Posttraumatic Stress Disorder, Traumatic Brain Injury, Sleep, and Performance in Military Personnel
Sleep disturbances, posttraumatic stress disorder, and traumatic brain injury are highly prevalent in military personnel and veterans. These disorders can negatively impact military performance. Although literature evaluating how posttraumatic stress disorder and traumatic brain injury directly impact military performance is limited, there is evidence supporting that these disorders negatively impact cognitive and social functioning. What is not clear is if impaired performance results from these entities individually, or a combination of each. Further research using standardized evaluations for the clinical disorders and ...
Source: Sleep Medicine Clinics - January 13, 2020 Category: Sleep Medicine Authors: Brian A. Moore, Matthew S. Brock, Allison Brager, Jacob Collen, Matthew LoPresti, Vincent Mysliwiec Source Type: research
Sensors Capabilities, Performance, and Use of Consumer Sleep Technology
This article reviews how CSTs can process information about sleep, physiology, and environment. The growing number of sensors in wearable devices and the meaning of the data collected are reviewed. CSTs have the potential to provide opportunities to measure sleep and sleep-related physiology on a large scale. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - January 5, 2020 Category: Sleep Medicine Authors: Massimiliano de Zambotti, Nicola Cellini, Luca Menghini, Michela Sarlo, Fiona C. Baker Source Type: research
You Snooze, You Win? An Ecological Dynamics Framework Approach to Understanding the Relationships Between Sleep and Sensorimotor Performance in Sport
Sleep has a widespread impact across different domains of performance, including sensorimotor function. From an ecological dynamics perspective, sensorimotor function involves the continuous and dynamic coupling between perception and action. Sport performance relies on sensorimotor function as successful movement behaviors require accurate and efficient coupling between perceptions and actions. Compromised sleep impairs different aspects of sensorimotor performance, including perceptual attunement and motor execution. Changes in sensorimotor performance can be related to specific features of sleep, notably sleep spindles ...
Source: Sleep Medicine Clinics - January 2, 2020 Category: Sleep Medicine Authors: Alice D. LaGoy, Fabio Ferrarelli, Aaron M. Sinnott, Shawn R. Eagle, Caleb D. Johnson, Christopher Connaboy Source Type: research
Brain Stimulation for Improving Sleep and Memory
Given the critical role of sleep, particularly sleep slow oscillations, sleep spindles, and hippocampal sharp wave ripples, in memory consolidation, sleep enhancement represents a key opportunity to improve cognitive performance. Techniques such as transcranial electrical and magnetic stimulation and acoustic stimulation can enhance slow oscillations and sleep spindles and potentially improve memory. Targeted memory reactivation in sleep may enhance or stabilize memory consolidation. Each technique has technical considerations that may limit its broader clinical application. Therefore, neurostimulation to enhance sleep qua...
Source: Sleep Medicine Clinics - January 2, 2020 Category: Sleep Medicine Authors: Roneil G. Malkani, Phyllis C. Zee Source Type: research
Sleep Predicts Collegiate Academic Performance
This article describes the evidence linking poor sleep with impaired academic performance; discusses mediating environmental, behavioral, and demographic factors that correlate with sleep; and highlights examples of successful health promotion initiatives on college campuses. Given that students who are traditionally minoritized on college campuses tend to have worse sleep, improving sleep health emerges as an important issue for retention, equity, and inclusion. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - November 30, 2019 Category: Sleep Medicine Authors: J. Roxanne Prichard Source Type: research
Insomnia and Cognitive Performance
This article updates and summarizes the recent literature investigating cognitive impairments in individuals with insomnia, and identifies the cognitive domains of functioning that are consistently impaired. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - November 27, 2019 Category: Sleep Medicine Authors: Janeese A. Brownlow, Katherine E. Miller, Philip R. Gehrman Source Type: research
Effect of Obstructive Sleep Apnea on Neurocognitive Performance
This article reviews the effects of obstructive sleep apnea on neurocognitive performance, proposed mechanisms of cognitive impairment, and the effects of continuous positive airway pressure on performance. Obstructive sleep apnea can affect several domains of neurocognitive performance to include attention and vigilance, memory and learning, psychomotor function, emotional regulation, and executive function. Proposed mechanisms include intermittent hypoxemia, sleep deprivation and fragmentation, hypercapnia, and disruption of the hypothalamic-pituitary-adrenal-axis. Continuous positive airway pressure can improve cognitiv...
