Sleep and mood in older adults: coinciding changes in insomnia and depression symptoms

A longitudinal network analysis of interaction factors among Chinese women at high risk for perinatal depression

OBJECTIVE

Few studies have applied a health ecological model to understand perinatal depression among high-risk women, and existing research remains primarily cross-sectional in nature. This study aimed to explore the interplay among family function, perceived stress, insomnia symptoms, cognitive reactivity subscales (such as hopelessness/suicidality, aggression, control/perfectionism, avoidant coping, and acceptance/coping), mindfulness subscales (including attention, present focus, awareness, and acceptance), physiological indicators (e.g., hgb, 25-hydroxyvitamin D, and HbA1C), and depressive symptoms in Chinese high-risk women during the perinatal period.

DESIGN

This was a longitudinal population-based cohort study.

SETTING

This two-wave prospective study was conducted in Fujian Province, China, from December 2021 to January 2023.

PARTICIPANTS

We used convenience sampling to enroll 368 pregnant patients from obstetrical clinics and inpatient departments of three tertiary hospitals (level 3) in Fuzhou and Quanzhou City, Fujian Province, China.

MEASUREMENTS AND FINDINGS

In the statistical analysis, cross-sectional data were analyzed via the contemporaneous network method, and longitudinal data were analyzed via the cross-lagged panel network method. The core symptoms in the depression-related symptom network during the third trimester and three months postpartum were identified as attention (ATT) (strength = 1.02) and acceptance/coping (ACC) (strength = 1.19). All bridge symptoms were shown as depression (EPDS) (bridging strength = 0.07 and 0.09). A comparison between the first and second survey networks showed a reduced edge weight for the association between depressive symptoms and insomnia symptoms (to 0 in the second survey network, diff = -0.18, P < 0.001). Conversely, the association between depressive symptoms and control/perfectionism increased to 0.252 (diff = 0.25, P < 0.001). Through cross-lagged panel network analysis, the EPDS (out strength = 3.68, OEI =3.60) was identified as the most influential symptom and the most predictable symptom (R² = 0.76). Perceived stress (PSS) (in strength = 2.49) and hopelessness/suicidality (HOP) (IEI = 1.96) were identified as the most susceptible symptoms.

KEY CONCLUSIONS

Cross-sectional network analysis combined with longitudinal network analysis revealed the mechanism of action between symptoms. Attention (ATT) and acceptance/coping (ACC) were identified as the core symptoms in the network of depression-related symptoms during the third trimester and three months postpartum, and the bridge symptoms were both depression (EPDS). In the dynamic network, depression (EPDS) was identified as the most influential and predictable symptom, and perceived stress (PSS) and hopelessness/suicidality (HOP) were identified as the most susceptible symptoms.

IMPLICATIONS FOR PRACTICE

Targeted interventions focused on attention and coping can reduce stress during pregnancy and enhance postpartum well-being. Strengthening family support and routine screening for symptoms such as stress and depression (EPDS) are crucial for improving maternal mental health globally, particularly in resource-limited settings.

Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice

Digital cognitive behavioural therapy for chronic insomnia (D-CBT-I) has been shown to be as efficacious as traditional CBT-I. However, not all patients achieve insomnia remission after treatment. We explored the factors influencing the effectiveness of D-CBT-I in a clinical practice. A total of 414 Asian chronic insomniacs were studied during a 6 week D-CBT-I intervention. All patients were assessed at baseline and posttreatment and were determined to be remitters or non-remitters, responders or non-responders by posttreatment criteria; Insomnia Severity Index (ISI <8) or ISI reduction ≥8, to examine whether remission and response status were associated with patient baseline characteristics. The average baseline ISI score in all subjects was 16.29 points. At posttreatment, 192 (46.4%) patients achieved ISI remission and 218 (52.7%) patients demonstrated an ISI response. An increased baseline early morning awakening time and ISI score were independently associated with a lower odds for remission (OR, 0.995 and 0.991, respectively). Increased baseline Patients Health Questionnaire-9 score was independently associated with higher odds for response (OR, 1.114). Our results suggest that D-CBT-I can be recommended as the first-line treatment for chronic insomnia, particularly in insomniacs with milder insomnia symptoms and more severe depressive symptoms. Meanwhile, the effectiveness of D-CBT-I was adversely affected by longer early morning awakening time and higher insomnia severity at pretreatment, which may be improved by more intense intervention and greater therapeutic support or by traditional CBT-I.

