Difference of cooling use during sleep between elderly and young people

In Japan, nearly 80% of heatstroke occurrences in recent years have involved people older than 65 years old. This study surveyed the actual use of cooling by elderly people at sleep time compared to those found for younger people. Results revealed the followings. 1) Ratios of cooling use at sleep time were 30.8% for elderly people and 57.4% for younger people. The respective ratios of natural ventilation use at sleep time were 39.9% and 32.4%. 2) Average wet bulb globe temperatures (WBGTs) of bed rooms during sleep were 26.9°C for elderly people and 26.4°C for younger people. 3) Elderly people feel warmer than younger people but they feel more thermally comfortable. 4) Sleep scores were 49.7 for elderly people and 48.5 for younger people. No difference was found for the frequency of night waking or the Sleep maintenance score, but the Fatigue recovery score showed the greatest difference between elderly and younger people.

The incidence of sleep disturbances among medical students

Sleep disturbance is a common health problem that can influence the quality of life. There are several types of sleep disorders, such as obstructive sleep apnea, insomnia, narcolepsy, periodic limb movement disorder, and circadian dysregulation. Medical students are probably more prone to sleep disturbances due to their extreme academic stress. In this research, the incidence of sleep disturbance among medical students was examined, and the concomitant risk factors were determined. That was one-time research. A questioning was used to collect social, demographic and sleeping data. 678 1st, 2nd and 3rd year medical students were surveyed. 29% complained of at least one sleep disturbance. The most widely spread sleep disturbance observed among 51.8% medical students included insomnia (initial insomnia and sleep maintenance). 4th year students and those who spend much time on smartphones were more prone to sleep disturbances. Sleep disturbances are common among medical students. They need to be discovered and paid attention to before the situation gets worse.

Realization of phosphorylation hypothesis of sleep by mammalian CaMKIIβ

ABSTRACTThe reduced sleep duration observed in Camk2a and Camk2b knockout mice revealed the role of Ca2+/calmodulin-dependent protein kinase II (CaMKII)α/CAMKIIβ as sleep-promoting kinases and lead to the phosphorylation hypothesis of sleep. However, the underlying mechanism of sleep regulation by kinases and protein phosphorylation is largely unknown. Here, we demonstrate that the phosphorylation states of CaMKIIβ regulates sleep duration and sleep needs. Importantly, the activation or inhibition of CaMKIIβ can increase or decrease sleep duration by almost two-fold, supporting the role of CaMKIIβ as a core sleep regulator in mammals. This sleep regulation depends on the kinase activity of CaMKIIβ in excitatory neurons. Furthermore, CaMKIIβ mutants mimicking different phosphorylation states can regulate various sleep steps including sleep induction, sleep maintenance, and sleep cancelation. Key CaMKIIβ residues responsible for the mode switch undergo ordered (auto-)phosphorylation. We thus propose that ordered multi-site phosphorylation of CaMKIIβ underlies multi-step sleep regulation in mammals.

The Different Faces of Insomnia

Objectives: The identification of clinically relevant subtypes of insomnia is important. Including a comprehensive literature review, this study also introduces new phenotypical relevant parameters by describing a specific insomnia cohort.Methods: Patients visiting the sleep center and indicating self-reported signs of insomnia were examined by a sleep specialist who confirmed an insomnia diagnosis. A 14-item insomnia questionnaire on symptoms, progression, sleep history and treatment, was part of the clinical routine.Results: A cohort of 456 insomnia patients was described (56% women, mean age 52 ± 16 years). They had suffered from symptoms for about 12 ± 11 years before seeing a sleep specialist. About 40–50% mentioned a trigger (most frequently psychological triggers), a history of being bad sleepers to begin with, a family history of sleep problems, and a negative progression of insomnia. Over one third were not able to fall asleep during the day. SMI (sleep maintenance insomnia) symptoms were most frequent, but only prevalence of EMA (early morning awakening) symptoms significantly increased from 40 to 45% over time. Alternative non-medical treatments were effective in fewer than 10% of cases.Conclusion: Our specific cohort displayed a long history of suffering and the sleep specialist is usually not the first point of contact. We aimed to describe specific characteristics of insomnia with a simple questionnaire, containing questions (e.g., ability to fall asleep during the day, effects of non-medical therapy methods, symptom stability) not yet commonly asked and of unknown clinical relevance as yet. We suggest adding them to anamnesis to help differentiate the severity of insomnia and initiate further research, leading to a better understanding of the severity of insomnia and individualized therapy. This study is part of a specific Research Topic introduced by Frontiers on the heterogeneity of insomnia and its comorbidity and will hopefully inspire more research in this area.

