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Wie Patient:innen besser schlafen lernen Relevanz: Über die Hälfte der Patient:innen mit psychischen und körperlichen Erkrankungen leiden unter insomnischen Beschwerden Grundlagen und Praxis: Einführung zu Schlaf und Insomnie sowie zur Kognitiven Verhaltenstherapie für Insomnie (KVT-I), Anleitung zur einfachen Umsetzung im klinischen Alltag Online: Arbeitsmaterialien Das verhaltenstherapeutische Behandlungsprogramm SCHLAFexperte zielt darauf ab, psychisch oder körperlich erkrankte Patient:innen in die Lage zu versetzen, ihren Schlaf selbst zu verbessern. Es wurde von Schlafexpert:innen und Patient:innen in Abstimmung mit medizinischem Fachpersonal wie Pflegepersonal, Psycholog:innen und Ärzt:innen aus anderen Bereichen gemeinsam entwickelt. Dieses Buch stellt griffbereit das Grundlagenwissen zur Schlafregulation bereit und erklärt, wie das individuelle Schlaffenster ermittelt wird – und wie dieses im klinischen Alltag umgesetzt werden kann. Lernen Sie, welche Schlaffenster bei welchem Schlaftyp sinnvoll sind und welche Rolle schlaf-wach-abhängige und tageszeitliche (zirkadiane) Komponenten spielen. Indem Sie und Ihre Patient:in zu Schlafexpert:innen werden, können Schlafstörungen sowie auch der Verlauf von psychischen oder körperlichen Erkrankungen verbessert werden.

Abstract: Perfectionism is related to insomnia and objective markers of disturbed sleep. This study examined whether multidimensional perfectionism is related to dysfunctional beliefs about sleep, sleep-effort, pre-sleep arousal, and polysomnography-determined markers of sleep among individuals with insomnia. The effects of cognitive behavioral therapy for insomnia (CBT-I) on perfectionism was also examined. This was a secondary analysis of a randomized controlled trial on CBT-I. Forty-three insomnia patients were randomized to treatment (receiving CBT-I) or waitlist control groups. Sleep was recorded using polysomnography at baseline. Participants completed measures of perfectionism, dysfunctional beliefs about sleep, sleep-effort and pre-sleep arousal at baseline and posttreatment. Total perfectionism scores and doubts about action, concern over mistakes and personal standards were each significantly related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep at baseline. Patients receiving treatment displayed increased total perfectionism scores posttreatment d = .49. In those receiving treatment, levels of organization d = .49 and parental expectations d = .47 were significantly increased posttreatment, relative to baseline. In line with the literature, our results confirm that perfectionism is related to insomnia. Here, insomnia was related to increased sleep effort, pre-sleep arousal and dysfunctional beliefs about sleep. The propensity to maintain a high standard of order and organization may be elevated following CBT-I, considering the treatment protocol expects patients to strictly adhere to a set of clearly defined rules. Levels of parental expectations may be increased following CBT-I since the patient-therapist-relationship may trigger implicit expectations in patients which are reminiscent of their relationship to their parents

Abstract: BackgroundPsychological models highlight the bidirectional role of self-referential processing, introspection, worry and rumination in the development and maintenance of insomnia; however, little is known about the underlying neural substrates. Default mode network (DMN) functional connectivity has been previously linked to these cognitive processes.MethodsWe used fMRI to investigate waking DMN functional connectivity in a well-characterized sample of patients with primary insomnia (PI) and good sleeper controls.ResultsWe included 20 patients with PI (8 men and 12 women, mean age 42.7 ± 13.4 yr) and 20 controls (8 men and 12 women, mean age 44.1 ± 10.6 yr) in our study. While no between-group differences in waking DMN connectivity were observed, exploratory analyses across all participants suggested that greater waking connectivity between the retrosplenial cortex/hippocampus and various nodes of the DMN was associated with lower sleep efficiency, lower amounts of rapid eye movement sleep and greater sleep-onset latency.LimitationsOwing to the cross-sectional nature of the study, conclusions about causality cannot be drawn.ConclusionAs sleep disturbances represent a transdiagnostic symptom that is characteristic of nearly all psychiatric disorders, our results may hold particular relevance to previous findings of increased DMN connectivity levels in patients with psychiatric disorders

Abstract: A well orchestrated coupling hierarchy of slow waves and spindles during slow-wave sleep supports memory consolidation. In old age, the duration of slow-wave sleep and the number of coupling events decrease. The coupling hierarchy deteriorates, predicting memory loss and brain atrophy. Here, we investigate the dynamics of this physiological change in slow wave-spindle coupling in a frontocentral electroencephalography position in a large sample (N = 340; 237 females, 103 males) spanning most of the human life span (age range, 15-83 years). We find that, instead of changing abruptly, spindles gradually shift from being driven by slow waves to driving slow waves with age, reversing the coupling hierarchy typically seen in younger brains. Reversal was stronger the lower the slow-wave frequency, and starts around midlife (age range, ∼40-48 years), with an established reversed hierarchy between 56 and 83 years of age. Notably, coupling strength remains unaffected by age. In older adults, deteriorating slow wave-spindle coupling, measured using the phase slope index (PSI) and the number of coupling events, is associated with blood plasma glial fibrillary acidic protein levels, a marker for astrocyte activation. Data-driven models suggest that decreased sleep time and higher age lead to fewer coupling events, paralleled by increased astrocyte activation. Counterintuitively, astrocyte activation is associated with a backshift of the coupling hierarchy (PSI) toward a "younger" status along with increased coupling occurrence and strength, potentially suggesting compensatory processes. As the changes in coupling hierarchy occur gradually starting at midlife, we suggest there exists a sizable window of opportunity for early interventions to counteract undesirable trajectories associated with neurodegeneration