1
|
Jeon MS, Allcroft P, Brown LR, Currow D, Kochovska S, Krishnan A, Webster A, Campbell R. Assessment and Management of Sleep Disturbance in Palliative Care Settings. J Palliat Med 2024; 27:905-911. [PMID: 38466992 DOI: 10.1089/jpm.2023.0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negatively affect the person's functioning and quality of life. Objectives: We aimed to review the current practice of assessment and management of sleep disturbances in people with life-limiting illnesses in Australian and New Zealand palliative care settings, and to define areas for improvement in assessment and management of sleep disturbances and further research. Design: A cross-sectional, online survey was conducted with palliative care health professionals (PCHPs) to explore current approaches to routine assessment of sleep disturbances and PCHPs' awareness of, and perceived access to, evidence-based resources for assessing and managing sleep disturbances in their local settings. Results: Fifty-four PCHPs responded to the survey, including allied health professionals (44%), palliative care nurses (26%), and physicians (19%). Over 70% of PCHPs endorsed routine verbal screening of sleep symptoms, and >90% recommended management with basic behavioral strategies. However, none of PCHPs used validated patient-reported outcome measures for sleep, and <10% of PCHPs demonstrated awareness or use of sleep-specific interventions (including medications). Only 40% reported they had access to sleep specialist services for patients. Conclusion: Our findings provide a useful snapshot of current approaches to managing sleep disturbances in palliative care. Gaps in current practice are highlighted, including the lack of structured, clinical assessment, referral pathways, and PCHPs' perceived lack of access to targeted interventions for sleep disturbances.
Collapse
Affiliation(s)
- Megan S Jeon
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Southern Adelaide Local Health Network and Flinders University, South Australia, Australia
| | - Linda Ruth Brown
- The Palliative Care Clinical Studies Collaborative (PaCCSC) and Cancer Symptom Trials (CST), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Anu Krishnan
- Western Australia Country Health Service and Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew Webster
- Faculty of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachel Campbell
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Mijnster T, Boersma GJ, van Veen MM, Liemburg E, Cath D, Pijnenborg GHM, De Jong PJ, Lancel M. Sleep disorders in a naturalistic cohort of Dutch psychiatric outpatients: prevalence rates and associations with psychopathology symptom severity and well-being. J Sleep Res 2024; 33:e14009. [PMID: 37533279 DOI: 10.1111/jsr.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
Sleep problems are very common in individuals with a mental disorder. Given the abundant evidence indicating the negative impact of disturbed sleep on mental health outcome, insight into the prevalence of all types of sleep disorders in specific mental disorders and neurodevelopmental conditions is of practical importance. Therefore, we estimated the prevalence of six types of sleep disorders with the Holland Sleep Disorders Questionnaire in an overall mental health sample (n = 1082) and separately for different mental and neurodevelopmental conditions. Furthermore, associations between specific sleep disorders, psychopathology and well-being were studied. The impact of the total number of sleep disorders on these associations was examined. Overall, 46.2% of all participants scored above the cut-off for having a sleep disorder. Specifically, 26.8% scored on insomnia, 12.1% on sleep breathing disorders, 9.7% on hypersomnia, 13.7% on circadian rhythm sleep-wake disorders, 11.2% on parasomnia, and 17.9% on sleep-related movement disorders. Most sleep disorders were associated with greater severity of psychopathology and lower well-being. These associations got stronger with an increasing number of sleep disorders. Our study revealed higher suspected prevalence of most sleep disorders in a mental disorder sample compared to the general population. Moreover, the presence of sleep disorder(s) was strongly associated with symptom severity and reduced well-being. These findings extend the notion that early detection and treatment of sleep disorders in mental health populations is essential for psychiatric outcome.
Collapse
Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Gretha J Boersma
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Maaike M van Veen
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Edith Liemburg
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniëlle Cath
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Peter J De Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| |
Collapse
|
3
|
Meaklim H, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Meltzer LJ, Jackson ML. Development of a Novel Behavioral Sleep Medicine Education Workshop Designed to Increase Trainee Psychologists' Knowledge and Skills in Insomnia Management. Behav Sleep Med 2023; 21:787-801. [PMID: 36606306 DOI: 10.1080/15402002.2022.2164766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management. METHODS The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data. RESULTS Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep. CONCLUSIONS The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
Collapse
Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | | | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Western Australia, Australia
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
| |
Collapse
|
4
|
Wieman ST, Arditte Hall KA, Park ER, Gorman MJ, Comander A, Goldstein MR, Cunningham TJ, Mizrach HR, Juhel B, Li R, Markowitz A, Grandner M, Liverant GI, Hall DL. Treatment-related changes in insomnia, anticipatory pleasure, and depression symptoms: A proof-of-concept study with cancer survivors. Sleep Med 2023; 103:29-32. [PMID: 36739822 PMCID: PMC10006323 DOI: 10.1016/j.sleep.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/06/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE/BACKGROUND Cancer survivors have elevated rates of insomnia and depression. Insomnia increases risk for depression onset, and the Integrated Sleep and Reward (ISR) Model suggests that impairments in reward responding (e.g., ability to anticipate and/or experience pleasure) plays a central role in this relationship. Cognitive behavioral therapy for insomnia (CBT-I) is efficacious for treating chronic insomnia and reducing depression in cancer survivor populations. The effects of CBT-I on anticipatory and consummatory pleasure are theoretically and clinically meaningful, yet remain unexamined. PATIENTS/METHODS This secondary analysis of a pilot RCT (N = 40 cancer survivors with insomnia) explicated changes in anticipatory and consummatory pleasure and depression symptoms following a 4-session, synchronous, virtual CBT-I program versus enhanced usual care (referral to a behavioral sleep medicine clinic + sleep hygiene handout). Linear mixed models examined changes in anticipatory and consummatory pleasure and depression symptoms as predictors of changes in insomnia severity from baseline to post-intervention and 1-month follow-up. RESULTS CBT-I buffered against deterioration in anticipatory pleasure but not consummatory pleasure or depression symptoms. Across conditions, increased anticipatory pleasure was associated with insomnia reduction through 1-month follow-up, even after adjusting for changes in depression symptoms. CONCLUSION CBT-I may improve reward processing deficits in cancer survivors with insomnia. Findings provide support for the ISR Model and implicate pleasure as an important target for insomnia and depression.
Collapse
Affiliation(s)
- Sarah T Wieman
- Suffolk University, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Elyse R Park
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Mark J Gorman
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Amy Comander
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michael R Goldstein
- Harvard Medical School, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tony J Cunningham
- Harvard Medical School, Boston, MA, United States; Beth Israel Deaconess Medical Center, Boston, MA, United States; Boston College, Chestnut Hill, MA, United States
| | | | - Brooke Juhel
- Massachusetts General Hospital, Boston, MA, United States
| | - Raissa Li
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | | | - Daniel L Hall
- Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| |
Collapse
|
5
|
Gruber J, Hinshaw SP, Clark LA, Rottenberg J, Prinstein MJ. Young Adult Mental Health Beyond the COVID-19 Era: Can Enlightened Policy Promote Long-Term Change? POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2023; 10:75-82. [PMID: 36942264 PMCID: PMC10018249 DOI: 10.1177/23727322221150199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
The status of mental health for adolescents and young adults has aptly been termed a "crisis" across research, clinical, and policy quarters. Arguably, the status quo provision of mental health services for adolescents and young adults is neither acceptable nor salvageable in its current form. Instead, only a wholesale policy transformation of mental health sciences can address crises of this scope. Pandemic-related impacts on mental health, particularly among young adults, have clearly exposed the need for the mental healthcare field to develop a set of transformative priorities to achieve long overdue, systemic changes: (1) frequent mental health tracking, (2) increased access to mental health care, (3) working with and within communities, (4) collaboration across disciplines and stakeholders, (5) prevention-focused emphasis, (6) use of dimensional descriptions over categorical pronouncements, and (7) addressing systemic inequities. The pandemic required changes in mental healthcare that can and should be the beginning of long-needed reform, calling upon all mental health care disciplines to embrace innovation and relinquish outdated traditions.
