in slow-wave activity (SWA). To address these questions, we examined SWA, cardiac sympathetic activity, heart rate and rectal and foot temperatures during the first three NREM/REM sleep cycles and during transitions between NREM and REM sleep. Subjects were required to maintain a constant sleep-wake cycle for at least a week and have at least one adaptation night, before their night of recording. Individual temperature controlled bedrooms. 10 young healthy males and females. NA. MEASUREMENTS and All variables showed the greatest change in the first NREM cycle. Specifically, SWA, sympathetic activity, heart rate and foot temperature increased while rectal temperature decreased. After the initial increase, cardiac sympathetic activity decreased across the sleep phase, in association with a decrease in heart rate. Cardiac sympathetic activity did not significantly alter across NREM-REM cycles. The results suggest that increases in heart rate and cardiac sympathetic activity early in the sleep period are, in part, a compensatory reaction to the concomitant thermoregulatory changes observed. These results also indicate that the effect of time asleep on cardiac sympathetic activity may be greater than the influence of sleep cycles. These results are discussed with reference to the recuperative value of naps.
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Thermoregulatory processes have long been implicated in initiation of human sleep. A meta-analysis of studies carried out under the controlled conditions of a constant routine protocol followed by nocturnal sleep revealed that heat loss, indirectly measured by the distal-proximal skin temperature gradient, was the best predictor variable for sleep onset latency (compared with core body temperature or its rate of change, heart rate, melatonin onset, and subjective sleepiness ratings). The cognitive signal of "lights out" induced relaxation, with a consequent shift in heat redistribution from the core to the periphery (as measured by an abrupt increase in skin temperatures and a rapid fall in heart rate). These thermoregulatory changes took place before sleep onset: sleep itself had minor further effects. Thus, when the confounding, long-lasting masking effects of lying down are controlled for, circadian thermoregulation initiates sleep, but does not appear to play a major role in its maintenance.
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The grouping of circadian rhythm sleep disorders dates back to the Diagnostic Classification of Sleep Disorders in 1979 [4], based on a shared cardinal feature: all these disorders represent one form or another of initial misalignment between the patient’s sleep and wake behaviours and that which is desired or regarded as the societal norm. In this Classification the circadian rhythm sleep disorders were divided into two groups, transient and persistent disorders. Nowadays, in the International Classification of Sleep Disorders [3], this subdivision has not been retained. However some of these disorders are only of an extrinsic type whereas the others depend on intrinsic and extrinsic factors (table 36.1).
Article
Seven healthy men were studied in a 34-h constant routine protocol to investigate whether the daily rhythm of heat production and heat loss has an endogenous circadian component. Under these unmasking conditions (constant bed rest, no sleep allowed, regular food and fluid intake), a significant circadian rhythm could be demonstrated for heat production, heart rate, and skin temperatures but not for the respiratory quotient. Heat production and heart rate were phase locked with a maximum at 1100-1200 h. Proximal skin temperatures (infraclavicular region, thigh, and forehead) followed the same circadian rhythm as rectal temperature, whereas distal skin temperatures (hands and feet) were opposite in phase. These physiological circadian rhythm parameters, as well as biochemical parameters (urinary sodium, potassium, urea, and urine flow), were phase advanced by 25-180 min with respect to the circadian rhythm in rectal temperature. Our findings under unmasking conditions show that the circadian variation in rectal temperature is a consequence of endogenous circadian rhythms in both heat production and heat loss.
Article
SUMMARY  The all‐night sleep EEGs of 314 (191 women, 123 men) healthy older subjects between the ages of 45 and 90 were studied for age trends in the power spectra of the all‐night NREM sleep EEG. Power spectra of the unnormalized EEG of the women show a power loss in the delta band and a power increase in the beta band with increasing age. For the men no significant trends in the power spectra of the unnormalized EEG were in evidence. A normalization of the power spectra was performed by referencing each logarithmically expressed spectra to its area between 2 Hz and 30 Hz. For both genders the normalized spectra show significant decreases in power at many frequencies below 16 Hz and significant increases in power at frequencies above 18 Hz with increasing age. The age trends observed in the spectra of this population (45‐90y age group) are about a third of the magnitude of those reported in the literature for subjects between the ages of 20y and 40y.
