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Sleep Initiation and Maintenance Disorders: HELP
Articles from San Diego
Based on 82 articles published since 2008

These are the 82 published articles about Sleep Initiation and Maintenance Disorders that originated from San Diego during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial Connecting insomnia, sleep apnoea and depression. 2017

Grandner, Michael A / Malhotra, Atul. ·Sleep and Health Research Program, Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona, USA. · Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California, USA. ·Respirology · Pubmed #28556352.

ABSTRACT: -- No abstract --

2 Review Piloting cognitive-behavioral therapy for insomnia integrated with prolonged exposure. 2019

Colvonen, Peter J / Drummond, Sean P A / Angkaw, Abigail C / Norman, Sonya B. ·VA San Diego Healthcare System. · Monash Institute for Cognitive and Clinical Neuroscience. · National Center for PTSD. ·Psychol Trauma · Pubmed #30211598.

ABSTRACT: OBJECTIVE: Approximately 35-61% of individuals with posttraumatic stress disorder (PTSD) report insomnia. Further, upward of 70% report clinically significant insomnia following PTSD treatment. There are converging lines of evidence suggesting that insomnia not only independently affects daytime functioning and worsens PTSD symptoms but also may compromise response to PTSD treatment, such as prolonged exposure (PE). Taken together, integrated insomnia and PTSD treatment may increase client-centered care and treatment outcomes. METHOD: This article reviews the theory and evidence for treating sleep prior to PTSD treatment, describes the key elements of integrated cognitive-behavioral treatment for insomnia (CBT-I) and PE (2NITE protocol), and presents pilot data from a sample of 12 treatment-seeking veterans with PTSD and insomnia who completed the 2NITE protocol. Sleep data were collected with sleep diaries and actigraphy watches. RESULTS: The Client Satisfaction Questionnaire indicated high satisfaction with the 2NITE protocol (mean score 29.66 out of 32 points). On average, there were statistical and clinically significant changes in all measures, including a 20.17-point decrease in the PTSD Checklist DSM-5, a 11.75-point decrease in the insomnia severity index, an 18.58-point increase in the World Health Organization Quality of Life index, a 11% increase in sleep efficiency, and a 51-min increase in total sleep time from the actigraphy data. CONCLUSIONS: Among individuals with insomnia and PTSD, integrating CBT-I and PE with the 2NITE protocol represents a logical, innovative, and empirically informed method for augmenting existing treatments and optimizing outcomes that justifies further investigation. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

3 Review Vasomotor and Related Menopause Symptoms. 2018

Stuenkel, Cynthia A. ·Division of Endocrinology and Metabolism, University of California School of Medicine, San Diego, La Jolla, California. ·Clin Obstet Gynecol · Pubmed #29863584.

ABSTRACT: Vasomotor symptoms are the most common manifestation of the menopause transition and postmenopausal phases of reproductive life. They interfere not only in quality of life, but also contribute to sleep and mood disturbances that potentially compromise home and work effectiveness. Treatment options include hormone therapy (HT), nonhormonal prescription drugs, mind body and behavior therapies, and over-the-counter preparations. Evidence confirms that HT is the most effective option. The initial reticence to prescribe HT immediately following publication of the Women's Health Initiative has been replaced by clear guidelines for confidently identifying women for whom this therapy will be safe.

4 Review Gabapentin for the treatment of alcohol use disorder. 2018

Mason, Barbara J / Quello, Susan / Shadan, Farhad. ·a Pearson Center for Alcoholism and Addiction Research , The Scripps Research Institute , La Jolla , CA , USA. · b Division of Hospital Medicine , Scripps Clinic and Scripps Green Hospital , La Jolla , CA , USA. ·Expert Opin Investig Drugs · Pubmed #29241365.

ABSTRACT: INTRODUCTION: Alcohol misuse is the fifth leading risk factor for premature death and disability worldwide. Fewer than 10% of afflicted Americans receive pharmacological treatment for alcohol use disorder. Gabapentin is a calcium channel GABAergic modulator that is widely used for pain. Studies showing reduced drinking and decreased craving and alcohol-related disturbances in sleep and affect in the months following alcohol cessation suggest therapeutic potential for alcohol use disorder. Areas covered: Human laboratory and clinical studies assessing gabapentin for alcohol use disorder are reviewed. Data were obtained by searching for English peer-reviewed articles on PubMed, reference lists of identified articles, and trials registered on clinicaltrials.gov. Additionally, the mechanism of action of gabapentin specific to alcohol use disorder, and studies of gabapentin for alcohol withdrawal and non-alcohol substance use disorders are summarized. Expert opinion: Alcohol use disorder represents a challenge and large, unmet medical need. Evidence from single-site studies lend support to the safety and efficacy of gabapentin as a novel treatment for alcohol use disorder, with unique benefits for alcohol-related insomnia and negative affect, relative to available treatments. Proprietary gabapentin delivery systems may open a path to pivotal trials and registration of gabapentin as a novel treatment for alcohol use disorder.

