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A Warm Footbath before Bedtime and Sleep in Older Taiwanese with Sleep Disturbance
Abstract
A single-group crossover design was used to examine the effects of a warm footbath on body temperatures, distal-proximal skin temperature gradient (DPG), and sleep outcomes in 15 Taiwanese elders with self-reported sleep disturbance. Body temperatures and polysomnography were recorded for three consecutive nights. Participants were assigned randomly to receive a 41 degrees C footbath for 40 minutes before sleep onset on night 2 or night 3. Mean DPG before lights off was significantly elevated on the bathing night. There were no significant differences in sleep outcomes between the two nights. However, when the first two non-rapid eye movement (NREM) sleep periods were examined, the amount of wakefulness was decreased in the second NREM period on the bathing night.
... 7 FB expands the blood vessels under the skin, increases blood flow through the capillaries, and enhances the distal-proximal skin temperature gradient, resulting in a temporary improvement in blood circulation, 8,9 systemic arterial stiffness, 10 and sleep quality. 11,12 In addition, foot baths have other health benefits, such as lowering of the heart rate and improvement of body movement. 12,13 However, most researchers have studied FB as a nondrug adjuvant therapy through pathological methods, and only a few studies have investigated the efficacy of FBs from the perspective of functional science imaging and neuroscience. ...
... 11,12 In addition, foot baths have other health benefits, such as lowering of the heart rate and improvement of body movement. 12,13 However, most researchers have studied FB as a nondrug adjuvant therapy through pathological methods, and only a few studies have investigated the efficacy of FBs from the perspective of functional science imaging and neuroscience. Furthermore, studies investigating the underlying mechanism between FB and human cognitive function using functional neuroimaging have been seldom reported, and are valuable and significant for human performance. ...
... All channels in this study showed significant differences, with p values less than 0.05. It can be seen from Fig. 4(a) that the FB stimulation activates the 2, 4, 5, 6,8,9,12,14, and 20 channels of the brain under the contrast resting state. From Fig. 4(b), it can be concluded that during the Stroop task (channels 5,6,8,9), the normal state and the FB stimulation state show significant differences. ...
As a nondrug complementary therapy and healthy leisure physiotherapy method, foot bath (FB) is gaining acceptance and popularity in many areas. The significance of this research is to study the close and complex connection between FB stimulation and the human brain using fNIRS neuroimaging techniques. Participants were placed under two different conditions (normal and foot bath) and instructed to perform Stroop task of color word matching. Research on the behavioral results of the subjects showed that FB can effectively regulate the efficiency of humans in the process of performing tasks in a natural state. The fNIRS findings showed that the PFC in the FB condition was weakly activated compared to the normal condition. FB can realize the natural and healthy regulation of human brain cognitive function, which will have an impact on many production activities in human daily life.
... The transfer of heat from the center to environment impairs by age and impaired vascular changes. 15,18,19 Cardiovascular diseases and hospitalization in cardiac care units create stress and anxiety. 20 This stress stimulates the sympathetic nervous system activity, vasoconstriction, decreased skin temperature of distal and the central extremities, 21 thereby reducing sleep quality and delaying the sleep onset. ...
... 24 Warm footbath can increase peripheral blood flow and may facilitate sleep onset and improve sleep quality. 19,25 So, this study aimed to examine the effect of warm footbath before bedtime on the quality of sleep in patients with Acute Coronary Syndrome in Cardiac Care Unit. ...
... Liao using polysomnography as a tool for sleep quality measurement (the most accurate method of measuring the quality of sleep).15,19 ...
Introduction: This study aimed to determine the effect of warm footbath before bedtime on the quality of sleep on patients with acute Coronary Syndrome in Cardiac Care Unit. Methods: This study was conducted on 120 patients admitted to CCU at Mazandaran Heart Center and randomly divided into two groups of intervention and control. In the intervention group, warm footbath was performed after the second night in hospital before bed time by 41 C water for 20 minutes for three consecutive nights; in contrast, the control group did not receive anything of this sort. The next day, St Mary's Hospital Sleep Questionnaire was completed to evaluate sleep quality. Then, the obtained data were analyzed using SPSS software and Friedman, Wilcoxon exact statistical tests. Results: The quality of sleep in the first night of hospitalization was different from the third night after the intervention in both groups and the improvement process of sleep quality was observed in both groups. Most patients had moderate impairments (23-36), which had not changed during the intervention. In intervention groups, 8 patients had severe sleep disorders (greater than 37), which declined to 1 after three nights of intervention. While, in the control group this number fell from 10 patients with severe sleep disorders to 5. Warm footbath had a great positive impact on patients suffering from severe sleep disorders (P<0.05). Conclusion: Although warm footbath did not improve the quality of sleep in all patients, it reduced the number of patients who had severe sleep disturbances.
... Liao ve ark. (14) ve Liao ve ark. (15) çalışmalarında ise, ayak banyosu uygulanan gece ile uygulanmayan gece polisomonografi sonuçlarında ve uyku kaliteleri arasında anlamlı bir fark olmadığı belirlenmiştir (p>0,05). ...
... Vücut kor ısısı ile uykuya eğilim arasında negatif yönde bir ilişki vardır. Vücut kor ısısı düştüğünde, uykuya geçiş daha kısa sürede olmaktadır (3,14) . Bireylere uygulanan ayak banyosu, damarlarda periferik vazodilatasyona yol açarak, vücut kor ısısını azaltır ve böylece bireylerin uykuya geçiş süresini kısaltarak uyku kalitesini arttırır (15,18) . ...
... İncelenen deneysel çaprazlama çalışmalarda ise polisamonografi sonuçlarında bireylerin uyku kalitesinde bir değişme olmadığı fakat bireylerin sözel olarak daha iyi uyduklarını söyledikleri belirtilmektedir (13)(14)(15) . Bu konu ile ilgili olarak Morin ve ark.'nın (17) yaptıkları çalışmada, uygulanan nonfarmakolojik uygulamalar sonucunda bireylerin uyku kalitesinde değişiklik olmadığı fakat uykuya daldıktan sonra uyanma sürelerinde azalma olduğu polisomografik sonuçlarla belirlenmiştir. ...
... Among the factors, CFB had the most significant impact, while the effect of HFB was the smallest. However, HFB provided better body-warming effects and health benefits for older adults and those who felt cold with poor circulation [4,12]. Although CFB is generally believed to have a stress-inducing effect on the cardiovascular system [13,14], the study results indicated that the impact on blood pressure was not enough for such an effect. ...
... For the parameters, CFB had a more substantial impact, while the effect of HFB was the smallest. Nevertheless, HFB provided better body-warming effects and health benefits for older adults who felt cold with poor circulation [4,12]. Although CFB is generally believed to have a stress-inducing effect on the cardiovascular system, this study's results indicated that the impact on blood pressure was not large enough. ...
... There have been robust debates on the most effective skin location for passive body heating, but most correlational studies tended to investigate effects of warming distal body sites such as the feet and hands, which function as heat exchangers in humans due to their greater surface area ratio per unit body mass and particular cutaneous circulation. A warm footbath before sleeping is a widely utilized method for feet warming in many studies and has been shown to be beneficial for improving sleep quality by reducing the length of time taken to pass from wakefulness to sleep [10,[12][13][14]. Its effectiveness on accelerating sleep initiation was reported to be based on the functional link between sleep-onset latency and heat loss through distal skin regions before sleep, which can indirectly be measured by the distal and the proximal skin temperature gradient (distal-proximal skin temperature gradient; DPG) [15,16]. ...
... It is plausible therefore to assume that elevated foot skin temperature by local warming using bed socks might activate the thermosensitive neurons raising their discharge rate in brain areas in charge of sleep regulation [31] and have a beneficial impact on enhancing the quality of a 7-h sleep. In some of the previous studies in which foot temperature was manipulated by a warm foot bath prior to sleep, however, feet warming was evaluated not to have remarkable effects on sleep quality [11,13,14]. The conflicting results in those previous studies and the current study can be attributed to the different methods of local feet warming. ...
Abstract Background As a way of helping to sleep in winter, methods of warming the feet through footbaths or heating pads before bedtime are tried. In particular, bed socks are popular during winter sleeping in Korea, but scientific evidence about the physiological effects of bed socks on sleep quality is rarely reported. The purpose of this study was to evaluate the effect of feet warming using bed socks on sleep quality and thermoregulatory responses during sleep in a cool environment. Methods Six young males (22.7 ± 2.0 years in age, 175.6 ± 3.5 cm in height, and 73.1 ± 8.5 kg in body weight) participated in two experimental conditions (with and without feet warming) in a random order. The following variables on sleep quality using a wrist actigraphy were measured during a 7-h sleep at an air temperature of 23 °C with 50% RH: sleep-onset latency, sleep efficiency, total sleep time, number of awakenings, wake after sleep onset, average awakening length, movement index, and fragmentation index. Heart rate and rectal and skin temperatures were monitored during the 7-h sleep. Questionnaire on sleep quality was obtained after awakening in the morning. Results The results showed that sleep-onset latency was on average 7.5 min shorter, total sleep time was 32 min longer, the number of awakenings was 7.5 times smaller, and sleep efficiency was 7.6% higher for those wearing feet-warming bed socks during a 7-h sleep than control (no bed socks) (all P
... Reduce in body core temperature (rectal) before and during sleep is associated with peripheral vasodilatation and possible heat loss from the body core to the peripheral parts of the body. Therefore, a Footbath with warm water may increase blood flow and ambient temperature, with no increase or decrease in core temperature; and thereby could facilitate the onset of sleep and improve sleep quality (15,16). ...
... Regarding foot bath intervention, Yang et al. study on sleep and fatigue in patients with genital cancer undergoing chemotherapy (24), Sung et al. study on sleep of healthy women (25), were consistent with the present study but were in conflict with a crossover study of Liao et al. on the quality of sleep of elderly (16). ...
Background:
Sleep disorders are common mental disorders reported among the elderly in all countries, and with nonpharmacological interventions, they could be helped to improve their sleep quality.
Objectives:
The aim of this study was to compare the effects of two interventions, foot reflexology and foot bath, on sleep quality in elderly people.
Patients and methods:
This three-group randomized clinical trial (two experimental groups and a control group) was conducted on 69 elderly men. The two experimental groups had reflexology (n = 23) and foot bath (n = 23) interventions for 6 weeks. The reflexology intervention was done in the mornings, once a week for ten minutes on each foot. The participants in the foot bath group were asked to soak their feet in 41°C to 42°C water one hour before sleeping. The pittsburgh sleep quality index (PSQI) was completed before and after the intervention through an interview process.
Results:
The results showed that the PSQI scores after intervention compared to before it in the reflexology and foot bath groups were statistically significant (P = 0.01 , P = 0.001); however, in the control group did not show a statistically significant difference (P = 0.14). In addition, the total score changes among the three groups were statistically significant (P = 0.01). Comparing the score changes of quality of sleep between the reflexology and foot bath groups showed that there was no significant difference in none of the components and the total score (P = 0.09). The two interventions had the same impact on the quality of sleep.
Conclusions:
It is suggested that the training of nonpharmacological methods to improve sleep quality such as reflexology and foot bath be included in the elderly health programs. In addition, it is recommended that the impact of these interventions on subjective sleep quality using polysomnographic recordings be explored in future research.
... This inclusion of control groups enhances the credibility and validity of the study outcomes. The findings of this research demonstrated that, in 80% of the conducted studies, water temperatures of 40 degrees Celsius and higher were associated with improved sleep quality in the elderly, aligning with the results observed in other studies [44,45]. Physiologically, it has been established that foot baths are linked to sleep by influencing core body temperature. ...
Introduction
Population aging is a problem that has affected most countries in the world. Poor-quality sleep is a common complaint among the elderly. Foot baths are a method of heat therapy and are performed as an independent nursing care in different departments. The present study was conducted with the aim of investigating the effects of foot baths with spa on improving the sleep quality of the elderly.
Methods
This research is a systematic review. We systematically searched six databases, including Google Scholar, PubMed, Web of Science, Scopus, Embase, and the World Health Organization databases, to retrieve the related articles based on the keywords used in our search strategy from 2010 to March 2023.
Result
Finally, 10 articles were included in this study. All studies were randomized controlled trial (RCTs) and semi-experimental. In all 9 studies, the positive effects of the foot bath were reported. In 9 studies, the effect of foot baths with water above 40 degrees Celsius was reported. The PSQR questionnaire was used in most of the studies.
Conclusion
The total findings of this study showed that due to the high prevalence of sleep problems in the elderly, foot baths with warm water can be used as an easy, simple, and safe nursing intervention to improve sleep quality. Therefore, it can be used in nursing homes and hospitals. It is also a non-pharmacological and inexpensive nursing intervention that can be implemented by the elderly themselves after training by community health nurses.
... While several studies have reported that footbaths are effective in promoting sleep onset or improving sleep quality for older adults as complementary and alternative medicine, [1,[3][4][5]23] other studies did not demonstrate this effect. [24,25] In Japan, one nursing study [19] describes footbaths as encouraging sleep onset; thus, participants who learned the effects of footbaths in school might think that footbaths had this effect. ...
Footbaths are generally used for women in labor in clinical settings in Japan. However, it is unclear how their effects are perceived by midwives, or what effects they expect. Therefore, this study aimed to describe midwives’ perception of footbaths’ effects for women in labor. This cross-sectional study was conducted during January–March, 2022. Participants were midwives who worked at perinatal medical centers in the Kanto region. Self-administered questionnaires were used to collect data. A total of 364 midwives were asked to participate; of these, 291 (79.9%) responded to the questionnaires. The participants’ mean age was 35.6 years old, and 120 (41.2%) had graduated from vocational schools. The average clinical experience was 12.1 years. Regarding the effects of footbaths, 274 (94.2%) participants selected “relaxes,” whereas 166 (57.0%) selected “strengthens uterine contractions.” These effects were related to educational attainment and the source of information about the effects of footbaths. Midwives’ perception of footbaths’ effects differed; thus, it is necessary to conduct studies which clarify the effects of footbaths in the future and to disseminate the results.
... China has a long history to treat insomnia by using TCM and specific treatment such as bath therapy. The active ingredient of TCM can be absorbed through the skin to assist in the treatment of sleep disorders (Liao et al., 2008;Ni et al., 2015;Haghayegh et al., 2019;Aghamohammadi et al., 2020). According to the analysis of clinical data, the potential pharmacological effects have been found in TCM for treating insomnia through the regulation of neurotransmitters and their receptors in the brain, including γaminobutyric acid, serotonin, orexin, acetylcholine (Shi et al., 2014;Singh and Zhao, 2017). ...
Lonicerae Japonicae Flos (LJF) is commonly used in Chinese herbal medicines and exhibits anti-viral, anti-oxidative, and anti-inflammatory properties. The reciprocal relationship between sleep, the immune system and the central nervous system is well-established in the animal models. In this study, we used the mouse model to analyze the beneficial effects of the LJF on the dysregulated sleep-wakefulness cycle in response to acute sleep deprivation and lipopolysaccharide (LPS)-induced inflammation and the potential underlying mechanisms. Polysomnography data showed that LJF increased the time spent in non-rapid eye movement (NREM) sleep during the day under basal conditions. Furthermore, latency to sleep was reduced and the time spent in rapid eye movement (REM) sleep was increased during recovery from acute sleep deprivation. Furthermore, LJF-treated mice showed increased REM sleep and altered electroencephalogram (EEG) power spectrum in response to intra-peritoneal injection of LPS. LJF significantly reduced the levels of proinflammatory cytokines such as IL-6, TNF-α, and IL-1β in the blood serum as well as hippocampus, and medial prefrontal cortex (mPFC) tissues in the LPS-challenged mice by inhibiting microglial activation. Moreover, LJF increased the time spent in REM sleep in the LPS-challenged mice compared to the control mice. These results suggested that LJF stimulated the sleep drive in response to acute sleep deprivation and LPS-induced inflammation, thereby increasing REM sleep for recovery and neuroprotection. In conclusion, our findings demonstrate that the clinical potential of LJF in treating sleep disorders related to sleep deprivation and neuro-inflammation.
... 71,83 Older sleep-disturbed subjects responded to hot foot bathing with slightly reduced sleep-onset latency to stage 1 (SOL1) and significantly decreased wakefulness in the second NREM sleep period. 84 In these older subjects not only DPG but also CBT were elevated after hot foot bathing during the first hour of sleep. However, the same authors reported later that warming the feet may improve sleep only for those who have cold feet. ...
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.
... The literature contains hints about the beneficial effects of external treatments such as warm footbaths on sleep quality [45,46]. The underlying mechanism, however, is open to speculation, with conflicting findings [45,47,48]. Most of the studies have applied the footbaths just prior to bedtime and reported a peripheral vasodilatation with a decrease in core temperature as the main mechanisms of the effects on sleep [8,45,46,49]. ...
Objective:
Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults.
Methods:
Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2 ℃, administered between 1:30-6:30pm) in a randomized order with a cross-over design: 1. with warm water only (WA), 2. with warm water and MU and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath.
Results:
At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality.
Conclusion:
Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.
... The questionnaires that asked the participants about feelings and consideration towards foot care were developed in this study. Previous studies have examined the effects of reflexology on anxiety and pain in cancer patients (Stephenson et al., 2000).Studies have also investigated the effects of foot baths or mixed interventions of foot bath and reflexology on sleep, pain, and fatigue (Liao et al., 2008;Rahmani et al., 2016;Yang et al., 2010).The foot bath, touch care, or a combination of the two activated parasympathetic nerves (Hirohashi et al., 2015). Although there is limited evidence regarding foot care itself, care related to feet may be associated with the production of saliva and good sleep by activating parasympathetic nerves. ...
Introduction
An increasing number of older people with frailty in Japan use geriatric day care centers. Older people who have been certified as requiring long-term care attend centers during the day and receive nursing care help with bathing, excretion, meals, and functional training services. Many older people have foot problems with need foot care by nurses and care workers (NCWs) at geriatric day care centers.
Objective
This study explored the effects of NCWs’ foot-care programs on the foot conditions of older people attending daytime services.
Methods
A before-after intervention study was conducted at geriatric day care centers for older people, where the foot-care program was presented by NCWs for two months. The foot conditions of 23 clients (8 men, 15 women, mean age = 78.6 years, standard deviation = 9.2) were assessed before and after the program. Changes in foot condition and clients’ perceptions after the study were analyzed through descriptive statistics, McNemar, and paired t-tests.
Results
Although dramatic changes in foot conditions were not observed, some conditions were improved or maintained. Changes were observed in mean dry skin scores ( p < .01; right foot: 1.6→1.1, left foot: 1.6→1.1), skin lesions and long nails (skin lesions R: 0.2→0.1; long nail R: 1.4→1.0, L: 1.1→0.8), and edema (R: 43.5%→39.1%, L: 52.2%→47.8%). Further, clients started perceiving that foot health is important and discussed their feet with staff more often.
Conclusion
The NCWs’ foot-care program was effective in maintaining and improving foot health in older people and positively affected their perception of foot care.
... Uyku başlangıcından önce ise sabah ulaşacağı en düşük noktaya doğru düşmeye başlar. Uykudan önce eller ve ayaklara sıcak uygulama yapmak periferik sıcaklık ile çekirdek sıcaklık arasındaki farkı arttırmakta ve bu da uykunun başlamasını kolaylaştırabilmektedir46 . Bu sistematik derlemeye dahil edilen çalışmada refleksoloji ve ayak banyosu uygulamalarının, uyku kalitesini arttırmada ayrı ayrı etkili yöntemler olduğu belirtilmiştir24 . ...
Amaç: Bu çalışmada yaşlı bireylerde uyku sorunlarını gidermeye yönelik nonfarmakolojik müdahaleleri içeren randomize kontrollü çalışmaların sistematik olarak incelenmesi amaçlanmıştır.Gereç ve Yöntem: Çalışma için, Nisan-Haziran 2019 tarihleri arasında; Google Akademik, Wiley, Web of Science, Springer Link, Scopus, Science Direct, Clinical Key, CINAHL, PubMed, Ulusal Tez Merkezi (https://tez.yok.gov.tr/UlusalTezMerkezi/), Dergipark ve Ulakbim arama motorlarından tarama yapılmıştır. Sistematik derlemeye Ocak 2014-Mayıs 2019 yıllarında yayımlanmış, yaşlılıkta uyku sorunlarına yönelik kullanılan nonfarmakolojik yöntemleri bildiren randomize kontrollü çalışmalar dahil edilmiştir.Bulgular: Tarama sonucunda altı çalışma ile veri çekme işlemi gerçekleştirilmiştir. İncelenen çalışmalarda yaşlı bireylerde uyku ile ilgili görülen sorunlara yönelik kullanılan yöntemler; bilişsel davranışçı terapi, müzik terapi, anımsama terapisi, fitoterapi (papatya özü), akupres, refleksoloji ve ayak banyosu olarak sıralanmaktadır.Sonuç: Sonuç olarak bu sistematik derlemeye dahil edilen çalışmalarda uygulanan yöntemlerin hiçbir yan etkisi bildirilmemiştir. Kullanılan yöntemlerin hepsinde uyku kalitesinde iyileşmeler olduğu görülmektedir. Bu yöntemler uyku sorunlarını gidermeye yönelik kolaylıkla kullanılacak yöntemler olmakla birlikte bu çalışmaların tekrarlanıp daha güçlü kanıtların sunulmasına ihtiyaç vardır.
... Regarding the relationship between skin warming and sleep, the location on the skin, temperature, and timing of skin warming are likely to play an important role in sleep. A few studies have reported that the warming the foot skin accelerated sleep onset 17,33 , whereas others have showed no significant difference in SOL 34,35 . Additionally, Van Someren and colleague have demonstrated that proximal skin warming was more effective than distal skin warming 18,19 . ...
Periocular skin warming was reported to have favorable effects on subjective and objective sleep quality. We hypothesized that enhancing body heat loss by periocular skin warming would reduce sleep onset and improve sleep quality. Eighteen healthy volunteers were asked to maintain wakefulness with their eyes closed for 60 min after applying either a warming or sham eye mask, followed by a 60-min sleep period. Compared to the sham, periocular warming increased the distal skin temperature and distal–proximal skin temperature gradient only during the 30-min thermal manipulation period. In the subsequent sleep period, periocular warming facilitated sleep onset, increased stage 2 sleep and electroencephalographic delta activity during the first half of the sleep period relative to the sham. These results suggest that periocular skin warming may accelerate and deepen sleep by enhancing physiological heat loss via the distal skin, mimicking physiological conditions preceding habitual sleep.
... Studies have proven that foot baths with warm water can promote sleep and improve sleep quality by increasing limb blood perfusion to regulate body temperature. [19][20][21] The previous systematic review has shown that Chinese herbal medicine can increase insomnia patients' sleep quality and improve their psychological health, [22] and the sedative-hypnotic functions of Chinese herbal medicine are mediated by the GABAergic system. [23,24] It may be reasonable to predict that the combination of bath therapy and Chinese herbal medicine is effective for patients with insomnia. ...
Introduction:
Insomnia is a major public health problem. Due to the side effects of pharmacological therapy, people are seeking to choose complementary and alternative therapies for insomnia disorder. Traditional Chinese herbal bath therapy is an important complementary therapy which combines advantages of Chinese herbs and bathing therapy. This protocol describes the methodology of a systematic review assessing the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia.
Methods and analysis:
Reporting of this review will be adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We will electronically search the following seven databases from inception to January 23, 2020: PubMed, Cochrane database (CENTRAL), EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database, and Wanfang Database. Parallel randomized controlled trials evaluating the effectiveness and safety of traditional Chinese herbal bath therapy for insomnia will be included. Study selection, data extraction and assessment of risk of bias will be performed independently by two researchers. The sleep quality will be assessed as the primary outcome. Global symptom improvement, anxiety and depression, and adverse events will be evaluated as secondary outcomes. The Cochrane's risk of bias tool will be utilized for assessing the methodological quality of included studies. Revman software (v.5.3) will be used for data synthesis and statistical analysis. Data will be synthesized by either fixed-effects or random-effects model according to a heterogeneity test. If it is not appropriate for a meta-analysis, a descriptive analysis will be conducted. GRADE system will be used to assess the quality of evidence.
Prospero registration number:
CRD42020168507.
... DPG, an indicator of distal blood flow and indirect measure of distal heat loss [12], is elevated by PBH WB [10, 38,63]. Thus, it is not surprising PBH WB treatment of proper temperature when applied at this optimal circadian time, 1e2 h before bedtime, is associated with improvement in SOL. ...
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.
... Review of the app by the PI confirmed that the app provides these aforementioned functions, and that the education materials and recommendations appeared to be generally in line with empirically supported treatment for insomnia, though there were exceptions to this. For example, research to support the point in the "Education" section that "a warm bath approximately 30 minutes prior to bedtime can raise the body temperature and help with sleep" in individuals with insomnia is mixed [41][42][43][44] and is not currently included in the sleep hygiene or insomnia treatment recommendations published by the American College of Physicians or the American Academy of Sleep Medicine [8]. Further, a number of points would likely be more beneficial if clarified. ...
BACKGROUND
Sleep difficulties are prevalent and concerning for many North Americans. Despite strong empirical support for insomnia treatment, lack of access presents a significant barrier to treatment dissemination. This is particularly true amongst teens and young adults. Mobile applications (‘apps’) are uniquely suited to address this need.
OBJECTIVE
We conducted a scoping review to identify and appraise commercially available apps for AYAs with sleep difficulties.
METHODS
Proceeding in 3 phases, a comprehensive search of commercially available apps was conducted between August 2016 and January 2017. The initial phase involved a search of app stores using relevant search terms (sleep; sleeping; insomnia; sleep aid; night). In the second phase, apps were assessed for eligibility using the following inclusion criteria: 1) Goal is to provide education, tools, or advice related to management of insomnia symptoms. 2) Primary intended users are AYAs. Exclusion criteria were: 1) App is classified as an ‘e-book.’ 2) Primary utility is meditation, hypnosis, or relaxation for sleep. 3) Primary function is background sleep music or sounds. 4) Primary function is alarm clock. 5) Sole sleep aid function is tracking/monitoring, with no education, tools, or advice for insomnia. In the third phase, apps were culled for functionality information, including: A) Self-monitoring of symptoms; B) Tracking sleep; C) Education related to insomnia; D) Advice or intervention for managing insomnia symptoms. Finally, the primary investigator conducted a final review of phase 3 apps, closely examining the functionality of these apps, based on app descriptions, app content, and developer website (where available).
RESULTS
The initial search yielded 2036 apps; after eligibility criteria were applied, functionality information was extracted for 48 apps. Twenty-three of these were later excluded. Of the final 25 apps, 24% included self-monitoring of symptoms; 28% included a sleep tracking function; 56% provided insomnia education; and 92% provided advice or intervention for managing sleep difficulties. The majority (80%) were free. Several (20%) provided sleep interventions that are not supported by research. In the final evaluation, only 6 apps met all four of the functionality criteria; of these, none were geared towards AYA users specifically. The purported and examined functionality of these six apps are discussed.
CONCLUSIONS
Insomnia is a unique problem among AYAs, as non-insomnia factors must also be considered when designing an appropriate intervention (e.g., AYAs are more delayed in sleep schedule, require more sleep than adults). There are currently 6 apps that are appropriate for self-management of adult insomnia. There are 0 apps designed for AYA users. Development of an evidence-based app for managing insomnia in this population is critical. Once an appropriate app becomes available, future studies should test its usability and efficacy in AYA samples.
... Some recent researchers have identified the beneficial effects of partial bath in inducing sleep [44]. Studies done to identify the hot foot bath effects on sleep could not identify much difference between sleep occurring on bath day and non-bath day [45]. Current studies are in favor of the findings that skin blood flow increases after taking a bath. ...
Sleep is so much important to human beings that it comprises almost 1/3 of one’s whole life span. It has a restorative, regenerative, and reparative potential, and hence any compromise to this eventually affects all these functions. Sleep disturbances are debilitating and are being linked to many diseases either as their cause or as manifestations. A global steep rise in noncommunicable diseases is also supposed to be linked with the aberrations in sleep architecture and quality. There are a number of approaches to deal with sleep disturbances including pharmacological and non-pharmacological approaches. Ayurveda, the ancient health-care wisdom of the Orient, gives a deep insight into clinical implications of sleep and also suggests various remedies to cope with sleep disorders. It further proposes many simple home remedies and sleep hygiene propositions which seem promising, are in folklore practice, and have indirect evidences of their effectiveness. Simple remedies like milk, head and foot massage, and shirodhara seem promising in the effective management of a variety of sleep disorders and hence require a thorough review for their possible integration with mainstream medicine. Present chapter outlines the concepts of sleep as are proposed in Ayurveda and tries to look at them in light of current evidences. Finally it proposes the translational possibilities of such propositions for their possible application in clinical practice.
... One of the first studies used infrared-based cameras to index motion during sleep (10). Subsequent studies used frameby-frame differencing to extract activity, with the assumption that the sleeping individual was the only source of 'difference' or activity (11)(12)(13). Within these studies, VSG data from five children and ten adults were used to calibrate the sleep data extracted from the videos. A similar differencing method was then applied in a study of six children with Attention Deficit/Hyperactivity Disorder (14). ...
The term videosomnography captures a range of video-based methods used to record and subsequently score sleep behaviors (most commonly sleep vs. wake states). Until recently, the time consuming nature of behavioral videosomnography coding has limited its clinical and research applications. However, with recent technological advancements, the use of auto-videosomnography techniques may be a practical and valuable extension of behavioral videosomnography coding. To test an auto-videosomnography system within a pediatric sample, we processed 30 videos of infant/toddler sleep using a series of signal/video-processing techniques. The resulting auto-videosomnography system provided minute-by-minute sleep vs. wake estimates, which were then compared to behaviorally coded videosomnography and actigraphy. Minute-by-minute estimates demonstrated moderate agreement across compared methods (auto-videosomnography with behavioral videosomnography, Cohen's kappa = 0.46; with actigraphy = 0.41). Additionally, auto-videosomnography agreements exhibited high sensitivity for sleep but only about half of the wake minutes were correctly identified. For sleep timing (sleep onset and morning rise time), behavioral videosomnography and auto-videosomnography demonstrated strong agreement. However, nighttime waking agreements were poor across both behavioral videosomnography and actigraphy comparisons. Overall, this study provides preliminary support for the use of an auto-videosomnography system to index sleep onset and morning rise time only, which may have potential telemedicine implications. With replication, auto-videosomnography may be useful for researchers and clinicians as a minimally invasive sleep timing assessment method.
... Older sleep-disturbed subjects responded to hot foot bathing with slightly reduced sleep onset latency to stage 1 (SOL1) and significantly decreased wakefulness in the second NREM sleep period. 61 In these older subjects not only DPG but also CBT was elevated after hot foot bathing during the first hour of sleep. However, the same authors recently reported that warming the feet may improve sleep only for those who have cold feet. ...
... Mechanism of foot bath is not clear yet, but soaking foot in warm water stimulates sense of touch and reduces sympathetic activity; the cause of this reduction is not clear yet, but reduced sympathetic nerve activity is the main mechanism of increased comfort and reduced pain in patients (17). Foot warm bath may increase peripheral blood flow and also peripheral temperature due to heat loss without increasing core body temperature, and improves falling asleep and sleep quality (24). It seems that soaking feet in warm water is more effective than taking a bath in terms of facilitating falling asleep and increasing sleep quality; it is recommended to people with disabilities, elderly, and also patients with cardiovascular disease (25). ...
... Older sleep-disturbed subjects responded to hot foot bathing with slightly reduced sleep onset latency to stage 1 (SOL1) and significantly decreased wakefulness in the second NREM sleep period. 61 In these older subjects not only DPG but also CBT was elevated after hot foot bathing during the first hour of sleep. However, the same authors recently reported that warming the feet may improve sleep only for those who have cold feet. ...
... 15 Moreover, warm foot baths may increase peripheral blood flow and peripheral temperature due to heat loss without increasing the central body temperature, hastening the onset of sleep and improving the quality of sleep. 19 Soaking feet in warm water appears to be more effective than bathing the entire body to facilitate the onset of sleep and increase sleep quality. It is frequently recommended for the disabled, retired persons and patients with cardiovascular disease. ...
Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS).
Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13.
Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group.
Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses.
... Effects on human health of footbath have been investigated and confirmed since 1960s [2][3][4]. The local exposure to warm water would dilate the blood vessels underneath the skin and then increases the blood flow via blood capillaries and finally enhance the distal-proximal skin temperature gradient, leading to a transient improvement in the blood circulation [5,6], systemic arterial stiffness [7], and sleep quality [8][9][10]. In the recent years, the warm footbath has become a nursing approach for older people for its safe and convenience, compared to immersion of the whole body in warm water. ...
Although warm footbath has been widely enjoyed in many Asian countries, little information is known about its effect on people’s thermal responses. This paper experimentally investigated the variations in objective and subjective thermal responses of foot bathers during summer and winter. The subjective thermal responses of foot bathers (12 males and 11 females) were collected by questionnaire, and their body skin temperatures were measured at seven locations. Due to blood circulation, the heat gained from immersed feet could affect other body parts, while the thermal effect of warm footbath varied in different body parts. The results indicate that the footbath could cause marked increases in the thermal sensation of feet, legs and overall body. Participants feel more comfortable at the early stage than other stages during footbath, even though the water temperature is constant. Higher water temperature is expected by the participants to remain footbath comfort. Additionally, noticeable differences in skin temperature and subjective human responses of the male and the female foot bathers were observed. This study demonstrates that the females’ foot is more sensitive to warm footbath than those of males. It can be concluded that warm footbath contributes to more satisfaction of thermal environment especially in winter and that males were likely to be more acceptable with footbath than females.
Purpose
The aim of the study is to determine the effect of of hot footbaths on the pain, anxiety, sleep, and comfort levels of patients who underwent laparoscopic cholecystectomy.
Design
The study is a randomized controlled designed.
Methods
This study was conducted in surgery clinic of a university hospital between January 2022 and November 2022. The research was completed with 54 patients in the experimental group and 54 patients in the control group.
Findings
The mean state anxiety score and VAS-Sleep score of the patients in the experimental group 120 minutes after the application was 31.07±4.70 and 612.62±82.37, respectively, which was statistically significantly lower than that of the patients in the control group ( P <0.05). On the other hand, at the 120th minutes after the application, the mean VAS-Comfort scores of the patients in the experimental group were statistically significantly higher than those of the patients in the control group ( P <0.05). A positive relationship was found between the mean VAS-Pain and VAS-Sleep scores of the patients in the experimental group, and a significant negative relationship was found between the mean VAS-Comfort and state anxiety scores.
Conclusions
Foot bath is effective in reducing the pain and anxiety levels of patients undergoing laparoscopic cholecystectomy surgery.
Background: Sleep disturbances, which are common problems in older adults, often lead to cognitive decline and depression and may even increase mortality risk. Foot thermal therapy is a simple and safe approach for improving sleep and is associated with relatively few side effects. However, the effect of different operations of foot thermal therapy on sleep quality in older adults is inconclusive. This study aimed to access the effects of temperature, duration, and heating height of foot thermal therapy (administered through a footbath) on the subjective and objective sleep quality of older adults. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, eight databases were searched for all relevant articles published up to July 2023, and a rigorous systematic review and meta-analysis was conducted. This study was registered in the PROSPERO database (CRD42022383460). Inclusion criteria were: (1) participants with a mean age ≥60 years; (2) interventions that included foot thermal therapy; (3) a control group that received routine care but no thermal therapy; (4) outcome measurements that assessed sleep quality; and (5) the studies that utilized randomized controlled trials or quasi-experimental studies. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. The meta-analysis was performed using RevMan version 5.4. Results: A total of 11 studies were included. Foot thermal therapy before bedtime improved subjective sleep quality in older adults, with optimal parameters of 40°C temperature (standardized mean difference [SMD] = 0.66, 95% confidence interval [CI]: 0.33 to 0.99), ≤20-min duration (SMD = 0.66, 95% CI: 0.39 to 0.93), and 10 cm heating height (SMD = 0.78, 95% CI: 0.45 to 1.11). Subgroup analyses revealed that a temperature of 41°C-42°C can improve objective sleep latency (SMD = 0.54, 95% CI: 0.09 to 0.99). Conclusions: It is recommended to administer foot thermal therapy (40°C; ≤20 min; 10 cm above the ankle) to older adults 1 h before their bedtime. If they have trouble falling asleep, the temperature can be increased to 41°C-42°C.
The purpose of this article was to review and assess the results obtained from human studies on the effects of hydrotherapy, balneotherapy, and spa therapy on sleep disorders. In this study, databases such as Pubmed, Embase, Web of Science, Google Scholar, Cochrane, Scopus, and sciences direct database were searched from the beginning to September 2022. All human studies that examined the effect of hydrotherapy, balneotherapy, and spa therapy on sleep disorders were published in the form of a full article in English. In the end, only 18 of the 189 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may by affecting some hormones such as histamine, serotonin, sympathetic nerves, and regulating body temperature led to increased quality and quantity of sleep. Also, the results obtained from Downs and Black show that 3 studies were rated as very good, 7 studies as good, 7 studies as fair, and 1 study as weak. The results of studies also showed that hydrotherapy leads to an improvement in the PSQI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on sleep disorders.
To preliminarily explore a nondrug intervention method and evaluate its effects (sleep quality, physical examination indicators, and general physical symptoms) on people with sleep disorders. The intervention was based on regular balneotherapy, coupled with targeted health education, appropriate exercise, diet management, and other sleep-promoting measures. It was the combined effects that we evaluated. We recruited 31 volunteers with sleep disorders to receive a 7-day sleep-promoting experience in Tianxing International Hot Spring City, Nanchuan District, Chongqing. The intervention adopted a plan that combined balneotherapy with various sleep-promoting measures. Persisting baths in hot springs 1-2 times per day targeted health lectures about 1 h every morning, appropriate exercise every day (sleep-aid yoga, forest hiking, morning exercises, etc.), and diet management (the principle is to control oil, salt, and sugar, diversify food, keep meat and vegetable balanced, and control total calories. The dinner is light and easy to digest). During the intervention period, all participants followed the above intervention plan, and they lived in the spa resort to accept unified arrangement. This study adopted a self-contrast method by comparing the changes in sleep quality, physical examination indicators, and general physical symptoms before and after the intervention through physical examinations and questionnaire surveys. After the intervention, the subjects' total score of Insomnia Severity Index (ISI) decreased significantly (P = 0.006), and all seven dimensions showed a decrease, four of which included early morning awakening, sleep dissatisfaction, noticeability of sleep problems by others, and distress caused by sleep problems decreased significantly (all P < 0.05). The subjects' body mass index, waist circumference, fasting blood glucose, and triglycerides decreased significantly (all P < 0.05), and systolic blood pressure increased significantly (P = 0.006). Total cholesterol, high-density lipoprotein, low-density lipoprotein, and diastolic blood pressure did not change significantly (all P > 0.05). To some extent, all general health problems were improved than before the intervention (the improvement rate was up to 70% or more). The non-pharmacological intervention of balneotherapy combined with various sleep-promoting measures showed positive effects on sleep quality, general physical symptoms, and some physical examination indicators of sleep disorders. This comprehensive intervention may be an effective way to improve people's health with sleep disorders.
BACKGROUND: Footbath has been a common form of activity in China, Egypt and India for
several hundred years. The beneficial effect of footbaths on sleep has been already known.
However, the optimal footbath conditions for improving sleep quality have received little
attention. OBJECTIVES: To investigate the effect of water temperature and footbath duration on body temperature responses during and after footbath using a thermoregulatory modelling approach. METHODS: A classical multi-node human thermoregulation model was modified to account for human exposure to warm water locally while seated during a footbath. The model was then used to systematically examine the effects of water temperature and footbath duration on body temperature responses during footbaths as well as to estimate the most optimal footbath duration in different water temperatures to improve sleep. RESULTS: This thermoregulatory modelling study revealed that the mean skin temperature after a footbath was higher than before, whereas the core temperature after footbath was lower. The higher the water temperature and duration of the footbath, the longer time that the core temperature was maintained with a decreasing trend while the core temperature was higher. The mean skin temperature would no longer rise if there was sweating during the footbath. The onset of sweating was roughly inversely proportional to the temperature of the water. CONCLUSIONS: The discrete thresholds thermoregulation model was able to predict body temperature responses during a footbath. A relationship curve between sweating onset time and water temperature has been established to determine the optimal conditions of footbath, which may provide reference to facilitate sleep onset.
Objectives
To compare the effects between warm water (WW) and ginger footbaths (WW+ginger) on sleep quality and warmth regulation in adults with self-reported insomnia symptoms.
Methods
A prospective randomized-controlled study in which 28 participants (mean age 50.9 years, 64.3% women, insomnia symptom duration 11.4 years) were randomized to receive WW (n=13) or WW+ginger (n=15) daily for 2 weeks. Treatment involved nightly footbaths (12 liters of 38-42 °C warm tap water, maximum duration 20 minutes) with and without topical ginger (80 grams of powdered ginger rhizomes).
Main outcome measures
The primary outcome measure was self-reported sleep quality (global score from Pittsburgh Sleep Quality Index, PSQI) at 2 weeks. Secondary outcomes included measures of insomnia severity (Insomnia Severity Index, ISI) and warmth regulation (Herdecke Warmth Perception Questionnaire, HWPQ and 24-hour distal-proximal skin temperature gradient, DPG).
Results
WW+ginger had no greater effect on PSQI (mean between-difference 0.0 [95% CI -3.0 to 2.9], Cohen’s d=0.0) or ISI (-0.2 [-3.9 to 3.4], 0.0) than WW. Nor were there any significant differences in HWPQ perceived warmth (0.1≥d≥0.5) or DPG (0.1≥d≥0.4) between WW and WW+ginger. Both groups improved over time in PSQI (WW+ginger: d=0.7, WW: d=1.3) and ISI (WW+ginger: d=0.8, WW: d=1.0). Perceived warmth of the feet increased only in WW+ginger over time (d=0.6, WW: d=0.0).
Conclusions
This dose of ginger (6.67 grams/liter) did not have greater effects on sleep quality, insomnia severity or warmth regulation than WW. Considering effect sizes, costs and risks, the use of WW would be recommended over WW+ginger in this patient population.
The current study aimed to compare the effects of foot reflexology and warm foot-bath on improving sleep quality in older adults. Participants were randomized to the foot reflexology group (n = 50) or warm footbath group (n = 50). Data were collected using a Descriptive Information Form and the Pittsburgh Sleep Quality Index (PSQI). Foot reflexology was applied 30 minutes twice per week for 6 weeks. Warm foot-bath was applied 1 hour before bedtime every evening for 6 weeks. Comparison of mean total scores from the PSQI before and after reflexology indicated that mean postintervention total scores decreased significantly compared to preintervention scores (p < 0.05). Comparison of PSQI mean total scores before and after warm footbath indicated that mean postintervention total scores decreased significantly compared to preintervention scores (p < 0.05). Comparison of PSQI mean scores of the reflexology and warm footbath groups showed no significant difference between groups in terms of the variance in mean scores (p > 0.05). According to current findings, both interventions improved sleep quality in older adults. [Journal of Gerontological Nursing, 48(3), 17-22.].
This pilot study was a randomized controlled trial that aimed to investigate the effect of the warm footbath on the sleep quality of Iranian older adults. Males and females aged over 60 were randomly divided into three groups (footbath group with water at 40°C, footbath group with water at 37°C, and one control group) using the permutation block method. Repeated measures design was used to compare the groups after week two and week four to study the effects of footbath on sleep quality. Footbath with water at 40°C and 37°C caused significant improvement in the participants' sleep quality. No significant difference was found between the participants' sleep quality treated with water at 40°C and 37°C. Future studies with larger samples are recommended for assessing the effectiveness of warm footbath in enhancing sleep quality in older adults.
Purpose:
This study aimed to investigate the effects of aroma foot baths on stress and sleep in terminally ill cancer patients.
Methods:
We performed a non-randomized intervention-control study with 30 terminal cancer patients who were admitted to a palliative care unit. Participants responded to questionnaires on stress and sleep before and after a 5-day interval. The intervention group received a daily aroma foot bath for 5 days. We performed multivariate regression analysis to examine the changes in outcomes on stress and sleep for the intervention group compared to the control group.
Results:
The differences in baseline characteristics between groups, excluding subjective economic status and general weakness, did not show statistical significance. In contrast to the control group, the intervention group showed a statistically significant change in physical stress and psychological stress levels, but significant changes were not observed in quality of sleep. Compared to the control group, the intervention group showed a significant reduction in physical stress (P=0.068) and psychological stress (P=0.021).
Conclusion:
Aroma foot baths are effective for reducing stress in patients hospitalized with terminal cancer.
Aims and background: Individuals with pronated feet suffer from many biomechanical dysfunctions during running. The purpose of this study was to compare the peak plantar pressure in ten areas of the foot, ground reaction force, center of pressure and loading rate during three different running patterns between healthy subjects and pronated feet individuals with and without LBP. Materials and methods: This semi-experimental and laboratory study was performed as a comparative research between three groups including healthy subjects (n=10), pronated feet individuals with (n=10) and without (n=10) low back pain. Plantar pressure variables were evaluated in 10 areas of the foot. Statistical analysis was performed using MANOVA test at a significance level of 0.05. Findings: The loading rate was significantly different between the three groups during running. There was a significant difference in loading rate in the mid-foot running pattern between the pronated feet individuals with and without low back pain. The loading rate in the pronated individuals with low back pain was higher in the mid-foot running pattern than in the rear-foot running pattern. Conclusion: The forefoot running pattern compared with other running patterns is more suitable for pronated feet individuals with low back pain. However, further study is warranted.
Introduction: Sleep disturbances are common mental problems reported among elders. It seems some non-pharmacological interventions, can improve their sleep quality. The aim of this study is to compare the effectiveness of two interventions, reflexology and foot bath, on sleep quality in elderly people.
Methods : This is a clinical trial without control group , conducted on 46 elderly men in two groups of reflexology and foot bath. Written informed consent was completed by subjects. Reflexology was done in the morning once a week for ten minutes on each foot. Subjects in the foot bath group were asked to soak their feet in 41 to 42°C water one hour before sleeping for 6 weeks. Pittsburgh Sleep Quality Index (PSQI) was completed before and after intervention. Data was analyzed using Wilcoxon, Mann-Whitney and Chi square tests.
Results: Result showed that the mean PSQI score after intervention in foot bath group was 4.13±3.57 and in reflexology group 4.04±3.91, which was decreased in both groups comparing before intervention (P=0.01 and P= 0.001). Comparing changes in quality of sleep score before and after intervention in foot massage group showed that there was no significant difference in overall and each part scores.
Conclusion: Findings indicate that both reflexology and footbath can improve sleep quality in elderly people .
Background and purpose
Restless legs syndrome (RLS) is a common sensory-motor disorder among the pregnant women. The aim of this study is to compare the impacts of two methods of immersion of legs in cold and warm water on the RLS symptoms among the pregnant women.
Methods
This randomized clinical trial was conducted on 80 pregnant women with RLS who referred to Taleghani educational-therapy center. After obtaining their informed consent, they were selected by accessible method and randomly allocated into group 1 (warm water) and group 2 (cold water). Group 1 were asked to put their legs in cold water for 10 min every night for 2 weeks. The group 2 put their legs in warm water under the same condition. The severity of RLS was measured before and after the study. Data analysis was conducted using descriptive as well as the analytical statistics such as Chi-square, independent T test, pair T test, Mann-Whitney U,Wilcoxon and covariance.
Results
After intervention, mean RLS of the cold water group was11.02 ± 4.93; while this mean was 13.50 ± 4.74 in the warm water group. The difference between the two groups was significant (p = 0.017). Results also revealed that the severity of RLS symptoms at the end of the treatment was different from the beginning of the research in both groups (p = 0.001). The intervention with both warm and cold water declined the RLS symptoms among pregnant women.
Conclusion
The warm and cold water can be used for this purpose depending on the women’s preference. However, this article recommends the cold water for more reducing of symptoms.
Introduction: Fatigue is a common symptom of advanced cancer, limiting one's activity and affecting the quality of life. It is a multidimensional symptom complex with subjective and objective components. Aim of the study was to assess the effect of Hot Water Foot immersion therapy on level of fatigue & to choose the action which is cost effective and cheap in reduction of fatigue among advanced stage cancer patients and to promote their quality of life. Objectives were to assess the level of fatigue of cancer patient before Hot Water Foot Immersion Therapy & to evaluate the effect of Hot Water Foot Immersion Therapy on fatigue among cancer patients. Method: This pre-experimental study with one group pretest post test design included a total 48 patients with advance stage (IIIrd & IVth) cancer of lung, oral cavity, cervix and ovary with the age group of 18 years and above who fulfilled the inclusion and exclusion criteria selected by Non purposive sampling technique. All the patients were assessed for severity of fatigue using Brief Fatigue Inventory (BFI) in Radiotherapy unit in the Regional cancer hospital in I.G.M.C. & Hospital, Shimla. Participants were guided to put their feet into the footbath device, which contained water at 41°C to 43°C to cover the feet up to 10 cm above the ankle. HWFIT administered twice a day for 1 day in the same group and post test was conducted on the 2nd day which provides level of fatigue from past 24 hours. This intervention was administered total 3 times and after each intervention 3 immediate post-test was taken. The soaking time was 15 minutes as measured by a timer. Result: It is revealed that mean ± S.D. for pre-test was 53.63±7.978 and for post-test mean ± S.D. value was 43.27±7.682. The result showed that there is statistically significant decrease (p<0.05) in the level of fatigue after the intervention. Conclusion: A hot water footbath is a local moist heat application. It is noninvasive and easy to apply at home. This study demonstrates its effectiveness in reducing fatigue among advance stage cancer patients. It can be a non-pharmaceutical method to help patients overcome fatigue and improve their quality of life.
Background: Multiple sclerosis (MS) is a neurodegenerative disease caused by dysfunction of the immune system that affects the central nervous system (CNS). It is characterized by demyelination, chronic inflammation, neuronal and oligodendrocyte loss and reactive astrogliosis. It can result in physical disability and acute neurological and cognitive problems. Despite the gains in knowledge of immunology, cell biology, and genetics in the last five decades, the ultimate etiology or specific elements that trigger MS remain unknown. The objective of this review is to propose a theoretical basis for MS etiopathogenesis.
Methods: Search was done by accessing PubMed/Medline, EBSCO, and PsycINFO databases. The search string used was “(multiple sclerosis* OR EAE) AND (pathophysiology* OR etiopathogenesis)”. The electronic databases were searched for titles or abstracts containing these terms in all published articles between January 1, 1960, and June 30, 2019. The search was filtered down to 362 articles which were included in this review.
Results: A framework to better understand the etiopathogenesis and pathophysiology of MS can be derived from four essential factors; mitochondria dysfunction (MtD) & oxidative stress (OS), vitamin D (VD), sex hormones and thyroid hormones. These factors play a direct role in MS etiopathogenesis and have a modulatory effect on many other factors involved in the disease.