Six healthy female volunteers (22–24 years), physically untrained (unfit), sat in baths of warm or cool water for 90 min, between 14.30 h and 17.30 h, on separate occasions. In the former condition (HOT), rectal temperature (Tr) rose by an average of 1.8°C, and in the latter (COOL), a thermoneutral condition, there was a nil Tr change. All-night sleep EEGs were monitored after both occasions and on baseline nights. Following COOL, there was no significant change in any sleep parameter. After HOT there were significant increases in: sleepiness at bed-time, slow wave sleep, and stage 4 sleep. REM sleep was reduced, particularly in the first REM sleep period.RésuméSix femmes volontaires, en bonne santé (22 à 24 ans), non entraînées physiquement, furent assises dans un bain d'eau chaude ou froide pour 90 min, entre 14 h 30 et 17 h 30, en 2 sessions distinctes. Dans la première situation (CHAUDE), la température rectale (Tr) s'élevait en moyenne de 1,8°C, alors que dans la seconde (FROIDE), une situation thermiquement neutre, il n'y avait pas de modification de la Tr. Les EEG de sommeil de la nuit complète furent suivis après les deux types de sessions ainsi que pendant des nuits témoins. Après une session FROIDE, il n'y avait pas de modification des paramètres du sommeil. Une augmentation significative était observée après une session CHAUDE: de l'endormissement à l'heure du coucher, du sommeil à ondes lentes et du stade 4 du sommeil. Le sommeil paradoxal était réduit, particulièrement dans sa première période d'apparition.
Article
Recent evidence suggests that body temperature at sleep onset affects the subsequent level of slow wave sleep. According to one hypothesis, the actual temperature is the critical factor determining the relationship. An alternative proposal is that it is the rate of fall of body temperature following sleep onset. These hypotheses were tested by measuring rectal temperature and sleep, following late afternoon passive heating in a warm bath and during a control condition. Passive heating increased rectal temperature, which then returned rapidly toward the control level. However, immediately before lights out rectal temperature was still higher in the passive heating condition, a difference that continued throughout the night. Following passive heating the amount of slow wave sleep was higher in the early part of the night. These results support the hypothesis that body temperature at sleep onset and the amount of slow wave sleep are positively related.
Experiments were carried out on four healthy male subjects in two separate sessions: (a) A baseline period of two consecutive nights, one spent at thermoneutrality [operative temperature (To) = 30 degrees C, dew-point temperature (Tdp) = 7 degrees C, air velocity (Va) = 0.2 m.s-1] and the other in hot condition (To = 35 degrees C, Tdp = 7 degrees C, Va = 0.2 m.s-1). During the day, the subjects lived in their normal housing and were engaged in their usual activities. (b) An acclimation period of seven consecutive daily heat exposures from 1400 to 1700 hours (To = 44 degrees C, Tdp = 29 degrees C, Va = 0.3 m.s-1). During each night, the subjects slept in thermoneutral or in hot conditions. The sleep measurements were: EEG from two sites, EOG from both eyes, EMG and EKG. Esophageal and ten skin temperatures were recorded continuously during the night. In the nocturnal hot conditions, a sweat collection capsule recorded the sweat gland activity in the different sleep stages. Results showed that passive body heating had no significant effect on the sleep structure of subsequent nights at thermoneutrality. In contrast, during nights at To = 35 degrees C an effect of daily heat exposure was observed on sleep. During the 2nd night of the heat acclimation period, sleep was more restless and less efficient than during the baseline night. The rapid eye movement sleep duration was reduced, while the rate of transient activation phases observed in sleep stage 2 increased significantly. On the 7th night, stage 4 sleep increased (+68%) over values observed during the baseline night.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
Previous studies have found enhanced delta sleep following body heating. This study assessed the influence of body heating as a function of its proximity to sleep. Electroencephalogram (EEG) sleep patterns were compared following body heating (1 h immersion in water at 41 degrees C) at each of four times of day: morning (MO), afternoon (AF), early evening (EE), and late evening (LE), ending just prior to sleep. A delta filter/integrator system provided objective measures of delta content. Relative to baseline nights, whole-night delta sleep was increased by the two evening heating sessions only, particularly LE heating. Following LE, the increased delta occurred primarily in the first sleep cycle, whereas EE heating elicited increased delta distributed across the later sleep cycles (cycles 2-4). Effects on manually staged indices of slow wave sleep (SWS) were confined to increases in Stage 4 in the first sleep cycle following LE heating. Heating just prior to sleep also resulted in a substantial reduction in the duration of the first rapid eye movement sleep period. Sleep onset time was reduced by heating, particularly EE heating. The results indicate that body heating induces temporary changes that affect sleep propensity and both the quantity and temporal distribution of delta activity in the sleep EEG.
