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CC BY-NC-ND 4.0 · Sleep Sci
DOI: 10.1055/s-0044-1787530
Original Article

Effects of Acute Aerobic Exercise Versus Acute Zolpidem Intake on Sleep in Individuals with Chronic Insomnia

Ariella Rodrigues Cordeiro Rozales
1   Health Sciences Institute, Universidade Federal de Jataí, Jataí, Goiás, Brazil
,
Marcos Gonçalves Santana
1   Health Sciences Institute, Universidade Federal de Jataí, Jataí, Goiás, Brazil
,
Shawn D. Youngstedt
2   Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, Arizona, United States
,
SeungYong Han
2   Arizona State University, Edson College of Nursing and Health Innovation, Phoenix, Arizona, United States
,
Daniela Elias de Assis
1   Health Sciences Institute, Universidade Federal de Jataí, Jataí, Goiás, Brazil
,
Bernardo Pessoa de Assis
1   Health Sciences Institute, Universidade Federal de Jataí, Jataí, Goiás, Brazil
,
Giselle Soares Passos 
1   Health Sciences Institute, Universidade Federal de Jataí, Jataí, Goiás, Brazil
› Author Affiliations Funding This work was supported by the National Council for Scientific and Technological Development - CNPq, Brazil [grant number 409185/2016-7].
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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 sedatives


Publication 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
    PubMedGoogle Scholar
  • 2 Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 2002; 6 (02) 97-111
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest 2017; 152 (02) 435-444
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Lovato N, Lack L. Insomnia and mortality: A meta-analysis. Sleep Med Rev 2019; 43: 71-83
    CrossrefPubMedGoogle Scholar
  • 10 Roux FJ, Kryger MH. Medication effects on sleep. Clin Chest Med 2010; 31 (02) 397-405
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000 Res 2016; 5: 918
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 American Psychiatry Association. Diagnostic and statistical manual of mental disorders, 5 ed. Washington: DC:: American Psychiatry Association,; 2013
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 30 McCall C, McCall WV. Comparison of actigraphy with polysomnography and sleep logs in depressed insomniacs. J Sleep Res 2012; 21 (01) 122-127
    CrossrefPubMedGoogle Scholar
  • 31 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ:: L Erbaum Associates,; 1988
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 35 Youngstedt SD, O'Connor PJ, Dishman RK. The effects of acute exercise on sleep: a quantitative synthesis. Sleep 1997; 20 (03) 203-214
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar