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Sleep Initiation and Maintenance Disorders: HELP
Articles by Chiara Baglioni
Based on 28 articles published since 2009
(Why 28 articles?)
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Between 2009 and 2019, C. Baglioni wrote the following 28 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline European guideline for the diagnosis and treatment of insomnia. 2017

Riemann, Dieter / Baglioni, Chiara / Bassetti, Claudio / Bjorvatn, Bjørn / Dolenc Groselj, Leja / Ellis, Jason G / Espie, Colin A / Garcia-Borreguero, Diego / Gjerstad, Michaela / Gonçalves, Marta / Hertenstein, Elisabeth / Jansson-Fröjmark, Markus / Jennum, Poul J / Leger, Damien / Nissen, Christoph / Parrino, Liborio / Paunio, Tiina / Pevernagie, Dirk / Verbraecken, Johan / Weeß, Hans-Günter / Wichniak, Adam / Zavalko, Irina / Arnardottir, Erna S / Deleanu, Oana-Claudia / Strazisar, Barbara / Zoetmulder, Marielle / Spiegelhalder, Kai. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · University Hospital for Neurology, Inselspital Bern, Bern, Switzerland. · Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. · Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia. · Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK. · Sleep Research Institute Madrid, Madrid, Spain. · Stavanger University Hospital, Stavanger, Norway. · Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal. · Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. · Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. · Centre du Sommeil et de la Vigilance et EA 7330 VIFASOM, Université Paris Descartes, Clinic Hotel-Dieu, Sorbonne Paris Cité, APHP, HUPC, Hotel Dieu de Paris, Paris, France. · University Hospital of Psychiatry, Bern, Switzerland. · Department of Medicine and Surgery, University of Parma, Parma, Italy. · National Institute for Health and Welfare Helsinki, Helsinki, Finland. · Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Wilrijk, Belgium. · Sleep Center Pfalzklinikum, Klingenmünster, Germany. · Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland. · Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency, Moscow, Russia. · Sleep Measurements, National University Hospital of Iceland, Reykjavik, Iceland. · Institute for Pneumology, Medical Faculty, University of Bucharest, Bucharest, Romania. · Centre for Sleep Disorders in Children and Adolescents, General Hospital Celje, Ljubljana, Slovenia. · Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. ·J Sleep Res · Pubmed #28875581.

ABSTRACT: This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

2 Review The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: A systematic review and network meta-analysis. 2018

Ballesio, Andrea / Aquino, Maria Raisa Jessica V / Feige, Bernd / Johann, Anna F / Kyle, Simon D / Spiegelhalder, Kai / Lombardo, Caterina / Rücker, Gerta / Riemann, Dieter / Baglioni, Chiara. ·Department of Psychology, Sapienza University of Rome, Italy. · School of Health Sciences, City, University of London, UK. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Sleep and Circadian Neuroscience Institute, University of Oxford, UK. · Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. Electronic address: chiara.baglioni@uniklinik-freiburg.de. ·Sleep Med Rev · Pubmed #28619248.

ABSTRACT: This review aimed to assess the impact of behavioural therapy for insomnia administered alone (BT-I) or in combination with cognitive techniques (cognitive-behavioural therapy for insomnia, CBT-I) on depressive and fatigue symptoms using network meta-analysis. PubMed, Scopus and Web of Science were searched from 1986 to May 2015. Studies were included if they incorporated sleep restriction, a core technique of BT-I treatment, and an adult insomnia sample, a control group and a standardised measure of depressive and/or fatigue symptoms. Face-to-face, group, self-help and internet therapies were all considered. Forty-seven studies were included in the meta-analysis. Eleven classes of treatment or control conditions were identified in the network. Cohen's d at 95% confidence interval (CI) was calculated to assess the effect sizes of each treatment class as compared with placebo. Results showed significant effects for individual face-to-face CBT-I on depressive (d = 0.34, 95% CI: 0.06-0.63) but not on fatigue symptoms, with high heterogeneity between studies. The source of heterogeneity was not identified even after including sex, age, comorbidity and risk of bias in sensitivity analyses. Findings highlight the need to reduce variability between study methodologies and suggest potential effects of individual face-to-face CBT-I on daytime symptoms.

3 Review Neuroimaging insights into insomnia. 2015

Spiegelhalder, Kai / Regen, Wolfram / Baglioni, Chiara / Nissen, Christoph / Riemann, Dieter / Kyle, Simon D. ·Department of Psychophysiology/Sleep Medicine, University Medical Center Freiburg, Hauptstraße 5, 79104, Freiburg, Germany, Kai.Spiegelhalder@uniklinik-freiburg.de. ·Curr Neurol Neurosci Rep · Pubmed #25687698.

