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Eus J W Van Someren - One of the best experts on this subject based on the ideXlab platform.

  • Is disturbed intracortical excitability a stable trait of chronic insomnia? A study using transcranial magnetic stimulation before and after multimodal Sleep Therapy.
    Biological psychiatry, 2010
    Co-Authors: Ysbrand D Van Der Werf, Ellemarije Altena, Rob L M Strijers, Karin Van Dijk, Wim De Rijke, Cornelis J. Stam, Eus J W Van Someren
    Abstract:

    Background Chronic insomnia is a poorly understood disorder. Risk factors for developing chronic insomnia are largely unknown, yet disturbances in brain indexes of arousal seem to accompany the disorder. We here investigate whether insomnia patients and control participants differ with respect to brain responses to direct stimulation, i.e., cortical excitability. Transcranial magnetic stimulation (TMS) offers a method to directly investigate the excitability level of the human cerebral cortex in psychiatric and neurological disease. Methods We investigated cortical excitability in 16 insomnia patients and 14 carefully matched control participants using absolute and relative amplitudes of motor evoked potentials in response to single- and paired-pulse stimulation using TMS. Results Nonmedicated insomnia patients showed, first, an exaggerated absolute response to both suprathreshold single- and paired-pulse stimulation compared with control participants and second, a reduced relative response to paired-pulse stimulation at long interpulse intervals (i.e., a reduced intracortical facilitation). The abnormal excitability persisted despite Sleep Therapy that effectively improved Sleep quality as well as behavioral and neuroimaging indexes of brain function. Conclusions The results suggest that a subtly disturbed intracortical excitability characterizes patients with chronic insomnia: a relatively reduced intracortical facilitation in the context of a globally increased absolute excitability. The findings do not resemble TMS findings after Sleep deprivation or in Sleep apnea and thus seem specific to insomnia. They may offer diagnostic value and implications for assessment of risk to develop this common and disabling disorder.

  • Sleep loss affects vigilance effects of chronic insomnia and Sleep Therapy
    Journal of Sleep Research, 2008
    Co-Authors: Ellemarije Altena, Rob L M Strijers, Ysbrand D Van Der Werf, Eus J W Van Someren
    Abstract:

    Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-Sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-Sleeping age-matched subjects. Secondly, we investigated the performance response to Sleep Therapy using a waiting-list controlled design. Sleep Therapy consisted of a multi-component intervention including Sleep restriction, cognitive behavioral Therapy, bright-light Therapy, structured physical activity and body temperature manipulations. The results show that insomniacs differed markedly from controls in their reaction times across tasks with different cognitive demands: patients responded faster on the 'simple' vigilance task, yet slower on the 'complex' vigilance task. Sleep Therapy effectively restored normal performance: patients became significantly slower on the 'simple' task and faster on the 'complex' task, returning to the performance levels of control subjects. These findings indicate that the performance decline associated with increasing cognitive demands is possibly the first sensitive and robust measure of the neurocognitive sequelae of insomnia. We suggest that future studies on cognition in primary insomnia should apply a design that varies task demands.

  • Prefrontal hypoactivation and recovery in insomnia
    Sleep, 2008
    Co-Authors: Ellemarije Altena, Ysbrand D Van Der Werf, Ernesto J. Sanz-arigita, Thom A. Voorn, Serge A.r.b. Rombouts, Joost P.a. Kuijer, Eus J W Van Someren
    Abstract:

    EXPERIMENTAL ACUTE Sleep DEPRIVATION INDUCES COGNITIVE DEFICITS, PARTICULARLY IN TASKS THAT RELY ON THE INTEGRITY OF THE PREFRONTAL CORTICAL system.1 An example of such a prefrontally dependent task is the verbal fluency task.2,3 Performance on this task is known to be affected by experimental Sleep deprivation.4 A naturalistic form of chronically disturbed Sleep is primary insomnia, occurring in a large proportion of the population and increasingly so with aging.5 Insomnia can be treated with non-pharmacological Therapy, which has proved its long-term effectiveness on Sleep measures and daytime functioning in numerous previous studies.6,7 Sleep restriction and multifaceted cognitive-behavior Therapy have been reported to be particularly effective for treating insomnia in the elderly.8 Cognitive dysfunction in insomnia has been suggested, but few behavioral studies found abnormal performance in this condition, and no patterns of consistent results have emerged across studies.9 A possible reason for this inconsistency is that two opposing factors could result in masking of performance differences between insomniacs and well-Sleeping participants: the high level of perfectionism and arousal that characterizes insomnia may mask performance decreases due to poor Sleep.10,11 As a result, the net performance could become indistinguishable from that of well-Sleeping controls. Cognitive neuroimaging studies could instead be used to elucidate alterations in cognitive processes that might not readily emerge in behavioral performance measures. These have, up till now, not been reported in insomnia. We therefore undertook a functional imaging study to test the hypothesis that chronic insomnia would interfere with prefrontal activation during verbal fluency, and to investigate whether this possible interference would be reversible upon successful Sleep Therapy.

Ellemarije Altena - One of the best experts on this subject based on the ideXlab platform.

  • Is disturbed intracortical excitability a stable trait of chronic insomnia? A study using transcranial magnetic stimulation before and after multimodal Sleep Therapy.
    Biological psychiatry, 2010
    Co-Authors: Ysbrand D Van Der Werf, Ellemarije Altena, Rob L M Strijers, Karin Van Dijk, Wim De Rijke, Cornelis J. Stam, Eus J W Van Someren
    Abstract:

    Background Chronic insomnia is a poorly understood disorder. Risk factors for developing chronic insomnia are largely unknown, yet disturbances in brain indexes of arousal seem to accompany the disorder. We here investigate whether insomnia patients and control participants differ with respect to brain responses to direct stimulation, i.e., cortical excitability. Transcranial magnetic stimulation (TMS) offers a method to directly investigate the excitability level of the human cerebral cortex in psychiatric and neurological disease. Methods We investigated cortical excitability in 16 insomnia patients and 14 carefully matched control participants using absolute and relative amplitudes of motor evoked potentials in response to single- and paired-pulse stimulation using TMS. Results Nonmedicated insomnia patients showed, first, an exaggerated absolute response to both suprathreshold single- and paired-pulse stimulation compared with control participants and second, a reduced relative response to paired-pulse stimulation at long interpulse intervals (i.e., a reduced intracortical facilitation). The abnormal excitability persisted despite Sleep Therapy that effectively improved Sleep quality as well as behavioral and neuroimaging indexes of brain function. Conclusions The results suggest that a subtly disturbed intracortical excitability characterizes patients with chronic insomnia: a relatively reduced intracortical facilitation in the context of a globally increased absolute excitability. The findings do not resemble TMS findings after Sleep deprivation or in Sleep apnea and thus seem specific to insomnia. They may offer diagnostic value and implications for assessment of risk to develop this common and disabling disorder.

  • Sleep loss affects vigilance effects of chronic insomnia and Sleep Therapy
    Journal of Sleep Research, 2008
    Co-Authors: Ellemarije Altena, Ysbrand D Van Der Werf, Rob L M Strijers, Eus J W Van Someren
    Abstract:

    Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-Sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-Sleeping age-matched subjects. Secondly, we investigated the performance response to Sleep Therapy using a waiting-list controlled design. Sleep Therapy consisted of a multi-component intervention including Sleep restriction, cognitive behavioral Therapy, bright-light Therapy, structured physical activity and body temperature manipulations. The results show that insomniacs differed markedly from controls in their reaction times across tasks with different cognitive demands: patients responded faster on the 'simple' vigilance task, yet slower on the 'complex' vigilance task. Sleep Therapy effectively restored normal performance: patients became significantly slower on the 'simple' task and faster on the 'complex' task, returning to the performance levels of control subjects. These findings indicate that the performance decline associated with increasing cognitive demands is possibly the first sensitive and robust measure of the neurocognitive sequelae of insomnia. We suggest that future studies on cognition in primary insomnia should apply a design that varies task demands. © 2008 European Sleep Research Society.