Article
On three different occasions, six healthy young adult subjects ahd their body temperatures raised by an average of 2.0 degrees C for 30 min while sitting in baths of warm water. This was done once at 1700 h and on two occasions at 2100 h, once after the subjects had taken aspirin and once after a placebo. Nighttime sleep was recorded after each experimental condition and for baseline nights following nil heating. Records were scored both visually and by an automated sleep stager. Electroencephalographic (EEG) power was computed over the night. Results from the automated scoring were very similar to those of the visual method. While the early bath caused no changes in sleep, the late bath + placebo resulted in significant rises in stage 4 sleep and slow wave sleep (SWS) and significant falls in sleep onset and in REM sleep. Aspirin mostly counteracted these effects and, in particular, left stage 4 sleep and SWS at baseline levels. EEG power was significantly increased only after the late bath plus placebo, supporting the SWS outcome. These findings were assessed in light of other comparable results from our laboratory. It seems that as the time of the day of heating recedes from nighttime sleep, a larger "dose" of heating is required to produce the same effect.
Article
Complaints of sleep disturbance increase with age. Objective sleep assessments using polysomnography reveal sleep impairments (increased wakefulness and arousal from sleep; decreased slow wave sleep) even in healthy seniors. Both polysomnographic sleep and subjective sleep worsen in the presence of health impairments related to drug use, pain, cardiovascular disease, diabetes, depression, or other emotional disorders. In addition to normal aging and chronic disease, sleep complaints can also result from poor sleep habits, specific occult disorders during sleep, or some combination of these factors. Occult disorders include sleep apnea syndrome, periodic leg movements, and restless legs syndrome during sleep. Diagnosis and treatment of these and other sleep disorders is discussed. Both pharmacological and nonpharmacological treatments are considered, with an emphasis on behavioral and educative treatment approaches.
Article
Changes in phasic events in the elderly are reviewed. Such phasic events may in part be determined by the macrostructure of sleep (sleep stages). Therefore, a brief description of sleep architecture and EEG morphology in the aged person is given. Second, there is a marked variability among individuals in the number of spindles and K-complexes and more so in older individuals than in younger. However, there is an overall decrease in these events with age. The characteristics of these events (amplitude, frequency content, and distribution) change simultaneously. Third, the number of rapid eye movement occurring during REM sleep decreases with aging, but important gender differences exist, in that women generally maintain a higher REM density. The degree of changes in phasic events might correlate with mental deterioration (sleep cognition theory), but physical factors might also be the underlying reason for the observed changes. Whether these changes are indicative of the individual's ability to maintain sleep remains to be determined.
Article
The purpose of this study was to evaluate passive body heating (PBH) as a treatment for insomnia in older adults. Polysomnographic recordings of older adults routinely show an increase in sleep fragmentation and a substantial decrease in slow-wave sleep (SWS) consistent with complaints of "lighter" more disturbed sleep. An increase in body temperature in young adults early in the evening by way of PBH has been shown to produce an increase in SWS in the early part of the sleep period. In a crossover design, nine female insomniacs (aged 60-72 yr) participated in two consecutive nights of PBH, involving hot (40-40.5 degrees C) and luke-warm (37.5-38.5 degrees C) baths 1.5 hours before bedtime. Significant improvement in sleep continuity and a trend toward an increase in SWS occurred after hot baths. Results of subjective measures showed that subjects experienced significantly "deeper" and more restful sleep after hot baths. In addition, hot baths resulted in a significant delay of temperature nadir in comparison to baseline nights.
Article
Many people believe that older adults need less sleep. However, it is not the need for sleep but the ability to sleep that diminishes with age. Older adults are objectively sleepier in the day, indicating they are not getting enough sleep at night. Their sleep is disrupted by circadian rhythm changes, disorders such as sleep disordered breathing (apnea) and periodic limb movements in sleep (PLMS), medical illness, psychiatric illness, medication use, and poor sleep habits. The physician can address each of these causes, thereby improving the night-time sleep and daytime functioning of the older adult.
