Brief counseling sessions treat insomnia up to six months

Older adults with insomnia could improve sleep quality with individualized, brief counseling.

In a randomized controlled study that included 79 older adults with insomnia, researchers from University of Pittsburgh School of Medicine compared the impact of face-to-face and phone counseling to printed educational information about insomnia. They found counseling was effective for helping older adults obtain needed sleep, potentially reducing the need for medications that could cause harm.

The group who received counseling received two sessions from a nurse clinician, followed by two telephone calls that included behavioral instructions for curbing insomnia. The average age of the participants was 71.7 years. In the group, 39 participants received nurse clinician instructions and the other 40 were given printed materials about insomnia and sleep habits.

The groups answered questions about sleep habits, kept diaries, provided demographic information, underwent sleep assessment studies using polysomnography in addition to actigraphy that involves wearing a wrist and ankle monitor.

According to the results, more older adults who received behavioral treatment for insomnia responded favorably – 67 percent versus 25 percent in the control group, after four weeks, reported by the study group. The benefits were noted six months later.

The researchers estimated that for every 2.4 patients counseled, one would no longer meet criteria for insomnia. The study results could ensure safety for older adults who have trouble falling or staying asleep. According to background information from the study, medications are equally as effective, but increase the risk for falls and other adverse events, especially in older populations.

Background information from the study states 15 to 35 percent of older adults in the US suffer from insomnia. Daytime fatigue from poor sleep increases the risk of falls and hip fractures that can lead to disability and hospitalization.

The authors note counseling is an “attractive” option for treating insomnia because it reduces the stigma of behavioral psychological treatments. The authors suggest training could be provided to nurses and other health care professionals who could counsel older patients experiencing insomnia, who were shown in the study to respond favorably.

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Negative Effects of Caffeine Are Stronger on Daytime Sleep Than on Nocturnal Sleep

Drinking Coffe and Sleeping

A new study at the Universite de Montreal has concluded that people drinking coffee to get through a night shift or a night of studying will strongly hurt their recovery sleep the next day. The study published in the current issue of Neuropsychopharmacology was conducted by Dr. Julie Carrier from the Department of Psychology at the Universite de Montreal. Dr. Carrier runs the Chronobiology Laboratory at the Hopital du Sacre-Coeur de Montreal

“We already knew that caffeine has important effects on nocturnal sleep. It increases the time taken to fall asleep, it increases the amount of awakenings, and it decreases the amount of deep sleep. We have shown that these effects of caffeine on sleep are way stronger when taken at night prior to a daytime recovery sleep episode than in the evening before a nocturnal sleep episode.”

“Caffeine makes daytime sleep episodes too shallow to override the signal from the biological clock that tells the body it should be awake at this time of day,” explains Dr. Carrier. “We often use coffee and other sources of caffeine during the nighttime to counteract sleepiness generated by sleep deprivation, jet lag, and shift-work. However, this habit may have important effects when you then try to recuperate during daytime.”

Thirty-four moderate caffeine consumers participated in both caffeine (200 mg) and placebo (lactose) conditions in a double-blind crossover design. Seventeen subjects followed their habitual sleep-wake cycle and slept in the laboratory during the night (Night), while 17 subjects were sleep deprived for one night and recovery sleep started in the morning (DayRec). All subjects received a capsule of 100 mg of caffeine (or placebo) 3 hours before bedtime, and the remaining dose 1 hour before bedtime. Compared to placebo, caffeine lengthened sleep latency, increased stage 1, and reduced stage 2 and slow-wave sleep (SWS) in both groups. However, caffeine reduced sleep efficiency more strongly in the DayRec group, and decreased sleep duration and REM sleep only in that group.

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Sleep Aids Impair Cognition and Balance in Adults

Adults who take the popular sleep aid zolpidem may be at greater risk for loss of balance leading to falls and cognitive impairment according to new research by the University of Colorado at Boulder.

Zolpidem is marketed under such brand names as Ambien, Zolpimist, Edluar, Hypogen, Somidem, and Ivedal.
The study, conducted by Associate Professor Kenneth Wright, involved 25 healthy adults who took zolpidem and then awakened after only two hours of sleep. The team measured balance using a technique known as a “tandem walk” in which subjects place one foot in front of the other with a normal step length on a 16-foot-long, six-inch-wide beam on the floor. All participants were provided with stabilizing assistance to prevent falls during the trials.

The participants also underwent computerized performance tests of cognition.

Read: Poor Night’s Sleep Increases Odds of Stroke, Heart Attack

Prior to taking the sleep aid, the participants walked the beam with no loss of balance. However, after taking zolpidem, older adults were more than twice as likely to have balance issues compared to when they were tested after taking a placebo.

