Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Sleep Initiation and Maintenance Disorders: HELP
Articles by Kai Spiegelhalder
Based on 54 articles published since 2009
(Why 54 articles?)
||||

Between 2009 and 2019, K. Spiegelhalder wrote the following 54 articles about Sleep Initiation and Maintenance Disorders.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
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 Editorial Insomnia research--Time for "fine-tuning". 2015

Riemann, Dieter / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. Electronic address: dieter.riemann@uniklinik-freiburg.de. · Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, Freiburg University Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany. ·Sleep Med Rev · Pubmed #25794842.

ABSTRACT: -- No abstract --

3 Editorial The "anti-inflammatory" properties of CBT-I. 2014

Kyle, Simon D / Spiegelhalder, Kai. · ·Sleep · Pubmed #25142561.

ABSTRACT: -- No abstract --

4 Review Making sleep easier: pharmacological interventions for insomnia. 2018

Frase, Lukas / Nissen, Christoph / Riemann, Dieter / Spiegelhalder, Kai. ·a Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine , University of Freiburg , Freiburg im Breisgau , Germany. · b University Hospital of Psychiatry and Psychotherapy , University Psychiatric Services , Bern , Switzerland. ·Expert Opin Pharmacother · Pubmed #30175928.

ABSTRACT: INTRODUCTION: The disorder insomnia represents a relevant and frequent condition in clinical care. Cognitive behavioral therapy of insomnia (CBT-I) is regarded as first line treatment. Pharmacotherapy can be considered if CBT-I is not available or effective. Therefore, pharmacological approaches for disturbed sleep are still among the most widely prescribed pharmacological treatments in clinical care. AREAS COVERED: In this review, the authors highlight basic physiological pathways of sleep regulation to understand fundamental pharmacological principles of sleep medicine. Available guidelines and reviews are summarized and recommendations formulated regarding the use of benzodiazepines and hypnotic benzodiazepine receptor agonists, melatonin and melatonin receptor agonists, sedating antidepressants, antipsychotics and antihistamines, and orexin receptor antagonists in insomnia disorder. Variations in the treatment of insomnia disorder in subpopulations with increased prevalence of sleep disorders - childhood, pregnancy and old age - are specified. EXPERT OPINION: The well-established off-label use of hypnotic drugs should evocate a debate about a better alignment of clinical practice and scientific evidence and guidelines. Better understanding of sleep regulation could help in the development of completely new substance classes. Focusing subjective sleep disturbances, such as superficial sleep perception might help identify novel pathways.

5 Review A lack of consistent brain alterations in insomnia disorder: An activation likelihood estimation meta-analysis. 2018

Tahmasian, Masoud / Noori, Khadijeh / Samea, Fateme / Zarei, Mojtaba / Spiegelhalder, Kai / Eickhoff, Simon B / Van Someren, Eus / Khazaie, Habibolah / Eickhoff, Claudia R. ·Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. · Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran. · Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. · Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1; INM-7), Research Center Jülich, Jülich, Germany. · Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 Amsterdam BA, The Netherlands; Department of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, De Boelelaan 1187, 1081 Amsterdam HV, The Netherlands. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. Electronic address: hakhazaie@gmail.com. · Institute of Neuroscience and Medicine (INM-1; INM-7), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience and Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. ·Sleep Med Rev · Pubmed #30093361.

ABSTRACT: Insomnia disorder is a prevalent sleep disorder, which affects about 10% of general population. However, its neural mechanisms are poorly understood. Recently, several structural and functional neuroimaging studies have been conducted in patients with insomnia disorder, but these studies have yielded diverse findings. Here, we aimed to identify consistent patterns of abnormal brain alterations in insomnia disorder by performing a quantitative coordinate-based meta-analysis. Following the preferred reporting for systematic reviews and meta-analyses statement, we searched PubMed database and used reference tracking and finally retrieved 19 eligible studies (six task-based functional magnetic resonance imaging, eight resting-state functional magnetic resonance imaging, three voxel-based morphometry, and two positron emission tomography). We extracted peak coordinates from these studies and tested for convergence using the activation likelihood estimation method. Using this method, we found no significant convergent evidence for combination of structural atrophy and functional disturbances across previous studies (p = 0.914). Inconsistencies across these studies might be related to heterogonous clinical populations, the explorative nature of these studies in combination with small sample sizes, different experimental designs, and various preprocessing and statistical approaches. Future neuroimaging studies on insomnia disorder should include larger well-characterized samples, as well as standard imaging and analysis protocols.

6 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.

7 Review Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI. 2017

Khazaie, Habibolah / Veronese, Mattia / Noori, Khadijeh / Emamian, Farnoosh / Zarei, Mojtaba / Ashkan, Keyoumars / Leschziner, Guy D / Eickhoff, Claudia R / Eickhoff, Simon B / Morrell, Mary J / Osorio, Ricardo S / Spiegelhalder, Kai / Tahmasian, Masoud / Rosenzweig, Ivana. ·Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. · Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Department of Neurosurgery, King's College Hospital, London, UK. · Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK. · Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany. · Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. · Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust,Sydney Street, London, SW3 6NP, UK. · Center for Brain Health, NYU School of Medicine, New York, NY, United States. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. · Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran. Electronic address: masoudtahmasian@gmail.com. ·Neurosci Biobehav Rev · Pubmed #28344075.

ABSTRACT: Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.

8 Review Insomnia disorder. 2015

Morin, Charles M / Drake, Christopher L / Harvey, Allison G / Krystal, Andrew D / Manber, Rachel / Riemann, Dieter / Spiegelhalder, Kai. ·Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec City, Québec G1V 0A6, Canada. · Henry Ford Hospital Sleep Disorders and Research Center, Detroit, Michigan, USA. · Department of Psychology, University of California, Berkeley, Berkeley, California, USA. · Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA. · Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany. ·Nat Rev Dis Primers · Pubmed #27189779.

ABSTRACT: Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.

9 Review Sleep-related attentional bias in insomnia: A state-of-the-science review. 2015

Harris, Kamelia / Spiegelhalder, Kai / Espie, Colin A / MacMahon, Kenneth M A / Woods, Heather Cleland / Kyle, Simon D. ·School of Psychological Sciences, Faculty of Medical and Human Sciences, The University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom. · Department of Psychiatry and Psychotherapy, University of Freiburg Medical Centre, Hauptstraße 5, Freiburg 79104, Germany. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. · Clinical Psychology, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Row, Edinburgh EH8 9AG, United Kingdom. · School of Psychology, University of Glasgow, 58 Hillhead Street, Glasgow G12 8QB, United Kingdom. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, United Kingdom. Electronic address: simon.kyle@ndcn.ox.ac.uk. ·Clin Psychol Rev · Pubmed #26284598.

ABSTRACT: Prominent models of insomnia posit that sleep-related attentional bias plays an important role in the development and maintenance of insomnia. Here we conduct the first systematic review of the sleep-related attentional bias construct, indexed through reaction time-based experimental tasks. Literature search identified 13 studies that met pre-defined inclusion/exclusion criteria. Included studies involved between-group comparisons (poor sleepers versus controls), as well as sleep manipulations and correlational investigations with healthy sleepers. For studies involving comparisons between poor sleepers and healthy controls, effect size estimates were computed for task-relevant dependent variables. Six of the nine studies comparing poor sleepers and controls revealed statistically significant group differences in support of a differential sleep-related attentional bias (medium-to-large effect sizes), with flicker, dot-probe and Posner tasks being most sensitive to group effects. Due to the paucity of studies and variability in design and measurement, no conclusions could be reached regarding manipulation or induction of attentional bias in good sleepers. Results from the relatively small number of studies support the presence of sleep-related attentional bias in insomnia; however, its role in the development and/or maintenance of insomnia remains to be elucidated. We set out a research agenda aimed at advancing the understanding of sleep-related attention bias.

10 Review The neurobiology, investigation, and treatment of chronic insomnia. 2015

Riemann, Dieter / Nissen, Christoph / Palagini, Laura / Otte, Andreas / Perlis, Michael L / Spiegelhalder, Kai. ·Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. Electronic address: dieter.riemann@uniklinik-freiburg.de. · Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Centre for Mental Disorders, Freiburg University Medical Centre, Freiburg, Germany. · Department of Clinical Experimental Medicine, Psychiatric Unit, University of Pisa, School of Medicine, Pisa, Italy. · Biomedical Engineering, Faculty of Electrical Engineering and Information Technology, Offenburg University, Offenburg, Germany. · Department of Psychiatry, Penn Behavioral Health, Perelman School of Medicine, Pennsylvania University, Philadelphia, PA, USA. ·Lancet Neurol · Pubmed #25895933.

ABSTRACT: Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep-wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.

11 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.

12 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.

13 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.

14 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.

15 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.

16 Review Chronic insomnia: clinical and research challenges--an agenda. 2011

Riemann, D / Spiegelhalder, K / Espie, C / Pollmächer, T / Léger, D / Bassetti, C / van Someren, E. ·Department of Psychiatry and Psychotherapy of Freiburg University Medical Center, Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Pharmacopsychiatry · Pubmed #21161882.

ABSTRACT: Chronic insomnia afflicts up to 10% of the population in Western industrialized countries. It is characterized by delayed sleep onset, problems in maintaining sleep, early morning awakening or the feeling of non-restorative sleep coupled with significant daytime impairments on an emotional, social or professional level. It can occur as a co-morbid condition in any other medical or mental disorder, but also as a primary condition. Within the last decade new diagnostic and differential diagnostic approaches have been suggested that enhance diagnostic precision. Epidemiological data and data relating to the health care and cost situation of chronic insomnia suggest a huge burden for society. Chronic insomnia leads to a clear-cut increased risk for psychopathology (i. e., affective disorders) and probably also for cardiovascular and metabolic dysfunction. The pathophysiology of the condition is still poorly understood and will profit from integrating modern neuroscientific approaches (animal studies, molecular biology, neuroimaging, neurophysiology, etc.). Current treatment strategies are mainly based on cognitive behavioural interventions (CBT-I) and hypnotic treatment with benzodiazepine receptor agonists and sedating antidepressants. Although the effectiveness of these treatments has been clearly demonstrated, a substantial proportion of patients proves to be treatment-resistant or profits only poorly. The question of long-term pharmaceutical treatment of chronic insomnia, at least in Europe, is unresolved and urgently needs answers. Novel rational treatment avenues require clues on causes and mechanisms from integrated neuroscientific approaches. The important issues concerning insomnia treatment in the future especially in Europe will be reviewed and discussed critically.

17 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.

18 Review The hyperarousal model of insomnia: a review of the concept and its evidence. 2010

Riemann, Dieter / Spiegelhalder, Kai / Feige, Bernd / Voderholzer, Ulrich / Berger, Mathias / Perlis, Michael / Nissen, Christoph. ·Department of Psychiatry & Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, D-79104 Freiburg, Germany. dieter.riemann@uniklinik-freiburg.de ·Sleep Med Rev · Pubmed #19481481.

ABSTRACT: Primary insomnia is defined as difficulties in falling asleep, maintaining sleep or non-restorative sleep accompanied by significantly impaired daytime functioning in the absence of a specific physical, mental or substance-related cause. The current review provides substantial support for the concept that hyperarousal processes from the molecular to the higher system level play a key role in the pathophysiology of primary insomnia. Autonomous, neuroendocrine, neuroimmunological, electrophysiological and neuroimaging studies demonstrate increased levels of arousal in primary insomnia during both night and daytime. In the light of neurobiological theories of sleep-wake regulation, primary insomnia may be conceptualized as a final common pathway resulting from the interplay between a genetic vulnerability for an imbalance between arousing and sleep-inducing brain activity, psychosocial/medical stressors and perpetuating mechanisms including dysfunctional sleep-related behavior, learned sleep preventing associations and other cognitive factors like tendency to worry/ruminate.

19 Review [Diagnosis and treatment of sleep disorders]. 2009

Spiegelhalder, K / Riemann, D. ·Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, 79104 Freiburg. Kai.Spiegelhalder@uniklinikfreiburg.de ·Fortschr Neurol Psychiatr · Pubmed #19340759.