Source: Sleep Medicine Clinics - November 26, 2019 Category: Sleep Medicine Authors: Gilbert Seda, Tony S. Han Source Type: research
Technology to Detect Driver Sleepiness
This article reports on sleepiness, drowsiness, tiredness, and fatigue. An assessment of sleepiness can be done with electroencephalograms, electrooculograms, and electromyograms in validated tests, such as the multiple sleep latency test and the maintenance of wakefulness test. These 2 tests serve as references for quantitative assessment of daytime sleepiness and drowsiness. Correlates for sleepiness, such as reaction time tests, can be used but are less reliable. Questionnaires are self-administered and popular measures for perceived sleepiness. Driver drowsiness assessment is an important part of sleep laboratory testi...
Source: Sleep Medicine Clinics - October 20, 2019 Category: Sleep Medicine Authors: Thomas Penzel, Ingo Fietze, Christoph Sch öbel, Christian Veauthier Source Type: research
Sleep Restriction, Sleep Hygiene, and Driving Safety
Sleep-related accidents are a frequent cause of death and injury in the world. Poor sleep hygiene is responsible for sleep deprivation, which is clearly associated with an increased risk of accidents. Evidence shows that self-reported sleepiness at the wheel and reporting of inappropriate line-crossings are strong predictors of accident risk. Although the Epworth sleepiness scale is widely used in clinical practice, it is not the best to evaluate driving risks. Simple questions on the occurrence of near misses and sleepiness at the wheel should be asked systematically to address the issue of fitness to drive. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 27, 2019 Category: Sleep Medicine Authors: Pierre Philip, Jacques Taillard, Jean-Arthur Micoulaud-Franchi Source Type: research
Screening for Sleepiness and Sleep Disorders in Commercial Drivers
This article provides an overview of screening, and specific approaches to screen for and manage obstructive sleep apnea in commercial drivers with the goal of reducing the risk of vehicular crashes. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 27, 2019 Category: Sleep Medicine Authors: Indira Gurubhagavatula, Shannon S. Sullivan Source Type: research
Assessment of Sleepiness in Drivers
This article discusses the current practice of the assessment of individuals’ sleepiness with respect to driving, the limitations of available techniques, and future possibilities. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 27, 2019 Category: Sleep Medicine Authors: Akshay Dwarakanath, Mark W. Elliott Source Type: research
Sleep Apnea, Sleepiness, and Driving Risk
Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scal...
Source: Sleep Medicine Clinics - September 25, 2019 Category: Sleep Medicine Authors: Maria R. Bonsignore, Oreste Marrone, Francesco Fanfulla Source Type: research
Vehicle and Highway Adaptations to Compensate for Sleepy Drivers
Sleepiness remains a major contributor to road crashes. Driver monitoring systems identify early signs of sleepiness and alert drivers, using real-time analysis of eyelid movements, EEG activity, and steering control. Other vehicle adaptations warn drivers of lane departures or collision hazards, with higher vehicle automation actively taking over vehicle control to prevent run off the road incidents and institute emergency braking. Similarly, road adaptations warn drivers (rumble strips) or mitigate crash severity (barriers). Infrastructure to encourage drivers to use countermeasures, such as rest stops for napping, is al...
Source: Sleep Medicine Clinics - September 25, 2019 Category: Sleep Medicine Authors: Mark E. Howard, Jennifer M. Cori, William J. Horrey Source Type: research
Sleepiness and Driving
Sleepiness accounts for approximately 20% of major highway motor vehicle accidents (MVAs) and the most common medical disorder associated with sleepiness is obstructive sleep apnea (OSA). OSA patients are 2 to 3 times more likely to have an MVA than the general population, although continuous positive airway pressure therapy can remove this excess risk. Several jurisdictions have introduced regulations to limit driving in patients with moderate or severe OSA associated with sleepiness until the disorder is effectively treated. Successful implementation of such regulations requires education regarding risk-benefit relations...