Article
The goal of this study was to compare insomniacs with and without objective verification, on the basis of sleep parameters, personality, and performance. An insomniac complaint group was subclassified as objective insomniac (OI) or subjective insomniac (SI) and compared to a non-complaint group. Groups did not differ on night sleep variables or daytime sleep latency measures; rather, a consistent sleep tendency was revealed for all three groups. The poorer the previous night sleep, the longer the daytime sleep latencies. Groups differed on subjective measures of conscious state during the day. SIs inaccurately estimated sleep/wake state in comparison to objective measures on the MSLT, whereas OIs were accurate in their estimations. Personality scores showed trends that suggested greater neuroticism for SIs and introversion for OIs. Results demonstrated subjective tendencies and related personality types that may help in the understanding of the complaint of insomnia with and without objective findings.
Article
The light-entrainable circadian pacemaker located in the suprachiasmatic nucleus of the hypothalamus regulates the timing and consolidation of sleep by generating a paradoxical rhythm of sleep propensity; the circadian drive for wakefulness peaks at the end of the day spent awake, ie close to the onset of melatonin secretion at 21.00-22.00 h and the circadian drive for sleep crests shortly before habitual waking-up time. With advancing age, ie after early adulthood, sleep consolidation declines, and time of awakening and the rhythms of body temperature, plasma melatonin and cortisol shift to an earlier clock hour. The variability of the phase relationship between the sleep-wake cycle and circadian rhythms increases, and in old age sleep is more susceptible to internal arousing stimuli associated with circadian misalignment. The propensity to awaken from sleep advances relative to the body temperature nadir in older people, a change that is opposite to the phase delay of awakening relative to internal circadian rhythms associated with morningness in young people. Age-related changes do not appear to be associated with a shortening of the circadian period or a reduction of the circadian drive for wake maintenance. These changes may be related to changes in the sleep process itself, such as reductions in slow-wave sleep and sleep spindles as well as a reduced strength of the circadian signal promoting sleep in the early morning hours. Putative mediators and modulators of circadian sleep regulation are discussed.
Article
The National Sleep Foundation in conjunction with the Gallup Organization conducted telephone interviews with a sample of Americans (N = 1000) to examine the prevalence and nature of difficulty with sleep. Consistent with other national studies, about one-third of Americans reported some type of sleep problem. Approximately one in four reported occasional insomnia while 9% reported that their sleep difficulty occurred on a regular nightly basis. The problem most frequently reported by insomniacs was waking up in the morning feeling drowsy or tired, followed by waking up in the middle of the night, difficulty going back to sleep after waking up and difficulty falling asleep initially. Importantly, insomniacs rarely visited a physician to discuss their sleep problem and four out of ten insomniacs self-medicated with either over-the-counter medications or with alcohol. Two-thirds of the insomniacs reported that they did not have an understanding of available treatments for insomnia.
In this study we investigated the effects of bathing on the quality of sleep in 30 elderly people (ages 65-83 years) and in 30 young people (ages 17-22 years) in their homes. Room temperature did not vary significantly during the nights that data were acquired, ranging from 8 to 12 degrees C. After bathing and at the beginning of sleep, the mean (SE) rectal temperatures of the young and the elderly were 37.8 (0.08) and 37.5 (0.07) degrees C, respectively, and were higher by 0.7 (0.13) and 0.6 (0.07) degrees C, respectively, than when the subjects had not bathed. At the beginning of the sleep after bathing in the young subjects, skin temperature was 32.5 (0.24) and 1.5 (0.34) degrees C higher than when those subjects had not bathed. In the elderly, however, there were no significant differences in skin temperature with and without prior bathing because they used electric blankets during sleep. After bathing, the young people reported "warmth" in their hands and/or legs, while the elderly more often reported "good sleep" or "quickness of falling asleep". During the first 3 h of sleep, body movements were less frequent after bathing for both the young and the elderly subjects. The results suggest that a bath before sleep enhances the quality of sleep, particularly in the elderly.