5 Review Sleep in Chronic Obstructive Pulmonary Disease: Evidence Gaps and Challenges. 2016

Jen, Rachel / Li, Yanru / Owens, Robert L / Malhotra, Atul. ·Clinical Investigator Program, Department of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 1M9; Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, CA 92037, USA. · Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Medicine Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China. · Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, La Jolla, CA 92037, USA. ·Can Respir J · Pubmed #27445564.

ABSTRACT: Chronic obstructive pulmonary disease (COPD) prevalence is rising to epidemic proportions due to historical smoking trends, the aging of the population, and air pollution. Although blaming the victims has been common in COPD, the majority of COPD worldwide is now thought to be nonsmoking related, that is, caused by air pollution and cookstove exposure. It is increasingly appreciated that subjective and objective sleep disturbances are common in COPD, although strong epidemiological data are lacking. People with obstructive sleep apnea (OSA) plus COPD (the so-called overlap syndrome) have a high risk of cardiovascular death, although again mechanisms are unknown and untested. This review aims to draw attention to the problem of sleep in COPD, to encourage clinicians to ask their patients about symptoms, and to stimulate further research in this area given the large burden of the disease.

6 Review Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence. 2012

Nappi, Carla M / Drummond, Sean P A / Hall, Joshua M H. ·University of California, San Diego and Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, MC116B, San Diego, CA 92161, United States. cnappi@ucsd.edu ·Neuropharmacology · Pubmed #21396945.

ABSTRACT: Emerging evidence supports the notion of disrupted sleep as a core component of Posttraumatic Stress Disorder (PTSD). Effective treatments for nighttime PTSD symptoms are critical because sleep disruption may be mechanistically linked to development and maintenance of PTSD and is associated with significant distress, functional impairment, and poor health. This review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. Published studies that examined evidence for therapeutic effects upon sleep were included. Some behavioral and pharmacological interventions show promise, especially for nightmares, but there is a need for controlled trials that include valid sleep measures and are designed to identify treatment mechanisms. Our ability to treat PTSD-related sleep disturbances may be improved by moving away from considering sleep symptoms in isolation and instead conducting integrative studies that examine sequential or combined behavioral and/or pharmacological treatments targeting both the daytime and nighttime aspects of PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

7 Review The effect of nocturia on sleep. 2011

Ancoli-Israel, Sonia / Bliwise, Donald L / Nørgaard, Jens Peter. ·Department of Psychiatry, University of California, San Diego, San Diego, CA 92093-0733, USA. sancoliisrael@ucsd.edu ·Sleep Med Rev · Pubmed #20965130.

ABSTRACT: Sleep plays a vital role in physical and mental functioning. It is increasingly recognized that disturbed sleep is a highly prevalent and chronic condition that merits greater awareness due to the wide-ranging and serious repercussions associated with it. Nocturia is one of the causes of sleep disturbance and has been shown to impair functioning, quality of life, health and productivity, with those experiencing two or more voids per night reporting significant 'bother'. Nocturia warrants full consideration as a significant target for intervention, aiming to reduce the burden of disturbed sleep on individuals, families and society. Currently, however, a definitive evaluation of the most relevant sleep endpoints in nocturia therapy is lacking. One endpoint often used is the duration of the initial sleep period, which when evaluated in combination with the number of voiding episodes per night, might be an indication of the severity of sleep disruption in patients with nocturia.

8 Review Sleep disorders in the elderly. 2010

Roepke, Susan K / Ancoli-Israel, Sonia. ·Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, USA. ·Indian J Med Res · Pubmed #20308755.

ABSTRACT: Nearly half of older adults report difficulty initiating and maintaining sleep. With age, several changes occur that can place one at risk for sleep disturbance including increased prevalence of medical conditions, increased medication use, age-related changes in various circadian rhythms, and environmental and lifestyle changes. Although sleep complaints are common among all age groups, older adults have increased prevalence of many primary sleep disorders including sleep-disordered breathing, periodic limb movements in sleep, restless legs syndrome, rapid eye movement (REM) sleep behaviour disorder, insomnia, and circadian rhythm disturbances. The present review discusses age-related changes in sleep architecture, aetiology, presentation, and treatment of sleep disorders prevalent among the elderly and other factors relevant to ageing that are likely to affect sleep quality and quantity.

