Article

Effects of different mattresses on sleep quality in healthy subjects: An actigraphic study

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Abstract

The purpose of this study was to verify whether different technological solutions for mattresses had different effects on sleep quality. To this end, 16 healthy volunteers tested a latex mattress and 16 healthy participants tested an independent spring mattress. Sleep quality was assessed before and after introducing new mattresses both objectively and subjectively by means of actigraphy and Mini Sleep Questionnaire (MSQ), respectively. Both kinds of mattress led to a significant improvement in several actigraphic sleep parameters: sleep efficiency, sleep onset latency and motor activity. On the contrary, no significant improvement in subjective sleep quality was detected. The use of both kinds of mattress is associated with an improvement in objective sleep quality. Future studies should investigate if sleep quality improvement is merely due to the introduction of a new mattress or prevalently to the technological features of the mattress.

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... A nine-zone latex mattress and a seven-zone independent spring mattress were assessed by means of actigraphy and Mini Sleep Questionnaire. 16 As the research on mattresses is deepened, different technological solutions to evaluate and/or improve sleep quality have been proposed regularly. Haex et al. 17 measured spinal distortion lying on a lateral and a posterior recumbency, comparing with an upright posture. ...
... 7,10,14,19,20 Recently, advanced apparatus and methods, such as polysomnography and actigraphy, were introduced to study sleep quality. 2,16 Moreover, many novel approaches were proposed and developed to investigate the effect of mattresses on spinal curvature, for example, using point distribution models to describe three-dimensional (3D) spinal deformations. Ninety-seven percent of the variations could be explained just with three mode shapes. ...
Article
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This article presents a method to predict and assess the interaction between a human body and a spring mattress. A three-layer artificial neural network model was developed to simulate and predict an indentation curve of human spine, characterized with the depth of lumbar lordosis and four inclination angles: cervicothoracic, thoracolumbar, lumbosacral and the back-hip (β). By comparing the spinal indentation curves described by the optimal evaluation parameters (depth of lumbar lordosis, cervicothoracic, thoracolumbar and lumbosacral), a better design of five-zone spring mattresses was obtained for individuals to have an effective support to the main part of the body. Using such approach, an operating process was further introduced, in which appropriate stiffness proportions were proposed to design mattress for the normal body types of Chinese young women. Finally, case studies were undertaken, which show that the method developed is feasible and practical.
... In a few studies, a thermal controlling device was applied to the developed mattress to improve the sleep quality of the users [28][29][30][31]; others studies have determined the relation between sleep quality and the rigidity of a mattress [27,32,33]. Furthermore, several studies have varied the materials used to design the mattress and have modified its structure [34][35][36]. Some studies investigated users' preferences on mattresses, where Kim et al. proposed a methodology for finding the appropriate hardness based on various analyzes that measure the users' experiences with mattresses and found their preferences to different types of mattress comfort were consistent with the outcomes using their methodology [37]. ...
... This result indicates that the length and sleep quality assumed by the participants could differ from the practical experience they had. Tonetti et al. conducted an objective sleep evaluation using actigraphic parameters and subjective sleep evaluation using MSQ questionnaire on spring mattresses and their proposed latex mattresses [34]. The study showed a discrepancy between the subjective and objective sleep evaluations. ...
Article
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Several studies, wherein the structure or rigidity of a mattress was varied, have been conducted to improve sleep quality. These studies investigated the effect of variation in the surface characteristics of mattresses on sleep quality. The present study developed a mattress whose rigidity can be varied by controlling the amount of air in its air cells. To investigate the effect of the variable rigidity of the air mattress on sleep quality, participants (Male, Age: 23.9 ± 2.74, BMI: 23.3 ± 1.60) were instructed to sleep on the air mattress under different conditions, and their sleep quality was subjectively and objectively investigated. Subjectively, sleep quality is assessed based on the participants’ evaluations of the depth and length of their sleep. Objectively, sleep is estimated using the sleep stage information obtained by analysing the movements and brain waves of the participants during their sleep. A subjective assessment of the sleep quality demonstrates that the participants’ sleep was worse with the adjustment of the air mattress than that without; however, the objective sleep quality results demonstrates an improvement in the sleep quality when the rigidity of the air mattress is varied based on the participant’s preference. This paper proposes a design for mattresses that can result in more efficient sleep than that provided by traditional mattresses.
