OBJECTIVE: Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it. METHODS: Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered. CONCLUSIONS: Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.

Menopause. 2015 Jun;22(6):674-84. doi: 10.1097/GME.0000000000000348. Attarian H(1), Hachul H, Guttuso T, Phillips B. Author information: (1)From the 1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL; 2Departments of Psychobiology and Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil; 3Department of Neurology, University at Buffalo School of Medicine, State University of New York, Buffalo, NY; and 4Department of Medicine, University of Kentucky College of Medicine, Lexington, KY.

Sleep quality markedly declines across the human lifespan. Particularly the amount of slow-wave sleep (SWS) decreases with age and this decrease is paralleled by a loss of cognitive functioning in the elderly. Here we show in healthy elderly females that the amount of SWS can be extended by a hypnotic suggestion "to sleep deeper" before sleep. In a placebo-controlled cross-over design, participants listened to hypnotic suggestions or a control tape before a midday nap while high density electroencephalography was recorded. After the hypnotic suggestion, we observed a 57% increase in SWS in females suggestible to hypnosis as compared to the control condition. Furthermore, left frontal slow-wave activity (SWA), characteristic for SWS, was significantly increased, followed by a significant improvement in prefrontal cognitive functioning after sleep. Our results suggest that hypnotic suggestions might be a successful alternative for widely-used sleep-enhancing medication to extend SWS and improve cognition in the elderly.

Neuropsychologia. 2015 Mar;69:176-82. doi: 10.1016/j.neuropsychologia.2015.02.001. Epub 2015 Feb 4. Cordi MJ1, Hirsiger S2, Mérillat S2, Rasch B3. Copyright © 2015. Published by Elsevier Ltd.

OBJECTIVE: Insomnia both as a symptom and as part of chronic insomnia disorder is quite common in menopause. Comorbid conditions, such as restless legs syndrome and obstructive sleep apnea, occur with high prevalence among perimenopausal women with insomnia. Insomnia in this population group is associated with adverse health outcomes, and there are no clear standards on how to treat it. METHODS: Based on extensive literature search, 76 articles were identified. Two authors independently graded evidence according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Evaluation and treatment of other comorbid sleep disorders are recommended, as is cognitive-behavioral therapy for insomnia. Hormone therapy, eszopiclone, escitalopram, gabapentin, isoflavones, valerian, exercise, and hypnosis are suggested. Zolpidem, quiteiapine XL, citalopram, mirtazapine followed by long-acting melatonin, ramelteon, Pycnogenol, Phyto-Female Complex, yoga, and massage may be considered. Kampo formulas are not recommended. Acupuncture may not be suggested, and cognitive-behavioral therapy that is not tailored for insomnia probably should not be considered. CONCLUSIONS: Although a variety of interventions are shown to be helpful in improving sleep in menopause, there is a need for well-designed head-to-head trials with uniform outcome measures.

Menopause. 2014 Oct 27.

Attarian H(1), Hachul H, Guttuso T, Phillips B. Author information: (1)From the 1Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Psychobiology and Gynecology, Universidade Federal de São Paulo, São Paulo, Brazil; 3Department of Neurology, University at Buffalo School of Medicine, State University of New York, Buffalo, NY; and Department of Medicine, University of Kentucky College of Medicine, Lexington, KY.

