Sleep Medicine Reviews RSS feed: Current Issue. Sleep Medicine Reviews provides International coverage of sleep disorders, their aetiology, diagnosis, treatment and implications for related conditions at an individual and public health level. Articles review the clinical information published in peer-reviewed journals devoted to the many disciplines involved in sleep medicine, including: pulmonology, psychiatry, psychology, physiology, otolaryngology, paediatrics, geriatrics, cardiology, dentistry, nursing, neurology and general medicine. The journal publishes narrative reviews, systematic reviews and editorials covering area of controversy and debate, as well as areas of future research. http://www.smrv-journal.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Sleep Medicine Reviews1087-0792141February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.smrv-journal.com/article/PIIS1087079209001294/abstract?rss=yesAims & Scope/ Editorial Board10.1016/S1087-0792(09)00129-4Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9iihttp://www.smrv-journal.com/article/PIIS108707920900121X/abstract?rss=yesWelcome to the 14th volume of Sleep Medicine Reviews (SMR). We confess, we continue to be astounded. Flattered, but astounded. We once again offer our heartfelt thanks to all of our readers, as 2009 was another banner year for SMR. 2009 began with an expansion of SMR from five state-of-the-art reviews per issue to six! We trust our readers found these six additional reviews useful in their research and clinical endeavors.Excelsior!Michael V. Vitiello, Jean Krieger10.1016/j.smrv.2009.11.001Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Editorial12http://www.smrv-journal.com/article/PIIS1087079209000951/abstract?rss=yes‘In treating these cases [of sleeplessness], the key to success lies in the management of the patient's mind, and unless we recognise the large share which is taken by mental disorder in producing and perpetuating the various and puzzling symptoms which present themselves, we shall not only fail in our object, but shall be in danger of actually aggravating the malady. Much may be done by soporifics and tonics; but our chief attention must be directed to regulating and strengthening the mind, otherwise our medicines will only serve to fix the patient's attention more closely upon the symptoms, and induce reliance upon external measures rather than upon self discipline. The treatment required is suggested by the nature of the malady. We find self-control diminished, the will inert, the emotions dominant, the thoughts of the sufferers occupied entirely about themselves, and the idea of disease the one subject engrossing their attention; we find every sensation registered, every fresh complaint welcomed and symptoms which at first seem to belong to organic disease are discovered, by further experience of the case, to have their origin in nothing but exaggerated sensitiveness or disordered fancy'…James Russell, ‘On Sleeplessness’ BMJ 1861 (Nov 9, p489)Primary insomnia: A disorder of sleep, or primarily one of wakefulness?Jim Horne10.1016/j.smrv.2009.09.004Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Guest editorial37http://www.smrv-journal.com/article/PIIS1087079209000458/abstract?rss=yesSummary: In the past few years it has become increasingly clear that insomnia is a chronic disease that interacts with many other medical conditions. As our ability to examine complex physiological activity during sleep has increased, additional evidence continues to suggest that insomnia is associated with inappropriate physiological arousal. It is now known that patients with primary insomnia have increased high-frequency EEG activation, abnormal hormone secretion, increased whole body and brain metabolic activation, and elevated heart rate and sympathetic nervous system activation during sleep. This activation can be measured throughout the day and night and is chronic. Other research suggests that insomnia, probably based upon the associated chronic physiologic arousal, is associated with increased risk for medical disorders such as depression, hypertension, or cardiac disease. An animal model that has used odor stress to produce poor sleep in rats has identified specific activated brain sites similar to those found in human brain metabolic studies to suggest that insomnia is a state in which sleep and arousal systems are both simultaneously active. The animal studies have also shown that the inappropriate arousal can be blocked by lesions in the limbic and arousal systems. It is hoped that these findings can be extended to identify new compounds that improve insomnia by acting at these sites of abnormal brain activation.Hyperarousal and insomnia: State of the scienceMichael H. Bonnet, Donna L. Arand10.1016/j.smrv.2009.05.002Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical review915http://www.smrv-journal.com/article/PIIS1087079209000938/abstract?rss=yesFirst of all I would like to thank the editors of Sleep Medicine Reviews (SMR) for giving me the opportunity to read Michael Bonnet's review on “Hyperarousal and insomnia: state of the science” prior to publication and to comment on it. I also want to express my gratitude to the editors for publishing two papers on the issue of hyperarousal and insomnia in the same issue of SMR.