Conclusions: For better MS prevention and treatment outcomes, efforts should be geared towards treating thyroid problems, sex hormone alterations, VD deficiency, sleep problems and melatonin alterations. MS patients should be encouraged to engage in activities that boost total antioxidant capacity (TAC) including diet and regular exercise and discouraged from activities that promote OS including smoking and alcohol consumption.
Multiple sclerosis (MS) is a complex human neurodegenerative dysimmune disease of the central nervous system (CNS) which is characterized by chronic inflammation, demyelination, loss of blood‐brain barrier (BBB) integrity, neuronal loss, reactive astrogliosis, and oligodendrocyte depletion. It can result in physical disability and severe neurological and cognitive deficits. Research indicates that MS prevalence has significantly increased in many regions since 1990. The specific elements that trigger MS remain unknown. In this paper, the critical role played by mitochondria dysfunction & oxidative stress in MS pathogenesis, progression, and clinical symptoms are elucidated. Their interactions with the key factors in the disease, as well as treatment strategies, are discussed. This article is protected by copyright. All rights reserved.
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.
Sleep disturbances are common in older people. This study was
conducted to examine the effects of a hot pack, which was used to warm the lower limbs, on
the sleep of elderly people living in a nursing home. This is a prospective cohort
involving seven elderly women. Subjects aged 74-93 years old were treated by warming the
lower limbs for 40 minutes using hot packs every night over 8 weeks. A hot pack made of a
dense polymer and warmed in a microwave oven was used as a warming device. In the first and
last week, the subjects were required to wear an activity monitor to determine their
sleep-awake status. During the second to ninth week, they received limb-warming treatment
by a hot pack heated to 42ºC for 40 min every night. Surface skin temperature data were
collected by thermographic measurement. As a result, lower-limb warming by a hot pack
significantly improved the quality of sleep in the subjects. During warming, the surface
temperature of the hands and face rose by approximately 0.5-1.5ºC. This study showed that
lower-limb warming with a hot pack reduced sleep latency and wake episodes after sleep
onset; thus, improving the quality of sleep in elderly people living in a nursing home.
We explored the effects of acupressure training on older adults' sleep quality and cognitive function. Ninety older adults with impaired sleep quality were selected from screened volunteers and randomly divided into equal control and experimental groups; 82 completed the 1-year follow-up. Participants in the control group were given instructions on sleep health, while those in the experimental group received sleep health instructions plus individual and small group acupressure training sessions and support to practice the intervention on their own each day. All participants were assessed by trained assistants blind to study group allocation using Chinese versions of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Mini-Mental State Examination, and four subscales from the revised Chinese version of the Wechsler Memory Scale, at baseline and at 3, 6, and 12 months. Repeated measures analysis of variance showed that acupressure training improved older adults' sleep quality and cognitive function, but the mediating effect of sleep on the relationship between acupressure training and cognitive function was not supported. Given the ease, simplicity, and safety of acupressure training observed with community-dwelling older adults in China, attempts should be made to replicate these preliminary positive findings with larger samples. © 2016 Wiley Periodicals, Inc.
Objectives:
To examine the long-term effects of foot-bathing therapy, using different water temperatures, on the sleep quality of older adults living in nursing homes.
Design:
A quasi-experimental study design with non-equivalent control group.
Settings:
Thirty participants were recruited from a nursing home in Gyeong-gi Province, South Korea.
Interventions:
The participants were randomly assigned to experimental, placebo, and control groups. The foot-bathing therapy was performed for 30min daily for four weeks. Water at 40°C was used for the experimental group, while water at 36.5°C was used for the placebo group. The control group did not receive any intervention.
Main outcome measures:
The participants' sleep patterns (total sleep amount, sleep efficiency, and sleep latency) and sleep-disturbed behaviors were compared based on group, using actigraphy and a sleep disorder inventory.
Results:
The total amount of sleep and sleep efficiency were significantly different for the experimental group, especially those with poor sleep quality. There were no differences in sleep latency or sleep-disturbed behaviors among the groups. The long-term effect of the therapy decreased in the third week of the therapy.
Conclusions:
Daily, 30-min foot-bathing therapy sessions with water at 40°C were effective in improving sleep quality for older adults. The therapy was more effective for participants with poor sleep quality at baseline assessment than those with relatively good sleep quality. The long-term effects of foot-bathing therapy decreased three weeks after initiation; therefore, it might be desirable to deliver the therapy for two weeks, pause it for a week, and then resume it.
Background: Patients with profound multiple disabilities (PMD) are defined as individuals with profound cognitive disabilities (IQ < 35) and neuromotor dysfunction. Additionally, PMD patients often have sensory impairment and clinical manifestations. These conditions may result in severe developmental disability, functional and behavioral deficits, and a lack of language-based communication. Warm footbaths are implemented for patients with PMD. But the objective evaluation of warm footbaths has not been established. The aim of this study was to investigate the effectiveness of warm footbaths through the monitoring of autonomic nervous activity using heart rate variability (HRV) in patients with PMD. Methods: Eight patients with PMD (five patients with cerebral palsy, one with Aicardi's syndrome, one with post-traumatic syndrome after a head injury, and one with Lennox-Gastaut syndrome) and one healthy adult male volunteer had a warm footbath for 20 minutes. We used electrocardiography to measure the high frequency components (HF; with frequency ranging from 0.15 to 0.4 Hz), which represent HRV due to parasympathetic activity. Analysis of variance was used to compare the level of HF pretreatment, during warm footbath, and post-treatment in each study participant. Results: Six of the eight patients, including three patients with clinically severe behavioral and emotional disturbance, showed significantly lower log HF during the warm footbath than pretreatment. Seven of the eight patients showed lower log HF in the first period phase (soak lower legs and feet in 40°C water) of the warm footbath.Discussion: Our results showed that warm footbaths in patients with PMD suppressed parasympathetic nervous activity and stimulated their tactile senses and emotional inputs when soaking their feet in warm water.
Objectives:
Doing-the-month practice has been commonly observed by women during the first month after delivery for hundreds of years in several countries of Asia. This retrospective study examined the correlation between these restricted behaviors and mental status in postpartum women.
Materials and methods:
The frequencies of seven restricted behaviors during the first month after delivery and levels of depression, anxiety, and sleep quality were measured in 341 women 4-6 weeks after delivery through self-reported questionnaires. The multivariate linear regression model was used to determine independent behavioral predictors for depression, anxiety, and sleep quality.
Results:
Bathing or showering was an independent predictor of low depression status, low anxiety status (p<0.05), and good sleep quality (p<0.001). Behaviors related to high depression status were touching cold water and squatting (both p<0.05). Squatting was also related to high anxiety status (p<0.01), while exposing oneself to drafts was related to poor sleep quality (p<0.05).
Conclusion:
The results indicate that the restrictions on squatting, touching cold water, and exposure to drafts are positively associated with good mental health in postpartum women and are worth preserving; however, the restriction on bathing or showering might negatively impact the mental health of postpartum women and needs further evaluation.
To assess the difference in the level of comfort between psychiatric inpatients who received a warmed blanket and psychiatric inpatients who did not receive a warmed blanket.
A descriptive pilot study from a convenience sample of 37 psychiatric patients aged 18-59. Subject's level of comfort was measured with Kolcaba's verbal rating scale (VRS).
Independent t-tests showed that the VRS mean score was lower in the control group (6.81) than the experimental group (7.29).
Comfort is central to nursing and there has been little research regarding the effects of warm topical applications in the psychiatric hospital setting. Warmed blankets are not routinely offered to patients in the psychiatric setting. The use of warmed blankets may increase patient comfort.
© 2015 Wiley Periodicals, Inc.
Infrared thermography provides a non-invasive and dynamic measure of heat. The thermal preservability effects of a salt footbath were evaluated by the infrared thermography technique. The subjects were 23 healthy college students. Feet were soaked for 10 min in a 40-42 degrees C normal footbath. Room temperature was set at 26.5-28 degrees C. At the same time on another day within 3 days of the normal footbath experiment, the same feet were soaked for 10 min in a 40-42 degrees C salt footbath. We measured blood pressure, heart rate and temperatures of the feet, second toes, hands and middle fingers, just before and after immersion and at 10-min intervals thereafter. Mean blood pressure changes showed no difference between the normal and the salt footbath. Mean heart rate changes were higher during the normal footbath than at 0, 15 and 20 min during the salt footbath, respectively (p < 0.05). Mean thermal preservability of the feet tended to be lower after the normal footbath than at 20 and 30 min, respectively, after the salt footbath, but these differences did not reach a statistical significance. Mean thermal preservability of the hands and middle fingers was significantly lower after the normal footbath than at 20 and 30 min, respectively, after the salt footbath (p < 0.05). The results suggest that stimulation by a salt footbath affects surface skin temperature, and that stimulation aimed at increasing skin thermal preservability shows a significant difference between normal and salt footbaths.
Even healthy people occasionally have difficulty falling asleep. Psychological relaxation techniques, hot baths, soothing infusions of plant extracts, melatonin and conventional hypnotics are all invoked in the search for a good night's sleep. Here we show that the degree of dilation of blood vessels in the skin of the hands and feet, which increases heat loss at these extremities, is the best physiological predictor for the rapid onset of sleep. Our findings provide further insight into the thermoregulatory cascade of events that precede the initiation of sleep.
We examined the effect of high local forearm skin temperature (Tloc) on reflex cutaneous vasodilator responses to elevated whole-body skin (Tsk) and internal temperatures. One forearm was locally warmed to 42 degrees C while the other was left at ambient conditions to determine if a high Tloc could attenuate or abolish reflex vasodilation. Forearm blood flow (FBF) was monitored in both arms, increases being indicative of increases in skin blood flow (SkBF). In one protocol, Tsk was raised to 39-40 degrees C 30 min after Tloc in one arm had been raised to 42 degrees C. In a second protocol, Tsk and Tloc were elevated simultaneously. In protocol 1, the locally warmed arm showed little or no change in blood flow in response to increasing Tsk and esophageal temperature (average rise = 0.76 +/- 1.18 ml X 100 ml-1 X min-1), whereas FBF in the normothermic arm rose by an average of 8.84 +/- 3.85 ml X 100 ml-1 X min-1. In protocol 2, FBF in the normothermic arm converged with that in the warmed arm in three of four cases but did not surpass it. We conclude that local warming to 42 degrees C for 35-55 min prevents reflex forearm cutaneous vasodilator responses to whole-body heat stress. The data strongly suggest that this attenuation is via reduction or abolition of basal tone in the cutaneous arteriolar smooth muscle and that at a Tloc of 42 degrees C a maximum forearm SkBF has been achieved. Implicit in this conclusion is that local warming has been applied for a duration sufficient to achieve a plateau in FBF.
