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Herring TE, Chopra A, Friedly JL, Bender JA, Gentile NL, Knowles LM. Post traumatic stress and sleep disorders in long COVID: Patient management and treatment. Life Sci 2024; 357:123081. [PMID: 39332491 DOI: 10.1016/j.lfs.2024.123081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/12/2024] [Accepted: 09/23/2024] [Indexed: 09/29/2024]
Abstract
Post traumatic stress disorder (PTSD) and sleep disorders are prevalent among patients with long COVID. The intersection of PTSD and/or sleep disorders with long COVID is complex. Thus, use of a biopsychosocial lens for assessment and treatment along with a trauma-informed approach to clinical care is recommended. This review provides an overview of the literature on PTSD and sleep disorders among patients with long COVID, including prevalence rates, risk factors, and potential pathophysiology. Pharmacological and non-pharmacological treatment options are reviewed. Also, we provide actionable steps clinicians can integrate into their practice to help effectively assess and treat PTSD and sleep disorders, including validated symptom assessments, recommended referrals, and specific components of non-pharmacological interventions.
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Affiliation(s)
- Tracy E Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Anita Chopra
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Janna L Friedly
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jessica A Bender
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | - Nicole L Gentile
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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2
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Nordström EEL, Kaltiala R, Kristensen P, Thimm JC. Bereaved parents' and siblings' healthcare needs, healthcare utilization, and satisfaction with healthcare services eight years after the 2011 Utøya terror attack. DEATH STUDIES 2024:1-13. [PMID: 39269892 DOI: 10.1080/07481187.2024.2400366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Understanding the healthcare needs of bereaved individuals following terrorism is crucial for organizing healthcare services. This cross-sectional study examined the terror-related healthcare needs, healthcare utilization, and satisfaction with professional healthcare among 122 traumatically bereaved parents and siblings eight years after the 2011 Utøya terrorist attack in Norway. Results showed that over 50% of the participants currently needed help coping with their grief or with mental and somatic symptoms, and only 34% were actively utilizing healthcare related to the terror attack. Furthermore, 68% reported not getting sufficient help, suggesting a treatment gap. One-third rated the professional help and treatment as unsatisfactory, with 28% reporting that they had not received competent help. More somatic and posttraumatic stress symptoms were associated with higher healthcare needs, whilst higher levels of insomnia symptoms were associated with lower healthcare satisfaction. This emphasizes the need to recognize, professionally intervene, and provide competent support for traumatically bereaved individuals.
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Affiliation(s)
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jens C Thimm
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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3
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Brown AD, Dowling J, Verma S, Gibson R, Valenta T, Piestch A, Cavuoto MG, McCurry SM, Bei B, Woodward M, Jackson ML, Varma P. Integrating lived experience to develop a tailored sleep intervention for people living with dementia and carepartners. DEMENTIA 2024:14713012241282769. [PMID: 39251415 DOI: 10.1177/14713012241282769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
OBJECTIVES Sleep disturbances are highly prevalent and have adverse health consequences for both people living with dementia and their carepartners. Despite this, they are under-addressed caregiving settings. This study aimed to explore these sleep disturbances and co-design a multimodal sleep intervention for people living with dementia and their carepartners. METHODS We conducted two focus groups and five semi-structured interviews (n = 4 people living with dementia, n = 6 carepartners). Active involvement of community advisors was sought throughout the design, development, and facilitation phases. Reflexive thematic analysis was used to explore sleep-related experiences and receive feedback to shape intervention development. FINDINGS People living with dementia reported disruptions to sleep and circadian rhythms, including sleep disturbances and confusion between day and night. Multiple sleep challenges were encountered by carepartners including insomnia, hypervigilance, and daytime impairment. The proposed sleep intervention was received positively, with significant insights emphasising the need for a multimodal toolkit approach, adaptation of the intervention across different dementia stages, and a focus on tailoring the program to carepartners. CONCLUSION Sleep interventions for caregivers and care-recipients should target both sleep and daytime functioning to ensure holistic support. Participants were receptive towards time-friendly, online, multimodal sleep interventions that combine cognitive behaviour therapies, light therapy, mindfulness, and exercise elements.