STUDY OBJECTIVES: Slow wave sleep (SWS) plays a critical role in body restoration and promotes brain plasticity; however, it markedly declines across the lifespan. Despite its importance, effective tools to increase SWS are rare. Here we tested whether a hypnotic suggestion to "sleep deeper" extends the amount of SWS. DESIGN: Within-subject, placebo-controlled crossover design. SETTING: Sleep laboratory at the University of Zurich, Switzerland. PARTICIPANTS: Seventy healthy females 23.27 ± 3.17 y. INTERVENTION: Participants listened to an auditory text with hypnotic suggestions or a control tape before napping for 90 min while high-density electroencephalography was recorded. MEASUREMENTS AND RESULTS: After participants listened to the hypnotic suggestion to "sleep deeper" subsequent SWS was increased by 81% and time spent awake was reduced by 67% (with the amount of SWS or wake in the control condition set to 100%). Other sleep stages remained unaffected. Additionally, slow wave activity was significantly enhanced after hypnotic suggestions. During the hypnotic tape, parietal theta power increases predicted the hypnosis-induced extension of SWS. Additional experiments confirmed that the beneficial effect of hypnotic suggestions on SWS was specific to the hypnotic suggestion and did not occur in low suggestible participants. CONCLUSIONS: Our results demonstrate the effectiveness of hypnotic suggestions to specifically increase the amount and duration of slow wave sleep (SWS) in a midday nap using objective measures of sleep in young, healthy, suggestible females. Hypnotic suggestions might be a successful tool with a lower risk of adverse side effects than pharmacological treatments to extend SWS also in clinical and elderly populations. CITATION: Cordi MJ, Schlarb AA, Rasch B. Deepening sleep by hypnotic suggestion. SLEEP 2014;37(6):1143-1152.

Sleep. 2014 Jun 1;37(6):1143-52. doi: 10.5665/sleep.3778. Cordi MJ(1), Schlarb AA(2), Rasch B(3). Author information: (1)University of Zurich, Institute of Psychology, Division of Biopsychology, Zurich, Switzerland, Binzmühlestrasse 14/5, 8050 Zürich. (2)University of Tübingen, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Tübingen, Germany. (3)University of Zurich, Institute of Psychology, Division of Biopsychology, Zurich, Switzerland, Binzmühlestrasse 14/5, 8050 Zürich ; Zurich Center for Interdisciplinary Sleep Research (ZiS), University of Zurich, Zurich, Switzerland; University of Fribourg, Department of Psychology, Division of Cognitive Biopsychology and Methods, Fribourg, Switzerland.

Full title: Nocturnal mouthpiece ventilation and medical hypnosis to treat severe obstructive sleep apnea in a child with cherubism.

A 4-year old boy presented severe obstructive sleep apnoea due to complete nasal obstruction secondary to cherubism. Because of anticipatory anxiety due to numerous surgical interventions, medical hypnosis was proposed to facilitate non-invasive continuous positive pressure ventilation (CPAP) acceptance. CPAP by means of an oral interface was completely accepted after three hypnosis sessions and resulted in the correction of his obstructive sleep apnea (OSA) syndrome. This report highlights the benefit of medical hypnosis in facilitating CPAP acceptance as well as the efficacy of mouthpiece ventilation in a severe form of cherubism with complete nasal obstruction. Pediatr Pulmonol. © 2012 Wiley Periodicals, Inc.

Pediatr Pulmonol. 2012 Nov 5. doi: 10.1002/ppul.22686. Khirani S, Kadlub N, Delord V, Picard A, Fauroux B. Inserm U 955 Pierre et Marie Curie-Paris 6 University, Paris, France.

by Suryanarayana Chennapragada

Engaging your mind on the process of breathing calms the mind and relaxes the body. At night it induces sleep. It substitutes sleeping pills. How can you do it? Lie down and close your eyes. Follow these easy steps.

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By Kathy Sexton-Radek and Gina M. Graci

While nearly one-third of our life is spent in slumber, many individuals underestimate the value and function of sleep. It is estimated that one in eight adults will experience discomfort and report lower quality of life rating due to a poor night of sleep. Frequently, our conversations include subjective ratings of "how well or how poor" we slept the previous night because so much of our alertness, ability to concentrate, and ability to function revolves around the length and quality of sleep.