The CHD8/CHD7/Kismet family links blood-brain barrier glia and serotonin to ASD-associated sleep defects

Sleep disturbances in autism and neurodevelopmental disorders are common and adversely affect patient’s quality of life, yet the underlying mechanisms are understudied. We found that individuals with mutations in CHD8, among the highest-confidence autism risk genes, or CHD7 suffer from disturbed sleep maintenance. These defects are recapitulated in Drosophila mutants affecting kismet, the sole CHD8/CHD7 ortholog. We show that Kismet is required in glia for early developmental and adult sleep architecture. This role localizes to subperineurial glia constituting the blood-brain barrier. We demonstrate that Kismet-related sleep disturbances are caused by high serotonin during development, paralleling a well-established but genetically unsolved autism endophenotype. Despite their developmental origin, Kismet’s sleep architecture defects can be reversed in adulthood by a behavioral regime resembling human sleep restriction therapy. Our findings provide fundamental insights into glial regulation of sleep and propose a causal mechanistic link between the CHD8/CHD7/Kismet family, developmental hyperserotonemia, and autism-associated sleep disturbances.

208 Sleep Disturbances During the COVID-19 Pandemic Associated with Worries and Fears About Possible Infection

Introduction The sudden COVID-19 pandemic and the uncertainty surrounding the virus has led to increased worry and fear. How this fear is associated with sleep remains unknown. Methods 419 US adults completed online surveys about sleep and COVID-19 experiences. Participants were asked about agreement with statements endorsing beliefs that they were currently infected, that they would someday be infected, that they fear testing, and that they are worried about a family member becoming infected. They were asked to rate agreement with statements regarding changes to sleep during the pandemic. Ordinal logistic regressions with degree of agreement with statements about sleep changes were outcomes, agreement with statements about COVID infection beliefs as predictor, and age, sex, and race/ethnicity as covariates were examined. Results Those who believed they were infected were 65% less likely to be keeping a regular schedule (p=0.001), 61% less likely to report improved sleep (p=0.009), 2.9 times as likely to report worse sleep (p=0.001), 2.7 times as likely to report difficulty falling asleep (p=0.002), 2.1 times as likely to report sleep maintenance problems (p=0.03), 2.9 times as likely to report sleepiness (p=0.001). Those who believed they would be infected in the future were 83% less likely to report improved sleep (p=0.005), 7.49 times as likely to report worse sleep (p=0.001), 5.3 times as likely to report difficulty falling asleep (p=0.003), 4.1 times as likely to report sleep maintenance problems (p=0.01), and 5.7 times as likely to report sleepiness (0.003). Those that feared testing were 5.7 times as likely to report more sleepiness (p=0.03). Those that worried about family were 80% less likely to be keeping a regular schedule (p=0.01), 75% less likely to report improved sleep (p=0.02), 4.5 times as likely to report worse sleep (p=0.02), 4.5 times as likely to report sleep maintenance problems (p=0.01), and 8.3 times as likely to report sleepiness (p=0.001). Conclusion Those who believed they were infected reported worsening sleep, though the degree was even greater among those who anticipated infection for themselves or a family member. Worries about COVID-19 may result in more adverse impact on sleep than potential infection itself. Support (if any):

329 High Prevalence of Sleep Difficulties and Low Rate of Seeking Professional Help in Polish Population

Introduction The number of people suffering from sleep disorders is on the rise. Insomnia is a complex issue with an impact on numerous aspects on everyday functioning. At the same time it is highly dependent on an individual’s lifestyle and untreated episodic sleep issues may lead to chronić insomnia. The aim of the present study was to assess complaints regarding sleep difficulties among men and women in Poland, as well as their severity and whether it leads to seeking treatment. Methods Data was gathered as a part of an online-based nationwide campaign on insomnia, which included a survey assessing sleep quality. The survey was developed for the purpose of this study. Statistical analysis included Chi-Square and Mann-Whitney tests as well as Spearman’s correlations. Results Responses were obtained from 3807 individuals – 2616 (68.7%) women and 1191 (31.3%) men. Sleep issues with the highest prevalence were sleep maintenance difficulties reported by 62.8% of the respondents, snoring among 61.2%, sleep initiation difficulties (sleep latency of over 30 minutes) among 55.6%, daytime sleepiness among 49.5%, and symptoms of Restless Leg Syndrome among 45.1%. Out of the participants who reported at least one sleep issue, the rate of having been to a professional consultation was 20.8% - 22.8% among women and 16.4% among men. Conclusion Even though the prevalence of different sleep troubles was very high, it did not correspond to the rate of seeking professional help. The vast majority of both men and women who experienced sleep difficulties had never consulted with a specialist regarding their sleep quality. There is a great need for psychoeducation of the general public on sleep as a vital component of health and on benefits of professional help. Support (if any) This study was supported by an unrestricted educational grant by Polfarmex. The funding source had no role in the design and conduct of the study, collection, management and analysis of the data, or preparation of the abstract. The authors declare no other conflicts of interest.