... Human beings usually spend around a third of their lifetime sleeping [1], even though this enables individuals to satisfactorily exploit the remaining two-thirds of the day only if sleep was free from disturbances or interruptions. In the past years, an increasing number of people have been complaining of sleep disorders [2]. ...
Article
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Energy spent during daily activities is recuperated by humans through sleep, ensuring optimal performance on the following day. Sleep disturbances are common: a meta-analysis on sleep quality showed that 15-30% of adults report sleep disorders, such as sleep onset latency (SOL), insufficient duration of sleep and frequently waking up at night. Low back pain (LBP) has been identified as one of the main causes of poor sleep quality. Literature findings are discordant on the type of mattress that might prevent onset of back pain, resulting in an improved quality of sleep. We conducted a systematic literature review of articles published until 2019, investigating the association of different mattresses with sleep quality and low back pain. Based on examined studies, mattresses were classified according to the European Committee for Standardization (2000) as: soft, medium-firm, extra-firm or mattresses customized for patients affected by supine decubitus. A total of 39 qualified articles have been included in the current systematic review. Results of this systematic review show that a medium-firm mattress promotes comfort, sleep quality and rachis alignment.
... In a different study, it was suggested that medium-firmed and custom inflated mattresses promote comfortable and quality sleep and aid in spinal alignment ( Radwan et al., 2015). Tonetti, Martoni and Natale (2011) supported this claim but were inconclusive on the effect of latex and independent spring mattresses on subjective sleep quality. ...
Article
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Patients are continually denied health care due to the shortages of hospital beds. Others are unnecessarily referred resulting in delays of care and the development of complications. In addition, some hospital beds are in a poor state and negatively impacting healthcare. This study; therefore, seeks to determine the overall comfortability of hospital beds to patients and the effects of bed shortages on patients. Furthermore, to define occupied beds without linens within a day and to find out the contribution of hospital beds and beddings to cross infection. The study involves the use of descriptive cross-sectional study design. The study population consisted of three hundred inpatients from three selected hospitals in the Ashanti region of Ghana. Thirteen clusters were randomly selected from eighteen clusters (wards). Simple random sampling technique was further used to select at most fifteen subjects from each of the thirteen clusters to make a sample size of 177. Data were collected in the year 2017. Major findings include; 29.4% of occupied beds were without linens and only 9.6% of subjects were very comfortable lying in the hospital beds. Just 10.7% of patients have experienced floor nursing and 30.5% of patients were unnecessarily referred. Subjects prematurely discharged accounted for 31.6% and 42.4% of respondents were cross-infected. In conclusion, hospital beds and beddings contribute to high levels of hospital-acquired infections and subject patients to various degrees of discomfort. Also, unavailability of hospital beds compounds the problem of floor nursing, unnecessary referrals and premature discharge from hospitals.
... Although the relationship between biomechanics and sleep-associated musculoskeletal problems has been recognized, most mattress evaluations pertain to the use of insecure techniques such as subjective feedback or questionnaires (Tonetti, Martoni & Natale, 2011;Verhaert et al., 2011b). The subjective responses gathered from questionnaires may change after an adaptation period (Liu, Lee & Liang, 2011), and the outcome of subjective comfort evaluation is argued to be easily manipulable based on manufacturer demands because of the highly diverse and vague definition of "comfort" (Wu, Yuan & Li, 2018). ...
Article
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Background Sleeping mattress parameters significantly influence sleeping comfort and health, as reflected by the extensive investigations of sleeping support biomechanics to prevent sleep-related musculoskeletal problems. Methodology Herein, we review the current trends, research methodologies, and determinants of mattress biomechanics research, summarizing evidence published since 2008. In particular, we scrutinize 18 articles dealing with the development of new designs, recommendation criteria, instruments/methods of spine alignment evaluation, and comparative evaluation of different designs. Results The review demonstrated that mattress designs have strived for customization, regional features, and real-time active control to adapt to the biomechanical features of different body builds and postures. However, the suggested threshold or target values for desirable spine alignment and body pressure distribution during sleep cannot yet be justified in view of the lack of sufficient evidence. Conclusions It is necessary to formulate standard objectives and protocols for carrying out mattress evaluation.