“Hyperarousal and insomnia: State of the science”Dieter Riemann10.1016/j.smrv.2009.09.002Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Commentary1717http://www.smrv-journal.com/article/PIIS1087079209000410/abstract?rss=yesSummary: Primary insomnia is defined as difficulties in falling asleep, maintaining sleep or non-restorative sleep accompanied by significantly impaired daytime functioning in the absence of a specific physical, mental or substance-related cause. The current review provides substantial support for the concept that hyperarousal processes from the molecular to the higher system level play a key role in the pathophysiology of primary insomnia. Autonomous, neuroendocrine, neuroimmunological, electrophysiological and neuroimaging studies demonstrate increased levels of arousal in primary insomnia during both night and daytime. In the light of neurobiological theories of sleep–wake regulation, primary insomnia may be conceptualized as a final common pathway resulting from the interplay between a genetic vulnerability for an imbalance between arousing and sleep-inducing brain activity, psychosocial/medical stressors and perpetuating mechanisms including dysfunctional sleep-related behavior, learned sleep preventing associations and other cognitive factors like tendency to worry/ruminate.The hyperarousal model of insomnia: A review of the concept and its evidenceDieter Riemann, Kai Spiegelhalder, Bernd Feige, Ulrich Voderholzer, Mathias Berger, Michael Perlis, Christoph Nissen10.1016/j.smrv.2009.04.002Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical review1931http://www.smrv-journal.com/article/PIIS1087079209000690/abstract?rss=yesThe reader of this issue is presented with a conundrum in understanding the role of hyperarousal in insomnia. Riemann et al. discuss the development of hyperarousal in insomnia from a psychological and behavioral view while Bonnet and Arand present a more physiologic basis for hyperarousal and insomnia. Readers may ‘agree’ more or less with either view, but, in the final analysis, many will find that similarities in the two approaches outweigh differences.Hyperarousal and insomniaMichael H. Bonnet10.1016/j.smrv.2009.07.003Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Commentary3333http://www.smrv-journal.com/article/PIIS108707920900094X/abstract?rss=yesSummary: During the last decade, several studies have shown that insomnia, rather than a symptom of depression, could be a medical condition on its own, showing high comorbidity with depression. Epidemiological research indicates that insomnia could lead to depression and/or that common causalities underlie the two disorders. Neurobiological and sleep EEG studies suggest that a heightened level of arousal may play a common role in both conditions and that signs of REM sleep disinhibition may appear in individuals prone to depression. The effects of antidepressant drugs on non-REM and REM sleep are discussed in relation to their use in insomnia comorbid with depression. Empirical treatment approaches are behavioral management of sleep combined with prescription of a sedative antidepressant alone, co-prescription of two antidepressants, or of an antidepressant with a hypnotic drug.Comorbidity of insomnia and depressionLuc Staner10.1016/j.smrv.2009.09.003Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical reviews3546http://www.smrv-journal.com/article/PIIS1087079209000483/abstract?rss=yesSummary: Primary insomnia is a sleep disorder where the subjective complaint of initiating or maintaining sleep, or the experience of sleep that is non-refreshing, cannot be directly attributed to a comorbid medical or psychiatric disorder. For a diagnosis of primary insomnia, a patient must also report that the nighttime sleep disturbance is impacting upon daytime functioning. Yet, while subjective complaints of impaired wake-time functioning are well documented, consistent objective evidence of these impairments has proved elusive, particularly with regard to cognitive functioning. We aimed to review the body of literature examining neurobehavioural impairments in primary insomnia to identify which cognitive domains appear to be most consistently impaired in this group. The relatively few studies that have investigated neurobehavioural performance deficits in patients with primary insomnia have produced inconsistent and sometimes conflicting findings. It