The frequency of body movement in the elderly and young people during sleep was measured in order to investigate the effect of hot thermal environments on sleep in summer. Simultaneously, room temperature and humidity were also measured. In the morning after measuring body movements, the subjects completed a questionnaire about their night's sleep. The results obtained were as follows: 1) The time of going to bed and rising in the elderly was significantly earlier than the young. 2) The elderly had a tendency to judge their sleep as "good", however, there were no significant differences between the two groups. 3) The room temperature for the elderly during sleep ranged from 25 to 28 degrees C (mean 26.5 degrees C). On the other hand, it was between 20 and 30 degrees C (mean 27.1 degrees C) in the young, which was significantly higher than that of the elderly. 4) Body movement in the elderly during sleep was significantly greater than those in the young. 5) A significant relation between body movement and room temperature was found within each group. Under conditions of less than 28 degrees C of room temperature, there were significantly higher rates of body movement in the elderly.
The role of the endogenous circadian pacemaker in the timing of the sleep-wake cycle and the regulation of the internal structure of sleep, including REM sleep, EEG slow-wave (0.75-4.5 Hz) and sleep spindle activity (12.75-15.0 Hz) was investigated. Eight men lived in an environment free of time cues for 33-36 d and were scheduled to a 28 hr rest-activity cycle so that sleep episodes (9.33 hr each) occurred at all phases of the endogenous circadian cycle and variations in wakefulness preceding sleep were minimized. The crest of the robust circadian rhythm of REM sleep, which was observed throughout the sleep episode, was positioned shortly after the minimum of the core body temperature rhythm. Furthermore, a sleep-dependent increase of REM sleep was present, which, interacting with the circadian modulation, resulted in highest values of REM sleep when the end of scheduled sleep episodes coincided with habitual wake-time. Slow-wave activity decreased and sleep spindle activity increased in the course of all sleep episodes. Slow-wave activity in non-REM sleep exhibited a low amplitude circadian modulation which did not parallel the circadian rhythm of sleep propensity. Sleep spindle activity showed a marked endogenous circadian rhythm; its crest coincident with the beginning of the habitual sleep episode. Analyses of the (nonadditive) interaction of the circadian and sleep-dependent components of sleep propensity and sleep structure revealed that the phase relation between the sleep-wake cycle and the circadian pacemaker during entrainment promotes the consolidation of sleep and wakefulness and facilitates the transitions between these vigilance states.
This study was conducted with a representative sample of the French population of 5,622 subjects of 15 years old or more. The telephone interviews were performed with EVAL, an expert system specialized for the evaluation of sleep disorders. From this sample, 20.1% of persons said that they were unsatisfied with their sleep or taking medication for sleeping difficulties or anxiety with sleeping difficulties (UQS). A low family income, being a woman, being over 65 years of age, being retired and being separated, divorced or widowed are significantly associated with the presence of UQS. A sleep onset period over 15 minutes, a short night's sleep and regular nighttime awakenings are also associated with UQS. Medical consultations during the past 6 months and physical illnesses are more frequent among the UQS group. The consumption of sleep-enhancing medication and medication to reduce anxiety is important: in the past, 16% of subjects had taken a sleep-enhancing medication and 16.2% a medication to reduce anxiety. At the time of the survey 9.9% of the population were using sleep-enhancing medication and 6.7% were using medication for anxiety. For most, hypnotic consumption was long-term: 81.6% had been using it for more than 6 months.
Sleep State Misperception insomnia has been commonly viewed as a perceptual or psychological problem. It was hypothesized that Sleep State Misperception insomnia, like psychophysiological insomnia, could be associated with increased physiological activation, here indexed by whole body metabolic rate.
Groups of nine patients with Sleep State Misperception insomnia and age-, sex-, and weight-matched normal sleepers were evaluated on sleep, performance, mood, personality, and metabolic measures over a 36-hour sleep laboratory stay.
Sleep State Misperception insomniacs had a subjective history of poor sleep and perceived their laboratory sleep as poor but had electroencephalogram (EEG) parameters that did not differ statistically from matched normal controls. Sleep State Misperception insomniacs had abnormal MMPI values and were subjectively more confused, tense, depressed, and angry than matched normals. Sleep State Misperception insomniacs also had a significantly increased 24-hour metabolic rate, compared with matched normals.
The overall increase in whole body oxygen use was less than that seen in psychophysiological insomniacs but was consistent with the view that Sleep State Misperception insomnia may be a mild version or a precursor to psychophysiological insomnia.
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.
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.
Thermoregulatory processes have long been implicated in initiation of human sleep. The purpose of this study was to evaluate the role of heat loss in sleep initiation, under the controlled conditions of a constant-routine protocol modified to permit nocturnal sleep. Heat loss was indirectly measured by means of the distal-to-proximal skin temperature gradient (DPG). A stepwise regression analysis revealed that the DPG 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). This study provides evidence that selective vasodilation of distal skin regions (and hence heat loss) promotes the rapid onset of sleep.
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.
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.
In young adults, sleep affects the regulation of growth hormone (GH) and cortisol. The relationship between decreased sleep quality in older adults and age-related changes in the regulation of GH and cortisol is unknown.
To determine the chronology of age-related changes in sleep duration and quality (sleep stages) in healthy men and whether concomitant alterations occur in GH and cortisol levels.
Data combined from a series of studies conducted between 1985 and 1999 at 4 laboratories.
A total of 149 healthy men, aged 16 to 83 years, with a mean (SD) body mass index of 24.1 (2.3) kg/m( 2), without sleep complaints or histories of endocrine, psychiatric, or sleep disorders.
Twenty-four-hour profiles of plasma GH and cortisol levels and polygraphic sleep recordings.
The mean (SEM) percentage of deep slow wave sleep decreased from 18.9% (1.3%) during early adulthood (age 16-25 years) to 3.4% (1.0%) during midlife (age 36-50 years) and was replaced by lighter sleep (stages 1 and 2) without significant increases in sleep fragmentation or decreases in rapid eye movement (REM) sleep. The transition from midlife to late life (age 71-83 years) involved no further significant decrease in slow wave sleep but an increase in time awake of 28 minutes per decade at the expense of decreases in both light non-REM sleep (-24 minutes per decade; P<.001) and REM sleep (-10 minutes per decade; P<.001). The decline in slow wave sleep from early adulthood to midlife was paralleled by a major decline in GH secretion (-372 microg per decade; P<.001). From midlife to late life, GH secretion further declined at a slower rate (-43 microg per decade; P<.02). Independently of age, the amount of GH secretion was significantly associated with slow wave sleep (P<.001). Increasing age was associated with an elevation of evening cortisol levels (+19. 3 nmol/L per decade; P<.001) that became significant only after age 50 years, when sleep became more fragmented and REM sleep declined. A trend for an association between lower amounts of REM sleep and higher evening cortisol concentrations independent of age was detected (P<.10).
In men, age-related changes in slow wave sleep and REM sleep occur with markedly different chronologies and are each associated with specific hormonal alterations. Future studies should evaluate whether strategies to enhance sleep quality may have beneficial hormonal effects. JAMA. 2000;284:861-868
Background
To examine the sleep habits and one-year prevalence of sleep disturbance (difficulty in falling asleep, broken sleep and early morning wakening) as well as insomnia (subjectively inadequate or poor sleep) in an elderly Chinese population in Hong Kong.
Method
In Phase 1, a representative sample of elderly aged 70 years or above were interviewed with a sleep questionnaire, and Cantonese versions of the Mini-Mental State Examination (CMMSE) and Geriatric Depression Scale(CGDS). In Phase 2, those with scores suggestive of cognitive impairment on CMMSE or depression on CGDS were interviewed by psychiatrists for making clinical diagnoses according to DSM IV.
Results
1,034 elderly were interviewed in Phase 1. Occasional or persistent sleep disturbance were reported by 75% and insomnia in 38.2% of elderly. Slightly less than half of elderly with sleep disturbance complained of insomnia. Advancing age was associated with a higher rate of sleep disturbance while females had a higher rate of insomnia. Factors associated with sleep disturbance and insomnia included poor perceived health, past history of smoking, current depressive disorders, more chronic physical illness, more life events and more somatic complaints. Only 2.8% of the sample had taken sleeping pills within a one -year period.
Conclusions
Sleep disturbance and insomnia are two separate but overlapping constructs and should be differentiated. Sleep disturbance is very common in the elderly and may be due to physiological changes with ageing. In contrast, those with a concommitant complaint of insomnia have impaired physical and mental health and may merit more medical attention.
Objective
The sleep of a large group of healthy older men and women was studied in an effort to better understand the relationship between self-reported subjective and objectively measured sleep quality.
In order to obtain control data on the temperature sense (warm and cool threshold values) of fingertips, the relationships between room temperature and either skin temperature, warm threshold or cool threshold of the middle fingertips were investigated in healthy subjects (6 males), using our thermo-esthesiometer. The skin temperature changes in a sigmoidal response with the variation of room temperature. A point of inflection for this response was observed at the room temperature of 15°C, at which the greatest standard deviation of skin temperature occurred. The warm and cool thresholds, on the other hand, were also affected by variations of room temperature. Warm threshold and skin temperature or cool threshold and skin temperature bore a linear relation to each other, and the correlation coefficient was 0.854 in the former, and 0.925 in the latter, respectively. The disorder of temperature sensitivity (warm and cool thresholds) must always be considered together with the room temperature or skin temperature. On the other hand, the width of the neutral zone between warm and cool thresholds was affected by neither the changes of room temperature nor the changes of skin temperature. Hence, the width of the neutral zone was approximately constant, especially, at the room temperatures in the vicinity of 15°C to 25°C.