Collapse
Affiliation(s)
- June Gruber
- University of Colorado Boulder, Boulder, CO, USA
- June Gruber, Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Muenzinger Hall #D321C, Boulder, CO 80309, USA.
| | - Stephen P. Hinshaw
- University of California, Berkeley, California, CA, USA
- University of California, San Francisco, California, CA, USA
| | | | | | | |
Collapse
|
6
|
Manti F, Giovannone F, Aceti F, Giacchetti N, Fioriello F, Maugeri A, Sogos C. Unraveling the Relationship between Sleep Problems, Emotional Behavior Disorders, and Stressful Life Events in Preschool Children. J Clin Med 2022; 11:jcm11185419. [PMID: 36143065 PMCID: PMC9503080 DOI: 10.3390/jcm11185419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/11/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The aims of this study were to: (1) explore sleep problems in preschool children with generalized anxiety disorder (GAD), selective mutism (SM), and oppositional defiant disorder (ODD) and (2) examine the relationship between stressful life events, sleep problems, and emotional behavior disorders in preschoolers. Methods: The parents of 213 preschool children with SM, GAD, ODD, and TD (typical development, age range 2–6 years) completed the Children’s Sleep Habits Questionnaire (CSHQ), the Coddington Life Events Scale, preschool version (CLES-P), and the CBCL 1½–5. Results: Eighty-three subjects reported sleep problems before the age of 2 years. Seventy-five children (86.14%) with a clinical diagnosis and eight children with TD (8.4%) exceeded the threshold level on the CSHQ. For the bedtime resistance (p = 0.042) and sleep duration subscales (p = 0.038), the SM group had significantly higher scores in comparison to the ODD group. The same pattern was also true for the sleep onset (p = 0.024) and sleep anxiety subscales (p = 0.019). The linear regression analysis model showed that the impact of stressful life events and internalizing problems could predict sleep habits in children. Conclusions: Emotional behavior disorders and stress factors should be regularly investigated in children who are referred to clinics for sleep problems. Clinicians should consider how these symptoms may exacerbate sleep problems and/or interfere with treatment.
Collapse
Affiliation(s)
- Filippo Manti
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-4997-2972
| | - Federica Giovannone
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Franca Aceti
- Department of Human Neuroscience, Unit of Post-Partum Disorders, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicoletta Giacchetti
- Department of Human Neuroscience, Unit of Post-Partum Disorders, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesca Fioriello
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Andrea Maugeri
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Carla Sogos
- Department of Human Neuroscience, Unit of Child Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| |
Collapse
|
7
|
Bersani FS, Barchielli B, Ferracuti S, Panno A, Carbone GA, Massullo C, Farina B, Corazza O, Prevete E, Tarsitani L, Pasquini M, Biondi M, Imperatori C. The association of problematic use of social media and online videogames with aggression is mediated by insomnia severity: A cross-sectional study in a sample of 18- to 24-year-old individuals. Aggress Behav 2022; 48:348-355. [PMID: 34870339 DOI: 10.1002/ab.22008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/24/2022]
Abstract
One of the worrying concomitants of problematic use of Internet (PUI) is aggression. Although the mechanisms underlying such link have not been completely clarified, it has been suggested that problematic use of social media and online videogames (i.e., two common forms of PUI among young adults) lead to increased sleep disturbances which, in turn, represent a relevant trigger for aggression. We have tested this hypothesis in a sample (N = 480) of young individuals (351 females and 129 males; mean age: 21.76 ± 1.92 years; range: 18-24). Self-report measures investigating symptoms related to social media addiction (SMA), Internet gaming disorder (IGD), insomnia severity, and aggression were used. Mediational models analyzing the direct and indirect associations of SMA- and IGD-related symptoms on aggression severity through insomnia-related symptoms were performed controlling for confounding factors. The models showed that the total effects of SMA-related symptoms (B = 0.018; p = .010) and of IGD-related symptoms (B = 0.018; p = .041) on aggression severity were significant and that these associations were mediated by insomnia-related symptoms (respectively, p < .001 and p = .003). Our findings support the potential mediating role of insomnia severity in the association of SMA- and IGD-related disturbances with levels of aggression.
Collapse
Affiliation(s)
| | | | - Stefano Ferracuti
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Angelo Panno
- Department of Human Sciences, Cognitive and Clinical Psychology Laboratory European University of Rome Rome Italy
| | - Giuseppe A. Carbone
- Department of Human Sciences, Cognitive and Clinical Psychology Laboratory European University of Rome Rome Italy
| | - Chiara Massullo
- Department of Human Sciences, Cognitive and Clinical Psychology Laboratory European University of Rome Rome Italy
| | - Benedetto Farina
- Department of Human Sciences, Cognitive and Clinical Psychology Laboratory European University of Rome Rome Italy
| | - Ornella Corazza
- Department of Clinical, Pharmaceutical and Biological Sciences University of Hertfordshire Hatfield UK
- Department of Medico‐Surgical Sciences and Biotechnologies Sapienza University of Rome Latina Italy
| | - Elisabeth Prevete
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Massimo Pasquini
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Massimo Biondi
- Department of Human Neurosciences Sapienza University of Rome Rome Italy
| | - Claudio Imperatori
- Department of Human Sciences, Cognitive and Clinical Psychology Laboratory European University of Rome Rome Italy
| |
Collapse
|
8
|
An Y, Shi J, Chuan-Peng H, Wu X. The symptom structure of posttraumatic stress disorder and co-morbid depression among college students with childhood abuse experience: A network analysis. J Affect Disord 2021; 293:466-475. [PMID: 34256208 DOI: 10.1016/j.jad.2021.06.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) and depression are highly co-morbid among individuals with childhood abuse history, while the mechanism of the co-morbidity is highly debated. This study sought to extent the work among college students with network analysis, which is a novel method that sees the co-morbidity from a symptom interacting perspective. METHODS Data was collected from 476 college students who were assessed to have childhood abuse history, PTSD and depression at the same time, using Childhood Trauma Questionnaire- Short Form, PTSD Checklist for DSM-5 and The Center for Epidemiological Studies Depression. We created a Graphical Gaussian Model (GGM) network to show associations between symptom pairs and a Directed Acyclic Graph (DAG) to estimate potential casual relationships among symptoms. RESULTS The GGM network was reliably stable, feeling sad (Depression) and trouble experiencing positive feelings (PTSD) were the most central nodes. Trouble experiencing positive feelings and several negative affect symptoms, sleep problems and difficulty in concentrating were acting as important bridging nodes. The DAG network suggested the key triggering roles of exaggerated startle (PTSD) and several re-experiencing symptoms. LIMITATIONS The study used cross-sectional data and self-reported measures. Results from network analysis could be affected by scale factors and contain spurious correlations. CONCLUSIONS In the childhood-abuse-related co-morbid structure, several negative affect symptoms both in PTSD and depression have pivotal roles, hyper-arousal symptoms and re-experiencing symptoms could trigger the co-morbid structure. Illustrating the strength and limitations of network analysis, this study help target the potentially influential symptoms for better clinical intervention.
Collapse
Affiliation(s)
- Yuanyuan An
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Junyi Shi
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou Distinct, Nanjing, PR China
| | - Hu Chuan-Peng
- Leibniz Institute for Resilience Research, 55131 Mainz, Germany
| | - Xinchun Wu
- Faculty of Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China; Beijing Key Laboratory of Applied Experimental Psychology, Beijing Normal University, No.19 Xinjiekou Wai Street, Beijing, PR China.
| |
Collapse
|
9
|
Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med 2021; 17:2085-2097. [PMID: 33985647 PMCID: PMC8494096 DOI: 10.5664/jcsm.9354] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/15/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to an increased prevalence of insomnia and mental health symptoms globally. However, most studies to date have not examined mental health symptoms between individuals with insomnia, either pre-existing or developing post-pandemic compared with good sleepers. This study examined differences in stress, anxiety, and depression between individuals with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no insomnia symptoms in response to the COVID-19 pandemic. METHODS A cross-sectional survey was completed by 2724 participants from 67 countries during the COVID-19 pandemic. Perceived stress, anxiety, and depressive symptoms were compared between individuals with post-pandemic insomnia symptoms (n = 1007), pre-existing insomnia symptoms (n = 804), and no insomnia symptoms (n = 913). RESULTS Post-pandemic insomnia symptoms were associated with higher levels of stress, anxiety, and depression than pre-existing or no insomnia symptoms (P < .001). Pre-existing insomnia symptoms were also associated with higher levels of stress, anxiety, and depression than no insomnia symptoms (P < .001). Individuals who met likely criteria for acute insomnia also reported higher stress, anxiety, and depression than those with insomnia disorder (P < .001). Across all groups, individuals reporting a previous mental health diagnosis had worse stress, anxiety, and depression than those without a previous mental health diagnosis (P < .001). Last, individuals from South Africa reported higher levels of stress, anxiety, and depression than other countries (P < .01). CONCLUSIONS Internationally, individuals with pre-existing and post-pandemic insomnia symptoms may be more susceptible to stress, anxiety, and depression during the COVID-19 pandemic. Public health initiatives should include insomnia management to improve mental health during the pandemic. CITATION Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097.
