Looking back at a life in sleep research-and some thoughts for the future.

In reviewing my studies, some of which are nearing the half century mark, I've described work on sleep-related growth hormone, the effects of hypnotics on the perception of sleep, REM sleep induction in humans by cholinergic drugs, the benzodiazepine receptor, the anatomic sites of action of hypnotics, the endocannabinoid system and sleep, and the relation of anesthesia to sleep. Special mention along the way goes to cases in which drugs produced totally unexpected effects, including methysergide producing opposite effects on growth hormone secretion in sleep and a waking provocative test, the converse actions on sleep of the B-10 benzodiazepine enantiomers, and the promotion of wakefulness by microinjection of the hypnotic triazolam into the dorsal raphe nuclei. This work is placed in the context of what was known at the time, as well as what has been observed in subsequent years.

Combining pharmacologic and nonpharmacologic therapies for insomnia.

Although both clinical experience and formal studies confirm the efficacy of cognitive-behavioral therapy (CBT) and hypnotic medications as treatments for insomnia, the interaction of the 2 treatments when combined has not been fully clarified. In principle, they could potentiate each other, not interact at all (in which case the benefits would be the sum of the 2 treatments alone), or inhibit each other. In this review, I suggest that the weight of available evidence indicates that the 2 treatments have a beneficial interaction, but that the paucity of data should prevent excessive generalization.

Effect of sleep deprivation on righting reflex in the rat is partially reversed by administration of adenosine A1 and A2 receptor antagonists.

Background: Similarities between naturally occurring sleep and general anesthesia suggest that the two states may interact physiologically. The authors have previously demonstrated that sleep deprivation potentiates anesthetic-induced loss of righting reflex (LORR) in rats. One possible mediator for this effect is adenosine, which accumulates in the brains of sleep-deprived animals and reduces anesthetic requirements.

A review of the evidence for the efficacy and safety of trazodone in insomnia.

Objective: Trazodone, a triazolopyridine antidepressant, is currently the second most commonly prescribed agent for the treatment of insomnia due to its sedating qualities. Given trazodone's widespread use, a careful review of the literature was conducted to assess its efficacy and side effects when given for treatment of insomnia.

Data Sources: In April 2003, a MEDLINE search was conducted using the search terms trazodone and insomnia and trazodone and sleep and restricted to 1980-2003, human subjects, and English language.