9 Review The neurobiology, clinical efficacy and safety of acamprosate in the treatment of alcohol dependence. 2010

Mason, Barbara J / Heyser, Charles J. ·Pearson Center for Alcoholism and Addiction Research, The Scripps Research Institute, 10550 North Torrey Pines Road, TPC-5, La Jolla, CA 92037, USA. mason@scripps.edu ·Expert Opin Drug Saf · Pubmed #20021295.

ABSTRACT: IMPORTANCE TO THE FIELD: Acamprosate, marketed under the brand name Campral, (Forest Pharmaceuticals, Inc., Saint Louis, MO, USA; Merck Sante s.a.s., Lyon, France) is an orally administered drug approved in the US and throughout much of the world for treating alcohol dependence. Its safety and efficacy have been demonstrated in a number of clinical trials worldwide and as with all pharmacotherapies for alcoholism, it is used in conjunction with psychosocial interventions. AREAS COVERED IN THIS REVIEW: This article reviews the mechanism of action, clinical efficacy and safety of acamprosate in Phase I, II and III randomized controlled trials involving healthy and alcohol-dependent populations using published reports from 1984 to 2009. WHAT THE READER WILL GAIN: This review provides an update of the mechanism of action and the safety and efficacy profile of acamprosate. TAKE HOME MESSAGE: Acamprosate appears to act centrally to restore the normal activity of glutamatergic neurotransmission altered by chronic alcohol exposure. Acamprosate's excellent safety profile along with several pharmacokinetic and pharmacodynamic characteristics make it well suited for treating a broad population of alcohol-dependent patients.

10 Review Sleep disorders in the older adult - a mini-review. 2010

Neikrug, Ariel B / Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, 92093-0733, USA. ·Gerontology · Pubmed #19738366.

ABSTRACT: Approximately 50% of older adults complain of difficulty sleeping. Poor sleep results in increased risk of significant morbidity and mortality. The decrements seen in the sleep of the older adult are often due to a decrease in the ability to get needed sleep. However, the decreased ability is less a function of age and more a function of other factors that accompany aging, such as medical and psychiatric illness, increased medication use, advances in the endogenous circadian clock and a higher prevalence of specific sleep disorders. Given the large number of older adults with sleep complaints and sleep disorders, there is a need for health care professionals to have an increased awareness of these sleep disturbances to better enable them to assess and treat these patients. A thorough sleep history (preferably in the presence of their bed partner) is required for a proper diagnosis, and when appropriate, an overnight sleep recording should be done. Treatment of primary sleep problems can improve the quality of life and daytime functioning of older adults. This paper reviews the diagnoses and characteristics of sleep disorders generally found in the older adult. While aimed at the practicing geriatrician, this paper is also of importance for any gerontologist interested in sleep.

11 Review Sleep and its disorders in aging populations. 2009

Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, CA, USA. sancoliisrael@ucsd.edu ·Sleep Med · Pubmed #19647483.

ABSTRACT: Most surveys confirm that older adults report sleeping about 7h a night. While sleep architecture does change with age, most age-related sleep architecture changes occur in early and mid-years. Nevertheless, the incidence of insomnia is higher in older adults than younger adults, but is most often associated with other age-related conditions, rather than age per se. The consequences of poor sleep in older adults are substantial and include poor health, cognitive impairment and mortality. Sleep difficulties are significantly associated with medical and psychiatric comorbidities and the presence of multiple medical conditions has been found to be detrimental to sleep quality. Careful health assessment is necessary to screen out sleep complaints and disorders in older populations.

12 Review Selective histamine H1 antagonism: novel hypnotic and pharmacologic actions challenge classical notions of antihistamines. 2008

Stahl, Stephen M. ·Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA. vj@mblcommunications.com ·CNS Spectr · Pubmed #19179941.

ABSTRACT: Numerous "antihistamines" as well as various psychotropic medications with antihistamine properties are widely utilized to treat insomnia. Over-the-counter sleep aids usually contain an antihistamine and various antidepressants and antipsychotics with antihistamine properties have sedative-hypnotic actions. Although widely used for the treatment of insomnia, many agents that block the histamine H1 receptor are also widely considered to have therapeutic limitations, including the development of next-day carryover sedation, as well as problems with chronic use, such as the development of tolerance to sedative-hypnotic actions and weight gain. Although these clinical actions are classically attributed to blockade of the H1 receptor, recent findings with H1 selective agents and H1 selective dosing of older agents are challenging these notions and suggest that some of the clinical limitations of current H1-blocking agents at their currently utilized doses could be attributable to other properties of these drugs, especially to their simultaneous actions on muscarinic, cholinergic, and adrenergic receptors. Selective H1 antagonism is emerging as a novel approach to the treatment of insomnia, without tolerance, weight gain, or the need for the restrictive prescription scheduling required of other hypnotics.