Collapse
Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Moira F. Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy A. Finck
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Meaklim H, Rehm IC, Monfries M, Junge M, Meltzer LJ, Jackson ML. Wake up psychology! Postgraduate psychology students need more sleep and insomnia education. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1955614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Moira Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- The Sleep Health Foundation, Blacktown, Australia
| | - Lisa J. Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| |
Collapse
|
11
|
Vestergaard CL, Vedaa Ø, Simpson MR, Faaland P, Vethe D, Kjørstad K, Langsrud K, Ritterband LM, Sivertsen B, Stiles TC, Scott J, Kallestad H. The effect of sleep-wake intraindividial variability in digital cognitive behaviour therapy for insomnia: A mediation analysis of a large-scale RCT. Sleep 2021; 44:6272558. [PMID: 33964166 PMCID: PMC8503826 DOI: 10.1093/sleep/zsab118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Study Objectives Digital cognitive behavioral therapy for insomnia (dCBT-I) is an effective treatment for insomnia. However, less is known about mediators of its benefits. The aim of the present study was to test if intraindividual variability in sleep (IIV) was reduced with dCBT-I, and whether any identified reduction was a mediator of dCBT-I on insomnia severity and psychological distress. Methods In a two-arm randomized controlled trial (RCT), 1720 adults with insomnia (dCBT-I = 867; patient education about sleep = 853) completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and sleep diaries, at baseline and 9-week follow-up. Changes in IIV were analyzed using linear mixed modeling followed by mediation analyses of ISI, HADS, and IIV in singular sleep metrics and composite measures (behavioral indices (BI-Z) and sleep disturbance indices (SI-Z)). Results dCBT-I was associated with reduced IIV across all singular sleep metrics, with the largest between-group effect sizes observed for sleep onset latency (SOL). Reduced IIV for SOL and wake after sleep onset had the overall greatest singular mediating effect. For composite measures, SI-Z mediated change in ISI (b = −0.74; 95% confidence interval (CI) −1.04 to −0.52; 13.3%) and HADS (b = −0.40; 95% CI −0.73 to −0.18; 29.2%), while BI-Z mediated minor changes. Conclusion Reductions in IIV in key sleep metrics mediate significant changes in insomnia severity and especially psychological distress when using dCBT-I. These findings offer important evidence regarding the therapeutic action of dCBT-I and may guide the future development of this intervention. Clinical trials Name: Overcoming Insomnia: Impact on Sleep, Health and Work of Online CBT-I Registration number: NCT02558647 URL: https://clinicaltrials.gov/ct2/show/NCT02558647?cond=NCT02558647&draw=2&rank=1
Collapse
Affiliation(s)
- Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Voss District Psychiatric Hospital, NKS Bjørkeli, Voss, Norway
| | - Melanie R Simpson
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Patrick Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Knut Langsrud
- St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,University of Newcastle, Newcastle, United Kingdom
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| |
Collapse
|
12
|
Hagen K, Nordahl H, Launes G, Kvale G, Öst LG, Hystad S, Hansen B, Solem S. Does Concentrated Exposure Treatment for Obsessive-Compulsive Disorder Improve Insomnia Symptoms? Results From a Randomized Controlled Trial. Front Psychiatry 2021; 12:625631. [PMID: 34489744 PMCID: PMC8417230 DOI: 10.3389/fpsyt.2021.625631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Insomnia is a substantial problem in patients with obsessive-compulsive disorder (OCD). There is, however, a lack of studies investigating changes in concurrent symptoms of insomnia in OCD after concentrated treatment. A recent randomized controlled trial randomized participants to the Bergen 4-day treatment (B4DT, n = 16), or 12 weeks of unguided self-help (SH, n = 16), or waitlist (WL, n = 16). Patients from the SH- and WL-group who wanted further treatment after the 12 weeks were then offered the B4DT (total of 42 patients treated with the B4DT). There were no significant differences in symptoms of insomnia between the conditions at post-treatment, but a significant moderate improvement at 3-month follow-up for patients who received the B4DT. Insomnia was not associated with OCD-treatment outcome, and change in symptoms of insomnia was mainly related to changes in depressive symptoms. The main conclusion is that concentrated exposure treatment is effective irrespective of comorbid insomnia, and that insomnia problems are moderately reduced following treatment.
Collapse
Affiliation(s)
- Kristen Hagen
- Department of Psychiatry, Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway.,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon Nordahl
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Clinic for B4DT, Haukeland University Hospital, Bergen, Norway
| | - Gunvor Launes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Sørlandet Sykehus, Department of Psychiatry, Kristiansand, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Clinic for B4DT, Haukeland University Hospital, Bergen, Norway
| | - Lars-Göran Öst
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Sigurd Hystad
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Sørlandet Sykehus, Department of Psychiatry, Kristiansand, Norway.,Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
13
|
Chen XY, Shi X, Li Y, Zhou Y, Chen H, Wang T, Fan F. Psychiatric comorbidity predicts sleep disturbances among adolescent earthquake survivors: a 10-year cohort study. Sleep Med 2020; 78:94-100. [PMID: 33418432 DOI: 10.1016/j.sleep.2020.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the prevalence of sleep disturbances 10 years after Wenchuan earthquake, and to explore whether comorbid post-traumatic stress disorder (PTSD) and depressive symptoms could predict sleep disturbances and whether such effects were modified by gender. METHODS Participants were 1357 adolescents in the Wenchuan Earthquake Adolescent Health Cohort Study (WEAHC). 799 of the participants completed the followed-up survey 10 years after the earthquake. At 12-month post-earthquake (T12m), a battery of standardized measures were used to assess individual earthquake exposure, sleep disturbances (insomnia symptoms and poor sleep quality), PTSD, and depressive symptoms. At 10 years post-earthquake (T10y), those survivors reported their sleep disturbances via an online survey. Data were analyzed using binary logistic regression. RESULTS The prevalence of insomnia (14.3%) and of poor sleep quality (19.8%) at T10y decreased when compared with it at T12m. After controlling for covariates, it is revealed that depression-only and comorbidity groups at T12m predicted sleep disturbances at T10y among the whole sample and males. As for females, who have depression-only and comorbidity were more likely to develop insomnia symptoms but not poor sleep quality. CONCLUSIONS Sleep disturbances remained highly prevalent among survivors even 10 years after the earthquake. Depression-only and comorbidity groups were related to higher risks of sleep disturbances, especially for males. Assessments and interventions targeting both depressive symptoms and comorbid PTSD to reduce sleep disturbances after a deadly disaster are warranted.
Collapse
Affiliation(s)
- Xiao-Yan Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
| | - Xuliang Shi
- College of Education, Hebei University, Hebei, China
| | - Yuanyuan Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
| | - Ya Zhou
- Department of Psychology, Lund University, 221 00 Lund, Sweden
| | - Huilin Chen
- Department of Psychology, University of Bath, Somerset, United Kingdom
| | - Tong Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
| | - Fang Fan
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China.
| |
Collapse
|
14
|
Sleep Deprivation and Neurological Disorders. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5764017. [PMID: 33381558 PMCID: PMC7755475 DOI: 10.1155/2020/5764017] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
Sleep plays an important role in maintaining neuronal circuitry, signalling and helps maintain overall health and wellbeing. Sleep deprivation (SD) disturbs the circadian physiology and exerts a negative impact on brain and behavioural functions. SD impairs the cellular clearance of misfolded neurotoxin proteins like α-synuclein, amyloid-β, and tau which are involved in major neurodegenerative diseases like Alzheimer's disease and Parkinson's disease. In addition, SD is also shown to affect the glymphatic system, a glial-dependent metabolic waste clearance pathway, causing accumulation of misfolded faulty proteins in synaptic compartments resulting in cognitive decline. Also, SD affects the immunological and redox system resulting in neuroinflammation and oxidative stress. Hence, it is important to understand the molecular and biochemical alterations that are the causative factors leading to these pathophysiological effects on the neuronal system. This review is an attempt in this direction. It provides up-to-date information on the alterations in the key processes, pathways, and proteins that are negatively affected by SD and become reasons for neurological disorders over a prolonged period of time, if left unattended.
Collapse
|
15
|
Lazarov A, Suarez-Jimenez B, Levi O, Coppersmith DDL, Lubin G, Pine DS, Bar-Haim Y, Abend R, Neria Y. Symptom structure of PTSD and co-morbid depressive symptoms - a network analysis of combat veteran patients. Psychol Med 2020; 50:2154-2170. [PMID: 31451119 PMCID: PMC7658641 DOI: 10.1017/s0033291719002034] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms. METHODS PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning. RESULTS The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample. CONCLUSIONS Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.
Collapse
Affiliation(s)
- Amit Lazarov
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin Suarez-Jimenez
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Ofir Levi
- Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
- Social Work Department, Ruppin Academic Center, Emek Hefer, Israel
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Daniel D. L. Coppersmith
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Gadi Lubin
- Division of Mental Health, Medical Corps, Israel Defense Forces, Israel
- The Jerusalem Mental Health Center, Eitanim-Kfar Shaul, Israel
| | - Daniel S. Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yair Bar-Haim
- School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Rany Abend
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, MD, USA
| | - Yuval Neria
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
16
|
Martin CM, Greene D, Harrell JP, Mwendwa DT, Williams CD, Horton S, Cradle M, Hudson BD, Taylor TR. The impact of social constraints on insomnia among African-American breast cancer survivors: The mediating role of fear of recurrence. Psychooncology 2020; 29:1296-1302. [PMID: 32458549 DOI: 10.1002/pon.5435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/25/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Insomnia is a significant concern among African-American breast cancer survivors (BCS). Social constraints (SC)-receiving unsupportive or critical responses when expressing trauma-related emotions-and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African-American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR. METHODS Sixty-four African-American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS. RESULTS The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Moreover, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41). CONCLUSIONS Experiencing SC from family and friends could produce cognitions that impact sleep for BCS, and FOR could be one of those cognitions. Family-based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impacts sleep.