Article
Fundamental changes in sleep patterns are associated with normal aging, but disturbed sleep with resultant daytime sleepiness and fatigue is an extremely common occurrence among older persons and a frequent catalyst for physician visits. Sleep disorders result from multiple factors--including pharmacologic, physiologic, biologic, and behavioral--and can be mildly debilitating or life-threatening. Diagnosis includes consideration of the presence of physical or mental illness, drug and/or alcohol use or abuse, a primary sleep disorder such as sleep-disordered breathing or periodic limb movements during sleep, changes in circadian rhythms, or poor sleep hygiene. Despite a high rate of use, hypnotics are best suited for periodic rather than chronic sleep disorder symptoms and, in general, should be used only after adjustments in sleep hygiene prove unsuccessful as first-line therapy.
Article
This study was the first nationwide population-based study to estimate the prevalence rates of sleep disturbance and hypnotic medication use in the general Japanese adult population. In 1997, 2,800 Japanese adults aged 20 years and over were randomly selected from the 1995 Census and 1,871 were examined using the Pittsburgh Sleep Quality Index. The respective estimated overall prevalences of insomnia (INS), difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), poor perceived quality of sleep (PQS) and hypnotic medication use (HMU) were 17.3%, 8.6%, 12.9%, 17.8%, and 3.5% in males and 21.5%, 12.6%, 16.2%, 20.2% and 5.4% in females. Among males, DIS (OR = 2.76) and PQS (OR = 2.12) were associated with never having married. DMS was associated with being 60 years and older (OR = 2.68) or divorced/separated (OR = 3.74). Among females, DMS was associated with being widowed (OR = 1.65), unemployed (OR = 1.60), 40 to 59 years old (OR = 0.57) or never having married (OR = 0.39). DIS was associated with being widowed (OR = 1.67) or unemployed (OR = 1.58). HMU was associated with advancing age (OR = 8.26-10.7), being widowed (OR = 2.12) or never having married (OR = 2.84). PQS was associated with advancing age (OR = 0.63-0.50). Our study showed sleep disturbance and hypnotic medication use were prevalent among Japanese adults and some sociodemographic factors contributed to them.
Article
The purpose of this meta-analysis was to determine the magnitude of change over the adult life span in four key sleep characteristics and to explore research design features that may account for variability in reported age-related sleep change. Forty-one published studies (combined N = 3293) provided 99 correlational effect sizes. Waking frequency and duration increased with age as previously concluded by narrative reviewers. Although narrative reviewers were less certain whether nighttime sleep amount or the ability to initiate sleep decreased with age, the meta-analysis suggested that both decreased. When sleep variables were measured by polysomnography rather than self-report, larger age-related changes were found. Few researchers who studied normal sleep controlled for important health moderators or studied women.
Article
Current knowledge of the population's sleep durations emanates primarily from questionnaires and laboratory studies. Using Actillumes, we investigated whether self-reported sleep durations were indicative of a population decline in sleep duration. We also explored illumination and activity patterns. San Diego adults (n = 273, age range: 40-64) were recruited through random telephone calls and were monitored at home while engaging in usual daily routines. Volunteers slept an average of 6.22 hours and received an average of 554 lux (environmental illumination). The timing of sleep, illumination, and activity occurred at 2:44, 12:57, and 13:43, respectively. Irrespective of ethnicity, age, and time reference, men received greater illumination than did women, but this gender effect was not independent of work status. Women and men exhibited a similar circadian activity profile; however, women exhibited better sleep-wake patterns. Interactions between gender and ethnicity suggested worse sleep-wake patterns among minority men. An age-related decline in activity was found, but no age trend in sleep duration or illumination patterns was observed. This study showed an objective population decline in sleep duration. Sociodemographic effects should be considered in analyses of sleep-wake patterns and illumination exposures.
