Sleep and Barbiturates: some Experiments and Observations

To determine the effect of barbiturates on sleep two subjects, after a control period, received 200 mg. of sodium amylobarbitone for 26 nights. All night sleep records taken during this period showed that the barbiturate shortened the delay to sleep, increased the total sleep period, lengthened the delay to rapid eye movement (R.E.M.) sleep, and depressed R.E.M. sleep. After five nights R.E.M. sleep returned to baseline values —that is, showed tolerance. On stopping the drug withdrawal phenomena were seen, even to this small dose of the drug.In a second experiment a subject dependent on 600 mg. of Tuinal was found to have low normal R.E.M. sleep while on drugs. On withdrawal, delay to sleep increased and total sleep time fell. R.E.M. sleep was doubled and the delay to R.E.M. became abnormally short.These findings suggest that hypnotics allow sleep to be “borrowed,” and that patients should be supported while they are being withdrawn.     

Persistent Behaviour and Electroencephalographic Changes after Single Doses of Nitrazepam and Amylobarbitone Sodium

In a double-blind cross-over trial the effects of nitrazepam (5 and 10 mg.), amylobarbitone sodium (100 and 200 mg.), and placebo were compared in normal healthy young people. Though they reported a good night''s sleep and adjudged themselves to be alert after all four drug treatments, behavioural tests showed their performance to be significantly impaired 13 hours after treatment with nitrazepam or amylobarbitone, and E.E.G. records showed more drowsiness and light sleep 18 hours after treatment with nitrazepam than with amylobarbitone or placebo. E.E.G. fast activity was more plentiful after drugs in either dosage than with placebo.     

Benzodiazepine hypnotics remain effective for 24 weeks.

Ninety-seven poor sleepers aged 40-68 years took capsules nightly for 32 weeks and made daily subjective ratings. The benzodiazepine hypnotics lormetazepam 2 mg and nitrazepam 5 mg appeared still to improve sleep after 24 weeks of intake when compared with continuous placebo intake. The sustained effectiveness was most evident in a significant shortening of the time taken to fall asleep in patients receiving lormetazepam. After weeks, sleep latency and the quality of sleep were significantly worse than baseline values. The impairment was maximal on the second night after withdrawal of lormetazepam and on the fourth night after withdrawal of nitrazepam. It is concluded that benzodiazepines remain effective for at least 24 weeks but that a period of disturbed sleep may be expected after withdrawal.     

Influence of repeated passive body heating on subsequent night sleep in humans

Experiments were carried out on four healthy male subjects in two separate sessions: (a) A baseline period of two consecutive nights, one spent at thermoneutrality [operative temperature (To) = 30 degrees C, dew-point temperature (Tdp) = 7 degrees C, air velocity (Va) = 0.2 m.s-1] and the other in hot condition (To = 35 degrees C, Tdp = 7 degrees C, Va = 0.2 m.s-1). During the day, the subjects lived in their normal housing and were engaged in their usual activities. (b) An acclimation period of seven consecutive daily heat exposures from 1400 to 1700 hours (To = 44 degrees C, Tdp = 29 degrees C, Va = 0.3 m.s-1). During each night, the subjects slept in thermoneutral or in hot conditions. The sleep measurements were: EEG from two sites, EOG from both eyes, EMG and EKG. Esophageal and ten skin temperatures were recorded continuously during the night. In the nocturnal hot conditions, a sweat collection capsule recorded the sweat gland activity in the different sleep stages. Results showed that passive body heating had no significant effect on the sleep structure of subsequent nights at thermoneutrality. In contrast, during nights at To = 35 degrees C an effect of daily heat exposure was observed on sleep. During the 2nd night of the heat acclimation period, sleep was more restless and less efficient than during the baseline night. The rapid eye movement sleep duration was reduced, while the rate of transient activation phases observed in sleep stage 2 increased significantly. On the 7th night, stage 4 sleep increased (+68%) over values observed during the baseline night.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparison of sleep patterns in natural and mandrax- and tuinal-induced sleep

A within-subject comparison of the effects on the overnight sleep EEG of 1 tablet of Mandrax (containing methaqualone base 250 mg. and diphenhydramine hydrochloride 25 mg.) and 200 mg. Tuinal (equal parts of quinalbarbitone sodium and amylobarbitone sodium) in 14 normal subjects is reported.Mandrax-induced sleep was not significantly different from natural sleep in the duration of light, moderate, deep and REM phases. Tuinal produced a significant reduction in REM sleep (P < 0.01) compared with natural sleep and with Mandrax-induced sleep.     