Collapse
Affiliation(s)
- Chloé M Martin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danyella Greene
- Department of Psychology, Howard University, Washington, DC, USA.,College of Medicine, Howard University, Washington, DC, USA
| | - Jules P Harrell
- Department of Psychology, Howard University, Washington, DC, USA
| | | | | | - Sara Horton
- College of Medicine, Howard University, Washington, DC, USA
| | - Melanie Cradle
- Health Careers Opportunity Program, Howard University, Washington, DC, USA
| | - Briana D Hudson
- Health Careers Opportunity Program, Howard University, Washington, DC, USA
| | | |
Collapse
|
17
|
|
18
|
Jeon MS, Dhillon HM, Descallar J, Lam L, Allingham S, Koh ES, Currow DC, Agar MR. Prevalence and severity of sleep difficulty in patients with a CNS cancer receiving palliative care in Australia. Neurooncol Pract 2019; 6:499-507. [PMID: 31832221 DOI: 10.1093/nop/npz005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty. Methods A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patient-reported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty. Results Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients' clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care. Conclusions Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.
Collapse
Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Australia
| | - Joseph Descallar
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Lawrence Lam
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia
| | - Samuel Allingham
- Palliative Care Outcomes Collaboration, University of Wollongong, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| | - David C Currow
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia
| |
Collapse
|
19
|
Repetitive transcranial magnetic stimulation of the right parietal cortex for comorbid generalized anxiety disorder and insomnia: A randomized, double-blind, sham-controlled pilot study. Brain Stimul 2018; 11:1103-1109. [DOI: 10.1016/j.brs.2018.05.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/20/2018] [Accepted: 05/26/2018] [Indexed: 01/04/2023] Open
|
20
|
Jeon MS, Dhillon HM, Agar MR. Sleep disturbance of adults with a brain tumor and their family caregivers: a systematic review. Neuro Oncol 2018; 19:1035-1046. [PMID: 28340256 DOI: 10.1093/neuonc/nox019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The high incidence and psychophysiological morbidities of sleep disturbance in cancer have been increasingly recognized. Yet, more detailed understanding of sleep disturbance and options for management have been neglected areas in both clinical care and research. Brain tumor patients have been particularly overlooked. A systematic search of the literature from 1990 to 2015 was performed to review sleep disturbance in adults with primary or secondary brain tumor and their family caregivers. Fifty eligible studies were identified, of which 12 focused on sleep, 37 reported sleep items within a health-related quality of life measure and 1 reported caregivers' sleep. No sleep intervention has been developed or tested for brain tumor patients. Sleep disturbance and somnolence were frequently reported as the most severely rated symptoms within health-related quality of life across the disease course or treatments, along with fatigue. However, sleep-focused studies yielded inconsistent results in small samples of mostly benign brain tumors in long-term remission from total tumor resection. The research using standardized, multifaceted sleep assessments, particularly in patients with malignant brain tumor and caregivers who are undergoing treatment, is seriously lacking. A more systematic examination of sleep disturbance is warranted to inform the development of better symptom management programs in this population.
Collapse
Affiliation(s)
- Megan Soohwa Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Haryana M Dhillon
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, Australia; Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, Australia
| |
Collapse
|
21
|
Ioannides AA. Neurofeedback and the Neural Representation of Self: Lessons From Awake State and Sleep. Front Hum Neurosci 2018; 12:142. [PMID: 29755332 PMCID: PMC5932408 DOI: 10.3389/fnhum.2018.00142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/29/2018] [Indexed: 01/12/2023] Open
Abstract
Neurofeedback has been around for half a century, but despite some promising results it is not yet widely appreciated. Recently, some of the concerns about neurofeedback have been addressed with functional magnetic resonance imaging and magnetoencephalography adding their contributions to the long history of neurofeedback with electroencephalography. Attempts to address other concerns related to methodological issues with new experiments and meta-analysis of earlier studies, have opened up new questions about its efficacy. A key concern about neurofeedback is the missing framework to explain how improvements in very different and apparently unrelated conditions are achieved. Recent advances in neuroscience begin to address this concern. A particularly promising approach is the analysis of resting state of fMRI data, which has revealed robust covariations in brain networks that maintain their integrity in sleep and even anesthesia. Aberrant activity in three brain wide networks (i.e., the default mode, central executive and salience networks) has been associated with a number of psychiatric disorders. Recent publications have also suggested that neurofeedback guides the restoration of “normal” activity in these three networks. Using very recent results from our analysis of whole night MEG sleep data together with key concepts from developmental psychology, cloaked in modern neuroscience terms, a theoretical framework is proposed for a neural representation of the self, located at the core of a double onion-like structure of the default mode network. This framework fits a number of old and recent neuroscientific findings, and unites the way attention and memory operate in awake state and during sleep. In the process, safeguards are uncovered, put in place by evolution, before any interference with the core representation of self can proceed. Within this framework, neurofeedback is seen as set of methods for restoration of aberrant activity in large scale networks. The framework also admits quantitative measures of improvements to be made by personalized neurofeedback protocols. Finally, viewed through the framework developed, neurofeedback’s safe nature is revealed while raising some concerns for interventions that attempt to alter the neural self-representation bypassing the safeguards evolution has put in place.
Collapse
Affiliation(s)
- Andreas A Ioannides
- Laboratory for Human Brain Dynamics, AAI Scientific Cultural Services Ltd., Nicosia, Cyprus
| |
Collapse
|
22
|
Goldberger-Raskin BS, Gothelf D, Bachner-Melman R, Lang C, Kushnir J. The association between sleep disturbances of children with anxiety disorders and those of their mothers. Sleep Med 2018; 43:77-82. [DOI: 10.1016/j.sleep.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 10/01/2017] [Accepted: 10/08/2017] [Indexed: 10/18/2022]
|
23
|
Zhang J, Xu Z, Zhao K, Chen T, Ye X, Shen Z, Wu Z, Zhang J, Shen X, Li S. Sleep Habits, Sleep Problems, Sleep Hygiene, and Their Associations With Mental Health Problems Among Adolescents. J Am Psychiatr Nurses Assoc 2018; 24:223-234. [PMID: 28758527 DOI: 10.1177/1078390317715315] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies in adults suggested that sleep could be a significant contributor to mental health. However, little is known about their relationship in adolescents. OBJECTIVE The present study aimed to examine the overall associations of full-spectrum sleep behaviors, including sleep habits, sleep problems, and sleep hygiene, with mental health problems among adolescents in Shanghai, China. DESIGN A stratified, cluster random sample of 4,823 adolescents aged 11 to 20 years participated in a cross-sectional survey. The Adolescent Sleep Disturbance Questionnaire and the modified Adolescent Sleep Hygiene Scale were used to examine sleep behaviors. The Strengths and Difficulties Questionnaire was used to evaluate mental health problems. RESULTS Five sleep variables were found to be associated with adolescents' mental health. The five factors covered three sleep domains: sleep habits (later bedtime during weekdays), sleep problems (maintaining sleep difficulties, disorders of arousal), and sleep hygiene (poor emotion at bedtime, unstable sleep schedule). CONCLUSIONS The clinical significance of the findings lies in the emphasis of comprehensive screening of sleep in the predicting, diagnosis, nursing, and intervention of adolescents' mental health problems.