ABSTRACT: -- No abstract --

20 Clinical Trial Sleep Stage Transition Dynamics Reveal Specific Stage 2 Vulnerability in Insomnia. 2017

Wei, Yishul / Colombo, Michele A / Ramautar, Jennifer R / Blanken, Tessa F / van der Werf, Ysbrand D / Spiegelhalder, Kai / Feige, Bernd / Riemann, Dieter / Van Someren, Eus J W. ·Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands. · Bernstein Center Freiburg and Faculty of Biology, University of Freiburg, Freiburg, Germany. · Centre for Chronobiology, Psychiatric Hospital of the University of Basel (UPK), Basel, Switzerland. · Departments of Psychiatry and Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University and Medical Center, Amsterdam, The Netherlands. · Department of Anatomy and Neurosciences, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands. · Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. ·Sleep · Pubmed #28934523.

ABSTRACT: Study Objectives: Objective sleep impairments in insomnia disorder (ID) are insufficiently understood. The present study evaluated whether whole-night sleep stage dynamics derived from polysomnography (PSG) differ between people with ID and matched controls and whether sleep stage dynamic features discriminate them better than conventional sleep parameters. Methods: Eighty-eight participants aged 21-70 years, including 46 with ID and 42 age- and sex-matched controls without sleep complaints, were recruited through www.sleepregistry.nl and completed two nights of laboratory PSG. Data of 100 people with ID and 100 age- and sex-matched controls from a previously reported study were used to validate the generalizability of findings. The second night was used to obtain, in addition to conventional sleep parameters, probabilities of transitions between stages and bout duration distributions of each stage. Group differences were evaluated with nonparametric tests. Results: People with ID showed higher empirical probabilities to transition from stage N2 to the lighter sleep stage N1 or wakefulness and a faster decaying stage N2 bout survival function. The increased transition probability from stage N2 to stage N1 discriminated people with ID better than any of their deviations in conventional sleep parameters, including less total sleep time, less sleep efficiency, more stage N1, and more wake after sleep onset. Moreover, adding this transition probability significantly improved the discriminating power of a multiple logistic regression model based on conventional sleep parameters. Conclusions: Quantification of sleep stage dynamics revealed a particular vulnerability of stage N2 in insomnia. The feature characterizes insomnia better than-and independently of-any conventional sleep parameter.

21 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 --

22 Clinical Trial The Glasgow Sleep Impact Index (GSII): a novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. 2013

Kyle, Simon D / Crawford, Megan R / Morgan, Kevin / Spiegelhalder, Kai / Clark, Ailie A / Espie, Colin A. ·University of Glasgow Sleep Centre, Institute of Neuroscience & Psychology, University of Glasgow, Scotland, United Kingdom. simon.kyle@manchester.ac.uk ·Sleep Med · Pubmed #23347908.

ABSTRACT: OBJECTIVES: Daytime dysfunction and quality of life impairment are important and salient consequences of poor sleep in those with insomnia. Existing measurement approaches to functional impact tend to rely on non-specific generic tools, non-validated scales, or ad hoc single scale items. Here we report the development and validation of the Glasgow Sleep Impact Index (GSII), a novel self-report measure which asks patients to generate, and assess, three domains of impairment unique to their own individual context. These three patient-generated areas of impairment are ranked in order of concern (1-3; i.e. 1=the most concerning impairment), and then rated on a visual analogue scale with respect to impact in the past two weeks. Patients re-rate these specified areas of impairment, post-intervention, permitting both individual and group-level analyses. METHODS: One-hundred and eight patients (71% female; Mean age=45 yrs) meeting Research Diagnostic Criteria for Insomnia Disorder completed the GSII, resulting in the generation of 324 areas (ranks) of sleep-related daytime and quality of life impairment. Fifty-five patients also completed the GSII pre- and post-sleep restriction therapy. The following psychometric properties were assessed: content validity of generated domains; relationship between ranks of impairment; and sensitivity to change post-behavioural intervention. RESULTS: Content analysis of generated domains support recent DSM-5 proposals for specification of daytime consequences of insomnia; with the most commonly cited areas reflecting impairments in energy/motivation, work performance, cognitive functioning, emotional regulation, health/well-being, social functioning and relationship/family functioning. Preliminary results with 108 patients indicate the GSII to have excellent face and construct validity. The GSII was found to be sensitive to change, post-behavioural treatment (p<0.001; Cohen's d≥0.85 for all three ranks of impairment), and improvements were associated with reductions in insomnia severity in both correlational (range of r=0.28-0.56) and responder versus non-responder analyses (all p<0.05). CONCLUSIONS: The development of the GSII represents a novel attempt to capture and measure sleep-related quality of life impairment in a valid and meaningful way. Further psychometric and clinical evaluation is suggested.