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Affiliation(s)
- Aimee D Brown
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Jasmine Dowling
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Sumedha Verma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Rosemary Gibson
- Health and Ageing Research Team, School of Psychology, Massey University, New Zealand
| | | | | | - Marina G Cavuoto
- School of Psychological Science, Faculty of Medicines, Turner Institute for Brain and Mental Health, Monash University, Australia; National Ageing Research Institute, Australia
| | | | - Bei Bei
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
| | | | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Australia
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Gallagher V, Mattos M, Patterson A, Thompson RC, Reilly S, Shaffer K, Manning C. Insomnia symptoms among caregivers of persons with cognitive decline in an outpatient memory clinic. Sleep Med 2024; 124:38-41. [PMID: 39270597 DOI: 10.1016/j.sleep.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/22/2024] [Accepted: 09/07/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Significant insomnia symptoms can have important impacts on the health and quality of life of caregivers of persons with cognitive decline (PwCD). OBJECTIVE To characterize the prevalence of clinically significant insomnia symptoms using the recommended community cutoff for the Insomnia Severity Index (ISI; ≥10) and identify correlates of the presence of symptoms. METHODS Eighty PwCD caregivers were recruited from a memory and aging care clinic in an academic medical center and completed all study procedures (Mage = 66.05 ± 13.45 years; 93.75 % non-Hispanic White, 71.00 % spouses, 81.25 % co-dwelling with PwCD). Caregivers completed the ISI, Hospital Anxiety and Depression Scale, and Zarit Burden Interview (12-item). RESULTS One-third of PwCD caregivers reported clinically significant insomnia symptoms. Caregivers reporting these symptoms were more likely to report difficulty sleeping due to stressful/anxious thoughts about the PwCD compared to caregivers without insomnia symptoms (p < .001). No group differences were detected between caregivers with and without insomnia symptoms based on reported frequency of PwCD nighttime care needs or behaviors. Caregivers with insomnia symptoms endorsed significantly higher depression symptoms, anxiety symptoms, and caregiving psychological burden (ps < 0.001). CONCLUSIONS PwCD stress and psychological burden, but not PwCD nighttime factors, appear to be associated with clinically significant insomnia symptoms among PwCD caregivers. Existing evidenced-based treatments for insomnia, such as cognitive behavioral therapy for insomnia, may be effective in this cohort.
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Affiliation(s)
- Virginia Gallagher
- Department of Neurology, School of Medicine, University of Virginia, PO Box 801018, Charlottesville, VA, 22908, USA.
| | - Meghan Mattos
- PO Box 800782, School of Nursing, University of Virginia, USA.
| | - Ashleigh Patterson
- Department of Neurology, School of Medicine, University of Virginia, PO Box 801018, Charlottesville, VA, 22908, USA.
| | - Ryan C Thompson
- Department of Neurology, School of Medicine, University of Virginia, PO Box 801018, Charlottesville, VA, 22908, USA.
| | - Shannon Reilly
- Department of Neurology, School of Medicine, University of Virginia, PO Box 801018, Charlottesville, VA, 22908, USA.
| | - Kelly Shaffer
- PO Box 801075, Charlottesville, VA, 22908, Center for Behavioral Health and Technology, School of Medicine, University of Virginia, USA.
| | - Carol Manning
- Department of Neurology, School of Medicine, University of Virginia, PO Box 801018, Charlottesville, VA, 22908, USA.
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Grotto G, Martinello M, Buja A. Use of mHealth Technologies to Increase Sleep Quality among Older Adults: A Scoping Review. Clocks Sleep 2024; 6:517-532. [PMID: 39311229 PMCID: PMC11417873 DOI: 10.3390/clockssleep6030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/30/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024] Open
Abstract
Sleep disorders increase with age and are known risk factors for several mental and physical diseases. They also significantly contribute to a lower quality of life. Nonpharmaceutical approaches, such as cognitive behavioral therapy for insomnia, sleep hygiene advice, relaxation exercises, and physical activity programs, can be delivered directly to patients via mHealth technologies, thereby increasing the accessibility of such interventions and reducing health care-related costs. This scoping review aims to evaluate the effectiveness of mHealth interventions for improving sleep quality among older adults. Published studies in the last 10 years (2013-2023) were identified by searching electronic medical databases (PubMed, PsycINFO, CINAHL, and Scopus) in July 2023 and were independently reviewed by two different authors. The analysis of the data was performed in 2023. The research retrieved 693 records; after duplicates were removed, 524 articles were screened based on their title and abstract, and 28 of them were assessed in full text. A total of 23 studies were excluded because they did not meet the inclusion criteria in terms of population age (60 years or over) or type of intervention (mHealth-based) or because they addressed secondary insomnia. A total of five studies were included in this review, and all of them reported improvements in subjective sleep quality after the application of the mHealth interventions. Two studies also conducted objective assessments of sleep outcomes using actigraphy, reporting improvements only in some of the variables considered. Despite the limited number of available studies, these results are promising and encourage further research.
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Affiliation(s)
- Giulia Grotto
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Via Marzolo, 5-35131 Padua, Italy
| | - Michela Martinello
- Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Via Vincenzo Gallucci, 13-35121 Padua, Italy;
| | - Alessandra Buja
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Via Loredan, 18-35127 Padua, Italy;
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Reed AC, Rogers DG, Berlin GS, Burrone L, Dante G, DeViva J, McCarthy E, Niculete ME, Santoro G, Hermes EDA. Does format matter? A naturalistic study of digital and provider-led cognitive behavioral therapy for insomnia implemented in a healthcare system. Behav Sleep Med 2024:1-11. [PMID: 39140646 DOI: 10.1080/15402002.2024.2385822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
OBJECTIVES Cognitive Behavioral Therapy for Insomnia (CBTi) is a first-line treatment for a prevalent and impairing disorder. Digital CBTi programs increase access to internet-based self-directed care. However, the clinical effect of offering different forms of CBTi in a healthcare setting is not clearly understood. This study examines treatment engagement and clinical outcomes for individuals referred to either digital or provider-led CBTi. METHODS Over two years, providers at a Veterans Health Administration (VHA) facility referred patients to digital CBTi with telephone coaching support or traditional provider-led CBTi. Characteristics of those referred, proportions engaging in and completing treatment, as well as insomnia severity were compared among those referred to each format. RESULTS Providers referred 139 individuals to digital CBTi, 340 to provider-led CBTi, and 14 to both formats. Individuals referred to digital CBTi were older with less severe insomnia. Despite lower levels of program engagement and completion in the digital CBTi cohort, measures of insomnia symptom change were similar between the groups. CONCLUSIONS This is the first study to evaluate both digital and provider-led evidence-based treatments for insomnia disorder simultaneously deployed in a healthcare setting. While engagement in digital CBTi lagged that for provider-led CBTi, offering both formats may expand access to different groups, while fostering similar outcomes.
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Affiliation(s)
| | - Daniel G Rogers
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Gregory S Berlin
- Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, USA
| | - Laura Burrone
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Greg Dante
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Jason DeViva
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Elissa McCarthy
- Department of Veterans Affairs, National Center for PTSD, White River Junction, VT, USA
| | - Maria E Niculete
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Gia Santoro
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Eric D A Hermes
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Mournet AM, Kleiman EM. A systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. J Sleep Res 2024; 33:e14133. [PMID: 38164094 DOI: 10.1111/jsr.14133] [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] [Received: 08/21/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
Researchers at the intersection of sleep and suicide research have advocated for investigation of sleep disturbances as a therapeutic target for the purposes of treating and preventing suicide. This study aims to provide the first systematic review and meta-analysis on the efficacy of sleep interventions to treat suicidal ideation. This systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews, was conducted in PsycINFO, through Ovid. A sample of eight articles were deemed eligible and a total of 21 effect sizes were included. Egger's test suggested that no publication bias was present (b = 0.3695; p = 0.0852). The pooled effect size for sleep treatments on suicidal ideation was small (g = -0.0931, p = 0.3047). Significant heterogeneity was present (I2 = 44.13%), indicating the need for moderator analyses. Treatment type (medication versus psychotherapy; g = -0.2487, p = 0.3368), sex (g = -0.0007; p = 0.9263), and race (g = -0.0081; p = 0.1624) were all considered as moderators and were all found to be insignificant. This meta-analysis revealed that initial studies exploring the efficacy of sleep interventions on suicidal ideation demonstrate small effect sizes. Despite this, the handful of studies included in this review nonetheless highlight this as an important area for continued exploration. The use of larger and more diverse samples, as well as intentionally designing sleep-related interventions to improve ideation and behaviour, have the potential to enhance the efficacy of sleep interventions for this novel purpose.
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Affiliation(s)
| | - Evan M Kleiman
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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Hinterberger A, Eigl ES, Schwemlein RN, Topalidis P, Schabus M. Investigating the subjective and objective efficacy of a cognitive behavioural therapy for insomnia (CBT-I)-based smartphone app on sleep: A randomised controlled trial. J Sleep Res 2024; 33:e14136. [PMID: 38156655 DOI: 10.1111/jsr.14136] [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: 09/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
Due to insufficient treatment options for insomnia, effective solutions are urgently needed. We evaluated the effects of a CBT-I-based app combining sleep training with subjective and objective sleep monitoring on (i) sleep and (ii) subjective-objective sleep discrepancies (SOSD). Fifty-seven volunteers (20-76 years; MAge = 45.67 ± 16.38; 39 female) suffering from sleep problems were randomly assigned to an experimental group (EG, n = 28) or a waitlist control group (CG, n = 29). During the 6-week app phase, the EG used the CBT-I-based programme and a heart rate sensor for daily sleep monitoring and -feedback, while the CG used sleep monitoring only. Sleep was measured (i) subjectively via questionnaires (Insomnia Severity Index, ISI; Pittsburgh Sleep Quality Index, PSQI), (ii) objectively via ambulatory polysomnography (PSG), and (iii) continuously via heart-rate sensor and sleep diaries. Data revealed interactions for ISI (p = 0.003, ƞ2 part = 0.11) and PSQI (p = 0.050, ƞ2 part = 0.05), indicating training-specific improvements in EG, yet not in CG. While PSG-derived outcomes appear to be less training-specific, a tendential reduction in wake after sleep onset (WASO) was found in EG (p = 0.061, d = 0.55). Regarding changes in SOSD, the results indicate improvements during the app phase (EG) for sleep efficiency, sleep onset latency, and WASO (p ≤ 0.022, d ≥ 0.46); for total sleep time both groups showed a SOSD reduction. The findings indicate beneficial effects of a novel smartphone app on sleep and SOSD. More scientific evaluation of such digital programmes is needed to ultimately help in reducing the gap in non-pharmacological insomnia treatment.
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Affiliation(s)
- Alexandra Hinterberger
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Robyn Nina Schwemlein
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Pavlos Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, University of Salzburg, Salzburg, Austria
- Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Salzburg, Austria
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Shi Y, Ren R, Zhang Y, Vitiello MV, Tang X. Factors influencing the effectiveness of digital cognitive behavioural therapy for chronic insomnia in clinical practice. J Sleep Res 2024; 33:e14077. [PMID: 37897204 DOI: 10.1111/jsr.14077] [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: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
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.
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Affiliation(s)
- Yuan Shi
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Ren
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Zhang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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Guo W, Nazari N, Sadeghi M. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: a non-inferiority internet delivered randomized controlled trial. PeerJ 2024; 12:e17491. [PMID: 39071123 PMCID: PMC11283175 DOI: 10.7717/peerj.17491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024] Open
Abstract
Background Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I). Objective The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR. Method Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, n = 67; ICBT-I, n = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I). Results The retention rate was 55% with 77.6% (n = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 (P = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen's d = 1.37) and PHQ-9 (Cohen's d = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen's d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness. Conclusion Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.
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Affiliation(s)
- Wanran Guo
- School of Public Policy and Administration, Nanchang University, Nanchang, Nanchang, China
| | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
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11
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Curry G, Cheung T, Zhang SD, Logue S, McAnena L, Price R, Sittlington JJ. Repeated electrical vestibular nerve stimulation (VeNS) reduces severity in moderate to severe insomnia; a randomised, sham-controlled trial; the modius sleep study. Brain Stimul 2024; 17:782-793. [PMID: 38797370 DOI: 10.1016/j.brs.2024.05.010] [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] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Insomnia is a prevalent health concern in the general population associated with a range of adverse health effects. New, effective, safe and low-cost treatments, suitable for long-term use, are urgently required. Previous studies have shown the potential of electrical vestibular nerve stimulation (VeNS) in improving insomnia symptoms, however only one sham-controlled trial has been conducted on people with chronic insomnia. OBJECTIVES/HYPOTHESIS Repeated VeNS delivered by the Modius Sleep device prior to sleep onset will show superior improvement in Insomnia Severity Index (ISI) scores over a 4-week period compared to sham stimulation. METHODS In this double-blinded, multi-site, randomised, sham-controlled study, 147 participants with moderate to severe insomnia (ISI≥15) were recruited and allocated a VeNS or a sham device (1:1 ratio) which they were asked to use at home for 30 min daily (minimum 5 days per week) for 4 weeks. RESULTS After 4 weeks, mean ISI score reduction was 2.26 greater in the VeNS treatment group than the sham group (p = 0.002). In the per protocol analysis, the treatment group had a mean ISI score decrease of 5.8 (95 % CI [-6.8, -4.81], approaching the clinically meaningful threshold of a 6-point reduction, with over half achieving a clinically significant decrease. Furthermore, the treatment group showed superior improvement to the sham group in the SF-36 (Quality of Life) energy/fatigue component (PP p = 0.004, effect size 0.26; ITT p = 0.006, effect size 0.22). CONCLUSIONS Modius sleep has the potential to provide a viable, non-invasive and safe clinically meaningful alternative treatment option for insomnia.
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Affiliation(s)
- Grace Curry
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China; The Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Shu-Dong Zhang
- School of Medicine, Ulster University, Londonderry, BT48 7JL, United Kingdom.
| | - Susan Logue
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Liadhan McAnena
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Ruth Price
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
| | - Julie J Sittlington
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom.
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Lau SCL, Hall ML, Terhorst L, Skidmore ER. Bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors: An ecological momentary assessment study. PM R 2024; 16:669-678. [PMID: 37950680 DOI: 10.1002/pmrj.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 11/04/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Sleep plays a critical role in daily functioning and stroke recovery but receives little attention in stroke rehabilitation. Sleep disturbances are linked to affective and cognitive impairments, but temporal associations between sleep and affect and cognitive symptoms are less clear. Understanding these temporal associations may inform new directions in intervention and prevention to support continued stroke recovery. OBJECTIVE To examine the bidirectional temporal associations between sleep and affect and cognitive symptoms among community-dwelling stroke survivors. DESIGN A secondary analysis of a longitudinal observational study involving 7 days of ecological momentary assessment (EMA), during which participants completed eight EMA surveys and a sleep diary per day. Multilevel modeling was used to analyze data. SETTING Community. PARTICIPANTS Community-dwelling stroke survivors (N = 40). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES EMA measures of depressed affect, cheerful affect, and cognitive symptoms. Sleep quality and duration as measured using a sleep diary. RESULTS Between-person sleep quality was negatively associated with next-day depressed affect (B = -.16; p = .028) and positively associated with next-day cheerful affect (B = .63; p < .001). Inversely, between-person depressed affect was negatively associated with next night sleep quality (B = -.77; p = .015), and vice versa for cheerful affect (between-person: B = .45; p < .001; within-person: B = .09; p = .008). Long sleep (>9 hours) was positively associated with next-day cognitive symptoms (B = .13; p = .002), whereas cognitive symptoms were associated with a higher odds of long sleep the following night (odds ratio [OR] = 0.25; p = .047). CONCLUSIONS This study identified the bidirectional associations of sleep with affect and cognitive symptoms in the context of the everyday life of stroke survivors. The findings suggest that interventions addressing sleep quality and duration may impact affect and cognitive symptoms, and vice versa.
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Affiliation(s)
- Stephen C L Lau
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Martica L Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Tadros M, Li S, Corkish B, Upton E, Newby J, Werner-Seidler A. Cognitive behavior therapy for insomnia in university students delivered via videoconferencing groups: A pilot study. Behav Sleep Med 2024:1-14. [PMID: 38949071 DOI: 10.1080/15402002.2024.2374258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Sleep difficulties are common amongst university students and are associated with mental illness and reduced wellbeing. This paper reports a pilot study of Cognitive Behavior Therapy for Insomnia (CBT-I) tailored specifically for university students. It was hypothesized that the intervention would be feasible, acceptable, and improve sleep, anxiety, depression, and wellbeing. METHOD Students aged 18-25 participated via videoconferencing small group sessions of CBT-I. Feasibility was assessed through sign-up, consent rates, and study attrition, while acceptability was assessed using intervention adherence and a measure of intervention acceptability. Outcome measures included sleep quality, insomnia, suicidal ideation, symptoms of depression, anxiety, and wellbeing, and were assessed at baseline and post-intervention. RESULTS Participants were 44 students (M = 21.8 years). Feasibility was confirmed by sign-up and consent rates (80% of the students who expressed interest agreed to participate); overall study attrition was 48%, comprised largely of participants not commencing treatment (27%). Participants perceived the program as effective and logical and made use of the skills suggested. In terms of adherence, 82% of the participants who engaged with treatment attended two or more sessions and 63% attended all four sessions; and 92% were either very satisfied or mostly satisfied. Sleep quality, insomnia, depression, anxiety, and wellbeing all significantly improved from pre- to post-intervention. DISCUSSION There was evidence that the CBT-I intervention tailored for university students was acceptable to participants and could be feasible to deliver. Sleep quality, depression, anxiety, and wellbeing improved significantly. These findings suggest that the intervention is suitable for evaluation in a fully powered randomized controlled trial.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sophie Li
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Britt Corkish
- The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Jill Newby
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, University of New South Wales, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
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Ludwig R, Rippee M, D'Silva L, Radel J, Eakman AM, Beltramo A, Drerup M, Siengsukon C. Cognitive Behavioral Therapy for Insomnia Improves Sleep Outcomes in Individuals With Concussion: A Preliminary Randomized Wait-List Control Study. J Head Trauma Rehabil 2024; 39:318-327. [PMID: 38466122 DOI: 10.1097/htr.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Cognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, but there is limited evidence on the treatment effect of CBT-I in individuals after a concussion. Therefore, the main purpose of this study was to evaluate the treatment effect of CBT-I on sleep outcomes and postconcussion symptoms. SETTING This study was conducted at an academic institution. The CBT-I sessions were conducted using a teleconferencing system (Zoom). PARTICIPANTS Participants were eligible to participate if they were at least 4 weeks post- concussion, aged 18 to 64 years, and scored 10 or more on the Insomnia Severity Index. A total of 40 people were enrolled; 32 participants were included in analyses. DESIGN This was a randomized controlled wait-list study. Participants were randomized into starting the CBT-I intervention immediately after the baseline assessment or into the wait-list group for 6 weeks before starting CBT-I. Assessments were performed at baseline, 6, 12, and 18 weeks. MAIN MEASURES The primary outcome was the Insomnia Severity Index. Secondary measures included the Pittsburg Sleep Quality Index, Post-Concussion Symptom Scale, and Beck Depression and Anxiety Inventories. Statistical analyses included a repeated-measures analysis of variance, t tests, and mixed linear regression modeling. RESULTS There was a group-by-time interaction for the sleep outcomes but not for the concussion or mood outcomes. Differences were seen between groups on sleep outcomes, symptom severity, and depression. The treatment effect was maintained following CBT-I for all outcomes. Improvement in sleep outcomes was predictive of improvement in postconcussion symptom severity and number of symptoms. CONCLUSIONS CBT-I reduces insomnia in individuals with concussions, and improved sleep was associated with lower postconcussion and mood symptoms. These effects were maintained 6 to 12 weeks following the intervention.
