A Novel Home Sleep Monitoring Device and Brief Sleep Intervention for Bipolar Disorder: Feasibility, Tolerability, and Preliminary Effectiveness

Authors:
Sylvia,Louisa G., Salcedo,Stephanie , Bianchi,Matt T. , Urdahl,Anna, Nierenberg,Andrew A., Deckersbach,Thilo

Reference:
Cognitive Therapy and Research February 2014, Volume 38, Issue 1, pp 55-61

Objectives:
The purpose of this study is to assess the feasibility and tolerability of a novel EKG-based home sleep monitoring device (M1) as well as a brief (two session) psychosocial sleep intervention for individuals with bipolar disorder. 

Conclusions:
We developed a brief psychosocial sleep intervention for bipolar disorder, as well as explored the feasibility and acceptability of a novel home sleep monitoring device (M1 device). Our data suggest that the brief psychosocial sleep intervention and the M1 device are both tolerable and feasible for participants given (1) their high adherence rates and (2) participants’ initially high expectations remained stable. Although participants reported being less likely to wear the M1 after the intervention, their acceptability rating for this device was still high. We also found that the brief sleep intervention improved sleep duration, but was also associated with more unstable sleep as measured by the M1.

One possibility for the increase in unstable sleep is that the brief sleep intervention may have been overly focused on ways to improve sleep duration as opposed to sleep quality. This may suggest that future sleep interventions for bipolar disorder should focus more on factors that contribute to the degree of restful sleep (e.g., intrusive thoughts, aspects of the sleep environment, ability to self-soothe). Nonetheless, participants slept longer as well as reported less day dysfunction due to sleepiness after receiving the brief sleep intervention. There was also a trend for improvements in other indices (e.g. manic and depressive symptoms, sleep quality) after the sleep intervention, but they did not reach statistical significance in this small sample.

Practical Significance:
All eight participants completed the sleep intervention and attended 100% of the sessions. Seventy five percent of patients were taking a mood stabilizer (e.g., lithium, valproic acid), 13% on anxiolytics/hypnotics (e.g., zolpidem, lorazepam), 50% on antidepressants (e.g., fluoxetine, buproprion), and 13% on antipsychotics (e.g., clozapine, quetiapine). Participants had high expectations for the sleep intervention as they strongly agreed that the intervention would be user friendly (M = 1.75, SD = 0.46), they would learn skills that would help them change (M = 1.88, SD = 0.35), and that they would like using those skills (M = 1.88, SD = 0.64). Most of their expectation scores/ratings did not change after receiving the sleep intervention (p’s >.05), suggesting that the intervention met their initially high expectations. In addition, participants were more likely to report learning skills that they could use on their own (t[7] = 2.65, p < .05), as well as recommend the intervention after receiving it (t[7] = 3.42, p < .05).

In regards to the M1, all participants wore it for at least two nights. The average number of nights the M1 was worn was 6.12 days after Visit 1 (SD = 1.36; Range = 4 to 8 days) and 5.5 days after Visit 3 (SD = 2.33; Range = 2 to 8 days). At Visit 2, participants agreed that the M1 was very easy to use (M = 4.50, SD = 0.54), easy to apply (M = 4.50, SD = 0.76), and did not interfere with their sleep (M = 4.88, SD = 0.35); at the end of the study, there were no statistically significant changes in these items; however, participants were less likely to report that they would wear the device again (t[7] = 3.42, p < .05). Nevertheless, the mean rating was still very high at visit 4 (M = 4.25), indicating that participants reported still being likely to wear the M1 again.

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Bupropion response on sleep quality in patients with depression: implications for increased cardiovascular disease risk.

Authors:
Schramm PJ, Poland RE, Rao U.

Reference:
Eur Neuropsychopharmacol. 2014 Feb; 24(2):207-14.

Objectives:
To evaluate bupropion response in depressed patients by polysomnography (PSG) and cardiopulmonary coupling (CPC) variables.

Conclusions:
Bupropion increased REM latency but did not impact PSG sleep continuity, architecture and CPC variables. A trend was observed towards increasing VLFC duration. Bupropion increased the number of stable-unstable sleep transitions. Moderate to strong correlations between PSG and CPC variables were found on placebo and bupropion nights.

Practical Significance:
Increased stable-unstable sleep transitions and VLFC duration may indicate vulnerability to cardiovascular disease due to their association with low heart rate variability that has been associated with increased mortality raising the question whether the beneficial effects of the antidepressant medication outweighs the impact on cardiopulmonary dynamics.

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Sleep Quality Changes in chronically depressed patients treated with mindfulness-based cognitive therapy or cognitive behavioral analysis system for psychotherapy: a pilot study

Authors:
Schramm P.J., Zobel I., Mönch K., Schramm E., Michalak J.

Reference:
Sleep Medicine 17 (2016) 57–63

Objectives:
To measure sleep quality changes in response to group psychotherapy for chronic depression.

Conclusions:
Physician-referred, chronically depressed patients (n = 25) were randomized to either eight group sessions of Mindfulness-based Cognitive Therapy (MBCT, n = 9) plus Treatment As Usual (TAU), or the Cognitive Behavioral Analysis System of Psychotherapy (CBASP, n = 8) plus TAU, or to TAU only (control group, n = 8). Participants recorded their sleep at home.

The primary outcome variables were: stable and unstable sleep, which were assessed using cardiopulmonary coupling (CPC) analysis, and estimated total sleep and wake time (minutes). Cardiopulmonary coupling measures heart rate variability and the electrocardiogram's R-wave amplitude fluctuations associated with respiration.

By post-treatment night 6, the CBASP group had more stable sleep (p = 0.044) and less wake (p = 0.004) compared with TAU, and less wake vs MBCT (p = 0.039).

Practical Significance:
The CBASP group psychotherapy treatment improved sleep quality compared with Treatment As Usual.

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Sleep State Instabilities in Major Depressive Disorder: Detection and Quantification with Electrocardiogram-based Cardiopulmonary Coupling Analysis

Authors:
Yang AC, Yang CH, Hong CJ, Tsai SJ, Kuo CH, Peng CK, Mietus JE, Goldberger AL, Thomas RJ.

Reference:
Psycho-physiology. 2011:48(2):285-291

Objectives:
To evaluate the utility of electrocardiogram (ECG)-based analysis to quantify physiologic sleep stability in patients with major depression

Conclusions:
Relative to controls, non-medicated depressed patients had a reduction in High-Frequency Coupling (HFC; index of stable sleep), an increase in Low Frequency Coupling (LFC; index of unstable sleep), and an increase in very Low Frequency Coupling (vLFC; index of wakefulness/REM sleep).

Practical Significance:
ECG-based analysis can offer a simple, cost-efficient point-of-care method to quantify sleep quality/stability and to objectively evaluate the severity of insomnia in patients with major depression.

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