Collapse
Affiliation(s)
- Jinwen Zhang
- 1 Jinwen Zhang, MD, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiwei Xu
- 2 Zhiwei Xu, MD, PhD, Queensland University of Technology, Brisbane, Australia
| | - Kena Zhao
- 3 Kena Zhao, MD, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Chen
- 4 Ting Chen, MD, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuxia Ye
- 5 Xiuxia Ye, MD, PhD, Shanghai Jiao Tong University, Shanghai, China
| | - Zhifei Shen
- 6 Zhifei Shen, MD, PhD, Shanghai Academy of Educational Sciences, Shanghai, China
| | - Zengjiang Wu
- 7 Zengjiang Wu, MD, PhD, Shanghai Academy of Educational Sciences, Shanghai, China
| | - Jun Zhang
- 8 Jun Zhang, MD, PhD, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoming Shen
- 9 Xiaoming Shen, MD, PhD, Shanghai Jiao Tong University, Shanghai, China
| | - Shenghui Li
- 10 Shenghui Li, MD, PhD, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
24
|
Seow LSE, Abdin E, Chang S, Chong SA, Subramaniam M. Identifying the best sleep measure to screen clinical insomnia in a psychiatric population. Sleep Med 2017; 41:86-93. [PMID: 29425582 DOI: 10.1016/j.sleep.2017.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/29/2017] [Accepted: 09/13/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insomnia symptoms are highly prevalent among patients with psychiatric disorders, and this mandates the need to identify the best self-administered sleep measure to screen for clinical insomnia among them. METHODS A total of 400 psychiatric outpatients completed the Pittsburgh Sleep Quality Index, Insomnia Severity Index (ISI), Epworth Sleepiness Scale, Flinders Fatigue Scale, Functional Outcomes of Sleep Questionnaire, and Dysfunctional Beliefs and Attitudes about Sleep Scale in a cross-sectional study. The sensitivity, specificity, positive, and negative predictive values of these six sleep scales were assessed and compared in relation to both ICD-10 and DSM-5 insomnia disorder status established using the interviewer-administered Brief Insomnia Questionnaire. RESULTS Receiver operator characteristic curves with the area under the curve (AUC) revealed the ISI to be the most accurate measure to discriminate cases and non-cases on both ICD-10 (AUC = 0.88, 95% CI = 0.84-0.92) and DSM-5 (AUC = 0.82, 95% CI = 0.78-0.86) criteria with "good" accuracy. The cut-off scores of ≥14 and ≥ 11 for the ISI provided optimal sensitivity and specificity for the detection of ICD-10 and DSM-5 insomnia, respectively. DISCUSSION With the new calling from DSM-5 to treat sleep symptoms in the presence of a co-existing mental condition, early detection of psychiatric patients with clinically significantly insomnia using a simple but accurate self-report sleep measure becomes important. Our study suggests that the ISI could be used as a potential screening tool for comorbid insomnia disorder in patients with mental disorders.
Collapse
Affiliation(s)
| | | | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | |
Collapse
|
25
|
Masoodi Z, Ahmad I, Khurram F, Haq A. Changes in sleep architecture after burn injury: ‘Waking up’ to this unaddressed aspect of postburn rehabilitation in the developing world. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255031302100404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Zulqarnain Masoodi
- Department of Plastic, Burn & Reconstructive Surgery, Jawaharlal Nehru Medical College Hospital, AMU Campus, Aligarh, India
| | - Imran Ahmad
- Department of Plastic, Burn & Reconstructive Surgery, Jawaharlal Nehru Medical College Hospital, AMU Campus, Aligarh, India
| | - Fahud Khurram
- Department of Plastic, Burn & Reconstructive Surgery, Jawaharlal Nehru Medical College Hospital, AMU Campus, Aligarh, India
| | - Ansaul Haq
- Department of Plastic, Burn & Reconstructive Surgery, Jawaharlal Nehru Medical College Hospital, AMU Campus, Aligarh, India
| |
Collapse
|
26
|
Madsen MT, Isbrand A, Andersen UO, Andersen LJ, Taskiran M, Simonsen E, Gögenur I. The effect of MElatonin on Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome (MEDACIS): study protocol for a randomized controlled trial. Trials 2017; 18:81. [PMID: 28228148 PMCID: PMC5322602 DOI: 10.1186/s13063-017-1806-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/20/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Depression following acute coronary syndrome (ACS) constitutes a serious and debilitating problem. Approximately one in five patients will develop significant depression following ACS and less severe depressive symptoms are even more frequent. Furthermore, anxiety symptoms and sleep-wake disturbances are frequent. The objective of the MEDACIS trial is to investigate whether prophylactic treatment with melatonin has a preventive effect on depression, depressive and anxiety symptoms, sleep, and circadian disturbances following ACS. METHODS/DESIGN "The effect of MElatonin and Depressive symptoms, Anxiety, CIrcadian and Sleep disturbances in patients after acute coronary syndrome" trial (MEDACIS) is a multicenter, double-blinded, placebo-controlled, randomized clinical trial. A total of 240 patients with ACS and no depressive symptoms will be included in the trial for treatment with either 25 mg melatonin or placebo for a 12-week period. Development and severity of depressive symptoms will be evaluated using Major Depression Inventory every 2 weeks with the purpose of investigating the potential preventive effect of melatonin on depressive symptoms. DISCUSSION Previously, only selective serotonin reuptake inhibitors (SSRIs) have been investigated in a primary preventive setup in patients following ACS. However, SSRIs are associated with several side effects. An ideal intervention would constitute the highest degree of prevention of depressive symptoms with the lowest risk of side effects. In this regard, melatonin may have advantages due to its low toxicity as well as its proven anxiolytic and hypnotic effects. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02451293 . Registered on 12 May 2015. EudraCT nr. 2015-002116-32.
Collapse
Affiliation(s)
- Michael Tvilling Madsen
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
- Department of Cardiology, Holbaek Hospital, Smedelundsgade 60, 4300 Holbaek, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
| | - Anders Isbrand
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | | | - Lars Juel Andersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Koegevej 7-13, 4000 Roskilde, Denmark
| | - Mustafa Taskiran
- Department of Cardiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, Faelledvej 6, Bygning 3, 4. Sal., 4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, University of Copenhagen, Lykkebaekvej 1, 4600 Koege, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
Wallace R. Sleep, Psychopathology, and Culture. COMPUTATIONAL PSYCHIATRY 2017. [DOI: 10.1007/978-3-319-53910-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
|
28
|
Conti EC, Stanley MA, Amspoker AB, Kunik ME. Sedative-Hypnotic Use Among Older Adults Participating in Anxiety Research. Int J Aging Hum Dev 2016; 85:3-17. [DOI: 10.1177/0091415016685330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Older adults are prescribed sedative-hypnotic medications at higher rates than younger adults. These are not recommended for older adults due to risk of sedation, cognitive impairment, and falls. Severe generalized anxiety disorder (GAD) is a possibly appropriate use of these medications in older people, but little is available on use of sedative-hypnotic medications among older adults with GAD. This study examined the frequency and predictors of sedative-hypnotic medication use among older adults screening positive for anxiety. 25.88% ( n = 125) of participants reported taking sedative-hypnotics over the past 3 months; 16.36% ( n = 79) reported taking benzodiazepines, and 12.22% ( n = 59) reported taking hypnotic sleep medications. Depressive symptoms were more strongly associated with sedative-hypnotic use than insomnia or worry. Major depressive disorder and posttraumatic stress disorder, but not GAD, predicted sedative-hypnotic use. Other medications and treatments are more appropriate and efficacious for depression, anxiety, and insomnia in this population.
Collapse
Affiliation(s)
- Elizabeth C. Conti
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Melinda A. Stanley
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Amber B. Amspoker
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E. Kunik
- HSR&D Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| |
Collapse
|
29
|
Wallace R. High metabolic demand in neural tissues: Information and control theory perspectives on the synergism between rate and stability. J Theor Biol 2016; 409:86-96. [PMID: 27582301 DOI: 10.1016/j.jtbi.2016.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/13/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
Evolutionary process has been selected for inherently unstable systems in higher animals that can react swiftly to changing patterns of threat or opportunity, for example blood pressure, the immune response, and gene expression. However, these require continual strict regulation: uncontrolled blood pressure is fatal, immune cells can attack 'self' tissues, and improper gene expression triggers developmental disorders. Consciousness in particular demands high rates of metabolic free energy to both operate and regulate the fundamental biological machinery: both the 'stream of consciousness' and the 'riverbanks' that confine it to useful realms are constructed and reconstructed moment-by-moment in response to highly dynamic internal and environmental circumstances. We develop powerful necessary conditions models for such phenomena based on the Data Rate Theorem linking control and information theories in the context of inherent instability. The synergism between conscious action and its regulation underlies the ten-fold higher rate of metabolic energy consumption in human neural tissues and implies a close, culturally modulated relation between sleep disorders and certain psychopathologies.
Collapse
Affiliation(s)
- Rodrick Wallace
- Division of Epidemiology, The New York State Psychiatric Institute, United States.
| |
Collapse
|
30
|
Ouellet MC, Savard J, Morin CM. Book Review: Insomnia following Traumatic Brain Injury: A Review. Neurorehabil Neural Repair 2016; 18:187-98. [DOI: 10.1177/1545968304271405] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sleep disturbances after a traumatic brain injury (TBI) have received very little scientific attention despite the fact that several studies indicate that they may occur in 30% to 70% of patients. For individuals with TBI, problems falling asleep or maintaining sleep can exacerbate other symptoms such as pain, cognitive deficits, fatigue, or irritability. Sleep disturbances can thus compromise the rehabilitation process and the ability to return to work. This article reviews the evidence on the epidemiology, etiology, and treatment of insomnia in the context of TBI and proposes areas for future research. Prevalence estimates of insomnia complaints in TBI patients are summarized. Potential etiological factors (i.e., lesions to the nervous system, anxiety) and possible consequences of insomnia (i.e., fatigue, cognitive problems) in the context of TBI are discussed. Finally, pharmacological and psychological treatments previously shown effective to treat insomnia in healthy individuals are discussed as valuable treatment options for TBI patients. Increased knowledge about the high prevalence, diagnosis, and potential etiological factors of insomnia following TBI may promote a better identification, evaluation, and treatment of sleeping difficulties in this population.
