A Preliminary Evaluation of the Physiological Mechanisms of Action for Sleep Restriction Therapy

Article (PDF Available) · November 2013with16 Reads
DOI: 10.1155/2013/726372 · Source: PubMed
Our objective was to investigate the physiological mechanisms involved in the sleep restriction treatment of insomnia. A multiple baseline across subjects design was used. Sleep of five participants suffering from insomnia was assessed throughout the experimentation by sleep diaries and actigraphy. Ten nights of polysomnography were conducted over five occasions. The first two-night assessment served to screen for sleep disorders and to establish a baseline for dependent measures. Three assessments were undertaken across the treatment interval, with the fifth and last one coming at follow-up. Daily cortisol assays were obtained. Sleep restriction therapy was applied in-lab for the first two nights of treatment and was subsequently supervised weekly. Interrupted time series analyses were computed on sleep diary data and showed a significantly decreased wake time, increased sleep efficiency, and decreased total sleep time. Sleepiness at night seems positively related to sleep variables, polysomnography data suggest objective changes mainly for stage 2, and power spectral analysis shows a decrease in beta-1 and -2 powers for the second night of treatment. Cortisol levels seem to be lower during treatment. These preliminary results confirm part of the proposed physiological mechanisms and suggest that sleep restriction contributes to a rapid decrease in hyperarousal insomnia.

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Available from: Celyne Bastien, Feb 18, 2014
    • "Rodenbeck and colleagues [13] reported a significant reduction in night time plasma cortisol secretion after three weeks of Doxepin compared to placebo in a crossover study with 10 insomnia patients. Another, study (n = 5) reported reduced salivary cortisol levels during Sleep Restriction Therapy (SRT: a standalone behavioural component of overall CBT for insomnia), suggesting that behavioural treatment, may also alter cortisol concentrations [14]. Both studies attributed changes to reduced HPA-axis activation. "
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: The aim of this preliminary study was to evaluate if Sleep Restriction Therapy for insomnia is associated with modifications to physiological arousal, indexed through overnight measures of plasma cortisol concentrations and core body temperature. Methods: In a pre-to-post open label study design, eleven patients with chronic and severe Psychophysiological Insomnia underwent 5 weeks of Sleep Restriction Therapy. Results: Eight (73%) patients out of 11 consented completed therapy and showed a decrease in insomnia severity pre-to-post treatment (mean (SD): 18.1 (2.8) versus 8.4 (4.8); p = .001). Six patients were analyzed with pre-to-post overnight measures of temperature and cortisol. Contrary to our hypothesis, significantly higher levels of plasma cortisol concentrations were found during the early morning at post-treatment compared to baseline (p < .01), while no change was observed in the pre-sleep phase or early part of the night. Core body temperature during sleep was however reduced significantly (overall mean [95% CI]: 36.54 (°C) [36.3, 36.8] versus 36.45 [36.2, 36.7]; p < .05). Conclusions: Sleep Restriction Therapy therefore was associated with increased early morning cortisol concentrations and decreased core body temperature, supporting the premise of physiological changes in functioning after effective therapy. Future work should evaluate change in physiological variables associated with clinical treatment response. Trial registration: Australian New Zealand Clinical Trials Registry ANZCTR 12612000049875.
    Full-text · Article · Dec 2015
    • "In fact, with a population sleeping by night, TST is expected to diminish in the first weeks of treatment and increase again later after treatment [31,52]. Furthermore, although sleepiness is a known side effect of sleep restriction [30,31,52], nearly all our participants improved on sleepiness. Taken together, these results suggest that insomnia responds faster to sleep restriction therapy in SWD than in day workers. "
    [Show abstract] [Hide abstract] ABSTRACT: About 30% of Canadian workers are on shift work schedules, and 8% to 32% of them suffer from Shift Work Disorder (SWD). Only a few behavioural treatments exist to treat this population. This study explores the efficacy and feasibility of sleep restriction therapy for insomnia in a group of night shift workers. Six participants (3 women) meeting SWD criteria were recruited. Mean age was 45.7 years old (SD=8.2). A multiple baseline design was used. After baseline, each participant received six to eight weekly treatment sessions. They completed several self reported questionnaires and a daily sleep diary throughout the study. For each sleep period, sleep variables were calculated from the sleep diary. Two participants had a high treatment response and all others participants had a moderate response. Moreover, all participants presented at least two significant clinical improvements. Five participants presented a decreased in both sleepiness scores. The study suggests that sleep restriction therapy is effective, feasible, and reliable. Sleep restriction therapy for insomnia could improve sleep and diminish sleepiness in shift workers suffering from SWD. The present study opens new possibilities of treatment for shift workers that deserve greater attention in the future.
    Full-text · Article · Jan 2015
  • [Show abstract] [Hide abstract] ABSTRACT: In this article, the effect of sleep and sleep disorders on endocrine function and the influence of endocrine abnormalities on sleep are discussed. Sleep disruption and its associated endocrine consequences in the critically ill patient are also reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.
    Article · Jul 2015
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