Performance, sleep and circadian phase during a week of simulated night work

The current study investigated changes in night-time performance, daytime sleep, and circadian phase during a week of simulated shift work. Fifteen young subjects participated in an adaptation and baseline night sleep, directly followed by seven night shifts. Subjects slept from approximately 0800 hr until they naturally awoke. Polysomnographic data was collected for each sleep period. Saliva samples were collected at half hourly intervals, from 2000 hr to bedtime. Each night, performance was tested at hourly intervals. Analysis indicated that there was a significant increase in mean performance across the week. In general, sleep was not negatively affected. Rather, sleep quality appeared to improve across the week. However, total sleep time (TST) for each day sleep was slightly reduced from baseline, resulting in a small cumulative sleep debt of 3.53 (SD = 5.62) hours. Finally, the melatonin profile shifted across the week, resulting in a mean phase delay of 5.5 hours. These findings indicate that when sleep loss is minimized and a circadian phase shift occurs, adaptation of performance can occur during several consecutive night shifts.     

Drugs of Dependence Though Not of Abuse: Fenfluramine and Imipramine

Measures of subjective feeling used by five patients indicated that depression of mood occurred about four days after fenfluramine withdrawal. An experiment in which another 11 patients took fenfluramine 80 mg for 28 days confirmed the depression, maximal on the fourth withdrawal day. It also indicated that in the first week of administration there was some mood elevation, but with feelings of impaired ability to concentrate. The drug reduced appetite and weight. A comparison is drawn with imipramine, which was found to induce initial and withdrawal changes of subjective experience (of dreaming) in six volunteers. It is suggested that certain mood-influencing drugs may not be drugs of abuse because of some unpleasant initial effects, though they can be drugs of dependence.     

Daytime cardiac autonomic activity during one week of continuous night shift

Shift workers encounter an increased risk of cardiovascular disease compared to their day working counterparts. To explore this phenomenon, the effects of one week of simulated night shift on cardiac sympathetic (SNS) and parasympathetic (PNS) activity were assessed. Ten (5m; 5f) healthy subjects aged 18-29 years attended an adaptation and baseline night before commencing one week of night shift (2300-0700 h). Sleep was recorded using a standard polysomnogram and circadian phase was tracked using salivary melatonin data. During sleep, heart rate (HR), cardiac PNS activity (RMSSD) and cardiac SNS activity (pre-ejection period) were recorded. Night shift did not influence seep quality, but reduced sleep duration by a mean of 52 +/- 29 min. One week of night shift evoked a small chronic sleep debt of 5 h 14 +/- 56 min and a cumulative circadian phase delay of 5 h +/- 14 min. Night shift had no significant effect on mean HR, but mean cardiac SNS activity during sleep was consistently higher and mean cardiac PNS activity during sleep declined gradually across the week. These results suggest that shiftwork has direct and unfavourable effects on cardiac autonomic activity and that this might be one mechanism via which shiftwork increases the risk of cardiovascular disease. It is postulated that sleep loss could be one mediator of the association between shiftwork and cardiovascular health.     

Metabolism during normal, fragmented, and recovery sleep.

Average metabolic data (O2 uptake and CO2 output) were obtained for each 3-min period during consecutive nights of normal, experimentally fragmented, and recovery sleep in a group of 12 normal young adult males. Naturally occurring arousals and awakenings resulted in a characteristic increase in metabolism on the baseline night. The placement of brief frequent experimental arousals on the following night resulted in significantly increased metabolism throughout the night and significantly decreased sleep restoration as measured by morning performance, mood, and alertness tests, even though total sleep time was minimally reduced. Metabolic variables were significantly decreased compared with baseline on the nondisturbed recovery night that followed the sleep fragmentation night. The data cannot be used to infer that increased metabolism during sleep causes nonrestorative sleep, but the direction and time course of metabolic change accompanying arousal are consistent with that hypothesis.     

Diazepam withdrawal syndrome: its prolonged and changing nature.