  • Sleep loss affects vigilance effects of chronic insomnia and Sleep Therapy
    Journal of Sleep Research, 2008
    Co-Authors: Ellemarije Altena, Rob L M Strijers, Ysbrand D Van Der Werf, Eus J W Van Someren
    Abstract:

    Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-Sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-Sleeping age-matched subjects. Secondly, we investigated the performance response to Sleep Therapy using a waiting-list controlled design. Sleep Therapy consisted of a multi-component intervention including Sleep restriction, cognitive behavioral Therapy, bright-light Therapy, structured physical activity and body temperature manipulations. The results show that insomniacs differed markedly from controls in their reaction times across tasks with different cognitive demands: patients responded faster on the 'simple' vigilance task, yet slower on the 'complex' vigilance task. Sleep Therapy effectively restored normal performance: patients became significantly slower on the 'simple' task and faster on the 'complex' task, returning to the performance levels of control subjects. These findings indicate that the performance decline associated with increasing cognitive demands is possibly the first sensitive and robust measure of the neurocognitive sequelae of insomnia. We suggest that future studies on cognition in primary insomnia should apply a design that varies task demands.

  • Prefrontal hypoactivation and recovery in insomnia
    Sleep, 2008
    Co-Authors: Ellemarije Altena, Ysbrand D Van Der Werf, Ernesto J. Sanz-arigita, Thom A. Voorn, Serge A.r.b. Rombouts, Joost P.a. Kuijer, Eus J W Van Someren
    Abstract:

    EXPERIMENTAL ACUTE Sleep DEPRIVATION INDUCES COGNITIVE DEFICITS, PARTICULARLY IN TASKS THAT RELY ON THE INTEGRITY OF THE PREFRONTAL CORTICAL system.1 An example of such a prefrontally dependent task is the verbal fluency task.2,3 Performance on this task is known to be affected by experimental Sleep deprivation.4 A naturalistic form of chronically disturbed Sleep is primary insomnia, occurring in a large proportion of the population and increasingly so with aging.5 Insomnia can be treated with non-pharmacological Therapy, which has proved its long-term effectiveness on Sleep measures and daytime functioning in numerous previous studies.6,7 Sleep restriction and multifaceted cognitive-behavior Therapy have been reported to be particularly effective for treating insomnia in the elderly.8 Cognitive dysfunction in insomnia has been suggested, but few behavioral studies found abnormal performance in this condition, and no patterns of consistent results have emerged across studies.9 A possible reason for this inconsistency is that two opposing factors could result in masking of performance differences between insomniacs and well-Sleeping participants: the high level of perfectionism and arousal that characterizes insomnia may mask performance decreases due to poor Sleep.10,11 As a result, the net performance could become indistinguishable from that of well-Sleeping controls. Cognitive neuroimaging studies could instead be used to elucidate alterations in cognitive processes that might not readily emerge in behavioral performance measures. These have, up till now, not been reported in insomnia. We therefore undertook a functional imaging study to test the hypothesis that chronic insomnia would interfere with prefrontal activation during verbal fluency, and to investigate whether this possible interference would be reversible upon successful Sleep Therapy.

Eus J W Van Someren - One of the best experts on this subject based on the ideXlab platform.

  • Sleep loss affects vigilance effects of chronic insomnia and Sleep Therapy
    Journal of Sleep Research, 2008
    Co-Authors: Ellemarije Altena, Ysbrand D Van Der Werf, Rob L M Strijers, Eus J W Van Someren
    Abstract:

    Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-Sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-Sleeping age-matched subjects. Secondly, we investigated the performance response to Sleep Therapy using a waiting-list controlled design. Sleep Therapy consisted of a multi-component intervention including Sleep restriction, cognitive behavioral Therapy, bright-light Therapy, structured physical activity and body temperature manipulations. The results show that insomniacs differed markedly from controls in their reaction times across tasks with different cognitive demands: patients responded faster on the 'simple' vigilance task, yet slower on the 'complex' vigilance task. Sleep Therapy effectively restored normal performance: patients became significantly slower on the 'simple' task and faster on the 'complex' task, returning to the performance levels of control subjects. These findings indicate that the performance decline associated with increasing cognitive demands is possibly the first sensitive and robust measure of the neurocognitive sequelae of insomnia. We suggest that future studies on cognition in primary insomnia should apply a design that varies task demands. © 2008 European Sleep Research Society.