... In addition, variations in weight and height can affect perceptions of comfort [28]. However, the current state of knowledge does not allow specifying the mattress characteristics that are likely to promote sleep in the elderly [29][30][31]. ...
Article
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The aim of this study was to draw a portrait of the sleep environment of elderly persons living in private households and to determine its relationship with the presence of insomnia. A sample of 599 individuals aged 70 years and older responded to questions about the comfort of their pillow and mattress and the noise level and brightness of their bedroom at night and in the morning. They were also asked whether or not they shared their bed or bedroom with a sleep partner. The Insomnia Severity Index was used to assess insomnia severity. Over 40% of the study participants were using a pillow that was not very comfortable, and almost 30% said that their bedroom was not completely quiet. Binomial logistic regression results revealed that two variables were significantly associated with insomnia symptoms: a pillow rated as moderately comfortable to very uncomfortable and a bedroom that was not completely quiet. No other sleep environment characteristics considered in this study were associated with the risk of insomnia. These results indicate that a nonnegligible proportion of the elderly population endures a suboptimal sleep environment. Although it is difficult to predict the real impact of changes to the sleep environment, this study supports the proposal that simple, minor changes to the bedroom can promote sleep in the elderly.
... The corresponding figure for poor pillow was about 25%. These findings are in line with studies emphasizing the importance of bed and bed accessories for sleep (Gordon & Grimmer-Somers, 2011;Lee & Park, 2006;Tonetti, Martoni, & Natale, 2011). It is interesting that poor pillow was reported as a more frequently disturbing factor than both mattress and duvet/ bedding -especially when this factor probably is less costly and easier to improve/alter than the two latter factors.. ...
Article
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The aim of the present study was to investigate how hotel guests sleep and the factors that typically disturb sleep when staying in hotels. A total of 2504 respondents for the survey were recruited through a link in a national online newspaper. They were asked to provide information about demographics, how they slept in hotels, factors disturbing sleep in hotels and how sleep typically developed with length of stay in hotels. On average, the respondents reported sleeping somewhat less well in hotels than at home. Males, younger people and people suffering from insomnia reported better sleep in hotels than did females, older people and subjects not suffering from insomnia, respectively. The factor which most frequently disturbed sleep in hotels was poor pillows, followed by high room temperature, poor mattress, poor duvet, noise from the street, poor indoor climate, too much daylight from the windows and noise from the ventilation system. Nearly 50% of the respondents reported that sleep usually improved with length of stay, whereas only 8.4% reported that sleep deteriorated with length of stay. The results point to several factors which could be altered by simple means and thereby improve sleep in hotels. The present study is the first large-scale survey that investigates how hotel guests in general experience sleep in hotels.
... It was highlighted that 7 % of sleep problems were related to an uncomfortable mattress (Addison et al., 1987). Few studies disclosed that the mattress could not affect sleep quality (Okamoto et al., 1997; Scharf et al., 1997; Okamoto et al., 1998; Bader and Engdal, 2000; Tonettik et al., 2011). However, a few recent studies have highlighted the fact that mattress could improve sleep quality in healthy people (Jacobson et al., 2006; Lee and Park, 2006; Jacobson et al., 2008). ...
Conference Paper
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Sleeping environment can have a significant influence on sleep quality. Sleeping on the incorrect mattress can cause lot of health problems and affects comfort. The mattress with extra firmness or softness does not allow the sleepers muscle to rest. This study developed a methodology to evaluate compatibility between human and mattress firmness using an electromyogram (EMG). Two mattresses were considered (spring and tempur mattress) with different firmness. Ten healthy participants were tested (age: 31.70 ± 2.19 years; height: 170.90 ± 7.90 cm; weight: 70.60 ± 13.95 kg) on each mattress when lying supine and turning to their right for ten times. The EMG activities (RMS) were measured from eight different muscles (right side cervical paraspinal, right and left side upper trapezius, right and left side latissimus dorsi, right and left side lumbar erector spinae, and right side gastrocnemius lateral). Subjective rating was also collected from the participants. The RMS results showed significantly lower muscle activities when subject tossing and turning to their right on the spring mattress than tempur mattress. Spring mattress provided significantly greater relaxation on subjective rating. This methodology can be used to evaluate different mattress compatibility with various material properties.
