Skip to main content
Erschienen in: Sleep and Breathing 1/2021

22.06.2020 | Psychiatrics • Original Article

Effects of a forehead cooling device in veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions: a pilot study

verfasst von: Vincent Mysliwiec, Thomas C. Neylan, Laurel Chiappetta, Eric A. Nofzinger

Erschienen in: Sleep and Breathing | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

While forehead cooling has been studied in patients with insomnia in the absence of comorbid medical/psychiatric disorders, it has never been evaluated in patients with insomnia in the presence of co-morbid medical/psychiatric disorders.

Methods

Veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions received 4-week open-label, in-home, nightly treatment with a forehead cooling device (14–16 °C) along with personalized sleep hygiene following baseline assessments. Pre- and post-treatment, participants completed the Insomnia Severity Index (ISI), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Patient Health Questionnaire 9-item scale (PHQ-9). Participants recorded daily sleep and anxiety/arousal symptoms.

Results

Of 24 veterans (20 men, 42.2 ± 9.5 years), 17 (71%) had marked insomnia severity improvement (a decrease of > 8 on the ISI) and 10 (42%) participants scored 7 or below on the ISI at post-treatment reflecting remission. Participants reported reductions in sleep onset latency (SOL) (F = 12.9, p < 0.001), and wakefulness after sleep onset (WASO) (F = 8.4, p < 0.001) across treatment. They also had significant reductions in insomnia severity (t = 10.04, p < 0.001), anxiety (t = 3.59, p = 0.002), and depression (t = 7.75, p < 0.001) from pre- to post-treatment.

Conclusion

This pilot study shows that 4-week nightly use of a forehead cooling device produces improvements in insomnia, anxiety, and depressive symptoms in veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions. Controlled studies are warranted to determine the role of this therapy in the management of insomnia in veterans.