Medulla glutamatergic neurons control wake-sleep transitions

SUMMARYSleep is a ubiquitous behavior in animal species. Yet, brain circuits controlling sleep remain poorly understood. Previous studies have identified several brain structures that promote sleep, but whether these structures are involved in sleep initiation or sleep maintenance remains largely unknown. Here we identified a population of glutamatergic neurons in the medulla that project to the preoptic area (POA), a prominent sleep-promoting region. Chemogenetic silencing of POA-projecting medulla neurons disrupts the transitions from wakefulness to Non-Rapid Eye Movement (NREM) sleep, whereas chemogenetic activation of these neurons promotes NREM sleep. Moreover, we show that optogenetic activation of medulla glutamatergic neurons or their projections in the POA reliably initiates long-lasting NREM sleep in awake mice. Together, our findings uncover a novel excitatory brainstem-hypothalamic circuit that controls the wake-sleep transitions.

Insomnia subtypes and clinical impairment in hospitalized children with autism spectrum disorder

Insomnia subtypes have not been characterized in severely affected youth with autism spectrum disorder. We examined indices of clinical impairment (i.e. length of hospital stay, autism severity, nonverbal intelligence quotient, and adaptive and maladaptive behaviors) across insomnia subtypes in 427 psychiatrically hospitalized children with autism spectrum disorder (mean age = 12.8 ± 3.4; 81.3% male). Multivariate analysis with Bonferroni adjustment tested for differences in clinical impairment across insomnia subtypes adjusting for age and sex. Per parent report, 60% (n = 257) of children had at least one form of insomnia. The distribution of subtypes was sleep onset (26.1%, n = 67), sleep maintenance (24.9%, n = 64), early morning waking (4.3%, n = 11), and combined (44.7%, n = 115). There was a significant multivariate effect of insomnia subtypes on clinical impairment (Pillai’s Trace = 0.25, F = 2.78, p < 0.001). Sleep maintenance and early morning waking were associated with longer hospital stays. Early morning waking was also associated with greater autism symptom severity. In general, children with sleep-maintenance or combined insomnias scored lower on adaptive behaviors and higher on maladaptive behaviors. Sleep-maintenance and combined insomnias appear to be more indicative of or consequential for impaired behavioral functioning. Lay abstract Insomnia subtypes are not well understood in the most severely affected children with autism spectrum disorder. We examined length of hospital stay, autism severity, nonverbal intelligence quotient, and behavioral functioning across insomnia subtypes in 427 psychiatrically hospitalized children with autism spectrum disorder (mean age = 12.8 ± 3.4; 81.3% male). Per parent report, 60% (n = 257) of children had at least one type of insomnia. The distribution of subtypes was difficulty falling asleep (26.1%, n = 67), difficulty staying asleep (24.9%, n = 64), early morning awakening (4.3%, n = 11), and multiple insomnia symptoms (44.7%, n = 115). Difficulty staying asleep and early morning awakenings were associated with longer hospital stays. Early morning awakening was also associated with higher autism symptom severity. In general, children with difficulty staying asleep or multiple insomnia symptoms scored lower on adaptive behaviors (e.g. communication, self-care, socialization) and higher on maladaptive behaviors (e.g. irritability, hyperactivity, emotional reactivity, and emotional dysphoria). Difficulty staying asleep or having multiple insomnia symptoms appears to be most strongly related to impaired behavioral functioning. Conversely, early morning awakenings may be more closely tied with autism spectrum disorder itself. Further research is needed regarding insomnia subtypes at the severe end of the autism spectrum.

A study on sleep apnea in patients with abnormal sewda type of depression

Objective: To preliminarily investigate the clinical features and PSG in abnormal sewda-type depressive insomnia. Methods: A total of 127 abnormal sewda-type depressive insomnia patients were evaluated with overnight PSG, and 32 normal participants were compared. Results: Patients with abnormal sewda-type depressive insomnia were compared with the control group; the sleep symptoms showed a long incubation period of sleep, low sleep maintenance rate, low sleep efficiency and poor sleep quality as well as daytime dysfunction. At process and continuity of sleep: Total sleep time, sleep efficiency, sleep maintenance rate in abnormal sewda-type depressive insomnia group were shorter than the control group. Wake after sleep onset, and sleep latency were longer than the control group. At sleep structure: N1 ratio and N2 ratio in depressive insomnia group were longer than the control group, N3 ratio and REM sleep ratio shorter than the control group. At REM index: REM latency, REM cycles, and REM sleep time were shorter than the control group. Conclusion: Insomnia symptoms in abnormal sewda-type depression comorbid insomnia patients were similar to the ordinary insomnia patients. The PSG characteristics had significant changes in sleep process, sleep structure and REM indicators. The severity of the abnormal sewda-type depression was closely related to REM indicators. Change of REM sleep characteristics may be the specificity, and these could be taken as reference in diagnosis and identification of abnormal sewda-type depressive insomnia.