The diazepam withdrawal syndrome was studied in 10 patients who had abused the drug for 3 to 14 years. In the previous 6 months their consumption of diazepam had ranged from 60 to 120 mg daily; none had used other drugs during this period. The withdrawal period lasted about 6 weeks. The intensity of the symptoms and signs was high initially, fell during the first 2 weeks, then rose again in the third week, before finally declining. Three groups of symptoms and signs were identified. Group A symptoms occurred throughout withdrawal and included tremor, anorexia, insomnia and myoclonus. Group B symptoms and signs were largely confined to the first 10 days and were those of a toxic psychosis. Group C symptoms reached a peak in the third and fourth weeks of withdrawal and were characterized by sense perceptions that were either heightened or lowered. The symptom groups, the presence of tremor and myoclonus, and the relief of symptoms by a test dose permit diazepam withdrawal to be distinguished from anxiety. The biphasic course of the symptoms is probably related to the pharmacokinetics of diazepam.     

Rapid-eye movement sleep and muscarinic receptor binding in rats are augmented during withdrawal from chronic scopolamine treatment

The purpose of this study was to determine whether a seven day, once-daily morning administration of scopolamine produces upregulation of muscarinic receptors and augments REMS during withdrawal. After obtaining two, six-hour baseline sleep recordings, beginning at 0900, independent groups of rats were administered either scopolamine or saline every morning for seven days. Six hour sleep recordings were obtained following the first and seventh day of injection and during the two subsequent withdrawal days. After obtaining the last sleep recording the rats were sacrificed and the following brain areas removed: cerebral cortex, hippocampii, caudate nuclei, brainstem, and cerebellum. 3H-QNB was used as the ligand to assess for changes in muscarinic receptor binding. Compared to baseline, scopolamine produced a significant decrease in REMS during the period of drug administration. During the withdrawal days, however, REMS increased during the morning period. Compared to the saline group, the scopolamine treated animals had increased muscarinic receptor binding in the caudate and hippocampus; no significant change in receptor density was observed in the cortex, brainstem or cerebellum.     

慢性吗啡给予、戒断及再给药过程中大鼠海马感觉门控的动态变化

药物成瘾被认为是药物长期作用于脑而产生的一种慢性复吸性脑疾病,长期反复的药物（如吗啡）滥用会导致一系列严重后果,如药物依赖、药物耐受、强迫性药物寻求等。本实验利用条件化位置偏好（conditioned place preference,CPP）模型来检测大鼠对吗啡依赖和心理渴求等过程;采用双声刺激听觉诱发电位来研究大鼠在慢性吗啡给予、戒断以及再给药过程中海马感觉门控（N40）的动态变化。吗啡组大鼠注射吗啡（10mg／kg,i．p．）12d,经历第一次戒断12d,再次注射吗啡（2．5mg／kg,i．P．）1d,之后经历第二次戒断2d;对照组大鼠注射同体积生理盐水,其余实验条件与吗啡组相同。CPP实验表明,这种药物给予方法促使大鼠对吗啡产生药物依赖和心理渴求。双声刺激诱发电位实验表明,吗啡组大鼠在吗啡给予期间海马感觉门控受到损伤;第一次戒断期的第1～2天海马感觉门控能力减弱,第3天增强,第4～12天逐渐恢复到正常水平;再次给予吗啡后海马感觉门控能力与对照组相比显著降低,并且随后2d的戒断期内海马感觉门控能力也一直保持较低水平,表明再次给药使大鼠海马感觉门控对吗啡更加敏感化。结果提示,长期反复的吗啡给予及再给药干扰了海马的感觉门控能力,吗啡成瘾对大脑可能产生长期影响。     

The effect of desmethylimipramine on the metabolism of norepinephrine

Eleven normal volunteers were given an acute and two chronic doses of desipramine (DMI). The plasma norepinephrine (NE), 3-methoxy-4-hydroxyphenylglycol (MHPG), and dihydroxyphenylglycol (DHPG) concentrations were measured before and during drug administration. DMI reduced plasma concentrations of MHPG by 13% and DHPG by 17%. After two weeks of drug administration, the MHPG/NE ratio was reduced, and there was a significant negative correlation with the concurrent drug concentration. These results suggest that DMI: (1) reduces the turnover of NE; and (2) diminishes the oxidative deamination of NE. In addition, the drug concentration response relationship indicates that the effects of uptake inhibition may not be maximal until concentrations in the apparent therapeutic range are achieved.     

