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Featured Article: Sleep quality varies as a function of 5-HTTLPR genotype and stress
Transcript of Additional Q&A
 | Guest Host: Thomas Roth, PhD Chief, Division Head Sleep Disorders and Research Center Henry Ford Hospital Detroit, MI |
 | Featured Author: Andrew D. Krystal, MD, MS Professor of Psychiatry and Behavioral Sciences Duke University School of Medicine Durham, NC |
1. You've mentioned distinguishing between insomnia vs. sleep disturbance, and how this particular aspect was not measured in this study. Could you expand upon this by discussing differences in sleep architecture? What are some key features for determining which of these is present when a caregiver complains of having trouble sleeping?
It is not possible to determine sleep architecture without doing a polysomnogram (overnight sleep study). As we did not perform polysomnography, it is not possible to determine the sleep architecture in our subjects. Further, sleep architecture does not differentiate sleep disturbance from insomnia. The difference between them is that sleep disturbance is a general term for describing sleep problems occurring in response to some stimulus/disturbance such as noise, a medication, pain, stress etc. Insomnia is defined as sleep difficulties occurring when there are no such factors disrupting sleep, that is, the individual is experiencing sleep difficulties despite an undisturbed opportunity to sleep. In the case of a caregiver, sleep disturbance and insomnia could be distinguished by asking whether there are problems with sleep when there is no disturbance occurring due to the person they are caring for or other factors.
2. From an evolutionary perspective, when one assumes the role of caregiver, could it be considered adaptive to be more vigilant to disturbances during sleep? Or do you think people with the long allele are somehow immune to the effects of caregiver stress on sleep disturbance, and that is the more adaptive response?
One can only speculate about such issues. If viewed from the point of view of effective caregiving, then being more vigilant would seem to be more adaptive. If viewed from the point of view of the quality of life/well-being of the caregiver, then being immune to the effects of stress would appear to be more adaptive.
3. Caring for aging parents with cognitive decline is stressful for most individuals, it is fascinating to hear that people may have a genetic predisposition for developing risk factors for depression in this type of situation. If you treat the insomnia/sleep disturbances in these caregivers, would you expect stress levels related to caregiving to decline? In an attempt to reduce the risk of developing depression, is it better to treat the insomnia/sleep disturbance, or to reduce the stressors using, for example, cognitive or behavioral techniques?
There are no data that address these issues as no one has carried out a study of the treatment of insomnia in caregivers or similar circumstances. It would certainly be a reasonable hypothesis to test that treatment of insomnia might reduce stress level. In terms of reducing risks for depression, it would make sense to do everything possible. We don't have any data demonstrating that the treatment of insomnia mitigates the associated increased risk for depression. However, there is no doubt that the insomnia adversely affects those with this condition. The stress is also likely to have adverse effects on things other than sleep. I would, therefore, institute treatment for the insomnia as well as use cognitive/behavioral or other approaches to reduce the stressors as much as possible.
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JC-001-021108-05