Association between sleep problems and functional disability in community-dwelling older adults

BACKGROUND

Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.

METHODS

This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.

RESULTS

Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.

CONCLUSIONS

Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Mediation of the Association Between Physical Exercise and Depressive/Anxiety Symptoms by Pain and Sleep Problems Among Older Adults

In this study, based on the 2022 National Health and Aging Trend Study (N = 5,593, age 65+), we examined direct associations between moderate and vigorous physical exercise (PE) and depressive/anxiety symptoms as well as bothersome pain and sleep problems. We then examined if the association between PE and depressive/anxiety symptoms would be partially mediated by the effects of PE on bothersome pain and sleep problems. Results from a path model showed that controlling for sociodemographic and health statuses, PE was negatively associated with depressive/anxiety symptoms and bothersome pain, but it was not significantly associated with sleep problems. The mediation analysis showed that 10% of the total effects of PE on depressive/anxiety symptoms was indirect effects of PE on bothersome pain. This study is important as it examined the associations among PE, pain, sleep, and depression/anxiety in community-dwelling older adults in their natural environments. Healthcare and social service providers for older adults need to emphasize the importance and benefits of PE for older adults' physical and mental health. Easy access to venues for PE is also important.

Association between sleep problems and multimorbidity patterns in older adults

BACKGROUND

Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults.

METHODS

This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns.

RESULTS

Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively.

CONCLUSIONS

These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.

A bibliometric analysis of sleep in older adults

Background

Sleep problems severely affect the quality of life in the elderly and have gradually gained attention among scholars. As a major hot spot of current research, sleep in older adults is highly exploratory and of great significance for human health.

Objective

Therefore, in this study, the current state of the art of sleep research in older adults was analyzed through the visual mapping function of CiteSpace software. Using this software, we analyzed popular research questions and directions and revealed the development trends and research frontiers of this field.

Methods

In this paper, we searched the Web of Science database for sleep-related studies focusing on older adults and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by using CiteSpace software.

Results

Our results revealed that the number of publications concerning sleep in older adults has gradually increased; after 2017, this field underwent rapid development. The journal Sleep has published the majority of the articles on sleep in older adults and has the highest citation frequency. The Journal of the American Geriatrics Society has the highest impact factor and CiteScore among the top 10 journals in terms of the number of published articles. The United States has the highest number of publications and most of the leading institutions in this field are located in the United States, with the University of California, Los Angeles, and the University of Pittsburgh having the highest number of publications. Dzierzewski JM is the most published author and has played an important role in guiding the development of this field. Research in this area is focused on insomnia, sleep quality, depression, and sleep duration.

Conclusion

The rapid development of sleep research in older adults, which shows a yearly growth trend, indicates that this field is receiving increasing attention from researchers. Insomnia in older adults is the most concerning problem in this field. At the same time, future research should continue to focus on the impact of sleep disorders on older adults to improve sleep and quality of life in older adults.

Daily sleep, well-being, and adult day services use among dementia care dyads

OBJECTIVES

The study aimed to describe daily sleep characteristics for dementia care dyads in the context of adult day services (ADS) use and examine the associations with sleep quality and daytime functioning (fatigue, affect, and behavior problems).

METHODS

Caregivers (CG; N = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons living with dementia (PLWD) across 8 consecutive days (N = 1359), where PLWD attended ADS at least 2 days of the week. On each day, caregivers also reported their own fatigue and affect and PLWD's daytime behavior problems and nighttime sleep problems. Considering the context of ADS use, we compared mean differences in bedtime, wake time, and total time in bed on nights before versus after ADS use. We estimated multilevel models to examine daily sleep-well-being associations.