23 Article Biological and clinical insights from genetics of insomnia symptoms. 2019

Lane, Jacqueline M / Jones, Samuel E / Dashti, Hassan S / Wood, Andrew R / Aragam, Krishna G / van Hees, Vincent T / Strand, Linn B / Winsvold, Bendik S / Wang, Heming / Bowden, Jack / Song, Yanwei / Patel, Krunal / Anderson, Simon G / Beaumont, Robin N / Bechtold, David A / Cade, Brian E / Haas, Mary / Kathiresan, Sekar / Little, Max A / Luik, Annemarie I / Loudon, Andrew S / Purcell, Shaun / Richmond, Rebecca C / Scheer, Frank A J L / Schormair, Barbara / Tyrrell, Jessica / Winkelman, John W / Winkelmann, Juliane / Anonymous1871412 / Hveem, Kristian / Zhao, Chen / Nielsen, Jonas B / Willer, Cristen J / Redline, Susan / Spiegelhalder, Kai / Kyle, Simon D / Ray, David W / Zwart, John-Anker / Brumpton, Ben / Frayling, Timothy M / Lawlor, Deborah A / Rutter, Martin K / Weedon, Michael N / Saxena, Richa. ·Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Broad Institute, Cambridge, MA, USA. · Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK. · Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. · Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA. · Netherlands eScience Center, Amsterdam, the Netherlands. · K.G. Jebsen Centre for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. · FORMI and Department of Neurology, Oslo University Hospital, Oslo, Norway. · Division of Clinical Neuroscience, Oslo University Hospital and University of Oslo, Oslo, Norway. · Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA. · Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA. · MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK. · Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. · College of Science, Northeastern University, Boston, MA, USA. · Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Farr Institute of Health Informatics Research, University College London, London, UK. · Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. · Department of Mathematics, Aston University, Birmingham, UK. · Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA. · Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK. · Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands. · Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA. · School of Social and Community Medicine, University of Bristol, Bristol, UK. · Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK. · Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. · Departments of Psychiatry and Neurology, Massachusetts General Hospital, Boston, MA, USA. · Cluster for Systems Neurology (SyNergy), Munich, Germany. · Institute of Human Genetics, Technische Universität München, Munich, Germany. · Neurogenetics, Technische Universität München, Munich, Germany. · Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. · Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA. · Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA. · Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. · Clinic for Psychiatry and Psychotherapy, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. · Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, OX37LE/NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK. · Department of Thoracic and Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. · Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. · Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. rsaxena@partners.org. · Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. rsaxena@partners.org. · Broad Institute, Cambridge, MA, USA. rsaxena@partners.org. ·Nat Genet · Pubmed #30804566.

ABSTRACT: Insomnia is a common disorder linked with adverse long-term medical and psychiatric outcomes. The underlying pathophysiological processes and causal relationships of insomnia with disease are poorly understood. Here we identified 57 loci for self-reported insomnia symptoms in the UK Biobank (n = 453,379) and confirmed their effects on self-reported insomnia symptoms in the HUNT Study (n = 14,923 cases and 47,610 controls), physician-diagnosed insomnia in the Partners Biobank (n = 2,217 cases and 14,240 controls), and accelerometer-derived measures of sleep efficiency and sleep duration in the UK Biobank (n = 83,726). Our results suggest enrichment of genes involved in ubiquitin-mediated proteolysis and of genes expressed in multiple brain regions, skeletal muscle, and adrenal glands. Evidence of shared genetic factors was found between frequent insomnia symptoms and restless legs syndrome, aging, and cardiometabolic, behavioral, psychiatric, and reproductive traits. Evidence was found for a possible causal link between insomnia symptoms and coronary artery disease, depressive symptoms, and subjective well-being.

24 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.

25 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.

Next