ABSTRACT: Insomnia is one of the most prevalent health complaints afflicting approximately 10% of the population in Western industrialized countries at a clinical level. Despite the proposition that both biological and psychological factors play a role in the experience of insomnia, the field continues to puzzle over so-called "discrepancies" between objective and subjective measurements of sleep and daytime functioning. The promise of neuroimaging is to uncover physiological processes that may readily explain patient reports. However, while there has been an explosion in the number of studies investigating the neural correlates of insomnia with neuroimaging technologies, there appears to be little consistency in findings across studies. We suggest a number of methodological reasons which may, at least partially, explain variability in findings across neuroimaging studies in insomnia.

4 Review Neuroimaging studies in insomnia. 2013

Spiegelhalder, Kai / Regen, Wolfram / Baglioni, Chiara / Riemann, Dieter / Winkelman, John W. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Hauptstraße 5, 79104, Freiburg, Germany, Kai.Spiegelhalder@uniklinik-freiburg.de. ·Curr Psychiatry Rep · Pubmed #24057158.

ABSTRACT: Chronic insomnia is one of the most prevalent psychiatric disorders and has a significant impact on individual's health. However, the pathophysiology of the disorder is poorly understood. The current review focuses on neuroimaging findings in insomnia. In summary, the current data suggest the following: (1) insomnia is characterized by corticolimbic overactivity during sleep and wakefulness that interferes with sleep initiation and/or maintenance; (2) insomnia patients' daytime performance is associated with a hypoactivation of task-related areas; (3) neurochemically, insomnia patients are probably characterized by reduced cortical GABA levels; (4) insomnia may be associated with abnormal brain morphometry in the frontal cortex, hippocampus and/or anterior cingulate cortex. Future investigations should include larger sample sizes or longitudinal within-subject comparisons. Other possible methodological improvements are discussed.

5 Review The microstructure of sleep in primary insomnia: an overview and extension. 2013

Feige, Bernd / Baglioni, Chiara / Spiegelhalder, Kai / Hirscher, Verena / Nissen, Christoph / Riemann, Dieter. ·Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstraße 5, 79104 Freiburg, Germany. Electronic address: Bernd.Feige@gmx.net. ·Int J Psychophysiol · Pubmed #23583625.

ABSTRACT: The present review was undertaken to summarize studies elucidating sleep microstructural differences in chronic insomnia. The etiology of insomnia is still unknown, whereas the hyperarousal concept has gained much attention with respect to pathophysiology. According to this model, insomnia is characterized by significant hyperarousal on an autonomous and central nervous level. Objective findings derived from polysomnography frequently show much less severe differences to good sleepers than subjective sleep complaints assessed by self-rating questionnaires. However, using more fine-grained methods to characterize the electrophysiology of sleep in insomnia, rather distinct differences between the sleep of good sleepers and patients with insomnia have been noted. These methods include the spectral analysis of the sleep EEG, micro-arousal and CAP (cyclic alternating pattern) analysis as well as the assessment of event-related potentials (ERPs) during night-sleep. The application of these methods shows stronger correlations with the subjective experience of disturbed sleep than standard sleep EEG scoring. An overview of the relevant empirical evidence is presented, previous investigations are extended and a theoretical synthesis within the framework of the hyperarousal concept of insomnia is attempted.

6 Review Is chronic insomnia a precursor to major depression? Epidemiological and biological findings. 2012

Baglioni, Chiara / Riemann, Dieter. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Hauptstraße 5, 79104 Freiburg, Germany. chiara.baglioni@uniklinik-freiburg.de ·Curr Psychiatry Rep · Pubmed #22865155.

ABSTRACT: Insomnia has been found to be a clinical predictor of subsequent depression. Nevertheless the biological processes underlying this causal relationship are yet not fully understood. Both conditions share a common imbalance of the arousal system. Patients with insomnia present fragmented REM sleep, which probably interferes with basal processes of emotion regulation. The interaction between the arousal and the affective system with the persistence of the disorder could slowly alter also the cognitive system and lead to depression. Although preliminary results seem to support this hypothesis, data are still too few to make valid conclusions.

7 Review REM sleep instability--a new pathway for insomnia? 2012

Riemann, D / Spiegelhalder, K / Nissen, C / Hirscher, V / Baglioni, C / Feige, B. ·Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Pharmacopsychiatry · Pubmed #22290199.

ABSTRACT: Chronic insomnia afflicts approximately 10% of the adult population and is associated with daytime impairments and an elevated risk for developing somatic and mental disorders. Current pathophysiological models propose a persistent hyperarousal on the cognitive, emotional and physiological levels. However, the marked discrepancy between minor objective alterations in standard parameters of sleep continuity and the profound subjective impairment in patients with insomnia is unresolved. We propose that "instability" of REM sleep contributes to the experience of disrupted and non-restorative sleep and to the explanation of this discrepancy. This concept is based on evidence showing increased micro- and macro-arousals during REM sleep in insomnia patients. As REM sleep represents the most highly aroused brain state during sleep it seems particularly prone to fragmentation in individuals with persistent hyperarousal. The continuity hypothesis of dream production suggests that pre-sleep concerns of patients with insomnia, i. e., worries about poor sleep and its consequences, dominate their dream content. Enhanced arousal during REM sleep may render these wake-like cognitions more accessible to conscious perception, memory storage and morning recall, resulting in the experience of disrupted and non-restorative sleep. Furthermore, chronic fragmentation of REM sleep might lead to dysfunction in a ventral emotional neural network, including limbic and paralimbic areas that are specifically activated during REM sleep. This dysfunction, along with attenuated functioning in a dorsal executive neural network, including frontal and prefrontal areas, might contribute to emotional and cognitive alterations and an elevated risk of developing depression.

