The Effects of Presleep Slow Breathing and Music Listening on Polysomnographic Sleep Measures - a pilot trial

The effect of breathing exercises on pain, sleep, and symptom management in patients undergoing hemodialysis: a randomized controlled trial

PURPOSE

This study was conducted to determine the effect of breathing exercises on pain, sleep, and symptom management in patients undergoing hemodialysis.

METHODS

The randomized controlled study was conducted with patients undergoing hemodialysis at a private dialysis center in the northern Black Sea region. Data were collected using the Descriptive Information Form, the Visual Analog Scale (VAS), the Richards-Campbell Sleep Questionnaire (RCSQ), the Dialysis Symptom Index (DSI), and the Vital Signs Form. According to the power analysis performed in the study, a total of 70 participants, 35 in each group, needed to be included in the study in order to conduct an independent t-test with a confidence level of 95%, a test power of 95%, and an effect size of d = 0.80. The study was conducted with a total of 69 patients divided into two groups: the experimental group (n = 35) and the control group (n = 34). Patients in the experimental group performed breathing exercises (Diaphragmatic breathing, Agni Sār, Nadi Shodhana, and the 4-7-8 breathing technique) on dialysis days for eight weeks. During this period, patients in the control group continued to receive routine nursing care in the hemodialysis unit.

RESULTS

Following the application, the average pain intensity in the control group (4.06 ± 3.1) was found to be statistically significantly higher than the average in the experimental group (0.4 ± 1.19) (p < 0.001). The average sleep score in the control group (48.56 ± 22.35) was found to be statistically significantly lower than the average in the experimental group (80.21 ± 16.46) (p < 0.001). The average DSI in the control group (92 ± 22.05) was found to be statistically significantly higher than the average in the experimental group (41.37 ± 7.15) (p < 0.001).

CONCLUSION

Breathing exercises in patients undergoing hemodialysis were found to reduce pain, improve sleep quality, and have a positive impact on symptom management. In light of this, it is recommended that nurses include breathing techniques as part of the care provided to hemodialysis patients. Using complementary methods such as breathing therapy supports the physical, psychological, psychosocial, and holistic care of patients, thus increasing patient satisfaction and quality of life. Training health professionals in breathing therapy will ensure a broader use of this complementary method in a larger patient population.

Meta-narrative review: the impact of music therapy on sleep and future research directions

Sleep is essential to human health, yet 27% of the global population suffers from sleep issues, which often lead to fatigue, depression, and impaired cognitive function. While pharmacological treatments exist, non-pharmacological approaches like music therapy have shown promise in enhancing sleep quality. This review, analyzing 27 studies with various experimental paradigms, confirms that music therapy significantly improves subjective sleep quality, largely by alleviating anxiety and regulating mood through perceptual pathways. However, the effects on objective sleep measures remain inconclusive, suggesting that individual differences may play a significant role. Future research should focus on refining intervention designs that integrate both subjective and objective sleep assessments to better elucidate the physiological and psychological mechanisms of music therapy. Key recommendations include personalized music selection, development of age-appropriate interventions, and minimization of external interferences to maximize therapeutic outcomes. Additionally, incorporating variables like psychological status, lifestyle, and environmental factors may offer a more comprehensive understanding of music therapy's long-term adaptability and effectiveness for diverse populations. This review offers critical research directions and practical support for future applications of music therapy in sleep health.

Sedative and hypnotic effects of the saponins from a traditional edible plant Liriope spicata Lour. in PCPA-induced insomnia mice

ETHNOPHARMACOLOGICAL RELEVANCE

Liriope spicata Lour., a species listed in the catalogue of 'Medicinal and Edible Homologous Species', is traditionally used for the treatment of fatigue, restlessness, insomnia and constipation.

AIM OF THE STUDY

This study is aimed to evaluate the sedative and hypnotic effect of the saponins from a natural plant L. spicata Lour. in vivo.

MATERIALS AND METHODS

The total saponin (LSTS) and purified saponin (LSPS) were extracted from L. spicata, followed by a thorough analysis of their major components using the HPLC-MS. Subsequently, the therapeutic efficacy of LSTS and LSPS was evaluated by the improvement of anxiety and depression behaviors of the PCPA-induced mice.