... Email: lorenzo.tonetti2@unibo.it Biological Rhythm Research Vol. 42, No. 3, June 2011, 247-254 ISSN (Jacobson et al. 2006;Lee and Park 2006;Jacobson et al. 2008;Jacobson et al. 2009;Tonetti et al. forthcoming). The results of these studies are hardly comparable because different types of mattress were examined and different tools were used in order to determine the effect of the mattress on sleep quality: polysomnography (PSG) (Suckling et al. 1957;Rosekind et al. 1976;Okamoto et al. 1997;Scharf et al. 1997;Okamoto et al. 1998;Bader and Engdal 2000;Lee and Park 2006), actigraphy (Tonetti et al. forthcoming) and questionnaires (Jacobson et al. 2006(Jacobson et al. , 2008(Jacobson et al. , 2009. ...
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The introduction of new mattresses with innovative technology has led to a significant improvement in objective sleep quality. We aimed to explore whether this improvement in sleep quality was merely due to the introduction of a new mattress regardless of the innovative level of its technological features. Twenty-eight healthy volunteers tested a standard technology mattress (traditional spring mattress) and a new technology mattress in expanded polyurethane and visco-elastic (Myform®). Sleep quality was assessed before and after introducing the new mattresses, objectively (through actigraphy) and subjectively (through the Mini Sleep Questionnaire). Myform® led to a significant improvement in actigraphic sleep parameters of sleep onset latency and sleep efficiency. Therefore it is not enough to introduce a new mattress with any technology in order to determine a significant objective sleep quality improvement; the innovative technological features of the mattress seem to be fundamental.
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This study aimed to evaluate the effect of a new mattress on sleep quality, perceived pain and recovery, and physical performance in top-level athletes. Twenty-five volleyball players were randomized to either an intervention group (INT, n = 13) or a control group (CON, n = 12). Sleep data were collected by actigraphy and Pittsburgh Sleep Quality Index (PSQI), perceived pain was evaluated by the Numeric Rating Scale (NRS), perceived recovery with the Total Quality Recovery scale (TQR), and physical performance with the Counter Movement Jump (CMJ) and Reaction Time (RT) tests. All evaluations were carried out during the competitive season at baseline condition (PRE) and four weeks later (POST). All actigraph parameters, PSQI, and NRS values improved for INT but not for CON while no differences were observed in CMJ and RT for both groups. TQR was higher for INT at POST compared to CON. A 4-weeks use of high-quality mattress could be beneficial for players’ sleep, pain, and recovery.
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A secondary analysis of longitudinal and cohort studies was carried out to quantitatively investigate the motor activity pattern, recorded through actigraphy, during the first six hours of nocturnal sleep. The first study was of longitudinal nature. Ten healthy participants (four females) were monitored three times, at baseline (T1) when they were infants (mean age 7.10 ± 0.32 months), at the first follow-up examination (T2) around 4 months later (mean age 11.20 ± 0.63 months) and at the second follow-up (T3) around three years later, when they were preschoolers (mean age 4.68 ± 0.14 years). At T1, T2 and T3 each participant wore the actigraph Basic Mini-Motionlogger (Ambulatory Monitoring, Inc., Ardsley, NY, USA) over at least two consecutive nycthemeral cycles, with the aim to measure the mean hourly motor activity count. Seven- and 11-month-old infants had a higher level of motor activity over the night compared to preschoolers. Furthermore, motor activity increased as the night progressed, with a pronounced increment at both T1 and T2, while at T3 such an increase was less marked. The second study was cross-sectional and aimed to explore the motor activity pattern, using actigraphy, during the first six hours of nocturnal sleep in multiple-age healthy groups, from infancy to adulthood. We assigned participants to eight groups according to age: 20 (five females) aged around 10 months old (mean age 10.65 ± 0.67 months); 13 (nine females) aged around 4 years (mean age 4.38 ± 0.51 years); 21 (10 females) aged around 10 years (mean age 9.67 ± 0.91 years); 21 (nine females) aged around 20 years (mean age 19.33 ± 2.44 years); 20 (10 females) aged around 30 years (mean age 29.80 ± 1.99 years); 20 (15 females) aged around 40 years (mean age 40.70 ± 1.26 years); 20 (11 females) aged around 50 years (mean age 50.15 ± 2.80 years) and 20 (nine females) aged around 60 years (mean age 59.25 ± 3.23 years). The participants aged between 10 and 60 years wore the actigraph Basic Mini-Motionlogger over seven consecutive nycthemeral cycles (infants and preschoolers wore the actigraph over at least two consecutive nycthemeral cycles), with the aim to measure the mean hourly motor activity count. The results indicated a significantly higher motor activity count in 10-month-old infants compared to all the remaining age groups. Moreover, the pattern of motor activity of 10-month-old infants was different from that of all other groups, with the highest motor activity counts from the second to the sixth hour of sleep. Considered as a whole, the results of both studies converge regarding the high motor activity detected among infants, which could be explained by the presence of a maturational process that has not yet been fully completed at this stage of life. In both studies, only the motor activity of infants was above the cutoff level established for normal adults, highlighting the need to establish a specific cutoff value for infants.