Collapse
Affiliation(s)
- Marie-Christine Ouellet
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada,
| | - Josée Savard
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada
| | - Charles M. Morin
- École de Psychologie, Centre d’Étude des Troubles du Sommeil, Université Laval, Québec, Canada
| |
Collapse
|
31
|
Henry AL, Kyle SD, Bhandari S, Chisholm A, Griffiths CEM, Bundy C. Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review. PLoS One 2016; 11:e0157843. [PMID: 27327082 PMCID: PMC4915697 DOI: 10.1371/journal.pone.0157843] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 06/06/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature. METHODS Searches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings. RESULTS Searches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting. CONCLUSION This review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.
Collapse
Affiliation(s)
- Alasdair L. Henry
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
- * E-mail:
| | - Simon D. Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sahil Bhandari
- Manchester Medical School, University of Manchester, Manchester, United Kingdom
| | - Anna Chisholm
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Christopher E. M. Griffiths
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Christine Bundy
- Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
32
|
Prospective study of predictors and consequences of insomnia: personality, lifestyle, mental health, and work-related stressors. Sleep Med 2015; 20:51-8. [PMID: 27318226 DOI: 10.1016/j.sleep.2015.12.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To prospectively investigate the reciprocal relationships between personality traits, lifestyle factors, mental health, sleepiness, and work-related stressors against insomnia. METHODS A total of 799 Norwegian shift-working nurses (mean age 33.2 years, 90% female) participated in this prospective cohort study. They were assessed on self-report instruments (Bergen Insomnia Scale, Diurnal Type Scale, Hospital Anxiety and Depression Scale, Negative Acts Questionnaire-Revised, Work-Family Interface Scale, among others) in 2008/2009 (wave 1) and 2011 (wave 3). Structural equation modeling was employed to investigate the bidirectional relationship between a wide range of individual and work-related variables and insomnia. RESULTS Languidity (β = 0.18***), anxiety (β = 0.11**), depression (β = 0.14***), exposure to bullying behavior (β = 0.08*), and negative spillover between work and family life (work to family, β = 0.08*; family to work, β = 0.07*) predicted increased symptoms of insomnia over time. Morningness (β = -0.09*) and positive spillover from work to family (β = -0.11**) predicted less symptoms of insomnia over time. No support was found for night work as a predictor of increased insomnia. Insomnia was a precursor for anxiety (β = 0.11**), but not for depression (*p <0.05, **p <0.01, ***p <0.001). CONCLUSION The data suggested that insomnia more often emerges as a consequence of individual and work-related factors than as a precursor to them. The scope of factors causing insomnia, and factors protecting against it, should be further investigated. Insomnia should be considered in prediction models for mental illnesses and as an outcome of adverse work-related experiences.
Collapse
|
33
|
Fagundes C, LeRoy A, Karuga M. Behavioral Symptoms after Breast Cancer Treatment: A Biobehavioral Approach. J Pers Med 2015; 5:280-95. [PMID: 26247972 PMCID: PMC4600148 DOI: 10.3390/jpm5030280] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/17/2015] [Accepted: 07/23/2015] [Indexed: 01/18/2023] Open
Abstract
Being diagnosed and treated for breast cancer is emotionally and physically challenging. Breast cancer is the most commonly diagnosed cancer and the second leading cause of death for women in the United States. Accordingly, women with a breast cancer history are the largest group of female cancer survivors. Psychological stress substantially augments adverse autonomic, endocrine, and immune discharge, including enhanced production of proinflammatory cytokines. Importantly, inflammation is a key biological mechanism underlying the symptom cluster of pain, depression, fatigue, and sleep disturbances; there is also good evidence that inflammation contributes to breast cancer recurrence. Stress may exert direct effects on psychological and physiological risk processes. In this review, we take a biobehavioral approach to understanding predictors and mechanisms underlying somatic symptoms in breast cancer survivors.
Collapse
Affiliation(s)
- Christopher Fagundes
- Department of Psychology, Rice University, Houston, TX 77005, USA.
- Department of Symptoms Research, MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA.
| | - Angie LeRoy
- Department of Psychology, University of Houston, Houston, TX 77004, USA.
| | - Maryanne Karuga
- Department of Science, Technology, Engineering, and Mathematics, Dillard University, New Orleans, LA 70122, USA.
| |
Collapse
|
34
|
Timpano KR, Carbonella JY, Bernert RA, Schmidt NB. Obsessive compulsive symptoms and sleep difficulties: exploring the unique relationship between insomnia and obsessions. J Psychiatr Res 2014; 57:101-7. [PMID: 25038630 DOI: 10.1016/j.jpsychires.2014.06.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS. METHODS Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions. RESULTS Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia. CONCLUSIONS Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.
Collapse
|
35
|
Night-time experiences and daytime dissociation: a path analysis modeling study. Psychiatry Res 2014; 216:236-41. [PMID: 24560022 DOI: 10.1016/j.psychres.2013.12.053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/03/2013] [Accepted: 12/29/2013] [Indexed: 11/22/2022]
Abstract
Dissociative symptoms may be the by-products of a labile sleep-wake cycle (Koffel and Watson, 2009a). This may help to explain why dissociation overlaps with fantasy proneness and cognitive failures. Using path analysis, we tested to what extent data gathered in a nonclinical, predominantly female sample (N=139) supported two conceptual models. The first model assumes that unusual sleep experiences increase fantasy proneness and cognitive failures, which in turn encourage trait dissociation and reports of trauma. The second model assumes that trauma leads to dissociative experiences both directly and through its influence on sleep. In this cross-sectional design, the data were reasonably well described by both models. Importantly, in both models, unusual sleep experiences serve as antecedents of trait dissociation. Our analysis underlines the importance of unusual sleep experiences and may inspire treatment intervention focusing on sleep normalization.
Collapse
|
36
|
Steinan MK, Krane-Gartiser K, Langsrud K, Sand T, Kallestad H, Morken G. Cognitive behavioral therapy for insomnia in euthymic bipolar disorder: study protocol for a randomized controlled trial. Trials 2014; 15:24. [PMID: 24433249 PMCID: PMC3903553 DOI: 10.1186/1745-6215-15-24] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with bipolar disorder experience sleep disturbance, even in euthymic phases. Changes in sleep pattern are frequent signs of a new episode of (hypo)mania or depression. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for primary insomnia, but there are no published results on the effects of CBT-I in patients with bipolar disorder. In this randomized controlled trial, we wish to compare CBT-I and treatment as usual with treatment as usual alone to determine its effect in improving quality of sleep, stabilizing minor mood variations and preventing new mood episodes in euthymic patients with bipolar disorder and comorbid insomnia. METHODS Patients with euthymic bipolar I or II disorder and insomnia, as verified by the Structured Clinical Interview for DSM Disorders (SCID-1) assessment, will be included. The patients enter a three-week run-in phase in which they complete a sleep diary and a mood diary, are monitored for seven consecutive days with an actigraph and on two of these nights with polysomnography in addition before randomization to an eight-week treatment trial. Treatment as usual consists of pharmacological and supportive psychosocial treatment. In this trial, CBT-I will consist of sleep restriction, psychoeducation about sleep, stabilization of the circadian rhythm, and challenging and correcting sleep state misperception, in three to eight sessions. DISCUSSION This trial could document a new treatment for insomnia in bipolar disorder with possible effects on sleep and on stability of mood. In addition, more precise information can be obtained about the character of sleep disturbance in bipolar disorder. TRIAL REGISTRATION ClinicalTrials.gov: NCT01704352.
Collapse
Affiliation(s)
- Mette Kvisten Steinan
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Østmarka Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Karoline Krane-Gartiser
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Knut Langsrud
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Østmarka Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Østmarka Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Østmarka Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Østmarka Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| |
Collapse
|
37
|
Markarian SA, Pickett SM, Deveson DF, Kanona BB. A model of BIS/BAS sensitivity, emotion regulation difficulties, and depression, anxiety, and stress symptoms in relation to sleep quality. Psychiatry Res 2013; 210:281-6. [PMID: 23845417 DOI: 10.1016/j.psychres.2013.06.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Abstract
Recent research has indicated that interactions between behavioral inhibition system (BIS)/behavioral activation system (BAS) sensitivity and emotion regulation (ER) difficulties increases risk for psychopathology. Considering sleep quality (SQ) has been linked to emotion regulation difficulties (ERD) and psychopathology, further investigation of a possible mechanism is needed. The current study examined associations between BIS/BAS sensitivity, ERD, and SQ to depression, anxiety, and stress symptoms in an undergraduate sample (n=459). Positive relationships between BIS sensitivity and both ERD and stress symptoms, and negative relationships between BAS-reward sensitivity and both ERD and depression symptoms were observed. Furthermore, ERD were positively related to depression, anxiety, and stress symptoms. Succeeding analyses revealed differential relationships between ERD and depression, anxiety, and stress symptoms among good quality and poor quality sleepers. The findings are discussed within the context of personality dimensions and self-regulatory mechanisms, along with implications for the treatment of depression, anxiety and sleep difficulties.
