Comorbidity Of Depression And Insomnia

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Jennifer Ocasio

Health & Medicine

Comorbidity of Depression and Insomnia Caused by Common Factors Jennifer K. Ocasio RISE

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1179journal.publications.chestnet.org Th e Pathophysiology of Insomnia Jessica C. Levenson , PhD ; Daniel B. Kay , PhD ; and Daniel J. Buysse , MD Insomnia disorder is characterized by chronic dissatisfaction with sleep quantity or quality that is associated with diffi culty falling asleep, frequent nighttime awakenings with diffi culty returning to sleep, and/or awakening earlier in the morning than desired. Although progress has been made in our understanding of the nature, etiology, and pathophysiology of insomnia, there is still no universally accepted model. Greater understanding of the pathophysiology of insomnia may provide important information regarding how, and under what conditions, the disorder develops and is maintained as well as potential targets for prevention and treatment. The aims of this report are (1) to summarize current knowledge on the pathophysiology of insomnia and (2) to present a model of the pathophysiology of insomnia that considers evidence from various domains of research. Working within several models of insomnia, evidence for the pathophysiology of the disorder is presented across levels of analysis, from genetic to molecular and cellular mechanisms, neural circuitry, physiologic mechanisms, sleep behavior, and self-report. We discuss the role of hyperarousal as an overarching theme that guides our concep- tualization of insomnia. Finally, we propose a model of the pathophysiology of insomnia that integrates the various types of evidence presented. CHEST 2015; 147� ( 4 ): 1179 - 1192 ABBREVIATIONS: GABA 5 g -aminobutyric acid ; MnPO 5 median preoptic area ; NREM 5 non-rapid eye movement ; PEP 5 pre-ejection period ; PSG 5 polysomnography ; REM 5 rapid eye movement ; SNP 5 single-nucleotide polymorphism ; TMN 5 tuberomammillary nucleus of the posterior hypothalamus ; VLPO 5 ventrolateral preoptic area [ Contemporary Reviews in Sleep Medicine ] Manuscript received July 3 , 2014 ; revision accepted October 28 , 2014 . AFFILIATIONS: From the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA. FUNDING/SUPPORT: Dr Buysse is supported by the National Institutes of Health [Grants MH024652, MH102412, AG020677, and HL125103]. Drs Levenson and Kay are supported by the National Institutes of Health [Grant HL082610, T32, PI Buysse]. CORRESPONDENCE TO: Daniel J. Buysse, MD, University of Pittsburgh, 3811 O’Hara St, WPIC E-1127, Pittsburgh, PA 15213; e-mail: [email protected] upmc.edu © 2015 AMERICAN COLLEGE OF CHEST PHYSICIANS. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details. ...

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The following proposed Scientific Consensus on Brain fingerprinting has arisen from discussionsamong forensic scientists, legal experts, psychophysiologists, and experts in law enforcementand national security. These discussions were initiated by Lawrence A. Farwell. This is a workin progress. Discussions of these and other related issues are ongoing. Please refer commentsand suggestions to Lawrence A. Farwell at LFarwell@brainwavescience.com .The most fundamental point of consensus among scientists and other relevant experts regardingbrain fingerprinting, forensic science, and science in general is that different methods producedifferent results. Brain fingerprinting, from the seminal Farwell and Donchin (1986; 1991) andFarwell and Smith (2001) papers to the present, has never produced an error, neither a falsenegative nor a false positive. Some alternative methods of applying the same brain responses inattempts to detect concealed information have resulted in 10% to 15% errors and in some casesas high as nearly 50% errors, no better than chance. Even some purported “replications” ofFarwell and Donchin have in fact used fundamentally different methods. Consequently theyhave failed to achieve accuracy approaching that of brain fingerprinting and, unlike brainfingerprinting, are susceptible to countermeasures. These fundamental differences in scientificmethods are the reason why brain fingerprinting has been successfully applied in the field andruled admissible in court, and these alternative methods are unsuitable for field use or applicationin the criminal justice system or national security.In developing this consensus, we have specified precisely the standard scientific methods thatconstitute brain fingerprinting and attempted to identify the specific standards that are necessaryand sufficient to obtain the results that brain fingerprinting has consistently attained. We havesought to identify differences in methods that are responsible for the widely divergent resultsobtained in different laboratories conducting related research.Fundamental brain fingerprinting scientific principles, methods, and scientific standards arebriefly described the first section of this article. The proposed Scientific Consensus on BrainFingerprinting presumes a thorough understanding of the information contained therein. It alsoassumes familiarity with the articles in the literature cited in the Background section below.In the course of developing a consensus, some points have arisen on which there is considerablediversity of opinion. Some of these Differing Views on Brain Fingerprinting are briefly outlinedfollowing the Scientific Consensus on Brain Fingerprinting.

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Sleep and dreams are taken for granted by those not affected by obstructive sleep apnea. Unfortunately in around 10 million population around the world, sleep is a nightly battle which leaves it‟s victims and their bed partners fatigued, stressed and much less healthy. Untreated sleep apnea is one of the major public health issues we face in common. The emergence of dental sleep medicine as a safe and effective treatment brings hope for the millions of patients looking for alternatives to CPAP treatment. Oral appliances used to date constitute a relatively heterogeneous group of devices for the treatment of sleep apnea and non-apneic snoring. As dental professionals, we have a significant role to play in the early diagnosis, management and care of patients suffering from sleep apnea. Oral appliances play a major role in the non surgical management of OSA and have become the first line of treatment in almost all patients suffering from OSA. The interplay between anatomic, functional, and neural factors that influence the upper airway patency during wakefulness and sleep is still unclear. Although the role played by the prosthodontists is still in its infancy, there is much to learn and understand in the rapidly evolving field of sleep medicine. The growing interest of prosthodontists in sleep medicine has contributed immensely toward effective prevention and treatment of OSA and sleep Bruxism for each patient based on his/her individual requirement

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Previous randomized controlled trials (RCTs) have shown that acupuncture may be efficacious for insomnia. Instead of needling, acupressure, reflexology, and auricular acupressure are procedures involving physical pressure on acupoints or reflex areas. These variants of acupuncture are gaining popularity, perhaps due to their non-invasive nature. A systematic review has therefore been conducted to examine their efficacy and safety for insomnia. Two independent researchers searched five English and 10 Chinese databases from inception to May 2010. Forty RCTs were identified for analysis. Only 10 studies used sham controls, four used double-blind design, nine studies scored three or more by the Jadad scale, and all had at least one domain with high risk of bias. Meta-analyses of the moderate-quality RCTs found that acupressure as monotherapy fared marginally better than sham control. Studies that compared auricular acupressure and sham control showed equivocal results. It was also found that acupressure, reflexology, or auricular acupressure as monotherapy or combined with routine care was significantly more efficacious than routine care or no treatment. Owing to the methodological limitations of the studies and equivocal results, the current evidence does not allow a clear conclusion on the benefits of acupressure, reflexology, and auricular acupressure for insomnia.

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