RESULTS

LSTS and LSPS exhibited similar saponin compositions but differ in their composition ratios, with liriopesides-type saponins accounting for a larger proportion in LSTS. Studies demonstrated that both LSTS and LSPS can extend sleep duration and immobility time, while reducing sleep latency in PCPA-induced mice. However, there was no significant difference in weight change among the various mice groups. Elisa results indicated that the LSTS and LSPS could decrease levels of NE, DA, IL-6, and elevate the levels of 5-HT, NO, PGD2 and TNF-α in mice plasma. LSTS enhanced the expression of neurotransmitter receptors, while LSPS exhibited a more pronounced effect in regulating the expression of inflammatory factors. In conclusion, the saponins derived from L. spicata might hold promise as ingredients for developing health foods with sedative and hypnotic effects, potentially related to the modulation of serotonergic and GABAAergic neuron expression, as well as immunomodulatory process.

Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial

BACKGROUND

One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep.

OBJECTIVE

We aim to verify the effectiveness of mindful breathing exercises using a tablet device.

METHODS

In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated.

RESULTS

On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5.

CONCLUSIONS

The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep.

TRIAL REGISTRATION

UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks.

Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App

BACKGROUND

Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals.

OBJECTIVE

This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability-based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps.

METHODS

In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events).

RESULTS

All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=-1524; P<.001) on daily steps.

CONCLUSIONS

The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs.

A novel music-based therapeutic approach: the Therapeutic Music Listening

The therapeutic use of music is frequently based on active interventions that directly involve the patient through a sonorous-music interaction with the music therapist. In contrast, approaches based on musical listening are characterized by a relationship aimed at promoting an introspective work and processing of one's emotional experiences. Increasingly, the scientific literature has shown how even listening to music related to the patient's personal tastes (preferred music listening) and by-passing the direct relationship with the patient, can produce therapeutic effects in different clinical settings. However, in many cases, a clear therapeutic rationale and specific application protocols are still lacking. The paper introduces a novel approach based on music listening: the Therapeutic Music Listening. This approach integrates the subjective component of listening (patient's musical tastes) and structural and parametric characteristics of the music in relation to the therapeutic aims. The article defines theoretical-applicative bases as well as therapeutic and research perspectives of this music listening-based intervention.

Deep breathing exercise at work: Potential applications and impact

Hypertension is a major contributor to cardiovascular disease and daily deep breathing exercise (DBE) is a promising intervention to reduce blood pressure and stress in adults. DBE is simple, time-efficient, and does not require specialized equipment, allowing participation in a wide variety of settings. The workplace is an ideal setting to implement DBE at the national level for several reasons, including a large proportion of waking hours spent in the workplace, high levels of sedentary time at work, prevalence of work-related stress, and regular breaks throughout the day potentially reducing worker error. While the degree of adherence to daily workplace DBE will be the responsibility of the individual, employers and managers can (and should) do much to remove barriers to participation. Specifically, this could include: implementing regular short breaks or classes to perform DBE throughout the day, covering subscription costs for smartphone applications that guide DBE, and creating incentive programs for continuing DBE participation. Implementing DBE in the workplace is a pragmatic approach to provide a low-cost blood pressure and stress reduction therapy to a substantial portion of the adult population in the US, at least 50% of whom have high blood pressure.

Gene-environment interaction between circadian clock gene polymorphisms and job stress on the risk of sleep disturbances

RATIONALE

Sleep disturbances was associated with numerous adverse health outcomes. Many studies have reported that long-term exposure to job stress can lead to sleep disturbances, which may be influenced by genetic and environmental factors.

OBJECTIVES

This cross-sectional study investigated whether circadian clock gene polymorphisms modulated the influence of job stress on sleep disturbances in a Chinese Han population, which to our best knowledge has not been explored.

METHODS

The Effort-Reward Imbalance (ERI) scale and the Pittsburgh Sleep Quality Index (PSQI) were both used to access job stress and sleep disturbances. The SNaPshot SNP assay was carried out by screening for circadian clock gene polymorphisms in every participant. Interactions associated with sleep disturbances were assessed by linear hierarchical regression analysis and SPSS macros (PROCESS).

RESULTS

Linear hierarchical regression analysis showed that job stress was significantly related to sleep disturbances. Likewise, our study found a significant effect of PER2 rs2304672 polymorphisms on sleep disturbances (p < 0.01), after controlling for confounding factors. In addition, the PER2 rs2304672 genotype modulated the relationship between job stress and sleep disturbances (β = 0.414, p = 0.007). Interestingly, further analysis of the results of the PER2 gene rs2304672 × job stress interaction showed that rs2304672 G-allele carriers had a high-risk effect on sleep disturbances under high job stress.

