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Passive Body Heating Ameliorates Sleep Disturbances in Patients With Vascular Dementia Without Circadian Phase-Shifting

Received October 23, 2004; revised January 12, 2005; accepted January 18, 2005. From the Dept. of Geriatric Psychiatry, Kyowa Hospital, Akita, Japan (TS, YH, KM), and the Division of Neuropsychiatry, Department of Neuro- and Locomotor Science, Akita University School of Medicine, Akita, Japan (YM, SH). Send correspondence and reprint requests to Kazuo Mishima, M.D., 1-1-1 Hondo, Akita-City, Akita, 010-8543, Japan. e-mail: mishima{at}psy.med.akita-u.ac.jp
© 2005 American Association for Geriatric Psychiatry

Objective: This study investigated the sleep-promoting, thermoregulatory, and circadian phase-shifting actions of passive body heating (PBH) in elderly insomniac patients (IPs) with mild-to-moderate vascular dementia. Methods: Thirteen elderly IPs with vascular dementia (mean age 76.9 years; male/female ratio 2/11) were subjected to a PBH trial session. This session comprised a 3-day baseline period, 2-day PBH period, and 1-day post-PBH period. In the PBH period, the subjects received PBH (immersion in hot water about 40.0°C to mid-thorax level) for 30 minutes beginning 2 hours before bedtime. Sleep–waking, estimated by actigraph, core body temperature (cBT), and heart rate variability were continuously monitored. Dim-light melatonin-onset time (DLMO) was determined in the baseline and post-PBH periods. Results: PBH significantly improved subjects’ sleep quality; sleep latency decreased; sleep efficiency increased; and wake time after sleep onset decreased. These trends were more prominent in the latter half of the sleep time. PBH induced a rapid cBT elevation of approximately 0.80°C, on average, followed by enhanced heat loss (cBT: difference in cBT between just after the PBH and bedtime), lasting 1.5 hours before sleep. There was a significantly positive correlation between cBT and sleep latency. PBH induced no significant phase shift in DLMO. Heart-rate variability data showed that PBH induced parasympathomimetic action during sleep time in the subjects. Conclusion: PBH may have a sleep-promoting effect by intervening in the thermoregulatory and autonomic systems in elderly IPs with vascular dementia.

Key Words: Vascular Dementia • Sleep • Core Body Temperature

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