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A significant number of US citizens lack appropriate sleep for several reasons. Back pain has been identified as possible cause for inappropriate sleep in adults. Previously, the quality of mattresses and bedding systems has been correlated to the pain perceived by individuals. However, there is controversy in the literature regarding the type and characteristics of a mattress that best serve the purpose of decreasing spinal pain, and improving spinal alignment and quality of sleep. This study gathered the best available evidence in the literature related to this matter through conducting a systematic review of controlled trials that were published since the year of 2000. In those trials, mattresses were subjectively identified as soft, medium firm, firm, or custom inflated. Articles examining the effect of temperature alterations of mattresses on promoting sleep quality and reducing pain were included as well. Twenty-four articles qualified for inclusion into this systematic review. The methodological quality of the reviewed clinical trials was deemed moderate to high according to the PEDro scale. Results of this systematic review show that a mattress that is subjectively identified as a medium-firm mattress and is custom inflated (self-adjusted) is optimal for promoting sleep comfort, quality, and spinal alignment. Evidence is not sufficient yet regarding the appropriate temperature of the optimum mattress; however, warm temperature has been recommended by authors.
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Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its clinical value.
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Article
Background Actigraphy is increasingly used in sleep research and the clinical care of patients with sleep and circadian rhythm abnormalities. The following practice parameters update the previous practice parameters published in 2003 for the use of actigraphy in the study of sleep and circadian rhythms. Methods Based upon a systematic grading of evidence, members of the Standards of Practice Committee, including those with expertise in the use of actigraphy, developed these practice parameters as a guide to the appropriate use of actigraphy, both as a diagnostic tool in the evaluation of sleep disorders and as an outcome measure of treatment efficacy in clinical settings with appropriate patient populations. Recommendations Actigraphy provides an acceptably accurate estimate of sleep patterns in normal, healthy adult populations and inpatients suspected of certain sleep disorders. More specifically, actigraphy is indicated to assist in the evaluation of patients with advanced sleep phase syndrome (ASPS), delayed sleep phase syndrome (DSPS), and shift work disorder. Additionally, there is some evidence to support the use of actigraphy in the evaluation of patients suspected of jet lag disorder and non-24hr sleep/wake syndrome (including that associated with blindness). When polysomnography is not available, actigraphy is indicated to estimate total sleep time in patients with obstructive sleep apnea. In patients with insomnia and hypersomnia, there is evidence to support the use of actigraphy in the characterization of circadian rhythms and sleep patterns/disturbances. In assessing response to therapy, actigraphy has proven useful as an outcome measure in patients with circadian rhythm disorders and insomnia. In older adults (including older nursing home residents), in whom traditional sleep monitoring can be difficult, actigraphy is indicated for characterizing sleep and circadian patterns and to document treatment responses. Similarly, in normal infants and children, as well as special pediatric populations, actigraphy has proven useful for delineating sleep patterns and documenting treatment responses. Conclusions Recent research utilizing actigraphy in the assessment and management of sleep disorders has allowed the development of evidence-based recommendations for the use of actigraphy in the clinical setting. Additional research is warranted to further refine and broaden its clinical value.
