A novel, digital, immersive virtual reality (VR)-based mind–body approach, designed to reduce bedtime arousal in adolescents with insomnia.
Human sleep program publications
How the COVID‐19 Pandemic Has Changed Our Lives: A Study of Psychological Correlates Across 59 Countries
Objective: This study examined the impact of the COVID-19 pandemic and subsequent social restrictions or quarantines on the mental health of the global adult population.
Method: A sample of 6,882 individuals ( M age = 42.30; 78.8% female) from 59 countries completed an online survey asking about several pandemic‐related changes in life and psychological status.
Results: Of these participants, 25.4% and 19.5% reported moderate‐to‐severe depression (DASS‐21) and anxiety symptoms (GAD‐7), respectively. Demographic characteristics (e.g. higher‐income country), COVID‐19 exposure (e.g., having had unconfirmed COVID‐19 symptoms), government‐imposed quarantine level, and COVID‐19‐based life changes (e.g., having a hard time transitioning to working from home; increase in verbal arguments or conflict with other adult in home) explained 17.9% of the variance in depression and 21.5% in anxiety symptoms.
Conclusions: In addition to posing a high risk to physical health, the COVID‐19 pandemic has robustly affected global mental health, so it is essential to ensure that mental health services reach individuals showing pandemic‐related depression and anxiety symptoms.
Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes and menopausal symptoms: A pilot study
Objective/Background: This pilot study explored the efficacy of a novel forehead cooling device for perceived sleep difficulties and hot flashes in menopausal-age women.
Participants: 20 women (55.1 ± 4.2 years; 19 post-menopausal) with insomnia symptoms and self-reported two or more hot flashes per day.
Methods: Participants completed daily assessments of sleep and hot flashes (via diaries) across 1 baseline week and 4 weeks of open-label, in-home, nightly treatment with a forehead cooling device (15–18°C) along with sleep hygiene instructions. They also completed ratings of insomnia and menopausal symptoms using standardized questionnaires.
Results: Women reported reductions in sleep onset latency (SOL), wakefulness after sleep onset (WASO), and nocturnal hot flash severity during the first week of treatment (SOL: 25.7 ± 18.4 min; WASO: 36.3 ± 27.3 min; hot flash severity: 3.0 ± 2.8) compared with baseline (SOL: 38 ± 26.3 min; WASO: 52.2 ± 35.6 min; hot flash severity: 6.8 ± 3.7), with further improvements after 2–4 weeks of use ( p < .001). There were also clinically meaningful reductions in insomnia severity and hot flash-related daily interference and lower psychological and physical symptom scores on the Greene climacteric scale after treatment (all p’s<0.001). Conclusions: This exploratory, naturalistic, pilot study shows that nightly use of a forehead cooling device produces improvements in self-reported sleep and reductions in insomnia, hot flash, and other menopausal, symptoms. Controlled studies are warranted to determine the role of this therapy in the management of sleep difficulties and menopausal symptoms in women. Further mechanistic studies are needed to understand the physiological impact of forehead cooling on sleep and menopausal symptoms.
A standardized framework for testing the performance of sleep-tracking technology: Step-by-step guidelines and open-source code
Sleep-tracking devices are increasingly used in both research and clinical settings, providing new opportunities for large-scale data collection.
Stress, Sleep, and Autonomic Function in Healthy Adolescent Girls and Boys: Findings from the NCANDA Study
Objectives : Starting in adolescence, female sex is a strong risk factor for the development of insomnia. Reasons for this are unclear but could involve altered stress reactivity and/or autonomic nervous system (ANS) dysregulation, which are strongly associated with the pathophysiology of insomnia. We investigated sex differences in the effect of stress on sleep and ANS activity in adolescents, using the first night in the laboratory as an experimental sleep-related stressor.
Design : Repeated measures (first night vs. a subsequent night) with age (older/younger) and sex (males/females) as between factors.
Setting: Recordings were performed at the human sleep laboratory at SRI International.
