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PubMed1992

Training subjective insomniacs to accurately perceive sleep onset.

Subjective insomniacs overestimate sleep latency at the beginning of their nocturnal sleep period. It was hypothesized that subjective insomniacs could be trained to accurately estimate sleep latency by learning to differentiate wakefulness from sleep. Ten subjective insomniacs were randomly assigned to one of two groups. Group 1 subjects participated in both a control and a training week; group 2 subjects participated only during a training week. Each week consisted of a baseline lab night, a training lab night (treatment or control), a home (unmonitored night) and a recovery lab night. During training, subjects were taught to use sleep markers (A, B or C) to help them more accurately estimate sleep latency and were given feedback about the accuracy of their estimates. Marker A corresponded to an electroencephalographic level of wakefulness; marker B corresponded to the initial sleep spindle; marker C corresponded to 5 minutes of continuous sleep after the first sleep spindle. In the control condition, subjects had no feedback and were not taught to use markers to help them judge sleep from wakefulness. Total sleep time and percent stage 3 sleep increased, and objective sleep latency decreased on recovery nights. After training, subjective sleep latency, correctness of estimates of sleep versus wakefulness and perceived ability to fall asleep significantly improved. This study helps to establish that subjective insomniacs can learn to more accurately estimate sleep from wakefulness with the use of sleep-wake markers.

Adolescent↗

PubMed1992

Operation Everest II: arterial oxygen saturation and sleep at extreme simulated altitude.

Frequent sleep disturbances and desaturation during sleep are common at high altitude, but few data are available from the highest altitudes at which humans are known to sleep. Because sleep fragmentation at low altitude may impair mental function and oxygen deprivation produces lasting central nervous system abnormalities, a better understanding of the severity of sleep disturbances and oxygen desaturation at extreme altitudes is important. The purpose of this study was to determine the severity of sleep disturbance and the extent of arterial oxygen desaturation at extreme simulated altitude. Out of eight healthy male subject volunteers who started, five aged 27.2 +/- 1.5 yr completed the study during 6 weeks of progressive hypobaric hypoxia in a decompression chamber. The men were studied at barometric pressures of 760, 429, 347, 282 mm Hg and following return to 760 mm Hg. All demonstrated frequent nighttime awakenings (37.2 awakenings per subject per night at 282 mm Hg, decreasing significantly to 14.8 on return to sea level, p less than 0.05). Total sleep time decreased from 337 +/- 30 min at 760 mm Hg to 167 +/- 44 min at 282 mm Hg (p less than 0.01). Rapid eye movement (REM) sleep decreased from 17.9% +/- 6.0% of sleep time at sea level to 4.0% +/- 3.3% at 282 mm Hg (p less than 0.01). Sleep continuity as reflected by brief arousals increased from 22 +/- 6 arousals per hour of sleep at sea level to 161 +/- 66 arousals per hour at 282 mm Hg (p less than 0.01). All subjects showed arterial oxygen desaturation proportional to the altitude. The average oxygen saturation (SaO2) was 79% +/- 3% at 429 mm Hg, 66% +/- 6% at 347 mm Hg, and 52% +/- 2% at 282 mm Hg. Sleep stage had only a minimal effect on SaO2 at any altitude. SaO2 was negatively correlated with brief sleep arousals, r = -0.72, p less than 0.01. All subjects demonstrated periodic breathing with apneas throughout much of the night at 347 and 282 mm Hg. These data indicate that sleep quality progressively worsens as SaO2 decreases despite lack of progressive changes in sleep stages at altitude. This study extends previous information on the severity of desaturation during sleep, and suggests that improvements in oxygenation might prove beneficial in restoring consolidated sleep, possibly even improving daytime performance.

Adult↗

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Community Health Services↗