13 Review Sleep in the elderly: normal variations and common sleep disorders. 2008

Ancoli-Israel, Sonia / Ayalon, Liat / Salzman, Carl. ·Department of Psychiatry, University of California San Diego, La Jolla, CA 92093-0603, USA. sancoliisrael@ucsd.edu ·Harv Rev Psychiatry · Pubmed #18803103.

ABSTRACT: The most common complaints of older adults concern their difficulty initiating or maintaining sleep, which results in insufficient sleep and an increased risk of falls, difficulty with concentration and memory, and overall decreased quality of life. Difficulties sleeping are not, however, an inevitable part of aging. Rather, the sleep complaints are often comorbid with medical and psychiatric illness, associated with the medications used to treat those illnesses, or the result of circadian rhythm changes or other sleep disorders. Health care professionals specializing in geriatrics need to learn to recognize the different causes of sleep disturbances in this population and to initiate appropriate treatment. Nonpharmacological treatment techniques are discussed; pharmacological treatments are discussed in a companion article.

14 Clinical Trial The Effects of Transdiagnostic Group CBT for Anxiety on Insomnia Symptoms. 2016

McGowan, Sarah Kate / Espejo, Emmanuel P / Balliett, Noelle / Werdowatz, Emily A. ·a Psychology Service , VA San Diego Healthcare System , San Diego , CA , USA. · b Psychology , VA Puget Sound Health Care System , Tacoma , WA , USA. · c Research Service , VA San Diego Healthcare System , San Diego , CA , USA. ·Cogn Behav Ther · Pubmed #26838091.

ABSTRACT: Insomnia is a common feature among individuals with anxiety disorders. Studies of cognitive behavioral therapy (CBT) for anxiety report moderate effects on concomitant insomnia symptoms, but further research is still needed especially toward understanding how CBT for anxiety renders beneficial effects on insomnia. The current study examined changes in insomnia symptoms reported by 51 Veterans who participated in a group-based transdiagnostic CBT for anxiety intervention. In addition, insomnia symptoms were examined in relation to symptoms of general distress (GD), anhedonic depression (AD), and anxious arousal (AA) pre- to post-treatment. Results revealed a small, though statistically significant (p < .05) beneficial effect on insomnia symptoms. When changes in GD, AD, and AA were simultaneously examined in relation to changes in insomnia, change in AA was the only significant predictor of insomnia symptoms. The current study highlights the role of AA in the relationship between anxiety disorders and insomnia and demonstrates that reductions in insomnia during transdiagnostic CBT for anxiety can be largely attributed to changes in AA.

15 Clinical Trial Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders. 2016

Ramsawh, Holly J / Bomyea, Jessica / Stein, Murray B / Cissell, Shadha H / Lang, Ariel J. ·a Center for the Study of Traumatic Stress, Department of Psychiatry , Uniformed Services University of the Health Sciences. · b San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology. · c Department of Psychiatry , University of California San Diego. · d Department of Family & Preventive Medicine , University of California San Diego. · e Veterans Administration San Diego Health Care System , Center of Excellence for Stress and Mental Health. ·Behav Sleep Med · Pubmed #26244485.

ABSTRACT: Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

16 Clinical Trial Decreased health-related quality of life in women with breast cancer is associated with poor sleep. 2013

Liu, Lianqi / Fiorentino, Lavinia / Rissling, Michelle / Natarajan, Loki / Parker, Barbara A / Dimsdale, Joel E / Mills, Paul J / Sadler, Georgia Robins / Ancoli-Israel, Sonia. ·Department of Psychiatry, University of California, San Diego, USA. ·Behav Sleep Med · Pubmed #23205513.

ABSTRACT: This study examined the longitudinal relation between health-related quality of life (HR-QOL) and subjective and objective sleep quality in 166 women with newly diagnosed Stage-1 through Stage-3 breast cancer, who were scheduled to receive ≥ 4 cycles of adjuvant/neoadjuvant chemotherapy. HR-QOL was assessed with the Medical Outcomes Study 36-item Short Form, Physical Component Scale (PCS), and Mental Component Scale (MCS) scores; subjective sleep was assessed with the Pittsburgh Sleep Quality Index; and objective sleep was measured with actigraphy. Data were collected before starting chemotherapy and during the last week of Cycle 4 of chemotherapy. Patients reported poor HR-QOL and poor sleep quality before and during chemotherapy. Short sleep time and long naps were recorded at both time points. The MCS score was related to reports of poor sleep, but not to recorded sleep; worse PCS scores were associated with reports of poor sleep and less recorded naptime, suggesting sleep plays an important role in cancer patients' HR-QOL.

17 Clinical Trial A 12-week, randomized, double-blind, placebo-controlled study evaluating the effect of eszopiclone 2 mg on sleep/wake function in older adults with primary and comorbid insomnia. 2010

Ancoli-Israel, Sonia / Krystal, Andrew D / McCall, W Vaughn / Schaefer, Kendyl / Wilson, Amy / Claus, Raymond / Rubens, Robert / Roth, Thomas. ·Department of Psychiatry, University of California San Diego, San Diego, CA 92093-0733, USA. sancoliisrael@ucsd.edu ·Sleep · Pubmed #20175406.

ABSTRACT: BACKGROUND: Longer-term pharmacologic studies for insomnia in older individuals are sparse. OBJECTIVE: To evaluate the efficacy and safety of 12 weeks of nightly eszopiclone in elderly outpatients with insomnia. METHODS: Participants (65-85 years) met DSM-IV-TR criteria for insomnia with total sleep times (TST) < or = 6 h, and wake time after sleep onset (WASO) > or = 45 min. Participants were randomized to 12 weeks of eszopiclone 2 mg (n = 194) or placebo (n = 194), followed by a 2-week single-blind placebo run-out. Subject-reported measures of sleep (sTST, sleep latency [sSL], sWASO) and daytime function (alertness, concentration, wellbeing, ability to function) were assessed. AEs were monitored. RESULTS: Subjects treated with 2 mg eszopiclone slept longer at night on average and at every individual time point compared to baseline than placebo subjects, as measured by TST over the 12-week double-blind period (P < 0.0001). Mean sTST over the double-blind period for eszopiclone-treated subjects was 360.08 min compared to 297.86 min at baseline, a mean change of 63.24 min. Over the double-blind period, eszopiclone-treated subjects also experienced a significantly greater improvement in sSL compared to placebo, with a mean decrease of 24.62 min versus a mean decrease of 19.92 min, respectively (P = 0.0014). Eszopiclone subjects also experienced a significantly greater decrease in WASO (mean decrease of 36.4 min) compared to placebo subjects (decrease of 14.8 min) (P < 0.0001). Post-discontinuation, sleep parameters were statistically improved versus baseline for eszopiclone (P-values < or = 0.01), indicating no rebound. The most common AEs (> or = 5%) were headache (eszopiclone 13.9%, placebo 12.4%), unpleasant taste (12.4%, 1.5%), and nasopharyngitis (5.7%, 6.2%). CONCLUSION: In this Phase IV trial of older adults with insomnia, eszopiclone significantly improved patient-reported sleep and daytime function relative to placebo. Improvements occurred within the first week and were maintained for 3 months, with no evidence of rebound insomnia following discontinuation. The 12 weeks of treatment were well tolerated. CLINICAL TRIAL INFORMATION: A Long-Term Safety and Efficacy Study of Eszopiclone in Elderly Subjects With Primary Chronic Insomnia; Registration #NCT00386334; URL - http://www.clinicaltrials.gov/ct2/show/NCT00386334?term=eszopiclone&rank=24

18 Clinical Trial Nelotanserin, a novel selective human 5-hydroxytryptamine2A inverse agonist for the treatment of insomnia. 2010

Al-Shamma, Hussien A / Anderson, Christen / Chuang, Emil / Luthringer, Remy / Grottick, Andrew J / Hauser, Erin / Morgan, Michael / Shanahan, William / Teegarden, Bradley R / Thomsen, William J / Behan, Dominic. ·Arena Pharmaceuticals, Inc., San Diego, California, USA. halshamma@arenapharm.com ·J Pharmacol Exp Ther · Pubmed #19841476.

ABSTRACT: 5-Hydroxytryptamine (5-HT)(2A) receptor inverse agonists are promising therapeutic agents for the treatment of sleep maintenance insomnias. Among these agents is nelotanserin, a potent, selective 5-HT(2A) inverse agonist. Both radioligand binding and functional inositol phosphate accumulation assays suggest that nelotanserin has low nanomolar potency on the 5-HT(2A) receptor with at least 30- and 5000-fold selectivity compared with 5-HT(2C) and 5-HT(2B) receptors, respectively. Nelotanserin dosed orally prevented (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2-aminopropane (DOI; 5-HT(2A) agonist)-induced hypolocomotion, increased sleep consolidation, and increased total nonrapid eye movement sleep time and deep sleep, the latter marked by increases in electroencephalogram (EEG) delta power. These effects on rat sleep were maintained after repeated subchronic dosing. In healthy human volunteers, nelotanserin was rapidly absorbed after oral administration and achieved maximum concentrations 1 h later. EEG effects occurred within 2 to 4 h after dosing, and were consistent with vigilance-lowering. A dose response of nelotanserin was assessed in a postnap insomnia model in healthy subjects. All doses (up to 40 mg) of nelotanserin significantly improved measures of sleep consolidation, including decreases in the number of stage shifts, number of awakenings after sleep onset, microarousal index, and number of sleep bouts, concomitant with increases in sleep bout duration. Nelotanserin did not affect total sleep time, or sleep onset latency. Furthermore, subjective pharmacodynamic effects observed the morning after dosing were minimal and had no functional consequences on psychomotor skills or memory. These studies point to an efficacy and safety profile for nelotanserin that might be ideally suited for the treatment of sleep maintenance insomnias.

19 Clinical Trial Post-bedtime dosing with indiplon in adults and the elderly: results from two placebo-controlled, active comparator crossover studies in healthy volunteers. 2008

Farber, Robert H / Burke, P Joshua. ·Neurocrine Biosciences, San Diego, CA, USA. rfarber@neurocrine.com ·Curr Med Res Opin · Pubmed #18257978.

ABSTRACT: OBJECTIVE: To assess the effects of post-bedtime dosing with indiplon on next-day function in adults and the elderly. RESEARCH DESIGN AND METHODS: Two randomized, double-blind, placebo-controlled crossover studies were conducted in two groups of healthy volunteers: an adult study (18-45 years) and an elderly study (65-80 years). In adults, a single post-bedtime dose of indiplon 10 mg and 20 mg was compared to placebo, with zolpidem 10 mg and zopiclone 7.5 mg included as controls. In the elderly, a single post-bedtime dose of indiplon 5 mg and 10 mg was compared to placebo, with zopiclone 3.75 mg included as a control. Next-day residual effects were evaluated in the morning at 4 and 6 h post-dose in adults, and 4, 6, and 8 h in the elderly, by a Visual Analog Scale of sleepiness (VAS-sleepiness), Digit Symbol Substitution Test (DSST), and the Symbol Copying Test (SCT). RESULTS: In adults, there were no statistically significant differences between indiplon and placebo on the VAS-sleepiness, DSST, or SCT at any time-point for either dose. In contrast, a significant increase versus placebo in VAS-sleepiness was observed for both zopiclone (at 4 and 6 h post-dose; p < 0.0001 and p = 0.002, respectively) and zolpidem (at 4 h post-dose; p = 0.042). In the elderly, there were no statistically significant differences between indiplon 5 mg and placebo on the VAS-sleepiness, DSST, or SCT at any time-point. DSST was significantly reduced for indiplon 10 mg versus placebo at 4 h only (p = 0.022), compared with a significant reduction in DSST for zopiclone at both 4 and 8 h post-dose (p = 0.002 and p = 0.003, respectively). In adults, the overall incidence of adverse events was higher on zopiclone compared to indiplon, zolpidem, and placebo. In the elderly, the incidence of adverse events was similar for indiplon, zopiclone, and placebo. Potential limitations of the current study include recruitment of healthy volunteers and the use of a limited pharmacodynamic battery. CONCLUSIONS: Indiplon, at doses of 10 mg in adults and 5 mg in the elderly, was not associated with next day residual sedation or impairment in simple cognitive and psychomotor tasks when administered during the night 4 h prior to awakening.

20 Article Physical Activity Intensity is Associated with Symptom Distress in the CNICS Cohort. 2019

Webel, Allison R / Willig, Amanda L / Liu, Wei / Sattar, Abdus / Boswell, Stephen / Crane, Heidi M / Hunt, Peter / Kitahata, Mari / Matthews, W Christopher / Saag, Michael S / Lederman, Michael M / Rodriguez, Benigno. ·Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA. arw72@case.edu. · School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. · Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44122, USA. · Fenway Health, Boston, MA, USA. · School of Medicine, University of Washington, Seattle, WA, USA. · School of Medicine, University of California, San Francisco, San Francisco, CA, USA. · University of California, San Diego Medical Center, San Diego, CA, USA. · School of Medicine, Case Western Reserve University, Cleveland, OH, USA. ·AIDS Behav · Pubmed #30368620.

ABSTRACT: Symptom distress remains a challenging aspect of living with HIV. Physical activity is a promising symptom management strategy, but its effect on symptom distress has not been examined in a large, longitudinal HIV-infected cohort. We hypothesized that higher physical activity intensity would be associated with reduced symptom distress. We included 5370 people living with HIV (PLHIV) who completed patient-reported assessments of symptom distress, physical activity, alcohol and substance use, and HIV medication adherence between 2005 and 2016. The most frequent and burdensome symptoms were fatigue (reported by 56%), insomnia (50%), pain (46%), sadness (45%), and anxiety (45%), with women experiencing more symptoms and more burdensome symptoms than men. After adjusting for age, sex, race, time, HIV medication adherence, alcohol and substance use, site, and HIV RNA, greater physical activity intensity was associated with lower symptom intensity. Although individual symptoms may be a barrier to physical activity (e.g. pain), the consistent association between symptoms with physical activity suggests that more intense physical activity could mitigate symptoms experienced by PLHIV.