8 Review Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. 2011

Baglioni, Chiara / Battagliese, Gemma / Feige, Bernd / Spiegelhalder, Kai / Nissen, Christoph / Voderholzer, Ulrich / Lombardo, Caterina / Riemann, Dieter. ·Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. chiara.baglioni@uniklinik-freiburg.de ·J Affect Disord · Pubmed #21300408.

ABSTRACT: BACKGROUND: In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. METHODS: PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. RESULTS: Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). LIMITATIONS: The main limit is that included studies did not always consider the role of other intervening variables. CONCLUSIONS: Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.

9 Review Sleep and emotions: a focus on insomnia. 2010

Baglioni, Chiara / Spiegelhalder, Kai / Lombardo, Caterina / Riemann, Dieter. ·Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. chiara.baglioni@uniklinik-freiburg.de ·Sleep Med Rev · Pubmed #20137989.

ABSTRACT: Insomnia disorder is defined as difficulties in initiating/maintaining sleep and/or non-restorative sleep accompanied by decreased daytime functioning, persisting for at least four weeks. For many patients suffering from depression and anxiety, insomnia is a pervasive problem. Many of the aetiological theories of insomnia postulate that heightened emotional reactivity contributes to the maintenance of symptoms. This review focuses on the role of emotional reactivity in insomnia, and how the relationship between insomnia and depression and anxiety may be mediated by emotional reactivity. Furthermore, studies investigating the valence of emotions in insomnia are reviewed. Overall, there is empirical evidence that dysfunctional emotional reactivity might mediate the interaction between cognitive and autonomic hyperarousal, thus contributing to the maintenance of insomnia. Moreover, dysfunctions in sleep-wake regulating neural circuitries seem to be able to reinforce emotional disturbances. It seems plausible that dysfunctional emotional reactivity modulates the relationship between insomnia and depression and anxiety. Considering the interaction between sleep and emotional valence, poor sleep quality seems to correlate with high negative and low positive emotions, both in clinical and subclinical samples. Good sleep seems to be associated with high positive emotions, but not necessarily with low negative emotions. This review underlines the need for future research on emotions in insomnia.

10 Clinical Trial Quality of life improvements after acceptance and commitment therapy in nonresponders to cognitive behavioral therapy for primary insomnia. 2014

Hertenstein, Elisabeth / Thiel, Nicola / Lüking, Marianne / Külz, Anne Katrin / Schramm, Elisabeth / Baglioni, Chiara / Spiegelhalder, Kai / Riemann, Dieter / Nissen, Christoph. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany. ·Psychother Psychosom · Pubmed #25323449.

ABSTRACT: -- No abstract --

11 Article Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls. 2019

Frase, Lukas / Selhausen, Peter / Krone, Lukas / Tsodor, Sulamith / Jahn, Friederike / Feige, Bernd / Maier, Jonathan G / Mainberger, Florian / Piosczyk, Hannah / Kuhn, Marion / Klöppel, Stefan / Sterr, Annette / Baglioni, Chiara / Spiegelhalder, Kai / Riemann, Dieter / Nitsche, Michael A / Nissen, Christoph. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Center for NeuroModulation, Faculty of Medciine, University of Freiburg, Germany. · Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland. · Department of Psychology, University of Surrey, UK. · Department of Clinical Neurophysiology, University Medical Center Göttingen, Germany; Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany. · Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland. Electronic address: christoph.nissen@upd.ch. ·Brain Stimul · Pubmed #30639236.

ABSTRACT: BACKGROUND: Arousal and sleep represent basic domains of behavior, and alterations are of high clinical importance. OBJECTIVE/HYPOTHESIS: The aim of this study was to further elucidate the neurobiology of insomnia disorder (ID) and the potential for new treatment developments, based on the modulation of cortical activity through the non-invasive brain stimulation technique transcranial direct current stimulation (tDCS). Specifically, we tested the hypotheses that bi-frontal anodal tDCS shortens and cathodal tDCS prolongs total sleep time in patients with ID, compared to sham stimulation. Furthermore, we tested for differences in indices of arousal between ID patients and healthy controls and explored their potential impact on tDCS effects. METHODS: Nineteen ID patients underwent a within-subject repeated-measures sleep laboratory study with adaptation, baseline and three experimental nights. Bifrontal anodal, cathodal and sham tDCS was delivered in a counterbalanced order immediately prior to sleep. Wake EEG was recorded prior to and after tDCS as well as on the following morning. Subsequently, we compared patients with ID to a healthy control group from an earlier dataset. RESULTS: Against our hypothesis, we did not observe any tDCS effects on sleep continuity or sleep architecture in patients with ID. Further analyses of nights without stimulation demonstrated significantly increased levels of arousal in ID patients compared to healthy controls, as indexed by subjective reports, reduced total sleep time, increased wake after sleep onset and increased high frequency EEG power during wakefulness and NREM sleep. Of note, indices of increased arousal predicted the lack of effect of tDCS in ID patients. CONCLUSIONS: Our study characterizes for the first time differential effects of tDCS on sleep in patients with ID and healthy controls, presumably related to persistent hyperarousal in ID. These findings suggest that adapted tDCS protocols need to be developed to modulate arousal and sleep dependent on baseline arousal levels.