Source: Sleep Medicine Clinics - September 25, 2019 Category: Sleep Medicine Authors: Walter T. McNicholas Source Type: research
Sleep and Transportation Safety
Human fatigue is an important factor in transportation safety and a major causal factor of accidents. Employers play a vital role in minimizing fatigue-related risk, and are legally liable for damages arising from failure to address the risk. By taking an active role as stakeholders in transportation safety, employers not only reduce their risk of adverse safety events and limit their legal liability but may also benefit from improvements in productivity, morale, and health care expenditures. Employers should focus on reducing fatigue-related risk, with ongoing support from sleep safety research. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 25, 2019 Category: Sleep Medicine Authors: David Rainey, Michael A. Parenteau, Stefanos N. Kales Source Type: research
The Economic Burden of Sleepy Driving
Driving while sleepy on a regular basis may be due to sleep restriction associated with work schedules or with poor sleep hygiene. It also may be associated with sleep disorders or with sedative drugs. This review assesses the potential consequences of driving sleepy on a regular basis from a societal point of view. Driving while sleepy on a regular basis increases the risk of motor vehicle accidents (MVAs), impairs the ability to work, has an impact on productivity, and probably also has an impact on the risk of non-MVA occupational accidents and on public disasters. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 23, 2019 Category: Sleep Medicine Authors: Damien L éger, Emilie Pepin, Gabriela Caetano Source Type: research
Shift Work – Sleepiness and Sleep in Transport
Driving a vehicle during a night shift increases the accident risk and incidents of falling asleep at the wheel. Individuals having worked a night shift (in any type of occupation) run a similar risk when commuting home from a night shift. Early starts of driving may increase risk. Detailed field studies of sleepiness indicate high levels of sleepiness during late night driving. The mechanism includes exposure to the circadian trough of alertness during work and sleep loss. High levels of sleepiness and sleep loss associated with night and early morning work define the diagnosis of shift work disorder. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - September 17, 2019 Category: Sleep Medicine Authors: Torbj örn Åkerstedt Source Type: research
Sleep Disturbances and Disorders: A Poorly Recognized Accident Risk
Speed and alcohol consumption are widely recognized contributory factors to motor vehicle accidents (MVA) and are almost universally regulated throughout the world by speed limits and blood/urine/breath alcohol levels while driving. In recent decades, there has been growing recognition that sleep disturbances and disorders with consequent sleepiness during the waking hours also represent important contributing factors to driving accident risk.1 However, this risk is difficult to quantify by objective measures such as are employed for speed and alcohol, which inevitably result in sleepiness being a less well-documented cont...
Source: Sleep Medicine Clinics - September 10, 2019 Category: Sleep Medicine Authors: Walter T. McNicholas Tags: Preface Source Type: research
Sleepiness and Driving
Drowsy driving is common and causes 21% of fatal crashes. Individuals at risk include young men, shift workers, older adults, and people with chronic short sleep duration, untreated obstructive sleep apnea (OSA), and narcolepsy. Untreated OSA is a particular concern in commercial drivers, who are at higher risk for the disorder. Treatment for sleep problems such as sleep extension for chronic short sleep, positive airway pressure (PAP) for OSA, pharmacologic treatments, and drowsy driving countermeasures may reduce the risk of crashes. Implementing screening measures to identify common sleep problems contributing to drowsy...
Source: Sleep Medicine Clinics - September 6, 2019 Category: Sleep Medicine Authors: Catherine A. McCall, Nathaniel F. Watson Source Type: research
Precision Medicine for Sleep Loss and Fatigue Management
Sleep loss is a widespread phenomenon and a public health threat. Sleep disorders, medical conditions, lifestyles, and occupational factors all contribute to insufficient sleep. Regardless of the underlying cause, insufficient sleep has well-defined consequences and the severity of said consequences partially influenced by individual characteristics. It is here where precision medicine needs to understand and define sleep insufficiency in hopes for personalizing medical approach to improve patient outcomes. Following a discussion on causes and consequences of sleep loss, this article discusses tools for assessing sleep suf...
Source: Sleep Medicine Clinics - July 31, 2019 Category: Sleep Medicine Authors: Luis E. Pichard, Guido Simonelli, Lindsay Schwartz, Thomas J. Balkin, Steven Hursh Source Type: research
Precision Medicine for Idiopathic Hypersomnia
Idiopathic hypersomnia (IH) is characterized by excessive daytime sleepiness despite normal or prolonged sleep. IH is distinguished from narcolepsy by the female predominance, severe morning inertia, continuous drowsiness (rather than sleep attacks), unrefreshing naps, absence of cataplexy, sleep onset in REM periods, and hypocretin deficiency. In IH, the multiple sleep latency test demonstrates low sensitivity, specificity, and reproducibility, compared with prolonged sleep monitoring. In some IH cases, an endogenous hypnotic peptide stimulating GABA receptors during wakefulness is suspected, which are improved by anti-GA...