Ysbrand D Van Der Werf - One of the best experts on this subject based on the ideXlab platform.

  • Is disturbed intracortical excitability a stable trait of chronic insomnia? A study using transcranial magnetic stimulation before and after multimodal Sleep Therapy.
    Biological psychiatry, 2010
    Co-Authors: Ysbrand D Van Der Werf, Ellemarije Altena, Rob L M Strijers, Karin Van Dijk, Wim De Rijke, Cornelis J. Stam, Eus J W Van Someren
    Abstract:

    Background Chronic insomnia is a poorly understood disorder. Risk factors for developing chronic insomnia are largely unknown, yet disturbances in brain indexes of arousal seem to accompany the disorder. We here investigate whether insomnia patients and control participants differ with respect to brain responses to direct stimulation, i.e., cortical excitability. Transcranial magnetic stimulation (TMS) offers a method to directly investigate the excitability level of the human cerebral cortex in psychiatric and neurological disease. Methods We investigated cortical excitability in 16 insomnia patients and 14 carefully matched control participants using absolute and relative amplitudes of motor evoked potentials in response to single- and paired-pulse stimulation using TMS. Results Nonmedicated insomnia patients showed, first, an exaggerated absolute response to both suprathreshold single- and paired-pulse stimulation compared with control participants and second, a reduced relative response to paired-pulse stimulation at long interpulse intervals (i.e., a reduced intracortical facilitation). The abnormal excitability persisted despite Sleep Therapy that effectively improved Sleep quality as well as behavioral and neuroimaging indexes of brain function. Conclusions The results suggest that a subtly disturbed intracortical excitability characterizes patients with chronic insomnia: a relatively reduced intracortical facilitation in the context of a globally increased absolute excitability. The findings do not resemble TMS findings after Sleep deprivation or in Sleep apnea and thus seem specific to insomnia. They may offer diagnostic value and implications for assessment of risk to develop this common and disabling disorder.

  • Sleep loss affects vigilance effects of chronic insomnia and Sleep Therapy
    Journal of Sleep Research, 2008
    Co-Authors: Ellemarije Altena, Rob L M Strijers, Ysbrand D Van Der Werf, Eus J W Van Someren
    Abstract:

    Although complaints of impaired daytime functioning are essential to the diagnosis of primary insomnia, objective evidence for cognitive dysfunction has been hard to establish. A prerequisite for understanding the neurocognitive consequences of primary insomnia is to establish task paradigms that robustly differentiate insomniacs from well-Sleeping subjects. We hypothesized that the decline in performance that typically occurs with an increasing cognitive demand would provide a more sensitive measure than performance on a single task version. The hypothesis was tested, first, by assessing the performance on two vigilance tasks with different cognitive demands in 25 elderly patients with primary insomnia and 13 healthy well-Sleeping age-matched subjects. Secondly, we investigated the performance response to Sleep Therapy using a waiting-list controlled design. Sleep Therapy consisted of a multi-component intervention including Sleep restriction, cognitive behavioral Therapy, bright-light Therapy, structured physical activity and body temperature manipulations. The results show that insomniacs differed markedly from controls in their reaction times across tasks with different cognitive demands: patients responded faster on the 'simple' vigilance task, yet slower on the 'complex' vigilance task. Sleep Therapy effectively restored normal performance: patients became significantly slower on the 'simple' task and faster on the 'complex' task, returning to the performance levels of control subjects. These findings indicate that the performance decline associated with increasing cognitive demands is possibly the first sensitive and robust measure of the neurocognitive sequelae of insomnia. We suggest that future studies on cognition in primary insomnia should apply a design that varies task demands.

  • Prefrontal hypoactivation and recovery in insomnia
    Sleep, 2008
    Co-Authors: Ellemarije Altena, Ysbrand D Van Der Werf, Ernesto J. Sanz-arigita, Thom A. Voorn, Serge A.r.b. Rombouts, Joost P.a. Kuijer, Eus J W Van Someren
    Abstract:

    EXPERIMENTAL ACUTE Sleep DEPRIVATION INDUCES COGNITIVE DEFICITS, PARTICULARLY IN TASKS THAT RELY ON THE INTEGRITY OF THE PREFRONTAL CORTICAL system.1 An example of such a prefrontally dependent task is the verbal fluency task.2,3 Performance on this task is known to be affected by experimental Sleep deprivation.4 A naturalistic form of chronically disturbed Sleep is primary insomnia, occurring in a large proportion of the population and increasingly so with aging.5 Insomnia can be treated with non-pharmacological Therapy, which has proved its long-term effectiveness on Sleep measures and daytime functioning in numerous previous studies.6,7 Sleep restriction and multifaceted cognitive-behavior Therapy have been reported to be particularly effective for treating insomnia in the elderly.8 Cognitive dysfunction in insomnia has been suggested, but few behavioral studies found abnormal performance in this condition, and no patterns of consistent results have emerged across studies.9 A possible reason for this inconsistency is that two opposing factors could result in masking of performance differences between insomniacs and well-Sleeping participants: the high level of perfectionism and arousal that characterizes insomnia may mask performance decreases due to poor Sleep.10,11 As a result, the net performance could become indistinguishable from that of well-Sleeping controls. Cognitive neuroimaging studies could instead be used to elucidate alterations in cognitive processes that might not readily emerge in behavioral performance measures. These have, up till now, not been reported in insomnia. We therefore undertook a functional imaging study to test the hypothesis that chronic insomnia would interfere with prefrontal activation during verbal fluency, and to investigate whether this possible interference would be reversible upon successful Sleep Therapy.

Colin A Espie - One of the best experts on this subject based on the ideXlab platform.

  • primary care treatment of insomnia study protocol for a pragmatic multicentre randomised controlled trial comparing nurse delivered Sleep restriction Therapy to Sleep hygiene the habit trial
    BMJ Open, 2020
    Co-Authors: Simon D Kyle, Claire D Madigan, Nargis Begum, Lucy Abel, Stephanie Armstrong, Paul Aveyard, Peter Bower, Emma Ogburn, Aloysius Niroshan Siriwardena, Colin A Espie
    Abstract:

    Introduction Insomnia is a prevalent Sleep disorder that negatively affects quality of life. Multicomponent cognitive-behavioural Therapy (CBT) is the recommended treatment but access remains limited, particularly in primary care. Sleep restriction Therapy (SRT) is one of the principal active components of CBT and could be delivered by generalist staff in primary care. The aim of this randomised controlled trial is to establish whether nurse-delivered SRT for insomnia disorder is clinically and cost-effective compared with Sleep hygiene advice. Methods and analysis In the HABIT (Health-professional Administered Brief Insomnia Therapy) trial, 588 participants meeting criteria for insomnia disorder will be recruited from primary care in England and randomised (1:1) to either nurse-delivered SRT (plus Sleep hygiene booklet) or Sleep hygiene booklet on its own. SRT will be delivered over 4 weekly sessions; total Therapy time is approximately 1 hour. Outcomes will be collected at baseline, 3, 6 and 12 months post-randomisation. The primary outcome is self-reported insomnia severity using the Insomnia Severity Index at 6 months. Secondary outcomes include health-related and Sleep-related quality of life, depressive symptoms, use of prescribed Sleep medication, diary and actigraphy-recorded Sleep parameters, and work productivity. Analyses will be intention-to-treat. Moderation and mediation analyses will be conducted and a cost-utility analysis and process evaluation will be performed. Ethics and dissemination Ethical approval was granted by the Yorkshire and the Humber - Bradford Leeds Research Ethics Committee (reference: 18/YH/0153). We will publish our primary findings in high-impact, peer-reviewed journals. There will be further outputs in relation to process evaluation and secondary analyses focussed on moderation and mediation. Trial results could make the case for the introduction of nurse-delivered Sleep Therapy in primary care, increasing access to evidence-based treatment for people with insomnia disorder. Trial registration number ISRCTN42499563