Changes in Plasma γ-Glutamyl Transpeptidase Activity Associated with Alterations in Drug Metabolism in Man

A significant rise in plasma γ-glutamyl transpeptidase activity (GGT) was observed on 13 out of 14 occasions on which patients on long-term treatment with the oral anticoagulant warfarin were given amylobarbitone, quinalbarbitone, or phenazone (antipyrine) for 30 days. In 13 of these 14 studies there was evidence that drug administration had stimulated the rate of warfarin metabolism. One patient showed no increase in plasma GGT activity, yet a significantly increased rate of warfarin metabolism, and another patient showed an increase in plasma GGT activity without a change in warfarin metabolism. When alterations in both plasma GGT activity and plasma warfarin concentration occurred together in response to drug administration the changes followed a similar time course, occurring after about one week of drug administration with maximal changes at about 10 or 15 days. Administration of chlordiazepoxide, diazepam, nitrazepam, and methaqualone did not stimulate the rate of warfarin metabolism in four patients studied, but plasma GGT activity increased significantly in two of these four instances. The implications of these observations in the interpretation of plasma GGT activities are discussed.     

Longitudinal Study of Mothers’ Sleep-Wake Behaviors and Circadian Time Patterns from Late Pregnancy to Postpartum – Monitoring of Wrist Actigraphy and Sleep Logs

This longitudinal study investigated sleep-wake behavior patterns during and after pregnancy, using an actimeter worn on the non-dominant wrist and a sleep log. Records were obtained from ten mothers, from the 34th week of gestation until the 15th week postpartum. Ten non-pregnant women were used as a control group, data being collected from them for 2 weeks. The sleep-wake behavior after delivery, obtained from wrist actigraphy, was greater in the postpartum period. Total sleep time, sleep efficiency, and circadian amplitude decreased in the weeks immediately following parturition, but wake after sleep onset increased. Subsequently, all the sleep and circadian variables improved slightly, but they had not returned to the levels of the non-pregnant control group even by the 15th postpartum week. The length of daytime naps increased, in order to make up for nocturnal sleep deprivation when the number of awakenings during nighttime had increased. There were significant positive correlations between total sleep time, sleep efficiency, wake after sleep onset, and the length of daytime naps, but the numbers of awakenings at night and daytime naps did not show this correlation. The total sleep time indicated by sleep logs tended to be greater than that indicated by actigraphy, but wake after sleep onset tended to be underestimated by the sleep logs. The implications of these results are discussed.     

Longitudinal Study of Mothers' Sleep-Wake Behaviors and Circadian Time Patterns from Late Pregnancy to Postpartum - Monitoring of Wrist Actigraphy and Sleep Logs

This longitudinal study investigated sleep-wake behavior patterns during and after pregnancy, using an actimeter worn on the non-dominant wrist and a sleep log. Records were obtained from ten mothers, from the 34th week of gestation until the 15th week postpartum. Ten non-pregnant women were used as a control group, data being collected from them for 2 weeks. The sleep-wake behavior after delivery, obtained from wrist actigraphy, was greater in the postpartum period. Total sleep time, sleep efficiency, and circadian amplitude decreased in the weeks immediately following parturition, but wake after sleep onset increased. Subsequently, all the sleep and circadian variables improved slightly, but they had not returned to the levels of the non-pregnant control group even by the 15th postpartum week. The length of daytime naps increased, in order to make up for nocturnal sleep deprivation when the number of awakenings during nighttime had increased. There were significant positive correlations between total sleep time, sleep efficiency, wake after sleep onset, and the length of daytime naps, but the numbers of awakenings at night and daytime naps did not show this correlation. The total sleep time indicated by sleep logs tended to be greater than that indicated by actigraphy, but wake after sleep onset tended to be underestimated by the sleep logs. The implications of these results are discussed.     

