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Brain Advance Access originally published online on January 11, 2008
Brain 2008 131(2):500-513; doi:10.1093/brain/awm315
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© The Author (2008). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Skin deep: enhanced sleep depth by cutaneous temperature manipulation

Roy J. E. M. Raymann1,*, Dick F. Swaab1 and Eus J. W. Van Someren1,2

1Department of Sleep & Cognition, Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences and 2VU University Medical Center, Departments of Clinical Neurophysiology, Neurology and Medical Psychology, Amsterdam, the Netherlands

Correspondence to: Roy J. E. M. Raymann, Department of Human Performance, TNO Defence, Security and Safety, P.O. Box 23, 3769 ZG Soesterberg, the Netherlands. E-mail: raymann{at}nin.knaw.nl

With ageing, an increasingly disturbed sleep is reported as a significant complaint affecting the health and well-being of many people. The available treatments for sleep disturbance have their limitations, so we have adopted a different approach to the improvement of sleep. Since in animal and human studies skin warming has been found to increase neuronal activity in brain areas that are critically involved in sleep regulation, we investigated whether subtle skin temperature manipulations could improve human sleep. By employing a thermosuit to control skin temperature during nocturnal sleep, we demonstrate that induction of a mere 0.4°C increase in skin temperature, whilst not altering core temperature, suppresses nocturnal wakefulness (P<0.001) and shifts sleep to deeper stages (P<0.001) in young and, especially, in elderly healthy and insomniac participants. Elderly subjects showed such a pronounced sensitivity, that the induced 0.4°C increase in skin temperature was sufficient to almost double the proportion of nocturnal slow wave sleep and to decrease the probability of early morning awakening from 0.58 to 0.04. Therefore, skin warming strongly improved the two most typical age-related sleep problems; a decreased slow wave sleep and an increased risk of early morning awakening. EEG frequency spectra showed enhancement of low-frequency cortical oscillations. The results indicate that subtle feedback control of in-bed temperature through very mild manipulations could have strong clinical relevance in the management of disturbed sleep especially in the elderly, who have an attenuated behavioural response to suboptimal environmental temperature, which may hamper them from taking appropriate action to optimize their bed temperature.

Key Words: insomnia; sleep; ageing; temperature manipulation; thermoregulation; electroencephalography

Abbreviations: CBT, core body temperature; POAH, preoptic area/anterior hypothalamus; REM, rapid eye movement; SWS, slow wave sleep

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Received June 27, 2007. Revised November 26, 2007. Accepted December 10, 2007.

*Present address: Department of Human Performance, TNO Defence, Security and Safety, P.O. Box 23, 3769 ZG Soesterberg, the Netherlands. E-mail: roy.raymann{at}tno.nl


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