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"Bootzin, Richard R."
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Quiet your mind & get to sleep : solutions to insomnia for those with depression, anxiety, or chronic pain
For people with insomnia and often comorbid disorders such as depression, anxiety, and chronic pain, this book has methods from cognitive behavioral therapy for getting the sleep they need and improving their symptoms in the process.
Book
Naps Promote Abstraction in Language-Learning Infants
Infants engage in an extraordinary amount of learning during their waking hours even though much of their day is consumed by sleep. What role does sleep play in infant learning? Fifteen-month-olds were familiarized with an artificial language 4 hr prior to a lab visit. Learning the language involved relating initial and final words in auditory strings by remembering the exact word dependencies or by remembering an abstract relation between initial and final words. One group napped during the interval between familiarization and test. Another group did not nap. Infants who napped appeared to remember a more abstract relation, one they could apply to stimuli that were similar but not identical to those from familiarization. Infants who did not nap showed a memory effect. Naps appear to promote a qualitative change in memory, one involving greater flexibility in learning.
Journal Article
Performance evaluation of an automated single-channel sleep-wake detection algorithm
A need exists, from both a clinical and a research standpoint, for objective sleep measurement systems that are both easy to use and can accurately assess sleep and wake. This study evaluates the output of an automated sleep-wake detection algorithm (Z-ALG) used in the Zmachine (a portable, single-channel, electroencephalographic [EEG] acquisition and analysis system) against laboratory polysomnography (PSG) using a consensus of expert visual scorers.
Overnight laboratory PSG studies from 99 subjects (52 females/47 males, 18-60 years, median age 32.7 years), including both normal sleepers and those with a variety of sleep disorders, were assessed. PSG data obtained from the differential mastoids (A1-A2) were assessed by Z-ALG, which determines sleep versus wake every 30 seconds using low-frequency, intermediate-frequency, and high-frequency and time domain EEG features. PSG data were independently scored by two to four certified PSG technologists, using standard Rechtschaffen and Kales guidelines, and these score files were combined on an epoch-by-epoch basis, using a majority voting rule, to generate a single score file per subject to compare against the Z-ALG output. Both epoch-by-epoch and standard sleep indices (eg, total sleep time, sleep efficiency, latency to persistent sleep, and wake after sleep onset) were compared between the Z-ALG output and the technologist consensus score files.
Overall, the sensitivity and specificity for detecting sleep using the Z-ALG as compared to the technologist consensus are 95.5% and 92.5%, respectively, across all subjects, and the positive predictive value and the negative predictive value for detecting sleep are 98.0% and 84.2%, respectively. Overall κ agreement is 0.85 (approaching the level of agreement observed among sleep technologists). These results persist when the sleep disorder subgroups are analyzed separately.
This study demonstrates that the Z-ALG automated sleep-wake detection algorithm, using the single A1-A2 EEG channel, has a level of accuracy that is similar to PSG technologists in the scoring of sleep and wake, thereby making it suitable for a variety of in-home monitoring applications, such as in conjunction with the Zmachine system.
Journal Article
Mindfulness-Based Cognitive Therapy Improves Polysomnographic and Subjective Sleep Profiles in Antidepressant Users with Sleep Complaints
Background: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. Methods: Twenty-three ADM users with sleep complaints were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep, residual depression symptoms. Results: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. Conclusions: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.
Journal Article
Near-Death Experiences and the Temporal Lobe
Many studies in humans suggest that altered temporal lobe functioning, especially functioning in the right temporal lobe, is involved in mystical and religious experiences. We investigated temporal lobe functioning in individuals who reported having transcendental \"near-death experiences\" during life-threatening events. These individuals were found to have more temporal lobe epileptiform electroencephalographic activity than control subjects and also reported significantly more temporal lobe epileptic symptoms. Contrary to predictions, epileptiform activity was nearly completely lateralized to the left hemisphere. The near-death experience was not associated with dysfunctional stress reactions such as dissociation, posttraumatic stress disorder, and substance abuse, but rather was associated with positive coping styles. Additional analyses revealed that near-death experiencers had altered sleep patterns, specifically, a shorter duration of sleep and delayed REM sleep relative to the control group. These results suggest that altered temporal lobe functioning may be involved in the near-death experience and that individuals who have had such experiences are physiologically distinct from the general population.
Journal Article
Examining the Theory and Clinical Utility of Writing about Emotional Experiences
Pennebaker's (this issue) intervention for writing about emotional experiences shows promise as a module for inclusion in therapeutic packages. There are conceptual, methodological, and practical issues to be considered, however. These issues are discussed, and parallels are drawn from the literatures on the moodregulatory function of dreams and on the effects of social support on health. Although there is evidence that writing about emotional experiences has beneficial effects on health, it is premature to recommend writing intervention as a treatment component for specific problems. What is needed at this point is systematic research to evaluate its clinical utility.
Journal Article
Beyond acetylcholine: Next steps for sleep and memory research
We consider Walker's thorough review in the context of thinking about future research on the relation between sleep and memory. We first address methodological issues including type of memory and sleep-stage dependency. We suggest a broader investigation of potential signaling molecules that may be critical to sleep-related consolidation. A brief review of the importance of the stress hormone cortisol illustrates this point.
Journal Article
Going Quasi: The Premature Disclosure Effect in a Randomized Clinical Trial
This paper describes a randomized clinical trial investigating a stress management program for women with breast cancer, which inadvertently turned quasi-experimental. Due to logistical considerations, group assignment was disclosed to participants (n = 63) prior to baseline assessment. Analyses of baseline measures unexpectedly revealed statistically significant differences between groups on psychological functioning. We suggest that what appears to be failed randomization may in fact point toward an important phenomenon which we have termed premature disclosure effect (PDE). A hierarchical regression model, developed to help explain the PDE, accounted for 47% of the variance. The findings indicate the importance of considering participant belief, preferences, and attributes when designing research protocols and interventions. Potential implications of PDE for clinical research in behavioral medicine are discussed and specific statistical methodologies suggested.
Journal Article
Implicit and Explicit Memory for Verbal Information Presented during Sleep
This study examined implicit memory for words presented during sleep. Ten experimental subjects were presented with word pairs including a homophone and a close associate (e.g., \"tortoise-hare\") and with category-instance pairs (e.g., \"bird-cardinal\") during REM or Stage 2 sleep and tested immediately afterward. Twelve control subjects underwent the same procedure while awake. Unlike the controls, subjects in the sleeping condition showed no learning effects on the implicit memory tasks. Recall and recognition were observed in a few cases, but only when presentation was immediately followed by arousal.
Journal Article