RESULTS

On nights before an upcoming ADS day, care dyads went to bed and woke up earlier, and spent less time in bed. Further, PLWD had better sleep quality the night before an upcoming ADS day. Using ADS during the day buffered the negative impact of PLWD's sleep problems in the previous night, reducing daytime negative affect for caregivers. For caregivers, using ADS yesterday attenuated the association between shorter than typical time in bed and daytime fatigue; it also attenuated the association between PLWD's nighttime sleep problems and lowered daytime positive affect.

CONCLUSIONS

Regular ADS use may promote earlier sleep timing and protect against the adverse impact of sleep disturbances on daytime functioning for dementia care dyads.

Depression among Older Adults in Indonesia: Prevalence, Role of Chronic Conditions and Other Associated Factors

Background

Depression is one of the most common illnesses worldwide, with a prevalence of 5.7% among older adults aged over 60. Depression is a severe health condition that can significantly affect the quality of life.

Objective

The objective of this study is to investigate the determinant factors of depression among older adults in Indonesia.

Methods

Data of 4236 adults of 60 years old and over were taken from the fifth wave of the Indonesian Family Life Survey (IFLS-5). Sociodemographic and multiple health-related variables collected through interviews and measurements were analyzed. Multivariate logistic regression was used to evaluate depression and its associated factors.

Results

The prevalence of depression assessed using ten questions from the Center for Epidemiologic Studies Depression Scale (CES-D 10) was 16.3%. Significant associated factors for depression were moderate and low subjective economic status, living in Java or other regions outside Sumatra and Java, no life satisfaction, self-perceived as having poor health, having dependency (IADL scores), and experienced falls and insomnia. Among chronic conditions, stroke, arthritis, and hearing impairment were also more common in depressed older adults.

Conclusion

Predictors of depression identified in this study may be used to help prevent and improve depression in Indonesian older adults, especially those who live on Java. Improvement in healthcare, especially in the prevention and rehabilitation of stroke, arthritis, possible frailty (falls and dependency), hearing impairment, and insomnia, concurrent with early detection of depression in these chronic conditions, may help create a better quality of life among Indonesian older adults.

Mindfulness-Based Movement Intervention to Improve Sleep Quality: A Meta-Analysis and Moderator Analysis of Randomized Clinical Trials

(1) Background: Given that the most effective dose, optimal type, and most beneficial population for improving sleep with mindfulness-based movement (MBM) remains unknown, we conducted a systematic review and meta-analysis with moderator analysis of randomized controlled trials (RCTs) to assess these effects. (2) Methods: Three electronic databases (PubMed, Web of Science, and EBSCO) were systematically searched for RCTs published through August 2021 for analysis. The risk of bias of the included studies was assessed with Review Manager 5.3, and the meta-analysis was performed in Stata 16.0. (3) Results: A meta-analysis of 61 RCTs with 2697 participants showed that MBM significantly improved sleep quality compared to controls (SMD = −0.794; 95% CI: −0.794 to −0.994, p < 0.001, I2 = 90.7%). Moderator analysis showed that a long-term MBM (SMD = −0.829; 95% CI: 0.945 to 0.712; p < 0.001) had a larger effect size on sleep than a short-term MBM (SMD = −0.714; 95% CI: 0.784 to 0.644; p < 0.001). Practicing at least twice per week (SMD = −0.793; 95% CI: −0.868 to −0.718; p < 0.001) was more effective compared to practicing once per week (SMD = −0.687; 95% CI: −0.804 to −0.570; p < 0.001). Studies with a total intervention time of more than 24 h also revealed better sleep quality improvement (SMD = −0.759; 95% CI: −0.865 to −0.653; p < 0.001). In addition, the healthy population and older adults gained more from MBM than the patients and younger adults. (4) Conclusions: MBM can effectively improve subjective sleep quality, and the optimal intervention dose of MBM can be utilized in future intervention studies to treat or improve sleep disturbance (MBM more than twice a week for more than three months, with a total intervention time of more than 24 h).

Cost-effectiveness of Guided Internet-Delivered Cognitive Behavioral Therapy in Comparison with Care-as-Usual for Patients with Insomnia in General Practice

STUDY OBJECTIVES

Clinical guidelines recommend cognitive-behavioral therapy for insomnia (CBT-I) as first-line treatment. However, provision of CBT-I is limited due to insufficient time and expertise. Internet-delivered CBT-I might bridge this gap. This study aimed to estimate the cost-effectiveness of guided, internet-delivered CBT-I (i-Sleep) compared to care-as-usual for insomnia patients in general practice over 26 weeks from a societal perspective.