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Information concerning the stages of sleep is one of the most important clues for determining the quality of a particular mattress. The purpose of this study was to determine the effects of mattress type on sleep quality by measuring skin temperature, by using a subjective mattress rating system, and through the use of Polysomnogram. Polysomnography involved the recording of brain waves through electroencephalography (EEG) and the generation of a video graphic record of eye movement (EOG), chin movements (EMG) and heart rhythm (ECG). Sixteen subjects were used in this study, which was a test of mattress comfort. Subjects spent 6 days and nights in the laboratory. Data was recorded for a period of 7 h for each of 3 nights. It was found that mean skin temperature, deep sleep (stage III and stage IV), sleep efficiency, wake after sleep onset (WASO), stage 1 and subjective ratings of mattress comfort were significantly affected according to mattress type. When subjects slept on “comfortable” mattresses, mean skin temperature was higher than for “uncomfortable” mattresses. Lower body skin temperature, sleep efficiency and percentage of deep sleep were higher as well. The percentages of WASO and stage 1 were lower when subjects slept on “comfortable” mattresses. Subjective ratings of sleep quality paralleled recorded sleep data.
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To compare personal and new bedding systems between subjects with reported high and low base line sleep quality. A convenience sample of healthy subjects (women = 30; men = 29) with no clinical history of disturbed sleep participated in the study. Subjects recorded perceived back discomfort and stiffness, sleep quality and comfort, and sleep efficiency upon waking for 28 consecutive days in their own beds (baseline) and for 28 consecutive days (post) on a new bedding system. Repeated measures analysis of variance was used to treat sleep data. Analysis revealed significant differences between pre- and post means in all areas for both high and low sleep quality groups. Analysis of sleep efficiency also yielded significant differences between, but not among pre- and post means. Improvement of sleep comfort and quality became more prominent with time (from wk 1 to 4 post observation). Similar significant benefits of new, medium- firm bedding systems can occur for those reporting both good and poor current sleep quality and variables such as age, weight, height, and body mass index are independent of such improvements.
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The purpose of this study was to develop and validate automatic scoring methods to distinguish sleep from wakefulness based on wrist activity. Forty-one subjects (18 normals and 23 with sleep or psychiatric disorders) wore a wrist actigraph during overnight polysomnography. In a randomly selected subsample of 20 subjects, candidate sleep/wake prediction algorithms were iteratively optimized against standard sleep/wake scores. The optimal algorithms obtained for various data collection epoch lengths were then prospectively tested on the remaining 21 subjects. The final algorithms correctly distinguished sleep from wakefulness approximately 88% of the time. Actigraphic sleep percentage and sleep latency estimates correlated 0.82 and 0.90, respectively, with corresponding parameters scored from the polysomnogram (p < 0.0001). Automatic scoring of wrist activity provides valuable information about sleep and wakefulness that could be useful in both clinical and research applications.
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A self-administered questionary (the General Health Questionnaire) aimed at detecting current psychiatric disturbance was given to 553 consecutive attenders to a general practitioner's surgery. A sample of 200 of these patients was given an independent assessment of their mental state by a psychiatrist using a standardized psychiatric interview. Over 90% of the patients were correctly classified as "well" or "ill" by the questionary, and the correlation between questionary score and the clinical assessment of severity of disturbance was found to be +0.80.The "conspicuous psychiatric morbidity" of a suburban general practice assessed by a general practitioner who was himself a psychiatrist and validated against independent psychiatric assessment was found to be 20%. "Hidden psychiatric morbidity" was found to account for one-third of all disturbed patients. These patients were similar to patients with "conspicuous illnesses" in terms both of degree of disturbance and the course of their illnesses at six-month follow-up, but were distinguished by their attitude to their illness and by usually presenting a physical symptom to the general practitioner.When 87 patients who had been assessed as psychiatric cases at the index consultation were called back for follow-up six months later, two-thirds of them were functioning in the normal range. Frequency of attendance at the surgery in the six months following index consultation was found to have only a modest relationship to severity of psychiatric disturbance.It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.