Participants : One hundred six healthy adolescents (Age, mean ± SD: 15.2 ± 2.0 years; 57 boys).
Measures: Polysomnographic sleep, nocturnal heart rate (HR), and frequency-domain spectral ANS HR variability (HRV) indices.
Results : Boys and girls showed a first-night effect, characterized by lower sleep efficiency, lower %N1 and %N2 sleep, more wake after sleep onset and %N3 sleep, altered sleep microstructure (increased high-frequency sigma and Beta1 electroencephalographic activity), and reduced vagal activity ( P < .05) on the first laboratory night compared to a subsequent night. The first night ANS stress effect (increases in HR and suppression in vagal HRV during rapid eye movement sleep) was greater in girls than boys P < .05). Conclusions: Sleep and ANS activity were altered during the first laboratory night in adolescents, with girls exhibiting greater ANS alterations than boys. Findings suggest that girls may be more vulnerable than boys to sleep-specific stressors, which could contribute to their increased risk for developing stress-related sleep disturbances.
Impact of evening alcohol consumption on nocturnal autonomic and cardiovascular function in adult men and women: A dose–response laboratory investigation
Study Objectives: To investigate the dose-dependent impact of moderate alcohol intake on sleep-related cardiovascular (CV) function, in adult men and women.
Methods: A total of 26 healthy adults (30–60 years; 11 women) underwent 3 nights of laboratory polysomnographic (PSG) recordings in which different doses of alcohol (low: 1 standard drink for women and 2 drinks for men; high: 3 standard drinks for women and 4 drinks for men; placebo: no alcohol) were administered in counterbalanced order before bedtime. These led to bedtime average breath alcohol levels of up to 0.02% for the low doses and around 0.05% for the high doses. Autonomic and CV function were evaluated using electrocardiography, impedance cardiography, and beat-to-beat blood pressure monitoring.
Results: Presleep alcohol ingestion resulted in an overall increase in nocturnal heart rate (HR), suppressed total and high-frequency (vagal) HR variability, reduced baroreflex sensitivity, and increased sympathetic activity, with effects pronounced after high-dose alcohol ingestion (p’s < 0.05); these changes followed different dose- and measure-dependent nocturnal patterns in men and women. Systolic blood pressure showed greater increases during the morning hours of the high-alcohol dose night compared to the low-alcohol dose night and placebo, in women only (p’s < 0.05).
Conclusions: Acute evening alcohol consumption, even at moderate doses, has marked dose- and time-dependent effects on sleep CV regulation in adult men and women. Further studies are needed to evaluate the potential CV risk of repeated alcohol-related alterations in nighttime CV restoration in healthy individuals and in those at high risk for CV diseases, considering sex and alcohol dose and time effects.
The Falling Asleep Process in Adolescents
Study objectives: To investigate the pre-sleep psychophysiological state and the arousal deactivation process across the sleep onset (SO) transition in adolescents.
Methods: Data were collected from a laboratory overnight recording in 102 healthy adolescents (48 girls, 12-20 years old). Measures included pre-sleep self-reported cognitive/somatic arousal, and cortical electroencephalographic (EEG) and electrocardiographic activity across the SO transition.
Results: Adolescent girls, compared with boys, reported higher pre-sleep cognitive activation (p = 0.025) and took longer to fall asleep (p < 0.05), as defined with polysomnography. Girls also showed a less smooth progression from wake-to-sleep compared with boys (p = 0.022). In both sexes, heart rate (HR) dropped at a rate of ~0.52 beats per minute in the 5 minutes preceding SO, and continued to drop, at a slower rate, during the 5 minutes following SO (p < 0.05). Older girls had a higher HR overall in the pre-sleep period and across SO, compared to younger girls and boys (p < 0.05). The EEG showed a progressive cortical synchronization, with increases in Delta relative power and reductions in Alpha, Sigma, Beta1, and Beta2 relative powers (p < 0.05) in the approach to sleep, in both sexes. Delta relative power was lower and Theta, Alpha, and Sigma relative powers were higher in older compared to younger adolescents at bedtime and across SO (p < 0.05).