12 Article Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. 2019

Hertenstein, Elisabeth / Feige, Bernd / Gmeiner, Tabea / Kienzler, Christian / Spiegelhalder, Kai / Johann, Anna / Jansson-Fröjmark, Markus / Palagini, Laura / Rücker, Gerta / Riemann, Dieter / Baglioni, Chiara. ·University Psychiatric Services Bern (UPD), Bern, Switzerland. Electronic address: elisabeth.hertenstein@upd.ch. · Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany. · Department of Psychology, Stockholm University, Sweden. · Department of Psychiatry, University of Pisa, Italy. · Institute for Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine University of Freiburg, Germany. ·Sleep Med Rev · Pubmed #30537570.

ABSTRACT: Previous research has identified insomnia as a predictor for the onset of depression. The aim of this meta-analysis is to investigate whether insomnia also predicts the onset of other mental disorders. Longitudinal studies were eligible for inclusion if they investigated insomnia at baseline (including nighttime- and daytime-symptoms) as a predictor of the later onset of psychopathology within a follow-up time-frame of at least 12 mo. Thirteen primary studies were included. The results suggest that insomnia is a significant predictor for the onset of depression (10 studies, OR 2.83, CI 1.55-5.17), anxiety (six studies, OR 3.23, CI 1.52-6.85), alcohol abuse (two studies, OR 1.35, CI 1.08-1.67, and psychosis (one study, OR 1.28, CI 1.03-1.59). The overall risk of bias in the primary studies was moderate. This meta-analysis provides evidence that insomnia increases the risk for psychopathology. A future research agenda should include more prospective studies using established diagnostic criteria, assessing insomnia at baseline and including long-term follow-up intervals evaluating a wider range of mental disorders. In addition, prospective long-term interventional studies investigating the efficacy of insomnia treatment for the prevention of mental disorders are called for.

13 Article Insomnia-perchance a dream? Results from a NREM/REM sleep awakening study in good sleepers and patients with insomnia. 2018

Feige, Bernd / Nanovska, Svetoslava / Baglioni, Chiara / Bier, Benedict / Cabrera, Laura / Diemers, Sarah / Quellmalz, Maximilian / Siegel, Markus / Xeni, Ireni / Szentkiralyi, Andras / Doerr, John-Peter / Riemann, Dieter. ·Department of Clinical Psychology and Psychophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Institute for Epidemiology and Social Medicine, University of Münster, Germany. ·Sleep · Pubmed #29432570.

ABSTRACT: Study Objectives: Insomnia disorder (ID) is a frequent sleep disorder coupled with increased risks for somatic and mental illness. Although subjective complaints are severe, polysomnography (PSG) parameters show only modest differences between groups. Rapid eye movement (REM) sleep as the most aroused sleep state may be especially vulnerable to be perceived as wake. To directly assess possible differences, we determined auditory waking thresholds and sleep perception in patients with ID and healthy control participants (good sleeper controls [GSC]) in N2 and REM sleep. Methods: In case-control study, 27 patients with ID and 27 age- and gender-matched controls were included. Four consecutive nights were assessed in the sleep laboratory, with nights 3 and 4 each containing three awakenings either from stable N2 or REM sleep. Awakening thresholds in patients with ID did not differ from GSC, but decreased over the course of the night. Patients with ID indicated significantly more frequently than GSC having been awake when woken from REM sleep but not from N2 and were less sure when indicating they had been asleep. Additionally, participants with ID rated their REM sleep mentation as more emotionally negative compared with GSC. Conclusions: This study presents direct evidence that the subjective experience of insomnia might be specifically coupled to the REM sleep state. Assuming chronic hyperarousal as a central pathophysiologically relevant pathway for insomnia, this might become especially evident during REM sleep, thus reflecting a hybrid sleep state in insomnia being coupled with altered sleep perception.

