Sleep Homeostasis in Primary Insomnia
| Status: | Completed |
|---|---|
| Conditions: | Insomnia Sleep Studies |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 25 - 55 |
| Updated: | 4/21/2016 |
| Start Date: | December 2005 |
| End Date: | December 2008 |
Sleep Homeostasis in Primary Insomnia Following Behavioral Treatment
About 10% of the population is believed to suffer from Primary Insomnia. It is also believed
that people with chronic insomnia have a sleep system that is essentially out of alignment
(we call this "homeostatic dysregulation"). We also know that a certain form of
non-medication therapy called cognitive-behavioral therapy is a very effective treatment for
insomnia. It is not known, however, whether cognitive-behavioral therapy actually works by
bringing the brain's sleep system back into alignment ("sleep homeostasis"). One of the
methods used to measure sleep homeostasis is to observe a person's brain waves during sleep
and particularly during sleep that follows a period of sleep loss.
The purposes of this study are to first learn whether persons with insomnia do have a
misaligned sleep system compared to persons who do not have insomnia by assessing the sleep
of people before and after a period of extended sleep loss. Second, the study will determine
whether cognitive-behavioral therapy can re-regulate the sleep system and its response to
sleep loss. Third, the final purpose is to examine whether the immune system of people with
insomnia is more altered following sleep loss than in the comparison group and whether
cognitive-behavioral therapy can alter immune function.
that people with chronic insomnia have a sleep system that is essentially out of alignment
(we call this "homeostatic dysregulation"). We also know that a certain form of
non-medication therapy called cognitive-behavioral therapy is a very effective treatment for
insomnia. It is not known, however, whether cognitive-behavioral therapy actually works by
bringing the brain's sleep system back into alignment ("sleep homeostasis"). One of the
methods used to measure sleep homeostasis is to observe a person's brain waves during sleep
and particularly during sleep that follows a period of sleep loss.
The purposes of this study are to first learn whether persons with insomnia do have a
misaligned sleep system compared to persons who do not have insomnia by assessing the sleep
of people before and after a period of extended sleep loss. Second, the study will determine
whether cognitive-behavioral therapy can re-regulate the sleep system and its response to
sleep loss. Third, the final purpose is to examine whether the immune system of people with
insomnia is more altered following sleep loss than in the comparison group and whether
cognitive-behavioral therapy can alter immune function.
Despite the magnitude of the problem of Primary Insomnia, and the good efficacy of Cognitive
Behavioral Treatment for Insomnia (CBT-I), little is known about the pathophysiology of
insomnia or whether treatment alters the factors that are thought to maintain chronic
insomnia. Three main factors have been explored as contributing to chronic insomnia:
hyperarousal, circadian dysrhythmia, and homeostatic dysregulation. Most of the empirical
work has been related to the role of hyperarousal along three dimensions: somatic,
cognitive, and cortical.
The present study is focused on homeostatic abnormalities and secondarily on hyperarousal as
exhibited in subjects with Primary Insomnia (PIs) compared to Good Sleeper controls (GSs).
Homeostatic abnormalities will be assessed by evaluating how patients with insomnia respond
to sleep deprivation.
This study will use a Modified Sleep Deprivation and Multiple Sleep Latency Test (MSD/MSLT)
procedure. Response to the procedure will be assessed in terms of sleep continuity, sleep
architecture and electroencephalographic (EEG) power spectral changes during recovery sleep.
Hyperarousal will be evaluated using serial measures of somatic (cortisol) and cortical (EEG
Beta/Gamma activity) arousal across the sleep deprivation protocol.
These parameters will be evaluated both prior to and following CBT-I in PIs and following an
equivalent time interval in GSs.
Behavioral Treatment for Insomnia (CBT-I), little is known about the pathophysiology of
insomnia or whether treatment alters the factors that are thought to maintain chronic
insomnia. Three main factors have been explored as contributing to chronic insomnia:
hyperarousal, circadian dysrhythmia, and homeostatic dysregulation. Most of the empirical
work has been related to the role of hyperarousal along three dimensions: somatic,
cognitive, and cortical.
The present study is focused on homeostatic abnormalities and secondarily on hyperarousal as
exhibited in subjects with Primary Insomnia (PIs) compared to Good Sleeper controls (GSs).
Homeostatic abnormalities will be assessed by evaluating how patients with insomnia respond
to sleep deprivation.
This study will use a Modified Sleep Deprivation and Multiple Sleep Latency Test (MSD/MSLT)
procedure. Response to the procedure will be assessed in terms of sleep continuity, sleep
architecture and electroencephalographic (EEG) power spectral changes during recovery sleep.
Hyperarousal will be evaluated using serial measures of somatic (cortisol) and cortical (EEG
Beta/Gamma activity) arousal across the sleep deprivation protocol.
These parameters will be evaluated both prior to and following CBT-I in PIs and following an
equivalent time interval in GSs.
Inclusion Criteria:
Primary Insomnia (PI) subjects:
- Difficulty falling or staying asleep for 6 or more months as evidenced by (a) 30 or
more minutes to fall asleep on 3 or more nights per week, or (b) early morning
awakenings > 30 minutes prior to desired rise time on 3 or more nights per week
- Reported impaired daytime function attributed to insomnia
Good-Sleeper (GS) controls:
- No history of sleep disorders
- No current sleep complaints and/or complaints of daytime fatigue or sleepiness
- Sleep characterized as restorative and relatively "unperturbable"; and will be
defined as: 5-15 minutes to fall asleep and no more than two awakenings per night of
> 5 minutes duration
Exclusion Criteria:
- Significant medical or psychiatric illness
- Diagnosed or occult sleep disorders (evident on screening PSG) other than PI
- Hearing or memory impairments
- Non-fluency in spoken or written English
- History of head injury (w/ loss of consciousness) or seizures
- Prescription medication or recreational drug use within 4 weeks of laboratory study
- Tobacco use or consume more than 3 cups of coffee per day (or an equivalent dose of
caffeine)
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