METHODS

Primary outcomes were the Insomnia Severity Index (ISI, continuous score and clinically relevant response), and Quality-Adjusted Life Years (QALYs). Societal costs were assessed at baseline, and at 8 and 26 weeks. Missing data were imputed using multiple imputation. Statistical uncertainty around cost and effect differences was estimated using bootstrapping, and presented in cost-effectiveness planes and acceptability curves.

RESULTS

The difference in societal costs between i-Sleep and care-as-usual was not statistically significant (-€318; 95% CI -1282 to 645). Cost-effectiveness analyses revealed a 95% probability of i-Sleep being cost-effective compared to care-as-usual at ceiling ratios of €450/extra point of improvement in ISI score and €7,000/additional response to treatment, respectively. Cost-utility analysis showed a 67% probability of cost-effectiveness for i-Sleep compared to care-as-usual at a ceiling ratio of 20,000 €/QALY gained.

CONCLUSIONS

The internet-delivered intervention may be considered cost-effective for insomnia severity in comparison with care-as-usual from the societal perspective. However, the improvement in insomnia severity symptoms did not result in similar improvements in QALYs.

Use of the Xiaomi Mi Band for sleep monitoring and its influence on the daily life of older people living in a nursing home

Background: Lower quantity and poorer sleep quality are common in most older adults, especially for those who live in a nursing home. The use of wearable devices, which measure some parameters such as the sleep stages, could help to determine the influence of sleep quality in daily activity among nursing home residents. Therefore, this study aims to analyse the influence of sleep and its changes concerning the health status and daily activity of older people who lived in a nursing home, by monitoring the participants for a year with Xiaomi Mi Band 2. Methods: This is a longitudinal study set in a nursing home in [Details omitted for double-anonymized peer reviewed]. The Xiaomi Mi Band 2 will be used to measure biomedical parameters and different assessment tools will be administered to participants for evaluating their quality of life, sleep quality, cognitive state, and daily functioning. Results: A total of 21 nursing home residents participated in the study, with a mean age of 86.38 ± 9.26. The main outcomes were that sleep may influence daily activity, cognitive state, quality of life, and level of dependence in activities of daily life. Moreover, environmental factors and the passage of time could also impact sleep. Conclusions: Xiaomi Mi Band 2 could be an objective tool to assess the sleep of older adults and know its impact on some factors related to health status and quality of life of older nursing homes residents. Trial Registration: NCT04592796 (Registered 16 October 2020) Available on: https://clinicaltrials.gov/ct2/show/NCT04592796.

Environmental factors related to sleep latency among inpatients in rehabilitation wards according to functional independence measure cognitive scores

BACKGROUND

No study has investigated sleep-related environmental factors in patients according to their functional independence measure (FIM) cognitive scores.

AIMS

The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards.

DESIGN

This is a prospective longitudinal study.

METHODS

This study measured the sleep state using a bed-based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed-effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores.

RESULTS

The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra-individual variance was larger than that of the high group.

CONCLUSION

These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score.

Nurse-Guided Internet-Delivered Cognitive Behavioral Therapy for Insomnia in General Practice: Results from a Pragmatic Randomized Clinical Trial

INTRODUCTION

Guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first line of treatment for insomnia in general practice, but CBT-I is rarely available. Nurse-guided Internet-delivered CBT-I might be a solution to improve access to care.

OBJECTIVE

We aimed to determine the effectiveness of nurse-guided Internet-delivered CBT-I (I-CBT-I) on insomnia severity experienced by patients in general practice.

METHODS

Nurse-guided I-CBT-I ("i-Sleep") was compared to care-as-usual (and I-CBT-I after 6 months) in 15 participating general practices among 134 patients (≥18 years old) with clinical insomnia symptoms. Assessments took place at 8, 26 and 52 weeks. Primary outcome was self-reported insomnia severity (Insomnia Severity Index) at 8 weeks. Secondary outcomes were sleep diary indices, depression and anxiety symptoms (Hospital Anxiety and Depression Scale), fatigue, daytime consequences of insomnia, sleep medication and adverse events.

RESULTS

Two thirds of the 69 intervention patients (n = 47; 68%) completed the whole intervention. At the posttest examination, there were large significant effects for insomnia severity (Cohen's d =1.66), several sleep diary variables (wake after sleep onset, number of awakenings, terminal wakefulness, sleep efficiency, sleep quality) and depression. At 26 weeks there were still significant effects on insomnia severity (d = 1.02) and on total sleep time and sleep efficiency. No significant effects were observed for anxiety, fatigue, daily functioning or sleep medication. No adverse events were reported.

CONCLUSIONS

Nurse-guided I-CBT-I effectively reduces insomnia severity among general practice patients. I-CBT-I enables general practitioners to offer effective insomnia care in accordance with the clinical guidelines.

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

STUDY OBJECTIVES

To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.

METHODS

Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests.

RESULTS

Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599).

CONCLUSION

Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.

The association between sleep pathology and depression: A cross-sectional study among adults in Greece

A cross-sectional population based study was conducted in order to evaluate the potential association of sleep characteristics with depression using self-reported questionnaires and taking into account several socio-demographic, lifestyle and health related characteristics. 957 participants aged between 19 and 86 years old were enrolled in our study. Depression symptoms were assessed using the Beck Depression Inventory. Participants self-reported their daily sleep habits and filled in the Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire. Overall prevalence of depression was 28.4%. Depression symptoms were more prominent among minority groups. Subjects with depression reported shorter sleep duration and had reduced sleep efficiency. In patients with depression mean sleep duration was reduced by 23 min and mean sleep efficiency by 4%. Patients with depression were at higher risk of insomnia, poor sleep quality and obstructive sleep apnea, but not of excessive daytime sleepiness. Concerning insomnia subtypes, depression was associated with difficulties maintaining sleep and early morning awakening, but not problems initiating sleep. Sleep disturbances are highly prevalent in depression and our findings support early pharmacological or cognitive behavioral interventions in order to address this key depression-associated symptom. Only addressing problems initiating sleep might not be sufficient in depression.

Insomnia and depression: How much is the overlap?

BACKGROUND

Previous literature considers insomnia as one of the features, predictor, and also as a residual symptom of depression. However, chronic insomnia and major depressive disorder (MDD) have overlapping features making differentiation between two difficult.

MATERIALS AND METHODS

Forty subjects in each of the three categories-MDD, insomnia (I) and combined diagnoses (MDD-I) were recruited in this study after excluding potential confounders. Diagnosis of MDD was made following Diagnostic and Statistical Manual 5 edition (DSM-5), while the International Classification of sleep disorders 3 edition criteria of insomnia were used for diagnosing insomnia. The severity of insomnia and depression was assessed using the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 (PHQ-9), respectively. Fatigue was assessed using the Fatigue Severity Scale (FSS), which was translated in Hindi for this study. All subjects were also asked regarding effect of good sleep at night on daytime symptoms, especially on mood.

RESULTS

Subjects in MDD group were younger than the other two. Insomnia group was significantly different from the other two groups on most of the measures according to the DSM-5 criteria for MDD. MDD group had lesser frequencies of initial insomnia, middle insomnia, dissatisfaction with sleep and overall distress during the day. MDD-I group had a higher prevalence of daytime sleepiness and hyperactivity/impulsivity. PHQ-9 score was the lowest in the insomnia group. Despite statistically significantly different, ISI score was clinically comparable. The severity of fatigue was comparable across three groups. Contrary to the MDD group, subjects in insomnia and MDD-I group reported significant improvement in daytime symptoms after a good sleep for even one night.

CONCLUSION

There is considerable overlap of symptoms between insomnia and MDD. Subjects having insomnia report significant improvement in daytime and mood symptoms after good sleep, contrary to subjects with MDD.