Collapse
|
38
|
Kallestad H, Hansen B, Langsrud K, Ruud T, Morken G, Stiles TC, Gråwe RW. Impact of sleep disturbance on patients in treatment for mental disorders. BMC Psychiatry 2012; 12:179. [PMID: 23107000 PMCID: PMC3505143 DOI: 10.1186/1471-244x-12-179] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 10/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In clinical practice, sleep disturbance is often regarded as an epiphenomenon of the primary mental disorder. The aim of this study was to test if sleep disturbance, independently of primary mental disorders, is associated with current clinical state and benefit from treatment in a sample representative of public mental health care clinics. METHOD 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses. RESULTS Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment. CONCLUSION Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.
Collapse
Affiliation(s)
- Håvard Kallestad
- Division of Psychiatry, Department of Research and Development, St Olav's University Hospital, Trondheim, Norway.
| | - Bjarne Hansen
- Faculty of Medicine, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,Division of Psychiatry, Department of Østmarka, St. Olav’s University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Faculty of Medicine, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,Division of Psychiatry, Department of Østmarka, St. Olav’s University Hospital, Trondheim, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Oslo, Norway,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Morken
- Faculty of Medicine, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C Stiles
- Faculty of Social Sciences and Technology Management, Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rolf W Gråwe
- Institute of Clinical Medicine, Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway,Drug and Alcohol Treatment Health Trust Central Norway, Department of Research and Development, Trondheim, Norway
| |
Collapse
|
39
|
Engel-Yeger B, Shochat T. The Relationship between Sensory Processing Patterns and Sleep Quality in Healthy Adults. The Canadian Journal of Occupational Therapy 2012; 79:134-41. [DOI: 10.2182/cjot.2012.79.3.2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. Sleep quality affects a person's performance and quality of life. Poor sleep was recently associated with hyperarousability and difficulties in processing sensory input. Purpose. To examine the relationships between sensory-processing difficulties (SPD) and sleep quality in healthy adults. Methods. The 185 participants, aged 21 to 60 (mean 33.64 ± 8.69), completed the Adolescent/Adult Sensory Profile (AASP) and the Pittsburgh Sleep Quality Index (PSQI). Findings. Sleep quality significantly correlated with sensory-processing patterns characterized by hypersensitivity. These patterns were manifested in specific modalities (tactile, visual, and auditory), which significantly predicted sleep quality. Implications. Sleep quality may be related to predisposing, sensory-processing patterns, particularly to hypersensitivity. Occupational therapists should refer to the possible relationship between SPD and sleep quality when treating individuals with SPD or poor sleepers. This may assist in implementing the optimal intervention based on the person's specific needs and contribute to performance and quality of life.
Collapse
Affiliation(s)
| | - Tamar Shochat
- Tamar Shochat, DSc, Associate Professor, Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, 31905, ISRAEL
| |
Collapse
|
40
|
Hood HK, Carney CE, Harris AL. Rethinking safety behaviors in insomnia: examining the perceived utility of sleep-related safety behaviors. Behav Ther 2011; 42:644-54. [PMID: 22035993 DOI: 10.1016/j.beth.2011.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 02/09/2011] [Accepted: 02/10/2011] [Indexed: 11/19/2022]
Abstract
Harvey's cognitive model of insomnia (2002a) proposes that sleep-related safety behaviors play a central role in the maintenance of insomnia because such maladaptive coping strategies are thought to reinforce threat-based appraisals of the likelihood and consequences of poor sleep. Research to date has assessed the frequency of safety behavior use in those with insomnia only; however, in addition to the frequency of occurrence, the function of safety behaviors (i.e., a belief that they will prevent a feared outcome from occurring), may be an important consideration. The purpose of this study was to examine sleep-related safety behaviors based on an expanded theoretical understanding of such behaviors across psychological disorders; that is, by examining both their frequency and perceived utility. Undergraduate students (N=376) completed an online survey about their sleep, mood, and use of sleep-related safety behaviors. Insomnia severity was associated with a greater perceived need to use safety behaviors (i.e., utility) but not with frequency of safety behavior use. Higher perceived utility of safety behaviors was also associated with unhelpful beliefs about sleep, fear and avoidance of fatigue, and both general and sleep-specific helplessness. These results suggest that these behaviors and the associated underlying maladaptive beliefs may be important targets in cognitive behavioral therapy for insomnia. The current study extends the existing literature and refines the concept of safety behaviors in insomnia to include both the function and frequency of these behaviors.
Collapse
Affiliation(s)
- Heather K Hood
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada M5B 2K3
| | | | | |
Collapse
|
41
|
Kallestad H, Hansen B, Langsrud K, Ruud T, Morken G, Stiles TC, Gråwe RW. Differences between patients' and clinicians' report of sleep disturbance: a field study in mental health care in Norway. BMC Psychiatry 2011; 11:186. [PMID: 22112049 PMCID: PMC3231868 DOI: 10.1186/1471-244x-11-186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 11/23/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aims of the study was to assess the prevalence of diagnosed insomnia and the agreement between patient- and clinician-reported sleep disturbance and use of prescribed hypnotic medication in patients in treatment for mental disorders. METHODS We used three cross-sectional, multicenter data-sets from 2002, 2005, and 2008. Data-set 1 included diagnostic codes from 93% of all patients receiving treatment in mental health care in Norway (N = 40261). Data-sets 2 (N = 1065) and 3 (N = 1181) included diagnostic codes, patient- and clinician-reported sleep disturbance, and use of prescribed hypnotic medication from patients in 8 mental health care centers covering 10% of the Norwegian population. RESULTS 34 patients in data-set 1 and none in data-sets 2 and 3 had a diagnosis of insomnia as a primary or comorbid diagnosis. In data-sets 2 and 3, 42% and 40% of the patients reported sleep disturbance, whereas 24% and 13% had clinician-reported sleep disturbance, and 7% and 9% used hypnotics. Patients and clinicians agreed in 29% and 15% of the cases where the patient or the clinician or both had reported sleep disturbance. Positive predictive value (PPV) of clinicians' evaluations of patient sleep disturbance was 62% and 53%. When the patient reported sleep disturbance as one of their most prominent problems PPV was 36% and 37%. Of the patients who received hypnotic medication, 23% and 29% had neither patient nor clinician-rated sleep disturbance. CONCLUSION When patients meet the criteria for a mental disorder, insomnia is almost never diagnosed, and sleep disturbance is imprecisely recognized relative to the patients' experience of sleep disturbance.
Collapse
Affiliation(s)
- Håvard Kallestad
- Division of Psychiatry, Department of Research and Development, St Olav's University Hospital, Trondheim, Norway.
| | - Bjarne Hansen
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience. Trondheim, Norway,St. Olav's University Hospital, Division of Psychiatry, Department of Østmarka. Trondheim, Norway
| | - Knut Langsrud
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience. Trondheim, Norway,St. Olav's University Hospital, Division of Psychiatry, Department of Østmarka. Trondheim, Norway
| | - Torleif Ruud
- Akershus University Hospital, Division of Mental Health Services. Norway,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine. Oslo, Norway
| | - Gunnar Morken
- Norwegian University of Science and Technology, Faculty of Medicine, Department of Neuroscience. Trondheim, Norway
| | - Tore C Stiles
- Norwegian University of Science and Technology, Faculty of Social Sciences and Technology Management, Department of Psychology. Trondheim, Norway
| | - Rolf W Gråwe
- University of Oslo, Institute of Clinical Medicine, Norwegian Centre for Addiction Research, Oslo, Norway,Drug and Alcohol Treatment Health Trust Central Norway. Department of Research and Development, Trondheim, Norway
| |
Collapse
|
42
|
Marques M, Bos S, Soares MJ, Maia B, Pereira AT, Valente J, Gomes AA, Macedo A, Azevedo MH. Is insomnia in late pregnancy a risk factor for postpartum depression/depressive symptomatology? Psychiatry Res 2011; 186:272-80. [PMID: 20638730 DOI: 10.1016/j.psychres.2010.06.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 05/06/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
Abstract
The aim of the present work was to investigate if insomnia in late pregnancy is a risk factor for postpartum depressive symptomatology/postpartum depression (PPD). 581 women in their last trimester of pregnancy answered questions/questionnaires about lifetime history of insomnia, current sleep perception, current mood and depressive symptomatology. They were interviewed with the Portuguese version of the Diagnostic Interview for Genetic Studies. After delivery 382 (65.7%) mothers participated again in the study. Insomnia in pregnancy was not a risk factor for PPD (DSM-IV or ICD-10) but was a significant predictor of postpartum depressive symptomatology. Negative Affect (NA) was a significant predictor of postpartum depressive symptomatology. Women with higher NA were 4.6 (CI95%=1.69-12.74) and 5.3 times (CI95%=2.26-12.58) more likely of experiencing PPD (DSM-IV/ICD-10, respectively) than women with lower NA. Lifetime Depression was a significant predictor of postpartum depressive symptomatology and ICD-10/PPD (OR=2.6; CI95%=1.16-4.38). Positive Affect (PA) showed to be a protective factor for postpartum depressive symptomatology and DSM-IV/PPD (OR=1.5; CI95%=1.20-2.33). Controlling NA, PA and Lifetime Depression, insomnia lost its predictive role, suggesting these variables might work as mediators. Associations between insomnia, NA, PA and Lifetime Depression should be assessed in pregnancy. This might help to preventively target NA, enhance PA and reduce the likelihood of experiencing postpartum depressive symptomatology.