Source: Sleep Medicine Clinics - July 31, 2019 Category: Sleep Medicine Authors: Isabelle Arnulf, Smaranda Leu-Semenescu, Pauline Dodet Source Type: research
Further Development of P4 Approach to Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a heterogeneous disorder. Cluster analysis has identified different physiologic subtypes with respect to symptoms. A difference exists in cardiovascular risk from OSA between the 7 subtypes identified. There are 3 basic subtypes replicated in multiple studies: (a) a group where insomnia is the main symptom; (b) an asymptomatic group; (c) a group with marked excessive sleepiness. The symptomatic benefit from treatment with nasal CPAP varies between these 3 subtypes. Data from the Sleep Heart Health Study reveal that the increased risk of cardiovascular disease from OSA occurs only in the exc...
Source: Sleep Medicine Clinics - July 4, 2019 Category: Sleep Medicine Authors: Allan I. Pack Source Type: research
Precision Medicine for Obstructive Sleep Apnea
Increasingly, obstructive sleep apnea treatment is being recognized as amenable to a precision medicine approach. Many pathophysiologic mechanisms (endotypes) beyond anatomic compromise have now been identified and are readily determined during polysomnography, although randomized controlled trials of endotype-specific therapies are needed. Research indicates that endotypes may also be important in predicting both adherence to therapy and disease consequences (phenotypes). Biomarker discovery and Big Data approaches derived from wearable technology are areas of active investigation and may allow more robust conclusions to ...
Source: Sleep Medicine Clinics - July 4, 2019 Category: Sleep Medicine Authors: Matthew Light, Robert L. Owens, Christopher N. Schmickl, Atul Malhotra Source Type: research
This article explores currently known characteristics and exploratory features that may aid in this transition to better understanding our individual patients with non-REM parasomnias and tailoring their treatments. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - July 1, 2019 Category: Sleep Medicine Authors: Joel Erickson, Bradley V. Vaughn Source Type: research
Precision Medicine in the Field of Sleep Medicine: Early Days
The term “precision medicine” has gained popularity in recent years, particularly when the Obama administration announced its “Precision Medicine Initiative” in 2015, which included focused investments in a national research cohort, identifying genetic drivers in cancer, and modernizing the regulator y landscape to support such research while maintaining privacy.1 (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 27, 2019 Category: Sleep Medicine Authors: Susheel P. Patil Tags: Preface Source Type: research
Precision Medicine in Rapid Eye Movement Sleep Behavior Disorder
In recent years, the diagnostic approach to rapid eye movement (REM) sleep behavior disorder (RBD) has become more objective and accurate. This was achieved mainly by introduction of methods to exactly quantify electromyographic (EMG) activity in various muscles during REM sleep. The most established muscle combination for RBD diagnosis is the mentalis and upper extremity EMG. Computer-assisted systems for this analysis have been described, and an increasing number of studies looked into analysis of video events. Recently, prodromal phases of isolated RBD have been recognized. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 21, 2019 Category: Sleep Medicine Authors: Birgit H ögl, Joan Santamaria, Alex Iranzo, Ambra Stefani Source Type: research
This article reviews the body of research indicating that there are genetic variations that affect the therapeutic actions and adverse effects of agents used for the treatment of sleep disorders to show the potential of pharmacogenetics to improve the clinical practice of sleep medicine. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 13, 2019 Category: Sleep Medicine Authors: Andrew D. Krystal, Aric A. Prather Source Type: research
Sleep and Memory
Given the complex and bidirectional nature of sleep and mild cognitive impairment/Alzheimer ’s disease and related dementias, a precision medicine approach to education, lifestyle changes, and early assessment in patients with a family history of snoring, sleep apnea, diabetes, and heart disease is warranted. Furthermore, a team-based approach allows for a coordinated precision diagnosis and management of common comorbid chronic illnesses. The significance of sleep disturbances in this population, contributing factors, assessment and diagnostic challenges, common sleep disorders and mechanisms, tailored behavioral an...
