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DOI: 10.1055/s-0044-1787530
Effects of Acute Aerobic Exercise Versus Acute Zolpidem Intake on Sleep in Individuals with Chronic Insomnia
Funding This work was supported by the National Council for Scientific and Technological Development - CNPq, Brazil [grant number 409185/2016-7].![](https://www.thieme-connect.de/media/10.1055-s-00056804/EFirst/lookinside/thumbnails/10-1055-s-0044-1787530_23aug0010oa-1.jpg)
Abstract
Introduction Sleeping pills are assumed to be the most efficacious means of treating acute insomnia, but their use has associated risks. Exercise could provide a healthy alternative treatment for insomnia, particularly if it could be shown to have comparable efficacy to sleeping pills.
Objective The purpose of this study was to compare the effects of acute exercise versus zolpidem on chronic insomnia.
Methods Seventeen participants with chronic insomnia (recruited from advertisements) participated in a parallel randomized controlled trial (exercise, n = 9; zolpidem, n = 8). Participants in the exercise treatment performed treadmill exercise for 50 minutes, at 50% of heart rate reserve, between 11 am and 2 pm. Participants in the zolpidem treatment received a 10 mg dose of zolpidem immediately before bedtime. Following baseline and following the treatment, sleep measures included sleep diary, polysomnography, and actigraphy. Treatments were compared with non-inferiority analysis, ANOVA, and effect sizes.
Results Non-inferiority of exercise relative to zolpidem was observed for polysomnographic measurement of sleep latency. For all other comparisons, the non-inferiority was inconclusive. Significant treatment-by-time interactions were observed for N3 sleep (p = 0.04) and REM sleep (p = 0.03). No other significant treatment-by-time effects were observed. Subjective sleep duration and sleep efficiency, and polysomnographic measurement of sleep efficiency were significantly increased after zolpidem and exercise. The effect size between groups was small for these variables.
Conclusion Exercise impacted sleep in a similar way to zolpidem in participants with chronic insomnia. Considering the far superior health benefits of exercise, further research addressing this question is warranted.
Keywords
insomnia - sleep initiation and maintenance disorders - exercise - complementary therapies - hypnotics and sedativesPublication History
Received: 03 August 2023
Accepted: 20 February 2024
Article published online:
05 June 2024
© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 ICSD-3. American Academy of Sleep Medicine. International classification of sleep disorders. 2014 ;3th Edition
- 2 Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002; 6 (02) 97-111
- 3 Riemann D, Spiegelhalder K, Feige B. et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev 2010; 14 (01) 19-31
- 4 Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol Metab Clin North Am 2002; 31 (01) 15-36
- 5 Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest 2017; 152 (02) 435-444
- 6 Vgontzas AN, Liao D, Bixler EO, Chrousos GP, Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. Sleep 2009; 32 (04) 491-497
- 7 Laugsand LE, Strand LB, Platou C, Vatten LJ, Janszky I. Insomnia and the risk of incident heart failure: a population study. Eur Heart J 2014; 35 (21) 1382-1393
- 8 Hertenstein E, Feige B, Gmeiner T. et al. Insomnia as a predictor of mental disorders: A systematic review and meta-analysis. Sleep Med Rev 2019; 43: 96-105
- 9 Lovato N, Lack L. Insomnia and mortality: A meta-analysis. Sleep Med Rev 2019; 43: 71-83
- 10 Roux FJ, Kryger MH. Medication effects on sleep. Clin Chest Med 2010; 31 (02) 397-405
- 11 Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008; 4 (05) 487-504
- 12 Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000 Res 2016; 5: 918
- 13 Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT. Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med 2010; 6 (03) 270-275
- 14 Morita Y, Sasai-Sakuma T, Inoue Y. Effects of acute morning and evening exercise on subjective and objective sleep quality in older individuals with insomnia. Sleep Med 2017; 34: 200-208
- 15 Passos GS, Poyares D, Santana MG. et al. Effects of moderate aerobic exercise training on chronic primary insomnia. Sleep Med 2011; 12 (10) 1018-1027
- 16 Reid KJ, Baron KG, Lu B, Naylor E, Wolfe L, Zee PC. Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med 2010; 11 (09) 934-940
- 17 Youngstedt SD, Ito W, Passos GS, Santana MG, Youngstedt JM. Testing the sleep hygiene recommendation against nighttime exercise. Sleep Breath 2021; 25 (04) 2189-2196
- 18 Chen LJ, Stevinson C, Fang SH, Taun CY, Ku PW. Effects of an Acute Bout of Light-Intensity Walking on Sleep in Older Women With Sleep Impairment: A Randomized Controlled Trial. J Clin Sleep Med 2019; 15 (04) 581-586
- 19 Youngstedt SD, O'Connor PJ, Crabbe JB, Dishman RK. Acute exercise reduces caffeine-induced anxiogenesis. Med Sci Sports Exerc 1998; 30 (05) 740-745
- 20 Meyer JD, Koltyn KF, Stegner AJ, Kim JS, Cook DB. Influence of Exercise Intensity for Improving Depressed Mood in Depression: A Dose-Response Study. Behav Ther 2016; 47 (04) 527-537
- 21 Youngstedt SD, Dishman RK, Cureton KJ, Peacock LJ. Does body temperature mediate anxiolytic effects of acute exercise?. J Appl Physiol 1993; 74 (02) 825-831
- 22 Taylor RP, Olsen ME, Starnes JW. Improved postischemic function following acute exercise is not mediated by nitric oxide synthase in the rat heart. Am J Physiol Heart Circ Physiol 2007; 292 (01) H601-H607
- 23 Passos GS, Poyares D, Santana MG. et al. Exercise improves immune function, antidepressive response, and sleep quality in patients with chronic primary insomnia. BioMed Res Int 2014; 2014: 498961
- 24 Ferreira WS, Santana MG, Youngstedt SD. et al. Effects of exercise training and exercise plus acupuncture on chronic insomnia: a feasibility study. Sleep Sci 2022; 15 (03) 288-296
- 25 American Psychiatry Association. Diagnostic and statistical manual of mental disorders, 5 ed. Washington: DC:: American Psychiatry Association,; 2013
- 26 Morin CM, Vallières A, Guay B. et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA 2009; 301 (19) 2005-2015
- 27 Carney CE, Buysse DJ, Ancoli-Israel S. et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 2012; 35 (02) 287-302
- 28 Iber C, Ancoli-Israel S, Chesson AJ, Quan S. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester:: American Academy of Sleep Medicine; 2007
- 29 Jean-Louis G, Kripke DF, Mason WJ, Elliott JA, Youngstedt SD. Sleep estimation from wrist movement quantified by different actigraphic modalities. J Neurosci Methods 2001; 105 (02) 185-191
- 30 McCall C, McCall WV. Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs. J Sleep Res 2012; 21 (01) 122-127
- 31 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ:: L Erbaum Associates,; 1988
- 32 Piaggio G, Elbourne DR, Pocock SJ, Evans SJ, Altman DG. CONSORT Group. Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement. JAMA 2012; 308 (24) 2594-2604
- 33 Kryger MH, Steljes D, Pouliot Z, Neufeld H, Odynski T. Subjective versus objective evaluation of hypnotic efficacy: experience with zolpidem. Sleep 1991; 14 (05) 399-407
- 34 Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ 2012; 345: e8343
- 35 Youngstedt SD, O'Connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep 1997; 20 (03) 203-214
- 36 Roehrs T, Roth T. Hyperarousal in insomnia: pre-sleep and diurnal cortisol levels in response to chronic zolpidem treatment. Sleep Med 2019; 61: 52-56