21 Article Disruptions in resting state functional connectivity in euthymic bipolar patients with insomnia symptoms. 2018

Yoon, Ho-Kyoung / Dev, Sheena I / Sutherland, Ashley N / Eyler, Lisa T. ·Department of Psychiatry, University of California, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea. · Department of Psychiatry, University of California, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. · Department of Psychiatry, University of California, San Diego, CA, USA; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA. Electronic address: lteyler@ucsd.edu. ·Psychiatry Res Neuroimaging · Pubmed #29572076.

ABSTRACT: Insomnia is prevalent in bipolar disorder (BD) even during periods of euthymic mood. We compared resting state brain activity and cognitive function between euthymic BD with and without insomnia, and secondarily to healthy individuals. BD patients with insomnia symptoms showed a significantly lower functional connectivity within the task-positive network, compared to those without insomnia. They also showed significantly slower cognitive processing speed. These two features of BD with insomnia appeared relatively independent of each other. Preliminary findings suggest that exploration of the mechanisms of sleep disturbance in BD could lead to improved understanding and treatment of inattention in BD.

22 Article Commuting and Sleep: Results From the Hispanic Community Health Study/Study of Latinos Sueño Ancillary Study. 2018

Petrov, Megan E / Weng, Jia / Reid, Kathryn J / Wang, Rui / Ramos, Alberto R / Wallace, Douglas M / Alcantara, Carmela / Cai, Jianwen / Perreira, Krista / Espinoza Giacinto, Rebeca A / Zee, Phyllis C / Sotres-Alvarez, Daniela / Patel, Sanjay R. ·College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona. Electronic address: megan.petrov@asu.edu. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts. · Department of Neurology, Northwestern University, Chicago, Illinois. · Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. · Department of Neurology, University of Miami, Miami, Florida. · School of Social Work, Columbia University, New York, New York. · Collaborative Studies Coordinating Center, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. · Department of Health Policy Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. · School of Public Health, San Diego State University, San Diego, California. · Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. ·Am J Prev Med · Pubmed #29338957.

ABSTRACT: INTRODUCTION: Commute time is associated with reduced sleep time, but previous studies have relied on self-reported sleep assessment. The present study investigated the relationships between commute time for employment and objective sleep patterns among non-shift working U.S. Hispanic/Latino adults. METHODS: From 2010 to 2013, Hispanic/Latino employed, non-shift-working adults (n=760, aged 18-64 years) from the Sueño study, ancillary to the Hispanic Community Health Study/Study of Latinos, reported their total daily commute time to and from work, completed questionnaires on sleep and other health behaviors, and wore wrist actigraphs to record sleep duration, continuity, and variability for 1 week. Survey linear regression models of the actigraphic and self-reported sleep measures regressed on categorized commute time (short: 1-44 minutes; moderate: 45-89 minutes; long: ≥90 minutes) were built adjusting for relevant covariates. For associations that suggested a linear relationship, continuous commute time was modeled as the exposure. Moderation effects by age, sex, income, and depressive symptoms also were explored. RESULTS: Commute time was linearly related to sleep duration on work days such that each additional hour of commute time conferred 15 minutes of sleep loss (p=0.01). Compared with short commutes, individuals with moderate commutes had greater sleep duration variability (p=0.04) and lower interdaily stability (p=0.046, a measure of sleep/wake schedule regularity). No significant associations were detected for self-reported sleep measures. CONCLUSIONS: Commute time is significantly associated with actigraphy-measured sleep duration and regularity among Hispanic/Latino adults. Interventions to shorten commute times should be evaluated to help improve sleep habits in this minority population.

23 Article Effect of concussion and blast exposure on symptoms after military deployment. 2017

Tsao, Jack W / Stentz, Lauren A / Rouhanian, Minoo / Howard, Robin S / Perry, Briana N / Haran, F Jay / Pasquina, Paul F / Wolde, Mikias / Taylor, Carolyn E / Lizardo, Radhames / Liu, Scott / Flores, Eusebio / Creason, Alia H / Sher, Katalina. ·From the University of Tennessee Health Science Center (J.W.T.) · Children's Foundation Research Center (J.W.T.), Le Bonheur Children's Hospital, Memphis, TN · Uniformed Services University of the Health Sciences (J.W.T., F.J.H., P.F.P.) · Walter Reed National Military Medical Center (L.A.S., M.R., R.S.H., B.N.P., P.F.P., M.W., C.E.T., K.S.), Bethesda, MD · Naval Medical Center San Diego (R.L.), CA · Naval Medical Center Portsmouth (S.L.) · Neuroscience Consultants, PLC (E.F.), Reston · and Information Innovators, Inc (A.H.C.), Springfield, VA. ·Neurology · Pubmed #29030450.