Article
The circadian pacemaker and sleep homeostasis play pivotal roles in vigilance state control. It has been hypothesized that age-related changes in the human circadian pacemaker, as well as sleep homeostatic mechanisms, contribute to the hallmarks of age-related changes in sleep, that is, earlier wake time and reduced sleep consolidation. Assessments of circadian parameters in healthy young (approximately 20-30 years old) and older people (approximately 65-75 years old)--in the absence of the confounding effects of sleep, changes in posture, and light exposure--have demonstrated that an earlier wake time in older people is accompanied by about a 1 h advance of the rhythms of core body temperature and melatonin. In addition, older people wake up at an earlier circadian phase of the body temperature and plasma melatonin rhythm. The amplitude of the endogenous circadian component of the core body temperature rhythm assessed during constant routine and forced desynchrony protocols is reduced by 20-30% in older people. Recent assessments of the intrinsic period of the human circadian pacemaker in the absence of the confounding effects of light revealed no age-related reduction of this parameter in both sighted and blind individuals. Wake maintenance and sleep initiation are not markedly affected by age except that sleep latencies are longer in older people when sleep initiation is attempted in the early morning. In contrast, major age-related reductions in the consolidation and duration of sleep occur at all circadian phases. Sleep of older people is particularly disrupted when scheduled on the rising limb of the temperature rhythm, indicating that the sleep of older people is more susceptible to arousal signals generated by the circadian pacemaker. Sleep-homeostatic mechanisms, as assayed by the sleep-deprivation-induced increase of EEG slow-wave activity (SWA), are operative in older people, although during both baseline sleep and recovery sleep SWA in older people remains at lower levels. The internal circadian phase advance of awakening, as well as the age-related reduction in sleep consolidation, appears related to an age-related reduction in the promotion of sleep by the circadian pacemaker during the biological night in combination with a reduced homeostatic pressure for sleep. Early morning light exposure associated with this advance of awakening in older people could reinforce the advanced circadian phase. Quantification of the interaction between sleep homeostasis and circadian rhythmicity contributes to understanding age-related changes in sleep timing and quality.
Article
The effects of daily bathing and hot footbath (immersion of feet in hot water) in winter on the sleep behavior of nine healthy female volunteers were studied. Subjects were assigned to three sleep conditions: sleep after bathing (Condition B), sleep after hot footbath (Condition F), and sleep without either treatment (Control). Polysomnograms (consisting of electroencephalograph, electrooculograph, and electromyograph) were obtained, and body movements during sleep were measured while monitoring both the rectal and skin temperatures of subjects. In addition, subjective sleep sensations were obtained with a questionnaire answered immediately by the subjects on awakening. The rectal temperature increased by approximately 1.0 degree C under Condition B, but this elevation was not observed under Condition F compared with Control. In contrast, the respective increases in the mean skin temperature of participants subjected to bathing and hot footbath were greater than those of Control, although these temperature differences became negligible 2 h after subjects went to bed. The sleep onset latency was shortened under both conditions compared with Control. Body movements during the first 30 min of sleep in Control were greater than under the other conditions. Rapid eye movement (REM) sleep decreased under Condition B compared with Condition F, and stage 3 was greater under the latter condition compared with Control. As such, the subjective sleep sensations were better under the two treatment conditions. These results suggest that both daily bathing and hot footbath before sleeping facilitates earlier sleep onset. A hot footbath is especially recommendable for the handicapped, elderly, and disabled, who are unable to enjoy regular baths easily and safely.
Article
Although primary studies suggest that ability to initiate sleep declines as people age, no systematic literature review has addressed the age(s) at which adults experience the greatest change in their ability to initiate sleep. To explore whether there are any points in time across the adult life span when the rate of change in ability to initiate sleep increases or decreases. Mathematical modeling was used to generate data points from information about central tendency, variance, and correlations between age and time to sleep onset provided by seven research reports. The reports represent 258 subjects ages 17 to 91 years. Smoothing splines were used to identify inflection points suggestive of major changes in sleep initiation across the life span. Two mathematical models were generated. One model suggested that inflection points may exist around ages 30 and 50 years, respectively. With this model, the amount of time until sleep onset increased until the age of 30 years, but was unchanged from ages 30 to 50 years. Ability to initiate sleep appeared to decline steadily after the age of 50 years. The second model, with a p value of 0.05, lacked adequate power to identify a significant nonlinear trend. Decline in ability to initiate sleep may not occur at a steady rate over the adult life span. Further research is needed to pinpoint thresholds of change and possible gender differences in thresholds.
Article
The incidence of disturbed sleep is strongly increased in healthy and demented elderly. Age-related alterations in the circadian timing system appear to contribute strongly to these problems. With increasing age, a lack of input to the suprachiasmatic nucleus (SCN), the biological clock of the brain, may accelerate de-activation of neurons involved in the generation of 24-h rhythm or output of this rhythm. This process appears to be reversible, since supplementation of stimuli that impinge on the SCN can re-activate these neurons and ameliorate disturbances in the sleep-wake rhythm.
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