14 Article Brain Reactivity and Selective Attention to Sleep-Related Words in Patients With Chronic Insomnia. 2018

Spiegelhalder, Kai / Baglioni, Chiara / Regen, Wolfram / Kyle, Simon D / Nissen, Christoph / Hennig, Jürgen / Doerr, John-Peter / Feige, Bernd / Riemann, Dieter. ·a Clinic for Psychiatry and Psychotherapy , Medical Center of the University of Freiburg , Freiburg , Germany. · b Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neuroscience , University of Oxford , Oxford , England. · c Department of Diagnostic Radiology , Medical Center of the University of Freiburg , Freiburg , Germany. ·Behav Sleep Med · Pubmed #27967237.

ABSTRACT: OBJECTIVE/BACKGROUND: Sleep-related attentional bias has been suggested to represent an important factor for the maintenance of chronic insomnia. However, little is known about potentially underlying psychological mechanisms such as threat or craving. As these are associated with distinguishable brain activation patterns, we performed a functional neuroimaging study. PARTICIPANTS/METHODS: Functional magnetic resonance imaging was used to investigate brain reactivity to sleep-related words in 20 patients with primary insomnia according to DSM-IV criteria and 35 good sleeper controls according to Research Diagnostic Criteria. In addition, an emotional Stroop task was performed in all participants outside the scanner to investigate sleep-related attentional bias. RESULTS: Contrary to the hypotheses, patients with chronic insomnia did not differ from good sleeper controls in terms of threat- or craving-related brain reactivity to sleep-related words. In addition, the emotional Stroop task did not reveal any significant group difference in sleep-related attentional bias. Exploratory analyses did not show any significant correlations between brain reactivity/selective attention to sleep-related words and questionnaire scores/PSG parameters. CONCLUSIONS: The results from the present study call into question that attentional bias to sleep-related stimuli is a core feature of chronic insomnia. Future studies may use pictorial stimuli and larger sample sizes for investigating sleep-related information processing in insomnia.

15 Article Perfectionism and Polysomnography-Determined Markers of Poor Sleep. 2017

Johann, Anna F / Hertenstein, Elisabeth / Kyle, Simon D / Baglioni, Chiara / Feige, Bernd / Nissen, Christoph / Riemann, Dieter / Spiegelhalder, Kai. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Germany. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neuroscience, University of Oxford, United Kingdom. ·J Clin Sleep Med · Pubmed #28992830.

ABSTRACT: STUDY OBJECTIVES: Perfectionism has been suggested to represent a predisposing factor for poor sleep. However, previous studies have relied on self-reported measures. The association between perfectionism and poor sleep measured by polysomnography (PSG) warrants further investigation. METHODS: The current retrospective exploratory study used the Frost Multidimensional Perfectionism Scale and PSG in an unselected sample of 334 consecutive sleep laboratory patients (140 males, 194 females, 44.6 ± 15.9 years). Data were analyzed using linear regression analyses. RESULTS: High levels of perfectionism were associated with PSG-determined markers of poor sleep in the first sleep laboratory night. The total Frost Multidimensional Perfectionism Scale score was significantly associated with the number of nocturnal awakenings in the first sleep laboratory night. The subscales "concern over mistakes" and "personal standards" of perfectionism were significantly associated with markers of poor sleep. In contrast, there were only a few associations between perfectionism and PSG variables of the second sleep laboratory night. CONCLUSIONS: This pattern of results suggests that high levels of perfectionism may predispose individuals to sleep disturbances in the context of acute stressors. Thus, the influence of perfectionism on poor sleep should be further investigated to improve treatment.

16 Article Insomnia with objective short sleep duration is associated with longer duration of insomnia in the Freiburg Insomnia Cohort compared to insomnia with normal sleep duration, but not with hypertension. 2017

Johann, Anna F / Hertenstein, Elisabeth / Kyle, Simon D / Baglioni, Chiara / Feige, Bernd / Nissen, Christoph / McGinness, Alastair J / Riemann, Dieter / Spiegelhalder, Kai. ·Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Sleep and Circadian Neuroscience Institute (SCNi), Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom. ·PLoS One · Pubmed #28746413.

ABSTRACT: STUDY OBJECTIVES: To replicate the association between insomnia with objective short sleep duration and hypertension, type 2 diabetes and duration of insomnia. DESIGN: Retrospective case-control study. SETTING: Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg. PARTICIPANTS: 328 patients with primary insomnia classified according to DSM-IV criteria (125 males, 203 females, 44.3 ± 12.2 years). INTERVENTIONS: N/A. MEASUREMENTS: All participants were investigated using polysomnography, blood pressure measurements, and fasting routine laboratory. RESULTS: Insomnia patients with short sleep duration (< 6 hours) in the first night of laboratory sleep presented with a longer duration of insomnia compared to those with normal sleep duration (≥ 6 hours) in the first night of laboratory sleep. Insomnia patients who were categorised as short sleepers in either night were not more likely to suffer from hypertension (systolic blood pressure of ≥ 140 mm Hg, diastolic blood pressure of ≥ 90 mm Hg, or a previously established diagnosis). Data analysis showed that insomnia patients with objective short sleep duration were not more likely to suffer from type 2 diabetes (fasting plasma glucose level of ≥ 126 mg/dl, or a previously established diagnosis). However, the diabetes analysis was only based on a very small number of diabetes cases. As a new finding, insomnia patients who were categorised as short sleepers in either night presented with increases in liver enzyme levels. CONCLUSIONS: The finding on insomnia duration supports the concept of two distinct sub-groups of insomnia, namely insomnia with, and without, objectively determined short sleep duration. However, our data challenges previous findings that insomnia patients with short sleep duration are more likely to suffer from hypertension.