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In our previous study, an air mattress with three series of air cells with inflation pressure, that was increased/decreased in time interval of 20 min, did not affect sleep quality and quantity, although the relative and absolute humidity inside the bedding was kept significantly higher than that of a Futon. The purpose of this study was to confirm the effects of a newly designed air mattress upon sleep and bed climate. In this newly designed air mattress, the cell series and time interval was reduced. Six healthy female volunteers, aged 18-22, served as subjects. The experiment was carried out under two conditions: using a regular Futon (Futon), and a newly-designed air mattress with the timer and pump activated (Airmat). The room temperature and relative humidity were controlled at 22-23 degrees C and RH 50-60%, respectively. The subjects' sleep was monitored by using an EEG machine and their skin temperatures and bed climates were also measured continuously. Subjective evaluations of bed comfort and sleep were obtained before and after the recording sessions. Sleep onset latency, wake after sleep onset and the sleep efficiency index showed no significant differences between the two conditions. A significant difference was observed in the bed climate of the waist area. The temperature of the waist was lower overall under the Airmat than the Futon, while relative humidity was higher under the Airmat. Absolute humidity also tended to be higher in the Airmat. Sleep evaluation and comfort sensation were good under both conditions. Although sleep was not disturbed and subjective sleep evaluation tended to be better in Airmat, our results indicate that changing the time intervals and cell series until this air mattress level is not effective in decreasing the bed climate humidity.
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The comparative effects of sleep patterns and rates of cyclic alternating patterns (CAP rate) in a high quality innerspring mattress were compared to those on a unique foam support mattress in 10 normal subjects. Results showed no differences in sleep stages, number of wakes, or total sleep time between the two conditions. CAP rates were significantly reduced on the foam surface. CAP rate was sensitive to the first-night effect on both surfaces, but was blunted on the foam mattress.
Article
The purpose of this study was to examine the effects of a truss mattress upon sleep and bed climate. The truss mattress which has been designed to decrease the pressure and bed climate humidity was tested. Six healthy female volunteers with a mean age of 23.3 years, served as subjects. The experiment was carried out under two conditions: a truss mattress (T) and a futon (F) (Japanese bedding). The ambient temperature and relative humidity were controlled at 19-20 degrees C, and RH 50-60% respectively. Sleep was monitored by an EEG machine and the rectal temperature, skin temperature and bed climate were also measured continuously. Subjective evaluations of bed and sleep were obtained before and after the recording sessions. No significant difference was observed in the sleep parameters and time spent in each sleep stage. Rectal temperature was significantly lower in T than F. Although there was no significant difference in bed climate over the T/F, the temperature under T/F was significantly higher in T. No significant difference was observed in subjective sleep evaluation. The subjective feeling of the mattress was significantly warmer in F than T before sleep. These results suggest that although T does not disturb the sleep parameters and the bed climate is maintained at the same level as with F, it may affect rectal temperature which can be due to low thermal insulation.
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We studied the relationship between sleep quality and bed surface firmness. Nine men were investigated, sleeping in their homes for at least 5 consecutive nights on a soft and a more firm mattress using a sensor pad placed under the mattress and a solid-state recording device. The subjective feeling of sleep quality did not always agree with the recorded sleep data. The difference was most marked when changing from the subject's own to one of the test mattresses. For the same subject the results were reproducible between nights provided there were no external disturbing factors. Four of the 9 subjects slept significantly better on the softer of the two mattresses and 2 on the hard mattress. The difference in sleep quality observed among the subjects tested makes it necessary to relate the results to the same person rather than considering a whole group as an entity. The adaptation period for a new sleep surface extended to many days.