ABSTRACT: OBJECTIVE: To examine whether blast exposure alone and blast-associated concussion result in similar neurologic and mental health symptoms. METHODS: A 14-item questionnaire was administered to male US Marines on their return from deployment in Iraq and/or Afghanistan. RESULTS: A total of 2,612 Marines (median age 22 years) completed the survey. Of those, 2,320 (88.9%) reported exposure to ≥1 blast during their current and/or prior deployments. In addition, 1,022 (39.1%) reported ≥1 concussion during the current deployment, and 731 (28.0%) had experienced at least 1 prior lifetime concussion. Marines were more likely to have sustained a concussion during the current deployment if they had a history of 1 (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-2.0) or ≥1 (OR 2.3, 95% CI 1.7-3.0) prior concussion. The most common symptoms were trouble sleeping (38.4%), irritability (37.9%), tinnitus (33.8%), and headaches (33.3%). Compared to those experiencing blast exposure without injury, Marines either experiencing a concussion during the current deployment or being moved or injured by a blast had an increased risk of postinjury symptoms. CONCLUSIONS: There appears to be a continuum of increasing total symptoms from no exposure to blast exposure plus both current deployment concussion and past concussion. Concussion had a greater influence than blast exposure alone on the presence of postdeployment symptoms. A high blast injury score can be used to triage those exposed to explosive blasts for evaluation.

24 Article Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. 2017

Fung, Constance H / Vaughan, Camille P / Markland, Alayne D / Huang, Alison J / Mitchell, Michael N / Bliwise, Donald L / Ancoli-Israel, Sonia / Redline, Susan / Alessi, Cathy A / Stone, Katie. ·Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California. · Department of Medicine, University of California Los Angeles, Los Angeles, California. · Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama. · Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia. · Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama. · Department of Medicine, University of California San Francisco, San Francisco, California. · Sleep Program, Emory University School of Medicine, Atlanta, Georgia. · Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California. · Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts. · California Pacific Medical Center, San Francisco, California. ·J Am Geriatr Soc · Pubmed #28914959.

ABSTRACT: OBJECTIVES: (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING: Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS: Community-dwelling women aged ≥80 years. MEASUREMENTS: Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS: Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R CONCLUSIONS: Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.

25 Article Effects of military service and deployment on clinical symptomatology: The role of trauma exposure and social support. 2017

Moore, Tyler M / Risbrough, Victoria B / Baker, Dewleen G / Larson, Gerald E / Glenn, Daniel E / Nievergelt, Caroline M / Maihofer, Adam / Port, Allison M / Jackson, Chad T / Ruparel, Kosha / Gur, Ruben C. ·Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: tymoore@upenn.edu. · Department of Psychiatry, University of California San Diego, CA, USA. · Department of Psychiatry, University of California San Diego, CA, USA; Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA. · Center for Excellence in Stress and Mental Health, VA San Diego Healthcare System, CA, USA. · Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Department of Psychiatry, Brain Behavior Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; VISN4 Mental Illness Research, Education, and Clinical Center at the Philadelphia VA Medical Center, Philadelphia, PA, USA. ·J Psychiatr Res · Pubmed #28843074.

ABSTRACT: The Marine Resiliency Study-II examined changes in symptomatology across a deployment cycle to Afghanistan. U.S. Servicemembers (N = 1041) received clinical testing at two time points either bracketing a deployment (855) or not (186). Factor analyses were used to generate summary and change scores from Time 1 to Time 2. A between-subject design was used to examine changes across the deployment cycle with deployment (low-trauma, high-trauma, and non-deployed) and social support (low vs. high) as the grouping variables. Insomnia increased post-deployment regardless of deployment trauma (std. effect for high-trauma and low-trauma = 0.39 and 0.26, respectively). Only the high-trauma group showed increased PTSD symptoms and non-perspective-taking (std. effect = 0.40 and 0.30, respectively), while low-trauma showed decreased anxiety symptoms after deployment (std. effect = -0.17). These associations also depend on social support, with std. effects ranging from -0.22 to 0.51. When the groups were compared, the high-trauma deployed group showed significantly worse PTSD and non-perspective-taking than all other groups. Similar to studies in other military divisions, increased clinical symptoms were associated with high deployment stress in active duty Servicemembers, and social support shows promise as a moderator of said association.