17 Article Magnetic Resonance Spectroscopy in Patients with Insomnia: A Repeated Measurement Study. 2016

Spiegelhalder, Kai / Regen, Wolfram / Nissen, Christoph / Feige, Bernd / Baglioni, Chiara / Riemann, Dieter / Hennig, Jürgen / Lange, Thomas. ·Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University Medical Center Freiburg, Freiburg, Germany. · Freiburg Institute of Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany. · Department of Radiology, Medical Physics, University Medical Center Freiburg, Freiburg, Germany. ·PLoS One · Pubmed #27285311.

ABSTRACT: Chronic insomnia is one of the most prevalent central nervous system disorders. It is characterized by increased arousal levels, however, the neurobiological causes and correlates of hyperarousal in insomnia remain to be further determined. In the current study, magnetic resonance spectroscopy was used in the morning and evening in a well-characterized sample of 20 primary insomnia patients (12 females; 8 males; 42.7 ± 13.4 years) and 20 healthy good sleepers (12 females; 8 males; 44.1 ± 10.6 years). The most important inhibitory and excitatory neurotransmitters of the central nervous system, γ-aminobutyric acid (GABA) and glutamate/glutamine (Glx), were assessed in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC). The primary hypothesis, a diurnal effect on GABA levels in patients with insomnia, could not be confirmed. Moreover, the current results did not support previous findings of altered GABA levels in individuals with insomnia. Exploratory analyses, however, suggested that GABA levels in the ACC may be positively associated with habitual sleep duration, and, thus, reduced GABA levels may be a trait marker of objective sleep disturbances. Moreover, there was a significant GROUP x MEASUREMENT TIME interaction effect on Glx in the DLPFC with increasing Glx levels across the day in the patients but not in the control group. Therefore, Glx levels may reflect hyperarousal at bedtime in those with insomnia. Future confirmatory studies should include larger sample sizes to investigate brain metabolites in different subgroups of insomnia.

18 Article The exploratory power of sleep effort, dysfunctional beliefs and arousal for insomnia severity and polysomnography-determined sleep. 2015

Hertenstein, Elisabeth / Nissen, Christoph / Riemann, Dieter / Feige, Bernd / Baglioni, Chiara / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University Medical Center Freiburg, Freiburg, Germany. ·J Sleep Res · Pubmed #25773981.

ABSTRACT: Differences between subjective sleep perception and sleep determined by polysomnography (PSG) are prevalent, particularly in patients with primary insomnia, indicating that the two measures are partially independent. To identify individualized treatment strategies, it is important to understand the potentially different mechanisms influencing subjective and PSG-determined sleep. The aim of this study was to investigate to what extent three major components of insomnia models, i.e., sleep effort, dysfunctional beliefs and attitudes about sleep, and presleep arousal, are associated with subjective insomnia severity and PSG-determined sleep. A sample of 47 patients with primary insomnia according to DSM-IV criteria and 52 good sleeper controls underwent 2 nights of PSG and completed the Glasgow Sleep Effort Scale, the Dysfunctional Beliefs and Attitudes about Sleep Scale, the Pre-Sleep Arousal Scale and the Insomnia Severity Index. Regression analyses were conducted to investigate the impact of the three predictors on subjective insomnia severity and PSG- determined total sleep time. All analyses were adjusted for age, gender, depressive symptoms and group status. The results showed that subjective insomnia severity was associated positively with sleep effort. PSG-determined total sleep time was associated negatively with somatic presleep arousal and dysfunctional beliefs and attitudes about sleep. This pattern of results provides testable hypotheses for prospective studies on the impact of distinct cognitive and somatic variables on subjective insomnia severity and PSG-determined total sleep time.

19 Article Perfectionistic Tendencies in Insomnia Patients' Behavior During Psychometric Testing. 2015

Regen, Wolfram / Hertenstein, Elisabeth / Weil, Peter / Kyle, Simon D / Holz, Johannes / Baglioni, Chiara / Nissen, Christoph / Feige, Bernd / Riemann, Dieter / Spiegelhalder, Kai. ·a Department of Psychiatry and Psychotherapy University Medical Center Freiburg. ·Behav Sleep Med · Pubmed #24925081.

ABSTRACT: According to self-report questionnaire studies, insomnia patients differ from healthy controls with respect to several personality traits. The current study aimed at exploring how these personality traits may translate into behavior. Insomnia patients' behavior during psychometric testing (n = 163) was investigated in comparison to healthy controls (n = 81), patients with other sleep disorders (n = 80), and patients with obsessive-compulsive disorder (n = 36). In line with our hypotheses, insomnia patients made more additional comments than healthy controls and more corrections than patients with other sleep disorders during sleep-related questionnaire completion. Furthermore, insomnia patients calculated the sum score of a depression questionnaire more frequently than both healthy controls and patients with other sleep disorders. These findings further support the assumption of an altered personality profile in patients with primary insomnia. Future work should aim to elucidate what personality factors these novel behavioral markers may reflect.

20 Article Insomnia disorder is associated with increased amygdala reactivity to insomnia-related stimuli. 2014

Baglioni, Chiara / Spiegelhalder, Kai / Regen, Wolfram / Feige, Bernd / Nissen, Christoph / Lombardo, Caterina / Violani, Cristiano / Hennig, Jürgen / Riemann, Dieter. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany. · Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany: Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Germany. · Department of Psychology, Sapienza University of Rome, Italy. · Department of Radiology, University of Freiburg Medical Center, Germany. ·Sleep · Pubmed #25325493.

ABSTRACT: STUDY OBJECTIVES: Alterations in emotional reactivity may play a key role in the pathophysiology of insomnia disorder (ID). However, only few supporting experimental data are currently available. We evaluated in a hypothesis-driven design whether patients with ID present altered amygdale responses to emotional stimuli related and unrelated to the experience of insomnia and, because of chronic hyperarousal, less habituation of amygdala responses. DESIGN: Case-control study. SETTING: Departments of Psychiatry and Psychotherapy and of Radiology of the University of Freiburg Medical Center. PARTICIPANTS: There were 22 patients with ID (15 females; 7 males; age 40.7 ± 12.6 y) and 38 healthy good sleepers (HGS, 21 females; 17 males; age 39.6 ± 8.9 y). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In a functional magnetic resonance imaging session, five different blocks of pictures with varying emotional arousal, valence, and content (insomnia-relatedness) were presented. Pictures were presented twice to test for habituation processes. Results showed that patients with ID, compared to HGS, presented heightened amygdala responses to insomnia-related stimuli. Moreover, habituation of amygdale responses was observed only in HGS, but not in patients with ID who showed a mixed pattern of amygdala responses to the second presentation of the stimuli. CONCLUSIONS: The results provide evidence for an insomnia-related emotional bias in patients with ID. Cognitive behavior treatment for ID could benefit from strategies dealing with the emotional charge associated with the disorder. Further studies should clarify the role of ID with respect to habituation of amygdala responses.

21 Article Reduced anterior internal capsule white matter integrity in primary insomnia. 2014

Spiegelhalder, Kai / Regen, Wolfram / Prem, Martin / Baglioni, Chiara / Nissen, Christoph / Feige, Bernd / Schnell, Susanne / Kiselev, Valerij G / Hennig, Jürgen / Riemann, Dieter. · ·Hum Brain Mapp · Pubmed #25050429.

ABSTRACT: Chronic insomnia is one of the most prevalent central nervous system diseases, however, its neurobiology is poorly understood. Up to now, nothing is known about the integrity of white matter tracts in insomnia patients. In this study, diffusion tensor imaging (DTI) was used in a well-characterized sample of primary insomnia (PI) patients and good sleeper controls to fill this void. Voxelwise between-group comparisons of fractional anisotropy (FA) were performed in 24 PI patients (10 males; 14 females; 42.7 ± 14.5 years) and 35 healthy good sleepers (15 males; 20 females; 40.1 ± 9.1 years) with age and sex as covariates. PI patients showed reduced FA values within the right anterior internal capsule and a trend for reduced FA values in the left anterior internal capsule. The results suggest that insomnia is associated with a reduced integrity of white matter tracts in the anterior internal capsule indicating that disturbed fronto-subcortical connectivity may be a cause or consequence of the disorder.

22 Article [Insomnia--state of the science]. 2014

Riemann, D / Baglioni, C / Feige, B / Spiegelhalder, K. ·Abteilung für Klinische Psychologie und Psychophysiologie/Schlafmedizin der Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland, dieter.riemann@uniklinik-freiburg.de. ·Nervenarzt · Pubmed #24346426.

ABSTRACT: Diagnostic systems such as the international classification of diseases (ICD-10) or the diagnostic and statistical manual of mental disorders (DSM IV) have frequently been criticized as not adequately reflecting the complexity and heterogeneity of insomnia. Progress was made through the introduction of the international classification of sleep disorders (ICSD-2) and the research diagnostic criteria (RDC). The DSM-5 introduced the new category of insomnia disorder, thus relinquishing the traditional dichotomy of primary versus secondary insomnia. Recent basic research indicates that genetic and epigenetic factors are involved in the etiology of insomnia; the so-called three P model (i.e. predisposing, precipitating and perpetuating factors) and the hyperarousal concept have gained much attention in trying to explain the pathophysiology of insomnia. With respect to the cognitive-behavioral therapy of insomnia (CBT-I), a plethora of empirical evidence supports the first-line character of this type of treatment for insomnia. Unfortunately, CBT-I is still administered to only a minority of afflicted patients, probably due to a lack of resources in the healthcare system. As a consequence, stepped-care models to improve insomnia therapy encompass self-help programs, internet-based treatment avenues, community-centered activities (specially trained nurses) and as a last resort medical specialists/psychotherapists and sleep experts to deal with insomnia.