Article
In summary, although actigraphy is not as accurate as PSG for determining some sleep measurements, studies are in general agreement that actigraphy, with its ability to record continuously for long time periods, is more reliable than sleep logs which rely on the patients' recall of how many times they woke up or how long they slept during the night and is more reliable than observations which only capture short time periods. Actigraphy can provide information obtainable in no other practical way. It can also have a role in the medical care of patients with sleep disorders. However, it should not be held to the same expectations as polysomnography. Actigraphy is one-dimensional, whereas polysomnography comprises at least 3 distinct types of data (EEG, EOG, EMG), which jointly determine whether a person is asleep or awake. It is therefore doubtful whether actigraphic data will ever be informationally equivalent to the PSG, although progress on hardware and data processing software is continuously being made. Although the 1995 practice parameters paper determined that actigraphy was not appropriate for the diagnosis of sleep disorders, more recent studies suggest that for some disorders, actigraphy may be more practical than PSG. While actigraphy is still not appropriate for the diagnosis of sleep disordered breathing or of periodic limb movements in sleep, it is highly appropriate for examining the sleep variability (i.e., night-to-night variability) in patients with insomnia. Actigraphy is also appropriate for the assessment of and stability of treatment effects of anything from hypnotic drugs to light treatment to CPAP, particularly if assessments are done before and after the start of treatment. A recent independent review of the actigraphy literature by Sadeh and Acebo reached many of these same conclusions. Some of the research studies failed to find relationships between sleep measures and health-related symptoms. The interpretation of these data is also not clear-cut. Is it that the actigraph is not reliable enough to the access the relationship between sleep changes and quality of life measures, or, is it that, in fact, there is no relationship between sleep in that population and quality of life measures? Other studies of sleep disordered breathing, where actigraphy was not used and was not an outcome measure also failed to find any relationship with quality of life. Is it then the actigraph that is not reliable or that the associations just do not exist? The one area where actigraphy can be used for clinical diagnosis is in the evaluation of circadian rhythm disorders. Actigraphy has been shown to be very good for identifying rhythms. Results of actigraphic recordings correlate well with measurements of melatonin and of core body temperature rhythms. Activity records also show sleep disturbance when sleep is attempted at an unfavorable phase of the circadian cycle. Actigraphy therefore would be particularly good for aiding in the diagnosis of delayed or advanced sleep phase syndrome, non-24-hour-sleep syndrome and in the evaluation of sleep disturbances in shift workers. It must be remembered, however, that overt rest-activity rhythms are susceptible to various masking effects, so they may not always show the underlying rhythm of the endogenous circadian pacemaker. In conclusion, the latest set of research articles suggest that in the clinical setting, actigraphy is reliable for evaluating sleep patterns in patients with insomnia, for studying the effect of treatments designed to improve sleep, in the diagnosis of circadian rhythm disorders (including shift work), and in evaluating sleep in individuals who are less likely to tolerate PSG, such as infants and demented elderly. While actigraphy has been used in research studies for many years, up to now, methodological issues had not been systematically addressed in clinical research and practice. Those issues have now been addressed and actigraphy may now be reaching the maturity needed for application in the clinical arena.
Article
The SDQ is a brief self-report insomnia questionnaire, which permits the rapid evaluation of insomnia based on the DSM-IV and ICSD-R criteria. The SDQ was developed to provide a fast and valid instrument both for the pre-screening of subjects who complain of insomnia and for epidemiological studies based on standardized definitions of this sleep disorder. Two studies were carried out in order to assess the validity of the SDQ as a self-report measure of insomnia. In the first study the convergent validity of the SDQ was assessed with respect to the global score of the Pittsburgh Sleep Quality Index (PSQI) in a sample of general practitioners' patients. The second study assessed the sensitivity and the specificity of the SDQ in discriminating between insomniacs or normal sleepers in a sample of college students who were given an extensive sleep evaluation within an insomnia counseling program. The SDQ classifications have a good convergent validity with the global sleep quality scores of the PSQI and its classifications of students who complain of or who do not complain of problems of insomnia have a sensitivity of 95% and a specificity of 87%. Results indicate that the SDQ is a valid paper and pencil instrument to screen insomnia.
Article
The purpose of this study was to compare sleep comfort and quality between personal and new bedding systems. A convenience sample (women, n=33; men, n=29) with no clinical history of disturbed sleep participated in the study. Subjects recorded back and shoulder pain, sleep quality, comfort, and efficiency for 28 days each in their personal beds (pre) and in new medium-firm bedding systems (post). Repeated measures ANOVAs revealed significant improvement between pre- and post-test means for all dependent variables. Furthermore, reduction of pain and stiffness and improvement of sleep comfort and quality became more prominent over time. No significant differences were found for the groupings of age, weight, height, or body mass index. It was found that for the cheapest category of beds, lower back pain was significantly (p<0.01) more prominent than for the medium and higher priced beds. Average bed age was 9.5yrs. It was concluded that new bedding systems can significantly improve selected sleep variables and that continuous sleep quality may be dependent on timely replacement of bedding systems.
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