Trial registration

Not required as a small sample size feasibility study.
Literatur
1.
Zurück zum Zitat Hughes JM, Ulmer CS, Gierisch JM, Nicole Hastings S, Howard MO (2018) Insomnia in United States military veterans: an integrated theoretical model. Clin Psychol Rev 59:118–125 CrossRef Hughes JM, Ulmer CS, Gierisch JM, Nicole Hastings S, Howard MO (2018) Insomnia in United States military veterans: an integrated theoretical model. Clin Psychol Rev 59:118–125 CrossRef
2.
Zurück zum Zitat Mysliwiec V et al (2020) The management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med Mysliwiec V et al (2020) The management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med
3.
Zurück zum Zitat Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008) Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 4(5):487–504 CrossRef Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008) Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 4(5):487–504 CrossRef
4.
Zurück zum Zitat Lader M (2011) Benzodiazepines revisited—will we ever learn? Addiction 106(12):2086–2109 CrossRef Lader M (2011) Benzodiazepines revisited—will we ever learn? Addiction 106(12):2086–2109 CrossRef
5.
Zurück zum Zitat Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161(11):2126–2128 CrossRef Nofzinger EA, Buysse DJ, Germain A, Price JC, Miewald JM, Kupfer DJ (2004) Functional neuroimaging evidence for hyperarousal in insomnia. Am J Psychiatry 161(11):2126–2128 CrossRef
6.
Zurück zum Zitat Nofzinger EA, Buysse DJ, Miewald JM, Meltzer CC, Price JC, Sembrat RC, Ombao H, Reynolds CF, Monk TH, Hall M, Kupfer DJ, Moore RY (2002) Human regional cerebral glucose metabolism during non-rapid eye movement sleep in relation to waking. Brain 125(Pt 5):1105–1115 CrossRef Nofzinger EA, Buysse DJ, Miewald JM, Meltzer CC, Price JC, Sembrat RC, Ombao H, Reynolds CF, Monk TH, Hall M, Kupfer DJ, Moore RY (2002) Human regional cerebral glucose metabolism during non-rapid eye movement sleep in relation to waking. Brain 125(Pt 5):1105–1115 CrossRef
7.
Zurück zum Zitat Nofzinger E et al Frontal cerebral hypothermia: a new approach to the treatment of insomnia. Sleep Nofzinger E et al Frontal cerebral hypothermia: a new approach to the treatment of insomnia. Sleep
8.
Zurück zum Zitat Roth T et al (2018) A novel forehead temperature-regulating device for insomnia: a randomized clinical trial. Sleep 41(5) Roth T et al (2018) A novel forehead temperature-regulating device for insomnia: a randomized clinical trial. Sleep 41(5)
9.
Zurück zum Zitat Yang M, Morin CM, Schaefer K, Wallenstein GV (2009) Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Curr Med Res Opin 25(10):2487–2494 CrossRef Yang M, Morin CM, Schaefer K, Wallenstein GV (2009) Interpreting score differences in the Insomnia Severity Index: using health-related outcomes to define the minimally important difference. Curr Med Res Opin 25(10):2487–2494 CrossRef
10.
Zurück zum Zitat Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL (2015) The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 28(6):489–498 CrossRef Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL (2015) The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress 28(6):489–498 CrossRef
11.
Zurück zum Zitat Keane TM, Fairbank JA, Caddell JM, Zimering RT, Taylor KL, Mora CA (1989) Clinical evaluation of a measure to assess combat exposure. Psychol Assess 1(1):53–55 CrossRef Keane TM, Fairbank JA, Caddell JM, Zimering RT, Taylor KL, Mora CA (1989) Clinical evaluation of a measure to assess combat exposure. Psychol Assess 1(1):53–55 CrossRef
12.
Zurück zum Zitat Saunders JB et al (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88(6):791–804 CrossRef Saunders JB et al (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction 88(6):791–804 CrossRef
13.
Zurück zum Zitat Donnelly KT, Donnelly JP, Dunnam M, Warner GC, Kittleson CJ, Constance JE, Bradshaw CB, Alt M (2011) Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool. J Head Trauma Rehabil 26(6):439–453 CrossRef Donnelly KT, Donnelly JP, Dunnam M, Warner GC, Kittleson CJ, Constance JE, Bradshaw CB, Alt M (2011) Reliability, sensitivity, and specificity of the VA traumatic brain injury screening tool. J Head Trauma Rehabil 26(6):439–453 CrossRef
14.
Zurück zum Zitat Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613 CrossRef Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613 CrossRef
15.
Zurück zum Zitat Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097 CrossRef Spitzer RL, Kroenke K, Williams JBW, Löwe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166(10):1092–1097 CrossRef
16.
Zurück zum Zitat Monk TH et al (1994) The Pittsburgh sleep diary. J Sleep Res 3(2):111–120 CrossRef Monk TH et al (1994) The Pittsburgh sleep diary. J Sleep Res 3(2):111–120 CrossRef
17.
Zurück zum Zitat Germain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ (2005) A brief sleep scale for posttraumatic stress disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord 19(2):233–244 CrossRef Germain A, Hall M, Krakow B, Katherine Shear M, Buysse DJ (2005) A brief sleep scale for posttraumatic stress disorder: Pittsburgh Sleep Quality Index Addendum for PTSD. J Anxiety Disord 19(2):233–244 CrossRef
18.
Zurück zum Zitat Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW (2003) Quantitative criteria for insomnia. Behav Res Ther 41(4):427–445 CrossRef Lichstein KL, Durrence HH, Taylor DJ, Bush AJ, Riedel BW (2003) Quantitative criteria for insomnia. Behav Res Ther 41(4):427–445 CrossRef
19.
Zurück zum Zitat Morin CM, Belleville G, Bélanger L, Ivers H (2011) The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608 CrossRef Morin CM, Belleville G, Bélanger L, Ivers H (2011) The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608 CrossRef
20.
Zurück zum Zitat Smith MT, Perlis ML, Park A, Smith MS, Pennington JM, Giles DE, Buysse DJ (2002) Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 159(1):5–11 CrossRef Smith MT, Perlis ML, Park A, Smith MS, Pennington JM, Giles DE, Buysse DJ (2002) Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 159(1):5–11 CrossRef
21.
Zurück zum Zitat Karlin BE, Trockel M, Taylor CB, Gimeno J, Manber R (2013) National dissemination of cognitive behavioral therapy for insomnia in veterans: therapist- and patient-level outcomes. J Consult Clin Psychol 81(5):912–917 CrossRef Karlin BE, Trockel M, Taylor CB, Gimeno J, Manber R (2013) National dissemination of cognitive behavioral therapy for insomnia in veterans: therapist- and patient-level outcomes. J Consult Clin Psychol 81(5):912–917 CrossRef
22.
Zurück zum Zitat Wu JQ, Appleman ER, Salazar RD, Ong JC (2015) Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med 175(9):1461–1472 CrossRef Wu JQ, Appleman ER, Salazar RD, Ong JC (2015) Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Intern Med 175(9):1461–1472 CrossRef
23.
Zurück zum Zitat Drake CL et al (2019) Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep 42(2) Drake CL et al (2019) Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep 42(2)
24.
Zurück zum Zitat Dutschmann M, Herbert H (1996) The Kolliker-Fuse nucleus mediates the trigeminally induced apnoea in the rat. Neuroreport 7(8):1432–1436 CrossRef Dutschmann M, Herbert H (1996) The Kolliker-Fuse nucleus mediates the trigeminally induced apnoea in the rat. Neuroreport 7(8):1432–1436 CrossRef
25.
Zurück zum Zitat Panneton WM, Gan Q, Juric R (2010) The rat: a laboratory model for studies of the diving response. J Appl Physiol (1985) 108(4):811–820 CrossRef Panneton WM, Gan Q, Juric R (2010) The rat: a laboratory model for studies of the diving response. J Appl Physiol (1985) 108(4):811–820 CrossRef
26.
Zurück zum Zitat Ulmer CS et al (2018) Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars. Sleep 41(12) Ulmer CS et al (2018) Posttraumatic stress disorder diagnosis is associated with reduced parasympathetic activity during sleep in US veterans and military service members of the Iraq and Afghanistan wars. Sleep 41(12)
Metadaten
Titel
Effects of a forehead cooling device in veterans with chronic insomnia disorder and co-morbid medical and psychiatric conditions: a pilot study
verfasst von
Vincent Mysliwiec
Thomas C. Neylan
Laurel Chiappetta
Eric A. Nofzinger
Publikationsdatum
22.06.2020
Verlag
Springer International Publishing
Erschienen in
Sleep and Breathing / Ausgabe 1/2021
Print ISSN: 1520-9512
Elektronische ISSN: 1522-1709
DOI
https://doi.org/10.1007/s11325-020-02126-w

Weitere Artikel der Ausgabe 1/2021

Sleep and Breathing 1/2021 Zur Ausgabe

Sleep Breathing Physiology and Disorders • Original Article

Increased frequency of obstructive sleep apnea in the patients with systemic sclerosis

Sleep Breathing Physiology and Disorders • Original Article

Associations between dietary consumption and sleep quality in young Japanese males

Update Innere Medizin

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.