Source: Sleep Medicine Clinics - June 8, 2019 Category: Sleep Medicine Authors: Patricia Carter, Lichuan Ye, Kathy Richards, Vani Vallabhaneni Source Type: research
Precision Medicine for Insomnia
This article discusses the leading behavioral treatment of insomnia, cognitive behavioral therapy for insomnia, and its ability to be tailored to an individual ’s specific symptoms. It then discusses pharmacologic options for treating insomnia, and offers some guidance on medication selection to enhance personalized care. In addition, it discusses how the current evidence base can help providers make choices between pharmacologic and behavioral treatment s. (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - June 5, 2019 Category: Sleep Medicine Authors: Elaine Boland, Jennifer Goldschmied, Matthew S. Kayser, Philip R. Gehrman Source Type: research
Internet-Delivered Cognitive Behavioral Therapy for Insomnia
Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI ’s effectiveness is influenced by treatment characteristics and patient-specific factors. We r...
Source: Sleep Medicine Clinics - June 5, 2019 Category: Sleep Medicine Authors: Tanja van der Zweerde, Jaap Lancee, Annemarie Ida Luik, Annemieke van Straten Source Type: research
Cognitive Behavioral Therapies for Insomnia
SLEEP MEDICINE CLINICS (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 25, 2019 Category: Sleep Medicine Authors: Jason C. Ong Source Type: research
Intensive Sleep Retraining Treatment of Insomnia
Effective and durable cognitive/behavioral therapies for insomnia are time consuming and not readily available to the large insomnia population. Intensive sleep retraining (ISR) provides multiple (>40) short ( (Source: Sleep Medicine Clinics)
Source: Sleep Medicine Clinics - April 2, 2019 Category: Sleep Medicine Authors: Leon Lack, Hannah Scott, Nicole Lovato Source Type: research
A Meta-Analysis of Mindfulness-Based Therapies for Insomnia and Sleep Disturbance
Mindfulness-based therapies (MBTs) are increasingly being investigated as a treatment for insomnia and general sleep disturbance, but significant gaps remain in the evidence base. In this article, the authors present (1) a unifying psychological process model that relates mindfulness to sleep; (2) a systematic review of the literature reporting on trials of MBTs for insomnia and sleep disturbance, which includes an assessment of quality of trial reporting, adaptation of MBTs for sleep, and whether mindfulness practice was associated with effects observed; and (3) a meta-analysis of MBTs for insomnia and sleep disturbance c...
Source: Sleep Medicine Clinics - April 1, 2019 Category: Sleep Medicine Authors: Joshua A. Rash, Victoria A.J. Kavanagh, Sheila N. Garland Source Type: research
Cognitive Behavioral Therapy for Insomnia and Acute Insomnia
The term “acute insomnia” has been part of the language of sleep medicine since the late 1970s. Despite that, a comprehensive research agenda on the topic has only recently been advanced. This has prevented a clinical viewpoint on the assessment and management of acute insomnia. Although there is a cogni tive behavioral therapy for insomnia focused intervention, designed to circumvent the transition from acute insomnia to insomnia disorder, the results from trials undertaken have been variable and limited by small sample sizes. There is much work to be done regarding the assessment, diagnosis, and m anagement o...
Source: Sleep Medicine Clinics - April 1, 2019 Category: Sleep Medicine Authors: Jason G. Ellis Source Type: research
Cognitive Behavioral Therapy for Insomnia (CBT-i) in School-Aged Children and Adolescents
Insomnia is one of the most prevalent sleep disorders in school-aged children and adolescents. Although cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment for adults, and existing studies show promising effects also for children and adolescents, the number of randomized controlled trials in younger age groups is rather small. CBT-i techniques for school-aged children and adolescents include bedtime shifts (including sleep restriction), stimulus control, thought challenging, psychoeducation, and relaxation techniques. The integration of parents, especially in school-aged children with insomnia, is...
Source: Sleep Medicine Clinics - April 1, 2019 Category: Sleep Medicine Authors: Julia Dewald-Kaufmann, Ed de Bruin, Gradisar Michael Source Type: research
Brief Behavioral Treatment of Insomnia
Cognitive behavioral treatment for insomnia (CBTI) is an effective treatment of insomnia; however, there are insufficient CBTI providers for the 10% to 25% of the population who have insomnia. Brief behavioral treatment for insomnia (BBTI) is a 4-session manualized treatment paradigm administrable in medical settings by nonpsychologist health professionals. BBTI is effective in reducing symptoms of insomnia, such as sleep onset latency, wake after sleep onset, and sleep efficiency. In some cases, BBTI resulted in full remission from insomnia. Ongoing clinical trials are further testing the efficacy of BBTI using alternativ...
Source: Sleep Medicine Clinics - April 1, 2019 Category: Sleep Medicine Authors: Heather E. Gunn, Joshua Tutek, Daniel J. Buysse Source Type: research