CONCLUSIONS

Our results suggest that the PER2 rs2304672 polymorphism may modulate the influence of job stress on sleep disturbances. These findings contribute to the field of sleep disturbances prevention and treatment.

Music-based Intervention for Improving Sleep Quality of Adults without Sleep Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Listening to music is often used as a self-help intervention to improve sleep quality, but its efficacy among individuals without sleep disorder remains unclear.

METHODS

A search was performed on five databases to identify for studies that examined the use of music-based intervention to improve sleep quality among individuals without sleep disorder. Random-effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

Twenty-two articles which recruited 1,514 participants were included for review. Meta-analysis of six studies including 424 participants did not find an improvement in sleep quality among recipients of music-based intervention compared to those with standard care (mean difference: -0.80; 95% CI: -2.15 to 0.54, low-quality evidence). Subgroup analysis showed a clear improvement in sleep quality when interventions were administered for at least 3 weeks (-2.09; -3.84 to -0.34, n = 3). No difference in terms of sleep onset latency (standardized mean difference (SMD) -0.32; 95% CI -0.88 to 0.25, n = 4, very-low quality evidence) and sleep efficiency (SMD: -0.59; 95% CI -3.15 to 1.97, n = 2, very-low quality evidence) were observed. The effect of music-based intervention on anxiety, depression and quality of life were mixed with suggestions of possible benefits.

CONCLUSION

Music-based intervention in addition to standard care appears to be a promising strategy to improve sleep quality when delivered for 3 week or longer. However, effects are inconsistent across studies and larger randomized controlled studies reporting long-term outcomes are needed before it can be recommended for routine use.

PROSPERO REGISTRATION

CRD42018081193.

Sleep Quality and Electroencephalogram Delta Power

Delta activity on electroencephalogram (EEG) is considered a biomarker of homeostatic sleep drive. Delta power is often associated with sleep duration and intensity. Here, we reviewed the literature to explore how sleep quality was influenced by changes in delta power. However, we found that both the decrease and increase in delta power could indicate a higher sleep quality due to the various factors below. First, the differences in changes in delta power in patients whose sleep quality is lower than that of the healthy controls may be related to the different diseases they suffered from. We found that the patients mainly suffered from borderline personality disorder, and Rett syndrome may have a higher delta power than healthy individuals. Meanwhile, patients who are affected by Asperger syndrome, respiratory failure, chronic fatigue, and post-traumatic stress disorder have lower delta power. Second, if the insomnia patients received the therapy, the difference may be caused by the treatment method. Cognitive or music therapy shows that a better therapeutic effect is associated with decreased delta power, whereas in drug treatment, there is an opposite change in delta power. Last, for healthy people, the difference in delta change may be related to sleep stages. The higher sleep quality is associated with increased delta power during the NREM period, whereas a deceased delta change accompanies higher sleep quality during the REM period. Our work summarizes the effect of changes in delta power on sleep quality and may positively impact the monitoring and intervention of sleep quality.

Transcutaneous Auricular Vagus Nerve Stimulation Combined With Slow Breathing: Speculations on Potential Applications and Technical Considerations

OBJECTIVES

Transcutaneous auricular vagus nerve stimulation (taVNS) is a relatively novel noninvasive neurostimulation method that is believed to mimic the effects of invasive cervical VNS. It has recently been suggested that the effectiveness of taVNS can be enhanced by combining it with controlled slow breathing. Slow breathing modulates the activity of the vagus nerve and is used in behavioral medicine to decrease psychophysiological arousal. Based on studies that examine the effects of taVNS and slow breathing separately, this article speculates on some of the conditions in which this combination treatment may prove effective. Furthermore, based on findings from studies on the optimization of taVNS and slow breathing, this article provides guidance on how to combine taVNS with slow breathing.

MATERIALS AND METHODS

A nonsystematic review.

RESULTS

Both taVNS and slow breathing are considered promising add-on therapeutic approaches for anxiety and depressive disorders, chronic pain, cardiovascular diseases, and insomnia. Therefore, taVNS combined with slow breathing may produce additive or even synergistic beneficial effects in these conditions. Studies on respiratory-gated taVNS during spontaneous breathing suggest that taVNS should be delivered during expiration. Therefore, this article proposes to use taVNS as a breathing pacer to indicate when and for how long to exhale during slow breathing exercises.

