Biomedical subjects

Arthur J Spielman

Publications and source records attributed to Arthur J Spielman.

5 recordsLinked to original sources

PubMed2006

Nonpharmacologic strategies in the management of insomnia.

Many psychiatric patients have significant sleep disturbance. Insomnia should be addressed directly even when comorbid with a psychiatric disorder. Nonpharmacologic treatments are effective and especially well suited for long-term management of sleep problems. Although the techniques themselves are fairly straightforward, they work best when applied with the kind of clinical insight and experience that psychiatrists regularly draw on in their practices. This article briefly reviews the evaluation of insomnia, with the aim of eliciting clinical material sufficiently comprehensive to inform the choice of treatment, and provides a practical overview of the basic nondrug approaches to insomnia, emphasizing what the clinician and the patient may expect from their application.

Cognitive Behavioral Therapy↗

PubMed2006

The effects of distal limb warming on sleep latency.

Sleep onset is best predicted by an increase in the amount of hand and foot warming relative to more proximal areas (Krauchi, Cajochen, Werth, & Wirz-Justice, 1999; Krauchi, Cajochen,Werth,& Wirz-Justice, 2000).We assessed if an increase in sleepiness would also occur if the distal limbs were warmed through an external manipulation. In this study, 5 min before participants (N = 11) attempted to fall asleep on a multiple sleep latency test (Carskadon et al., 1986) their hands and feet were immersed in water heated to either 42 degrees C or heated to the temperature of the warmest limbs. The results show no difference in sleep latency between the warm and control water conditions. There was a decrease in sleep latency in the control and warm water conditions compared to the initial (noncounterbalanced) baseline multiple sleep latency test. Further studies are necessary to determine if any degree of limb warming hastens sleep onset.

Adult↗

PubMed2005

Daily rhythm of cerebral blood flow velocity.

BACKGROUND: CBFV (cerebral blood flow velocity) is lower in the morning than in the afternoon and evening. Two hypotheses have been proposed to explain the time of day changes in CBFV: 1) CBFV changes are due to sleep-associated processes or 2) time of day changes in CBFV are due to an endogenous circadian rhythm independent of sleep. The aim of this study was to examine CBFV over 30 hours of sustained wakefulness to determine whether CBFV exhibits fluctuations associated with time of day. METHODS: Eleven subjects underwent a modified constant routine protocol. CBFV from the middle cerebral artery was monitored by chronic recording of Transcranial Doppler (TCD) ultrasonography. Other variables included core body temperature (CBT), end-tidal carbon dioxide (EtCO2), blood pressure, and heart rate. Salivary dim light melatonin onset (DLMO) served as a measure of endogenous circadian phase position. RESULTS: A non-linear multiple regression, cosine fit analysis revealed that both the CBT and CBFV rhythm fit a 24 hour rhythm (R2 = 0.62 and R2 = 0.68, respectively). Circadian phase position of CBT occurred at 6:05 am while CBFV occurred at 12:02 pm, revealing a six hour, or 90 degree difference between these two rhythms (t = 4.9, df = 10, p < 0.01). Once aligned, the rhythm of CBFV closely tracked the rhythm of CBT as demonstrated by the substantial correlation between these two measures (r = 0.77, p < 0.01). CONCLUSION: In conclusion, time of day variations in CBFV have an approximately 24 hour rhythm under constant conditions, suggesting regulation by a circadian oscillator. The 90 degree-phase angle difference between the CBT and CBFV rhythms may help explain previous findings of lower CBFV values in the morning. The phase difference occurs at a time period during which cognitive performance decrements have been observed and when both cardiovascular and cerebrovascular events occur more frequently. The mechanisms underlying this phase angle difference require further exploration.

Journal Article↗

PubMed2005

Insomnia.

The pathogenesis of insomnia in an individual usually is multifaceted. Effective treatments require a thorough evaluation to determine the factors that need to be addressed. Pharmacologic treatments generally are safe and effective for short-term use. Long-term hypnotic use remains controversial because of the potential risk of tolerance and dependency. Various cognitive and behavioral treatments for insomnia have been shown to be effective in the management of insomnia. For long-term follow-up, multicomponent cognitive behavioral therapy, alone or in combination with hypnotic use, has been shown to be superior to hypnotic use alone.

Journal Article↗

PubMed2004

A standard procedure enhances the correlation between subjective and objective measures of sleepiness.

OBJECTIVE: The goal of this study was to assess whether instituting a standard procedure to minimize transient activation prior to the subjective rating of sleepiness can improve the predictive value of the rating process. METHODS: Thirty young adults, aged 19 to 26 years, participated in the study. Subsequent to sleeping at home with bedtime restricted to 5 hours, they came to the sleep laboratory. They were instructed to rate their level of sleepiness on the Stanford Sleepiness Scale (SSS) and visual analog scales (VAS). A "calm-down" procedure, sitting quietly with eyes closed for 1 minute, was instituted prior to sleepiness ratings for half of the subjects (experimental group) but not for the other half of the subjects (control group). A nap trial with polysomnographic recording was then conducted, followed by a vigilance test. RESULTS: For the experimental group, VAS results of "sleepiness" and "alertness" both correlated significantly with sleep-onset latency during the nap (SOL: r = -.62 and .64, respectively, P values < .05) and with reaction time (RT) on the vigilance test (r = .56 and -.54, P values < .05). The SSS ratings showed significant correlation with nap SOL (r = -.58, P < .05) but not with RT on the vigilance test (r = .19, p = .52). For the control group, none of the subjective ratings showed significant correlation with objective measures. The differences between the resultant correlations for the 2 groups were statistically significant for 2 sets of correlations: the correlation between VAS of "alertness" and nap SOL and the correlation between VAS of "sleepiness" and RT on the vigilance test. CONCLUSION: The results indicate that the subjective ratings of the sleepiness state for individuals with mild sleep restriction more faithfully reflect a physiologic tendency to fall asleep as well as cognitive attentiveness when the ratings are conducted subsequent to sitting still with eyes closed for a sufficient time to minimize transient activation.

Adult↗