Validation of the Patient Empowerment Strategies Questionnaire (PES-Q) in Greek adult patients with chronic insomnia: a pilot study on basic psychometric values

Aim:

The objectives of this study were to validate the Patient Empowerment Strategies Questionnaire (PES-Q) in a Greek sample and to study its psychometric properties in a sample of patients diagnosed with chronic insomnia.

Background:

This is a validation of the PES-Q in Attikon General Hospital, School of Medicine, National and Kapodistrian University of Athens. The questionnaire was administered to 93 subjects aged between 18 and 85 years (mean age ± SD: 54.7 ± 15.2, 28% males).

Methods:

The criterion validity of the questionnaire was tested with the use of four specific criteria: the Athens Insomnia Scale, the Pittsburg questionnaire (Pittsburg Sleep Quality Index), the Depression, Anxiety and Stress Scale, and the Self-Esteem Scale.

Findings:

According to factor analysis results, the structure of the original scale was confirmed by the presence of one main factor in the Greek sample, explaining 40.1% of the variance of PES-Q queries. The questionnaire showed satisfactory reliability (Cronbach’s α = 0.887). The results of the current study suggest that the PES-Q may be used as an accurate psychometric instrument for the purposes of chronic insomnia. Future research should examine the psychometric qualities of the PES-Q Greek version in a larger sample.

Internet-Delivered Cognitive Behavioral Therapy for Insomnia: Tailoring Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Insomnia

Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI.

Does online insomnia treatment reduce depressive symptoms? A randomized controlled trial in individuals with both insomnia and depressive symptoms

BACKGROUND

Insomnia is effectively treated with online Cognitive Behavioral Therapy for Insomnia (CBT-I). Previous research has suggested the effects might not be limited to sleep and insomnia severity, but also apply to depressive symptoms. Results, however, are mixed.

METHODS

In this randomized controlled trial we investigated the effects of guided online CBT-I on depression and insomnia in people suffering from symptoms of both. Participants (n = 104) with clinical insomnia and at least subclinical depression levels were randomized to (1) guided online CBT-I and sleep diary monitoring (i-Sleep) or (2) control group (sleep diary monitoring only). The primary outcome was the severity of depressive symptoms (Patient Health Questionnaire-9 without sleep item; PHQ-WS). Secondary outcomes were insomnia severity, sleep diary parameters, fatigue, daytime consequences of insomnia, anxiety, and perseverative thinking.

RESULTS

At post-test, participants in the i-Sleep condition reported significantly less depressive symptoms (PHQ-WS) compared with participants in the sleep-diary condition (d = 0.76). Large significant effects were also observed for insomnia severity (d = 2.36), most sleep diary parameters, daytime consequences of insomnia, anxiety, and perseverative thinking. Effects were maintained at 3 and 6 month follow-up. We did not find significant post-test effects on fatigue or total sleep time.

CONCLUSIONS

Findings indicate that guided online CBT-I is not only effective for insomnia complaints but also for depressive symptoms. The effects are large and comparable with those of depression therapy.

CLINICAL TRIAL REGISTRATION NUMBER

NTR6049 (Netherlands Trial Register).

Psychological Interventions for Late-life Insomnia: Current and Emerging Science

Purpose of Review

Late-life insomnia is a serious medical condition associated with many untoward consequences. The high prevalence of late-life insomnia, along with the concomitant risks inherent in the use of hypnotic medications in older adults necessitates non-pharmacological (i.e., psychological) treatment options. We aim to summarize and evaluate the state-of-the-science of psychological treatment options for late-life insomnia.

Recent Findings

Cumulative scientific evidence suggests the efficacy of psychological treatment of late-life insomnia. During the previous decade, trials of psychological treatments for insomnia have begun to test various modifications to treatments that have the potential to improve access for older adults, along with expanding their focus to include individuals with comorbid conditions that are common to older adults. While these modifications represent positive advances in the science of treatment for late-life insomnia, the evidence is still largely explanatory/efficacious in nature.

Summary

Psychological strategies represent the best approaches for the treatment of late-life insomnia. Future investigations would be wise to progressively move towards increasingly pragmatic/effectiveness investigations, adding to the literature base regarding the treatment of late-life insomnia under usual/real-world conditions as opposed to ideal/artificial conditions.