CONCLUSIONS

Combining taVNS with slow breathing seems to be a promising hybrid neurostimulation and behavioral intervention.

Sleep Well and Recover Faster with Less Pain-A Narrative Review on Sleep in the Perioperative Period

Sleep disturbance, pain, and having a surgical procedure of some kind are all very likely to occur during the average lifespan. Postoperative pain continues to be a prevalent problem and growing evidence supports the association between pain and sleep disturbances. The bidirectional nature of sleep and pain is widely acknowledged. A decline in sleep quality adds a risk for the onset of pain and also exacerbates existing pain. The risk factors for developing insomnia and experiencing severe pain after surgery are quite similar. The main aim of this narrative review is to discuss why it is important to be aware of sleep disturbances both before and after surgery, to know how sleep disturbances should be assessed and monitored, and to understand how better sleep can be supported by both pharmacological and non-pharmacological interventions.

Heart Rate Variability and Firstbeat Method for Detecting Sleep Stages in Healthy Young Adults: Feasibility Study

Background

Polysomnography (PSG) is considered the only reliable way to distinguish between different sleep stages. Wearable devices provide objective markers of sleep; however, these devices often rely only on accelerometer data, which do not enable reliable sleep stage detection. The alteration between sleep stages correlates with changes in physiological measures such as heart rate variability (HRV). Utilizing HRV measures may thus increase accuracy in wearable algorithms.

Objective

We examined the validity of the Firstbeat sleep analysis method, which is based on HRV and accelerometer measurements. The Firstbeat method was compared against PSG in a sample of healthy adults. Our aim was to evaluate how well Firstbeat distinguishes sleep stages, and which stages are most accurately detected with this method.

Methods

Twenty healthy adults (mean age 24.5 years, SD 3.5, range 20-37 years; 50% women) wore a Firstbeat Bodyguard 2 measurement device and a Geneactiv actigraph, along with taking ambulatory SomnoMedics PSG measurements for two consecutive nights, resulting in 40 nights of sleep comparisons. We compared the measures of sleep onset, wake, combined stage 1 and stage 2 (light sleep), stage 3 (slow wave sleep), and rapid eye movement (REM) sleep between Firstbeat and PSG. We calculated the sensitivity, specificity, and accuracy from the 30-second epoch-by-epoch data.

Results

In detecting wake, Firstbeat yielded good specificity (0.77), and excellent sensitivity (0.95) and accuracy (0.93) against PSG. Light sleep was detected with 0.69 specificity, 0.67 sensitivity, and 0.69 accuracy. Slow wave sleep was detected with 0.91 specificity, 0.72 sensitivity, and 0.87 accuracy. REM sleep was detected with 0.92 specificity, 0.60 sensitivity, and 0.84 accuracy. There were two measures that differed significantly between Firstbeat and PSG: Firstbeat underestimated REM sleep (mean 18 minutes, P=.03) and overestimated wake time (mean 14 minutes, P<.001).

Conclusions

This study supports utilizing HRV alongside an accelerometer as a means for distinguishing sleep from wake and for identifying sleep stages. The Firstbeat method was able to detect light sleep and slow wave sleep with no statistically significant difference to PSG. Firstbeat underestimated REM sleep and overestimated wake time. This study suggests that Firstbeat is a feasible method with sufficient validity to measure nocturnal sleep stage variation.

Updated Review of the Acoustic Modulation of Sleep: Current Perspectives and Emerging Concepts

With growing interest in the use of acoustic stimuli in sleep research and acoustic interventions used therapeutically for sleep enhancement, there is a need for an overview of the current lines of research. This paper summarizes the various ways to use acoustic input before sleep or stimulation during sleep. It thereby focuses on the respective methodological requirements, advantages, disadvantages, potentials and difficulties of acoustic sleep modulation. It highlights differences in subjective and objective outcome measures, immediate and whole night effects and short versus long term effects. This recognizes the fact that not all outcome parameters are relevant in every research field. The same applies to conclusions drawn from other outcome dimensions, consideration of mediating factors, levels of stimulation processing and the impact of inter-individual differences. In addition to the deliberate influences of acoustic input on sleep, one paragraph describes adverse environmental acoustic influences. Finally, the possibilities for clinical and basic research-related applications are discussed, and emerging opportunities are presented. This overview is not a systematic review but aims to present the current perspective and hence summarizes the most up-to-date research results and reviews. This is the first review providing a summary of the broad spectrum of possibilities to acoustically influence sleep.