The researchers also noted a significant impairment to cognition after taking zolpidem. Waking two hours after taking sleep aids enhances “sleep inertia” or grogginess that temporarily impairs working memory and decision-making, especially important if someone is awakened in the middle of the night due to fire alarm or a family member having a medical emergency.

Unexpectedly, this study shows that cognition impairments due to sleep inertia impacted younger people more so than older adults. This could be due to the dosage used for the study, explains Wright. The normal dose for older adults (and the dose used in the trial) is 5 milligrams. The usual dose for a younger person is 10 milligrams.

Read: Hospital Delirium Puts Elderly at Risk

The findings are important because falls are the leading cause of injury in older adults, and 30 percent of adults 65 and older who fall require hospitalization each year, said Wright, lead study author.

“This suggests to us that sleep medication produces significant safety risks,” says Wright, who emphasizes that the authors are not suggesting that sleep medications not be used, but that adults and health care workers should be educated about the potential problems.

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College Students Sleep-Deprived, Stressed Out

Stress about school and life keeps 68 percent of students awake at night – 20 percent of them at least once a week. Stress affects the quality of their sleep far more than alcohol, caffeine or late-night electronics use, a new study shows.

Not only that, more than 60 percent of college students have disturbed sleep/wake patterns and many regularly take drugs and alcohol to help them do one or the other.

The study of 1,125 students appears online in the Journal of Adolescent Health. It found that only 30 percent of students sleep at least eight hours a night — the average requirement for young adults.

On weeknights, 20 percent of students stay up all night at least once a month and 35 percent stay up until 3 a.m. at least once a week. Twelve percent of poor sleepers miss class three or more times a month or fall asleep in class.

“Students underestimate the importance of sleep in their daily lives. They forgo sleep during periods of stress, not realizing that they are sabotaging their physical and mental health,” said study co-author Roxanne Prichard, an assistant professor of psychology at the University of St. Thomas, in St. Paul, Minn, where the study took place.

Impairments in the immune and cardiovascular systems are health risks associated with insufficient sleep, as is weight gain, Prichard said.

Daniel Taylor, an assistant professor of psychology at the University of North Texas, said, “We know little about the health of this age range even though the consequences — substance use, psychopathology, poor grades, dropout and subsequent unemployment — of sleep disturbance could be greatest.”

Of concern to researchers was the students’ tendency to use alcohol and drugs to regulate their cycle. Poor sleepers are more likely than good sleepers to use medication to stay awake or fall asleep, and twice as likely to use alcohol to induce sleep. Alternating between stimulants and sedatives has been associated to a higher risk of addiction.

Prichard said that physicians, counselors and student health professionals should be more aware of and proactive in helping students realize the importance of sleep.

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Sleep On It, Your Memory Will Improve

“I’ll sleep on it” is a phrase people say when they are going to think about something, but what if sleep actually helps you remember new information and improves your memory? Researchers at the University of York and Harvard Medical School suggest that sleep may have such an effect on memory.

Sleep helps people remember new words and enhances memory

Results of the new study are important because it is the first time scientists have been able to observe how sleep has a role in reorganizing new memories and to understand a critical factor in the transfer of information in the process. Researchers utilized two groups of volunteers in their study.

Volunteers in one group were taught new words in the morning and tested on their memory of the words after learning them and then again in the evening, with no sleep in between. These individuals did not improve in their memory of the words during the re-test in the evening.

Volunteers in a second group were taught new words in the evening, after which they immediately took a test. These individuals then slept overnight in a lab and had their brain activity monitored using an electroencephalogram (EEG).

When the volunteers in the second group were retested in the morning after a night of sleep, they were able to remember more words than they had recalled immediately after learning them the night before. They also were able to recognize the words faster, which suggests sleep strengthens new memories.

When researchers evaluated the volunteers’ brainwaves, they found that deep sleep rather than rapid eye movement sleep or light sleep strengthened new memories. Further evaluation showed that volunteers who had more sleep spindles during sleep were better at integrating the new words with existing knowledge.

Sleep spindles are brief and intense bursts of brain activity that indicate information is being transferred between different memory areas in the brain; specifically, the hippocampus and the neocortex. The hippocampus stores memories separately from other memories, while the neocortex contains memories that are linked with other knowledge.

Results of this study suggest that if you “sleep on it,” you could improve your memory. Dr. Jakke Tamminen, the study’s lead author, points out that “New memories are only really useful if you can connect them to information you already know.” He and his team found the “brain activity during sleep that organizes new memories and makes those vital connections with existing knowledge.”

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