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Hypnosis can be defined as a procedure during which changes in sensations, perceptions, thoughts, feelings or behaviour are suggested. Hypnosis can be used to amplify whatever it is about therapy that makes it therapeutic. It permits a wide range of choices regarding where and how to intervene in the patient's problems. In this paper, we set out to examine the rationale of using hypnotherapy to manage various types of sleep disorders, and to explore the techniques, strategies and hypnotic scripts employed by various hypnotherapists. We also examine the research data available on the efficacy of hypnosis in the treatment of sleep disorders. Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions. Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking. Hypnosis is a specialised technique, not a therapy itself, and should be used as an adjunctive intervention within a complete psychological and medical treatment package. Most of the literature is limited to case reports or studies with such a small sample that at times it is very difficult to interpret the results. There is a major placebo effect, so uncontrolled trials are of limited value. It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.

Ann Acad Med Singapore. 2008 Aug;37(8):683-8. Ng BY, Lee TS. Department of Psychiatry, Singapore General Hospital, Singapore. ng.beng.yeong@sgh.com.sg

by Mary Llewellyn BA(Hons) psychology EFT Master

"Mary, I hear you are good a helping people to sleep. Can you help me?" This is a question we are frequently asked as therapists, part of our everyday experience. This lady we will call her Sarah had been experiencing poor sleep for over seventeen year.

On the phone, I asked her, was there any reason her mind felt that it was not safe to sleep. She said, "When you see me you will know why.". We booked an appointment and I looked forward to meeting her.

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Hypnosis can be defined as a procedure during which changes in sensations, perceptions, thoughts, feelings or behaviour are suggested. Hypnosis can be used to amplify whatever it is about therapy that makes it therapeutic. It permits a wide range of choices regarding where and how to intervene in the patient's problems. In this paper, we set out to examine the rationale of using hypnotherapy to manage various types of sleep disorders, and to explore the techniques, strategies and hypnotic scripts employed by various hypnotherapists. We also examine the research data available on the efficacy of hypnosis in the treatment of sleep disorders. Acute and chronic insomnia often respond to relaxation and hypnotherapy approaches, along with sleep hygiene instructions. Hypnotherapy has also helped with nightmares and sleep terrors. There are several reports of successful use of hypnotherapy for parasomnias, specifically for head and body rocking, bedwetting and sleepwalking. Hypnosis is a specialised technique, not a therapy itself, and should be used as an adjunctive intervention within a complete psychological and medical treatment package. Most of the literature is limited to case reports or studies with such a small sample that at times it is very difficult to interpret the results. There is a major placebo effect, so uncontrolled trials are of limited value. It is hard to perform a randomised, double-blind, controlled trial to evaluate hypnotherapy given that cooperation and rapport between patient and therapist is needed to achieve a receptive trance state.

Ann Acad Med Singapore. 2008 Aug;37(8):683-8. Ng BY, Lee TS. Department of Psychiatry, Singapore General Hospital, Singapore. ng.beng.yeong@sgh.com.sg

Approximately half of patients with sleep-disordered breathing (SDB) also experience insomnia. The relationship between these two common sleep disorders is complex and unclear but patients with both SDB and insomnia have poorer sleep quality and are more likely to have psychiatric disorders than those with SDB alone. SDB is more common in men than women; however, the incidence of comorbid insomnia is greater in women with SDB than in men. The management of comorbid SDB and insomnia involves the screening of patients with insomnia or psychiatric disorders for SDB; although interviews may be effective in diagnosing SDB in patients with insomnia, polysomnography can diagnose veiled SDB. To address comorbid SDB and insomnia therapies should be aimed at both disorders. Patients should first be encouraged to improve their sleep hygiene and make lifestyle changes to improve sleep. Treatments for SDB include continuous positive airway pressure and oral appliances, while upper airway surgery may improve sleep outcomes in some patients. The use of pharmacological drugs such as hypnotics for the treatment of insomnia in patients with SDB remains controversial.

Sleep Med. 2007 Dec;8 Suppl 4:S21-5. Lavie P. Lloyd Rigler Sleep Apnea Research Laboratory, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. plavie@tx.technion.ac.il