23 Article Sleep changes in the disorder of insomnia: a meta-analysis of polysomnographic studies. 2014

Baglioni, Chiara / Regen, Wolfram / Teghen, Armand / Spiegelhalder, Kai / Feige, Bernd / Nissen, Christoph / Riemann, Dieter. · ·Sleep Med Rev · Pubmed #23809904.

ABSTRACT: Insomnia is a highly prevalent health problem worldwide. Primary insomnia (PI), i.e., insomnia not due to another disorder or substance use, represents a model to elucidate the pathophysiology of sleep. However, prior research in patients with PI has failed to demonstrate consistent abnormalities in the state-of-the-art assessment of sleep (polysomnography). The aim of this meta-analysis was to clarify whether there are identifiable polysomnographic sleep changes that correspond to the subjective complaints of patients with PI. Medline and PsycInfo databases were searched from 1994 to 2012. Effects were calculated as standardized mean differences. Studies were pooled with the random-effects metaanalytic model. Twenty-three studies met inclusion criteria. In total, 582 patients with PI and 485 good sleeper controls (GSC) were evaluated. The results showed that patients with PI present a disruption of sleep continuity and a significant reduction of slow wave sleep (SWS) and rapid eye movement (REM) sleep compared to GSC. The observed changes in sleep architecture, i.e., reductions in SWS and REM sleep, hitherto did not count among the typical polysomnographic findings in patients with PI. An advanced knowledge of the polysomnographic changes in PI may add to foster the understanding of the pathophysiology of sleep and its bi-directional relationships with somatic and mental disorders.

24 Article Insomnia does not appear to be associated with substantial structural brain changes. 2013

Spiegelhalder, Kai / Regen, Wolfram / Baglioni, Chiara / Klöppel, Stefan / Abdulkadir, Ahmed / Hennig, Jürgen / Nissen, Christoph / Riemann, Dieter / Feige, Bernd. ·Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Germany. Kai.Spiegelhalder@uniklinik-freiburg.de ·Sleep · Pubmed #23633756.

ABSTRACT: STUDY OBJECTIVES: Sleep has been demonstrated to significantly modulate brain plasticity and the manifestation of mental disorders. However, previous studies on the effect of disrupted sleep on brain structure have reported inconsistent results. The goal of the current study was to investigate brain morphometry in a well-characterized large sample of patients with primary insomnia (PI) in comparison with good sleeper controls. DESIGN: Automated parcellation and pattern recognition approaches were supplemented by voxelwise analyses of gray and white matter volumes to analyze magnetic resonance images. All analyses included age, sex, and total intracranial volume as covariates. SETTING: Department of Psychiatry and Psychotherapy of the University of Freiburg Medical Center. PARTICIPANTS: There were 28 patients with PI (10 males; 18 females; age 43.7 ± 14.2 y) and 38 healthy, good sleepers (17 males; 21 females; age 39.6 ± 8.9 y). INTERVENTIONS: N/A. RESULTS: No significant between-group differences were observed in any of the investigated brain morphometry variables. CONCLUSIONS: Altered brain function in insomnia does not appear to have a substantial effect on brain morphometry on a macroscopic level.

25 Article Increased EEG sigma and beta power during NREM sleep in primary insomnia. 2012

Spiegelhalder, Kai / Regen, Wolfram / Feige, Bernd / Holz, Johannes / Piosczyk, Hannah / Baglioni, Chiara / Riemann, Dieter / Nissen, Christoph. ·Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Germany. Kai.Spiegelhalder@uniklinik-freiburg.de ·Biol Psychol · Pubmed #22960269.

ABSTRACT: The hyperarousal model of primary insomnia suggests that a deficit of attenuating arousal during sleep might cause the experience of non-restorative sleep. In the current study, we examined EEG spectral power values for standard frequency bands as indices of cortical arousal and sleep protecting mechanisms during sleep in 25 patients with primary insomnia and 29 good sleeper controls. Patients with primary insomnia demonstrated significantly elevated spectral power values in the EEG beta and sigma frequency band during NREM stage 2 sleep. No differences were observed in other frequency bands or during REM sleep. Based on prior studies suggesting that EEG beta activity represents a marker of cortical arousal and EEG sleep spindle (sigma) activity is an index of sleep protective mechanisms, our findings may provide further evidence for the concept that a simultaneous activation of wake-promoting and sleep-protecting neural activity patterns contributes to the experience of non-restorative sleep in primary insomnia.

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