Collapse
Affiliation(s)
- Mariana Marques
- Institute of Medical Psychology, University of Coimbra, Coimbra, Portugal.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Dependent negative life events and sleep quality: An examination of gene–environment interplay. Sleep Med 2011; 12:403-9. [DOI: 10.1016/j.sleep.2010.09.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/23/2010] [Accepted: 09/09/2010] [Indexed: 11/18/2022]
|
44
|
Dohrenwend BP. Toward a Typology of High-Risk Major Stressful Events and Situations in Posttraumatic Stress Disorder and Related Psychopathology. PSYCHOLOGICAL INJURY & LAW 2010; 3:89-99. [PMID: 20975984 DOI: 10.1007/s12207-010-9072-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The diagnosis of posttraumatic stress disorder (PTSD) was introduced in 1980 with the publication of the Diagnostic and Statistical Manual of the American Psychiatric Association, Third Edition (DSM-III). DSM-III put forward a novel syndrome consisting of intrusive, avoidance/numbing, and arousal symptoms as distinctive psychopathology following exposure to traumatic events. The traumatic stressors, although expanded in later editions published in 1987 (DSM-III-R) and 1994 (DSM-IV), focus on life-threatening events and situations. However, at least 12 studies, most of them recent, have found associations between the PTSD symptoms and the PTSD symptom syndrome with stressors, such as unemployment and divorce that would not qualify, even in the broadened DSM-IV diagnosis, as traumatic stressors. These findings challenge the basic assumption on which the PTSD diagnosis is based, the assumption that exposure to life-threatening stressors is the primary cause of a unique set of stress response symptoms. The purpose of this paper is to show how to confront this challenge by developing a typology of stressful situations and events that can be tested systematically for their relation to the PTSD symptom syndrome and other relevant variables. The typology includes but is not limited to the types of situations and events defined as "traumatic" in the DSMs.
Collapse
Affiliation(s)
- B P Dohrenwend
- Columbia University, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
45
|
Siomos KE, Avagianou PA, Floros GD, Skenteris N, Mouzas OD, Theodorou K, Angelopoulos NV. Psychosocial correlates of insomnia in an adolescent population. Child Psychiatry Hum Dev 2010; 41:262-73. [PMID: 19949972 DOI: 10.1007/s10578-009-0166-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines the nature of the relationship between psychosocial factors and insomnia complaints in an adolescent non-clinical population. It is a cross-sectional study of a stratified sample of 2,195 Greek adolescent high-school students. Subjects were given the Athens insomnia scale, the Symptom Checklist scale (SCL-90-R) and a questionnaire concerning demographic characteristics. None of the subjects had received help for insomnia complaints or other overt psychopathology. Adolescents classified as suffering from insomnia presented higher levels of general psychopathology. Age, tobacco and alcohol use, self-reported patterns of communication in the family, perceived economic status and school performance were identified as correlates of the insomnia complaints. A significant number of adolescents fail to receive appropriate treatment for insomnia. Psychosocial correlates are important factors to consider when faced with insomnia complaints in this age group. More research is needed in important timelines in the developmental history of a young adult.
Collapse
Affiliation(s)
- Konstantinos E Siomos
- Department of Psychiatry, University of Thessaly Medical School, University Hospital, Larisa, Greece.
| | | | | | | | | | | | | |
Collapse
|
46
|
Barclay NL, Gregory AM. The presence of a perseverative iterative style in poor vs. good sleepers. J Behav Ther Exp Psychiatry 2010; 41:18-23. [PMID: 19733343 DOI: 10.1016/j.jbtep.2009.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 07/30/2009] [Accepted: 08/11/2009] [Indexed: 11/28/2022]
Abstract
Catastrophizing is present in worriers and poor sleepers. This study investigates whether poor sleepers possess a 'perseverative iterative style' which predisposes them to catastrophize any topic, regardless of content or affective valence, a style previously found to occur more commonly in worriers as compared to others. Poor (n=23) and good sleepers (n=37) were distinguished using the Pittsburgh Sleep Quality Index (PSQI), from a sample of adults in the general population. Participants were required to catastrophize 2 topics: worries about sleep, and a current personal worry; and to iterate the positive aspects of a hypothetical topic. Poor sleepers catastrophized/iterated more steps to a greater extent than good sleepers to these three interviews, (F(1, 58)=7.35, p<.05). However, after controlling for anxiety and worry, this effect was reduced to non-significance for the 'sleep' and 'worry' topics, suggesting that anxiety may mediate some of the association between catastrophizing and sleep. However there was still a tendency for poor sleepers to iterate more steps to the 'hypothetical' topic, after controlling for anxiety and worry, which also suggests that poor sleepers possess a cognitive style which may predispose them to continue iterating consecutive steps to open-ended tasks regardless of anxiety and worry. Future research should examine whether the presence of this cognitive style is significant in leading to or maintaining insomnia.
Collapse
Affiliation(s)
- N L Barclay
- Department of Psychology, University of London, New Cross, UK.
| | | |
Collapse
|
47
|
Abstract
Although sleep problems often comprise core features of psychiatric disorders, inadequate attention has been paid to the complex, reciprocal relationships involved in the early regulation of sleep, emotion, and behavior. In this paper, we review the pediatric literature examining sleep in children with primary psychiatric disorders as well as evidence for the role of early sleep problems as a risk factor for the development of psychopathology. Based on these cumulative data, possible mechanisms and implications of early sleep disruption are considered. Finally, assessment recommendations for mental health clinicians working with children and adolescents are provided toward reducing the risk of and improving treatments for sleep disorders and psychopathology in children and adolescents.
Collapse
Affiliation(s)
- Candice A Alfano
- Children's National Medical Center, The George Washington University School of Medicine
| | | |
Collapse
|
48
|
Kendall-Tackett KA. Inflammation, cardiovascular disease, and metabolic syndrome as sequelae of violence against women: the role of depression, hostility, and sleep disturbance. TRAUMA, VIOLENCE & ABUSE 2007; 8:117-26. [PMID: 17545569 DOI: 10.1177/1524838007301161] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Women who experience violence are significantly more likely to have serious health problems above and beyond any injuries they might incur. The intriguing question is why this is so. In this article, the author describes how three sequelae of violence against women-depression, hostility, and sleep disturbance-can increase the risk of disease. One possible mechanism by which these sequelae increase risk is by elevating levels of pro-inflammatory cytokines. These cytokines have an adaptive function in fighting infection and repairing injured tissues. However, chronically high levels of pro-inflammatory cytokines have been implicated in a wide range of diseases. The author focuses on two illnesses that have not received much attention in the violence against women (VAW) literature: cardiovascular disease and metabolic syndrome, the precursor to type 2 diabetes. Preliminary studies also suggest that treatments that can lower inflammation may be promising adjuncts for survivors of VAW.
Collapse
|
49
|
Abstract
A sample of 358 Kuwaiti volunteer college students responded to the Insomnia Scale, the Somatic Symptoms Inventory, and the Center for Epidemiologic Studies-Depression Scale. The only significant sex difference was in somatic symptoms on which women had a higher mean score than the men. Correlations between scores on the Insomnia Scale and both Depression scales were .51 and .54 and for Somatic Symptoms were .53 and .61 (p < .01) among men and women, respectively. The factor analysis of the intercorrelations yielded a highly loaded general factor for Psychological Disorder in both samples.
Collapse
Affiliation(s)
- Freih O El-Anzi
- The Public Authority for Applied Education and Training, Kuwait
| |
Collapse
|
50
|
Jansson M, Linton SJ. The role of anxiety and depression in the development of insomnia: Cross-sectional and prospective analyses. Psychol Health 2006. [DOI: 10.1080/14768320500129015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|