is suggested that methodological limitations, including heterogeneous test populations, variable testing protocols and conditions as well as unsuitable cognitive tasks have contributed to our inability to describe unequivocally the daytime impairments associated with insomnia. Based on our review, it appears that the deficits associated with insomnia are relatively subtle and may be qualitatively different to those that result from other sleep disorders and from imposed sleep deprivation. Attention tasks, which have a high cognitive load, and working memory tasks appear to show performance deficits more often than not in insomnia patients. It is important to more definitively characterise the daytime impairments associated with primary insomnia so that the efficacy of treatments to remedy the wake-time consequences of the disorder, in addition to the nighttime symptoms, can be investigated.Searching for the daytime impairments of primary insomniaJulia A. Shekleton, Naomi L. Rogers, Shantha M.W. Rajaratnam10.1016/j.smrv.2009.06.001Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical reviews4760http://www.smrv-journal.com/article/PIIS1087079209000732/abstract?rss=yesSummary: Insomnia is a highly prevalent sleep disorder, known to affect psychological well-being and quality of life. While perpetuating factors have received much attention, the role of predisposing factors has not been studied in much detail. The susceptibility to develop insomnia may be linked to the presence of certain personality features. Here, we review studies that assessed this particular aspect of insomnia. Due to various methodological issues, definitive conclusions cannot be drawn as of yet, and several conflicting findings remain. However, there is a common trend indicating that insomniacs display more signs of ‘neuroticism’, ‘internalization’, anxious concerns and traits associated with perfectionism. These factors may play varying roles depending on the specific subdiagnosis of insomnia. In addition, certain personality traits may be related to the response to (cognitive) behavioral treatment. For instance, insomniacs reporting less ‘guardedness’ and have a higher score on the MMPI ‘hypomania’ scale show less improvement through psychological treatment. The specific role of personality traits in the etiology of insomnia is not yet clear, because of a lack of longitudinal data. Personality factors may play a causal role in the development of insomnia, but may also be a consequence of the sleep problem and the associated daytime dysfunction. Future longitudinal studies should not view personality as a single predisposing factor, but assess it as a part of a larger group of interacting psychological and physiological factors involved in the predisposition to and perpetuation of chronic insomnia.The role of personality traits in insomniaMerijn van de Laar, Ingrid Verbeek, Dirk Pevernagie, Albert Aldenkamp, Sebastiaan Overeem10.1016/j.smrv.2009.07.007Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical reviews6168http://www.smrv-journal.com/article/PIIS1087079209000719/abstract?rss=yesSummary: Health-related Quality of Life (HRQoL) has become an important construct in contemporary medicine and health care, permitting assessment of disorder burden and evaluation of interventions on various aspects of functioning, in a standardized manner. Here we review literature on the measurement of HRQoL in insomnia populations, and the extent to which insomnia treatment improves domains of HRQoL. It is concluded from the relatively small literature that insomnia impacts on diverse areas of HRQoL, and that both pharmacological and non-pharmacological interventions can produce, to varying degrees, improvements in domains spanning physical, social and emotional functioning. Limitations of the current literature are identified; with particular emphasis on measurement and conceptual shortcomings. Suggestions are made in relation to improving the quality of future research, and how to further shed light on the impact of insomnia – and treatment thereof – on both HRQoL and global quality of life.Insomnia and health-related quality of lifeSimon D. Kyle, Kevin Morgan, Colin A. Espie10.1016/j.smrv.2009.07.004Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-9Clinical reviews6982http://www.smrv-journal.com/article/PIIS1087079209001440/abstract?rss=yesThe Co-Editors-in-Chief wish to thank these individuals for their expertise in ensuring the quality of Sleep Medicine Reviews. APeer Reviewers Volume 1310.1016/S1087-0792(09)00144-0Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-98383http://www.smrv-journal.com/article/PIIS1087079209001452/abstract?rss=yesArticles to appear in forthcoming issues10.1016/S1087-0792(09)00145-2Sleep Medicine Reviews 14, 1 (2010)2010-02-01Sleep Medicine Reviews2010-02-01141S1087-0792(09)X0007-98484