Sensitivity and Validity of Psychometric Tests for Assessing Driving Impairment: Effects of Sleep Deprivation

ObjectiveTo assess drug induced driving impairment, initial screening is needed. However, no consensus has been reached about which initial screening tools have to be used. The present study aims to determine the ability of a battery of psychometric tests to detect performance impairing effects of clinically relevant levels of drowsiness as induced by one night of sleep deprivation.MethodsTwenty four healthy volunteers participated in a 2-period crossover study in which the highway driving test was conducted twice: once after normal sleep and once after one night of sleep deprivation. The psychometric tests were conducted on 4 occasions: once after normal sleep (at 11 am) and three times during a single night of sleep deprivation (at 1 am, 5 am, and 11 am).ResultsOn-the-road driving performance was significantly impaired after sleep deprivation, as measured by an increase in Standard Deviation of Lateral Position (SDLP) of 3.1 cm compared to performance after a normal night of sleep. At 5 am, performance in most psychometric tests showed significant impairment. As expected, largest effect sizes were found on performance in the Psychomotor Vigilance Test (PVT). Large effects sizes were also found in the Divided Attention Test (DAT), the Attention Network Test (ANT), and the test for Useful Field of View (UFOV) at 5 and 11 am during sleep deprivation. Effects of sleep deprivation on SDLP correlated significantly with performance changes in the PVT and the DAT, but not with performance changes in the UFOV.ConclusionFrom the psychometric tests used in this study, the PVT and DAT seem most promising for initial evaluation of drug impairment based on sensitivity and correlations with driving impairment. Further studies are needed to assess the sensitivity and validity of these psychometric tests after benchmark sedative drug use.     

Acute effects of drug administration and withdrawal on the benzodiazepine receptor

Effects of one week of benzodiazepine drug administration on central benzodiazepine receptor binding characteristics were evaluated in a series of experiments in male Sprague-Dawley rats. Administration of short- and intermediate-acting benzodiazepines was observed to increase the number of available receptor binding sites (B_max) without changing affinity of drug for receptor. Furthermore, these changes did not occur after administration and withdrawal of long-acting benzodiazepines. In addition, there appeared to be a relationship between the affinity of the different benzodiazepines for the receptor and the degree of increase in the number of receptor binding sites. The results may help to explain the relationship between withdrawal of certain benzodiazepine drugs and the occurrence of rebound phenomena in clinical situations.     

Effects of methylphenidate on whirler mice: an animal model for hyperkinesis

The neurological mutant whirler mouse, one of several strains of waltzing mice, may be suitable as an animal model for testing studies relative to hyperkinesis. As in hyperkinetic children, behaviorally the mice are extremely restless, nervous, excitable, irritable and aggressive but also show symptoms of rotation behavior, head-shaking and deafness. This study demonstrated that paradoxically oral intubation of daily doses of 5.0 mg/kg of methylphenidate during a 23 week period significantly decreased circling activity in test mice. The effects on circling behavior were reversible following cessation of methylphenidate administration. After 18 weeks of cessation of the CNS stimulant, oral administration of a single dose of 2.5 mg/kg of methylphenidate caused a 37.8% increase in circling activity but the increase compared to control whirler mice was not significant. Use of this strain as an animal model may be especially beneficial in the screening of new drugs for the treatment of hyperkinesis.     

Alterations in collagen metabolism in heart and kidney on dexamethasone administration in rats

Total collagen content in heart decreased significantly till day 8 of dexamethasone (Dex: 2.5 mg/kg week; s.c. for 2 weeks) treatment and increased on withdrawal of Dex. Acid soluble collagen content in heart decreased till day 12 of Dex treatment, reached normal level on day 16 of Dex treatment and exhibited an increase thereafter. Pepsin solubilized fraction in heart also behaved similarly as the acid soluble fraction, but reached normal level on Dex withdrawal. The total collagen content and the acid soluble collagen in kidney decreased significantly throughout treatment as well as on Dex withdrawal whereas, the pepsin solubilized collagen fraction in kidney exhibited a significant increase from day 8 of Dex treatment and the level was maintained throughout the experiment. Incorporation of 14C-proline in both, heart and kidney was found to be reduced. Electrophoretic pattern of pepsin collagen solubilized fraction of heart and kidney revealed alterations in subunit composition and its types on Dex administration and withdrawal. Thus, administration of Dex induced alterations in the metabolism of collagen and on Dex withdrawal, the system slowly tended to attain normalcy.