The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in α-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an eitiologic factor but, contrary to several literature assertions, α-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 247–257, 1997
Anxiety and depression in Taiwanese cancer patients with and without pain
The purpose of this investigation was to compare anxiety and depression in Taiwanese cancer patients with and without pain. In 1998, a convenience sample of 203 hospitalized cancer patients, 77 with pain and 126 without pain, were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Disease‐related factors such as performance status, disease stage and perceived treatment effect were also assessed and controlled for their effect on anxiety and depression. The prevalence of both anxiety and depression in the pain group was significantly higher than that for the pain‐free group. After controlling the effect of disease‐related factors, patients’ pain status had a significant effect on depression, but not on anxiety. Patients with pain had more depressive symptoms than patients without pain. Cancer patients’ anxiety can be predicted significantly by functional status and perceived treatment effect. In addition to pain status, cancer patients’ depression can be predicted by their functional status.
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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.
Circadian rhythms are a ubiquitous adaptation of eukaryotic organisms to the most reliable and predictable of environmental changes, the daily cycles of light and temperature. Prominent daily rhythms in behavior, physiology, hormone levels and biochemistry (including gene expression) are not merely responses to these environmental cycles, however, but embody the organism's ability to keep and tell time. At the core of circadian systems is a mysterious mechanism, located in the brain (actually the Suprachiasmatic nucleus of the hypothalamus) of mammals, but present even in unicellular organisms, that functions as a clock. This clock drives circadian rhythms. It is independent of, but remains responsive to, environmental cycles (especially light). The interest in temporal regulation — its organization, mechanism and consequences — unites investigators in diverse disciplines studying otherwise disparate systems. This diversity is reflected in the brief reviews that summarize the presentations at a meeting on circadian rhythms held in New York City on October 31, 1992. The meeting was sponsored by the Fondation pour l'Étude du Systéme Nerveux (FESN) and followed a larger meeting held 18 months earlier in Geneva, whose proceedings have been published (M. Zatz (Ed.), Report of the Ninth FESN Study Group on ‘Circadian Rhythms’, Discussions in Neuroscience, Vol. VIII, Nos. 2 + 3, Elsevier, Amsterdam, 1992). Some speakers described progress made in the interim, while others addressed aspects of the field not previously covered.
The purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini-Mental State Examination (MMSE).
The reviewed studies assessed a wide variety of subjects, ranging from cognitively intact community residents to those with severe cognitive impairment associated with various types of dementing illnesses.
The validity of the MMSE was compared against a variety of gold standards, including DSM-III-R and NINCDS-ADRDA criteria, clinical diagnoses, Activities of Daily Living measures, and other tests that putatively identify and measure cognitive impairment.
Reliability and construct validity were judged to be satisfactory. Measures of criterion validity showed high levels of sensitivity for moderate-to-severe cognitive impairment and lower levels for mild degrees of impairment. Content analyses revealed the MMSE was highly verbal, and not all items were equally sensitive to cognitive impairment. Items measuring language were judged to be relatively easy and lacked utility for identifying mild language deficits. Overall, MMSE scores were affected by age, education, and cultural background, but not gender.
In general, the MMSE fulfilled its original goal of providing a brief screening test that quantitatively assesses the severity of cognitive impairment and documents cognitive changes occurring over time. The MMSE should not, by itself, be used as a diagnostic tool to identify dementia. Suggestions for the clinical use of the MMSE are made.
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
In order to obtain control data on the temperature sense (warm and cool threshold values) of fingertips, the relationships between room temperature and either skin temperature, warm threshold or cool threshold of the middle fingertips were investigated in healthy subjects (6 males), using our thermo-esthesiometer. The skin temperature changes in a sigmoidal response with the variation of room temperature. A point of inflection for this response was observed at the room temperature of 15 degrees C, at which the greatest standard deviation of skin temperature occurred. The warm and cool thresholds, on the other hand, were also affected by variations of room temperature. Warm threshold and skin temperature or cool threshold and skin temperature bore a linear relation to each other, and the correlation coefficient was 0.854 in the former, and 0.925 in the latter, respectively. The disorder of temperature sensitivity (warm and cool thresholds) must always be considered together with the room temperature or skin temperature. On the other hand, the width of the neutral zone between warm and cool thresholds was affected by neither the changes of room temperature nor the changes of skin temperature. Hence, the width of the neutral zone was approximately constant, especially, at the room temperatures in the vicinity of 15 degrees C to 25 degrees C.
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
We have developed a quantitative model of human sleep-wake rhythms based on a thermoregulatory feedback control mechanism modulated by two circadian oscillators. Homeostatic features of sleep regulation are realized through the heat memory which represents the history of the masking process associated with sleep-wake cycles: heat load during wake and heat loss during sleep. Simulations under entrained conditions showed that the model closely mimics well-known features of human sleep-wake rhythm, and that the homeostatic and the oscillatory aspects of the human circadian system are successfully integrated in our model. In this paper, parameter dependency of the model behavior is studied by simulations. Because of its physiology-based structure, the parameter dependency could show the possible underlying mechanism for the typical features of human sleep-wake rhythm. In addition, the model stability is analyzed by the linear system theory and the simulations, which establishes the stability condition and suggests that the presented simulation results are basically stable. These results are informative to apply our model to actual data of sleep-wake rhythms, and to interpret them from the physiological point of view.
Circadian rhythms are a ubiquitous adaptation of eukaryotic organisms to the most reliable and predictable of environmental changes, the daily cycles of light and temperature. Prominent daily rhythms in behavior, physiology, hormone levels and biochemistry (including gene expression) are not merely responses to these environmental cycles, however, but embody the organism's ability to keep and tell time. At the core of circadian systems is a mysterious mechanism, located in the brain (actually the suprachiasmatic nucleus of the hypothalamus) of mammals, but present even in unicellular organisms, that functions as a clock. This clock drives circadian rhythms. It is independent of, but remains responsive to, environmental cycles (especially light). The interest in temporal regulation--its organization, mechanism and consequences--unites investigators in diverse disciplines studying otherwise disparate systems. This diversity is reflected in the brief reviews that summarize the presentations at a meeting on circadian rhythms held in New York City on October 31, 1992. The meeting was sponsored by the Fondation pour l'Etude du Système Nerveux (FESN) and followed a larger meeting held 18 months earlier in Geneva, whose proceedings have been published (M. Zatz (Ed.), Report of the Ninth FESN Study Group on 'Circadian Rhythms', Discussions in Neuroscience, Vol. VIII, Nos. 2 + 3, Elsevier, Amsterdam, 1992). Some speakers described progress made in the interim, while others addressed aspects of the field not previously covered.
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.
This study examined the relationship between circadian temperature rhythm amplitude reduction and sleep consolidation parameters in a group of healthy elders experiencing a 6-h phase advance in routine. Twenty-five healthy old people (15 women, 10 men, 77-91 years old) lived in a time-isolation apartment. Throughout the study, subjects were instructed when to go to bed, get up, and take meals. The experiment started with 5 baseline days during which subjects were kept to a daily routine corresponding to their habitual sleep-wake cycle. The wake time of the 6th night was phase-advanced by 6 h and the routine for the remainder of the experiment was held constant at the new earlier phase position. Rectal temperature was recorded continuously and all sleep episodes recorded polygraphically. Time series of temperature data for each subject were analyzed by complex demodulation (CD). Five of the subjects were excluded from analysis because the percentage of variance accounted for by the remodulate was less than 55% for the postshift days and one subject was excluded because he showed an average sleep efficiency of less than 55% during baseline. In the remaining 19 subjects, the phase shift produced a large decrease of the mean amplitude of the temperature circadian rhythm (from 0.45 degree C to 0.25 degree C). During the first 3 nights following the phase shift, sleep efficiency was decreased and amount of wakefulness in the first half of the night (WFirst) was increased. No effect was found for the amount of wake in the second half of the night (WSecond). The change in amplitude of the temperature rhythm was significantly correlated with change in sleep efficiency (r = 0.5; p = 0.03) and with change in WFirst (r = -0.7; p < 0.001). There was no correlation between change in the amplitude of the temperature rhythm and WSecond. These results suggest that in older subjects, amplitude of the output of the circadian oscillator might indeed be involved in the sleep consolidation process but, in the first, rather than the second half of the night.
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.
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.
The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.
To examine whether there is a circadian variation in skin blood flow response to passive heat stress and maximal skin blood flow, which was measured by local warming to 42 degrees C for 45 min, we studied six men at an ambient temperature of 28 degrees C at four different times of day [0400-0700 (morning), 1000-1300 (daytime), 1600-1900 (evening), and 2200-0100 hours (night)], each time of day being examined on separate days. Heat stress at rest was performed by immersing the legs below the knee in hot water (42 degrees C) for 60 min. The esophageal temperature (Tes) at rest was significantly higher in the evening than in the morning. The maximal skin blood flow (SkBFmax) on both sites, back and forearm, did not show a significant difference among the four times of day. The variation in Tes thresholds for cutaneous vasodilation to heat stress was similar to the circadian rhythm in resting Tes. The relationship of the percentage of SkBFmax (%SkBF) with Tes was significantly lower in the morning than in the evening. The results suggest that the maximal skin blood flow during local warming does not show variation over the day, but the sensitivity of vasodilation to passive heat stress shows a circadian variation.
Objectives:
Although changes in the circadian timing system are thought to be a major factor in the decline of sleep quality that often accompanies aging, few reports have actually examined this relationship in detail. Because some treatments for age-related insomnia are based on putative circadian changes, it is important to expand the limited database that specifically addresses this issue. This study examined age-related changes in sleep, and relationships between those sleep changes and alterations in the circadian timing system, in a group of middle-aged and older subjects.
Design:
Sixty healthy men and women between the ages of 40 and 84 were studied. A subset of older subjects (< 65 years) had reported sleep disturbance for at least 1 year before participation. Polysomnography was obtained, and body core temperature was recorded continuously for 24 hours. All recordings took place in the Laboratory of Human Chronobiology, Department of Psychiatry, Cornell University Medical College.
Results:
There were no differences in sleep quality between middle-aged and non-sleep-disturbed older subjects. However, timing of the minimum body temperature was earlier in the older non-sleep-disturbed subjects than in the middle-aged group. In contrast, sleep-disturbed older people had shorter total sleep times, reduced sleep efficiency, more waking time after sleep onset, and a reduced proportion of REM sleep compared with non-sleep-disturbed older subjects. Yet, there were no differences between the two older groups in the rhythm of body temperature. For the entire group, age was correlated negatively with total sleep time, sleep efficiency, percentage of stage 2 sleep, and the timing