Conclusions: Our findings show the dynamics of the cortical-cardiac de-arousing process across the SO transition in a non-clinical sample of healthy adolescents. Findings suggest a female-specific vulnerability to inefficient sleep initiation, which may contribute to their greater risk for developing insomnia.
The use of immersive virtual reality and slow breathing to enhance relaxation and sleep in adolescents
Introduction: Sleep disturbances frequently emerge during adolescence amongst profound, normative, sleep maturation and biopsychosocial changes. Factors like stress, worry or rumination may make falling asleep and maintaining sleep more difficult. Here, we evaluate the efficacy of a novel intervention based on virtual reality (VR) and slow breathing to promote bedtime relaxation and facilitate sleep in high-school adolescents.
Methods: Twenty-nine 16-18 year-old adolescents with (N=9, 6 girls) and without (N=20, 11 girls) sleep difficulties underwent two counterbalanced in-lab relaxation and baseline polysomnography (PSG) nights. For the relaxation condition, immediately preceding bedtime, participants were engaged in slow diaphragmatic breathing (to promote physiological downregulation) whilst passively experiencing a relaxation immersive VR environment, designed to promote cognitive relaxation/distraction (20min). On the baseline night, participants engaged in quiet activities (e.g., reading a book) before bedtime (20min).
Results: The VR intervention resulted in a significant immediate increase in perceived relaxation and reduced worry (p<0.05). Also, heart rate dropped (~5bpm) in the pre-to-post intervention (p<0.05), while no significant change in heart rate was evident before and after the time spent in quiet activities on the baseline night. PSG-defined sleep onset latency was shorter (~6min reduction) and sleep efficiency was greater (~3% increase) on the VR relaxation night compared to the baseline night (p<0.05). In addition, baseline sleep onset latency was related to the magnitude of the baseline-to-relaxation reduction in sleep onset latency in participants (R2=0.70; p<0.01). There was no apparent difference in responses to the VR intervention between adolescents with or without insomnia.
Conclusion: Our data highlight the potential for combining cognitive relaxation/distraction strategies, using immersive VR technology and physiological downregulation, to promote bedtime relaxation and improve overall sleep quality in adolescents. Further research is needed to evaluate the feasibility and effectiveness of such interventions over time.
Support: National Heart, Lung and Blood Institute (NHLBI) R01HL139652 (to MdZ)
Sleep Disturbance Predicts Depression Symptoms in Early Adolescence: Initial Findings From the Adolescent Brain Cognitive Development Study
Purpose: The aim of the study was to investigate associations between sleep disturbances and mental health in adolescents.
Methods: Data are from a national sample of 11,670 U.S. participants (5,594 females, aged 9-10 years, 63.5% white) in the Adolescent Brain Cognitive Development study. Initial longitudinal analyses were conducted for a subset of the sample (n = 4,951). Measures of youth sleep disturbance (disorders of initiating and maintaining sleep, sleep-wake transition disorders, and disorders of excessive somnolence) and “typical” total sleep time (number of hours slept on most nights in the past 6 months) were obtained from the parent-report Sleep Disturbance Scale (Data Release 2.0). Parent-report measures of youth mental health (depression, internalizing, and externalizing behaviors) from the Child Behavior Checklist and typical screen time were included.
Results: At baseline, greater sleep disturbance and shorter total sleep time were associated with greater internalizing, externalizing, and depression scores. After controlling for baseline mental health symptoms, baseline sleep disturbance significantly predicted depression and internalizing and externalizing scores at 1-year follow-up. A significant interaction with sex indicated that the association between disorders of excessive somnolence and depression 1 year later was steeper for girls, compared with boys (p < .001; 95% confidence interval 1.04-3.45).
Conclusions: Sleep disturbances predicted future mental health, particularly depression in this young sample, highlighting the potential to harness sleep as a tool to mitigate the persistence of depression across early adolescence and potentially prevent an adolescent onset of major depressive disorder.
