Biomedical subjects
Publications and source records attributed to A W MacLean.
In healthy young women, rapid eye movement sleep decreased, slow-wave sleep increased, sleep-onset latency decreased and late-night disturbance of sleep increased with increasing doses of alcohol.
One hundred subjects (50 men, 50 women), of whom 80 had suffered a unilateral cerebrovascular accident (40 left, 40 right), were tested on the WAIS. In the case of left hemisphere damage the male patients showed lower Verbal than Performance Scale IQ scores; for the right brain damaged men Performance Scale scores were Lower than their scores on the Verbal Scale. Women with unilateral brain damage showed no such reliable discrepancies between their Verbal and Performance Scale scores. This difference in the patterning of WAIS IQs in male and female stroke patients persisted even after the scores of those few patients with any significant degree of expressive aphasia had been excluded from consideration.
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Unlike sleep stages, which are assessed by standardized criteria, an informal survey by us showed that the definition of REM latency is relatively idiosyncratic. Differences in definition arise for two reasons: Differences in the definition of sleep onset, and the inclusion or exclusion of wakefulness that may occur prior to the first REM period. Seven definitions are identified. Each was applied to 70 records taken from 14 depressed patients, 5 remitted depressives, and 5 normal subjects. In all three samples, REM latencies calculated on the basis of the different definitions differed significantly. Reasons for adopting a common definition are discussed. It is suggested that, if established, the reliability and validity (concurrent and predictive) of the available measures would provide an empirical basis for selection.
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Six drug-free depressed patients, each of whom acted as their own control, were studied for eleven consecutive days during which they were twice deprived of sleep for either 36 or 40 hours. The sequence of events was baseline (3 days), SD, recovery (3 days), SD, recovery (3 days). Blind ratings of clinical state were made on the basis of four-hourly interviews (standardized for each case), which were videotaped; sleep was monitored by conventional electrophysiological methods. Sleep deprivation had a beneficial, but transient, effect on four of the six patients studied. Changes in sleep were unrelated to changes in clinical state.
By chance, we were able to record for five consecutive nights the sleep of a 61-year-old woman before each of two successive depressive episodes. In this patient, marked changes in EEG sleep (notably a decline in "sleep efficiency") preceded both episodes. These changes are considered to be of predictive, but not of etiological, significance.
Systematic variation in aspects of the sleep-wakefulness cycle of a depressed woman showed that recovery occurred reliably after 19 to 20 hours sustained wakefulness, unrelated to diurnal rhythm. Depression returned during as little as 15 minutes sleep. The effect of sleep deprivation was a specific response, probably unrelated to REM sleep.
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This study describes, and examines the initial efficacy of, a sleep therapy programme developed for cancer patients with insomnia. The six-session group programme included stimulus control therapy, relaxation training, and other strategies aimed at consolidating sleep and reducing cognitive-emotional arousal. The 12 final participants were patients of a regional cancer centre; mean age was 54.7 years (S.D. 10.4); median time from cancer diagnosis was 33.6 months; all had high performance status. Participants kept sleep diaries and rated their sleep quality, mood and functioning at baseline, week 4 and week 8. Significant improvement over baseline was observed at weeks 4 and 8 in the number of awakenings, time awake after sleep onset, sleep efficiency, sleep quality ratings, and scores on European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 role functioning and insomnia. Total sleep time and fatigue were significantly improved at week 8. The sleep therapy programme was associated with improved sleep, reduced fatigue and enhanced ability to perform activities in relatively well individuals attending a cancer centre. This is preliminary evidence of the efficacy of the programme. Further research is required to examine the programme's effectiveness and suitability for a wider range of people with cancer. Options for providing cancer patients with access to nonpharmacologic treatments for insomnia are discussed.