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Affiliation(s)
- Rebecca Ludwig
- Departments of Physical Therapy, Rehabilitation Science, and Athletic Training (Ms Ludwig and Drs D'Silva and Siengsukon), Neurology (Dr Rippee), Occupational Therapy and Therapeutic Science (Dr Radel), and Biostatistics and Data Science (Mr Beltramo), University of Kansas Medical Center, Kansas City; Department of Occupational Therapy, Colorado State University, Fort Collins (Dr Eakman); and Neurological Institute, Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio (Dr Drerup)
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15
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Carson EK, Dhillon HM, Vardy JL, Brown C, Nunes-Zlotkowski KF, Della-Fiorentina S, Khan S, Parsonson A, Roncoloato F, Pearson A, Barnes T, Kiely BE. Telehealth cognitive behaviour therapy for the management of sleep disturbance in women with early breast cancer receiving chemotherapy: a feasibility study. Support Care Cancer 2024; 32:375. [PMID: 38780707 PMCID: PMC11116244 DOI: 10.1007/s00520-024-08554-8] [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: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Sleep quality commonly deteriorates in people receiving chemotherapy for breast cancer (BC). We aimed to determine feasibility and acceptability of telehealth-delivered cognitive behaviour therapy for insomnia (CBT-I) in people with early BC receiving (neo)adjuvant chemotherapy. METHODS Multi-centre, single arm, phase 2 feasibility trial. People with stage I-III BC received 4 sessions of telehealth CBT-I over 8 weeks, during chemotherapy. Participants completed Pittsburgh Sleep Quality Index (PSQI) and other Patient Reported Outcome Measures (PROMs) at baseline, post-program (week 9) and post-chemotherapy (week 24); and an Acceptability Questionnaire at week 9. Primary endpoint was proportion completing 4 sessions of telehealth CBT-I. RESULTS In total, 41 participants were recruited: mean age 51 years (range 31-73). All 4 CBT-I sessions were completed by 35 (85%) participants. Acceptability of the program was high and 71% reported 'the program was useful'. There was no significant difference in the number of poor sleepers (PSQI score ≥ 5) at baseline 29/40 (73%) and week 24 17/25 (68%); or in the mean PSQI score at baseline (7.43, SD 4.06) and week 24 (7.48, SD 4.41). From baseline to week 24, 7/25 (28%) participants had a ≥ 3 point improvement in sleep quality on PSQI, and 5/25 (20%) had a ≥ 3 point deterioration. There was no significant difference in mean PROM scores. CONCLUSION It is feasible to deliver telehealth CBT-I to people with early BC receiving chemotherapy. Contrary to literature predictions, sleep quality did not deteriorate. Telehealth CBT-I has a potential role in preventing and managing sleep disturbance during chemotherapy. Australian New Zealand Clinical Trials Registry (ANZCTR) registration number: ACTRN12620001379909 and date 22/12/2020.
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Affiliation(s)
- Emma-Kate Carson
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia.
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Chris Brown
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kelly Ferrao Nunes-Zlotkowski
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Stephen Della-Fiorentina
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Southern Highlands Cancer Centre, Southern Highlands Private Hospital, Bowral, NSW, Australia
- Cancer Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Sarah Khan
- Southern Highlands Cancer Centre, Southern Highlands Private Hospital, Bowral, NSW, Australia
| | - Andrew Parsonson
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Felicia Roncoloato
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Antonia Pearson
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Tristan Barnes
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
- Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Belinda E Kiely
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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Salehi M, Zamiri A, Kim J, Texeira C, Shah K, Gunturu S. Exploring the Psychiatric Manifestations of Primary Sjögren's Syndrome: A Narrative Review. Int J Rheumatol 2024; 2024:5520927. [PMID: 38774059 PMCID: PMC11108699 DOI: 10.1155/2024/5520927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 05/24/2024] Open
Abstract
Background Primary Sjögren's syndrome (pSS) is recognized for its autoimmune origin. Its hallmark symptoms, dry eyes and mouth, result from glandular inflammation. Prior literature indicates that pSS not only affects the peripheral system but also involves the central nervous system (CNS), giving rise to various neuropsychiatric symptoms. However, there is limited published research on the psychiatric comorbidities in individuals with pSS. Methods A comprehensive search was conducted on PubMed and Google Scholar for this narrative review. The search spanned from inception until August 2023. Its aim was to locate studies focusing on the psychiatric manifestations of pSS and the potential underlying mechanisms. Results The most commonly reported psychiatric complications among these individuals are depression and cognitive dysfunction. Other psychiatric manifestations that have been reported in pSS individuals include anxiety, sleep disorders, psychosis, catatonia, bipolar disorder, and obsessive-compulsive disorder. Conclusion In conclusion, patients with pSS often display multiple psychiatric symptoms. These symptoms can significantly impair functioning and reduce quality of life. Hence, prompt diagnosis and management are crucial.
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Affiliation(s)
- Mona Salehi
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Azadeh Zamiri
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
| | - Jeffrey Kim
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
| | - Chenique Texeira
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
| | - Ketki Shah
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
| | - Sasidhar Gunturu
- Department of Psychiatry, Bronx Care Health System, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bousgheiri F, Allouch A, Sammoud K, Navarro-Martínez R, Ibáñez-del Valle V, Senhaji M, Cauli O, El Mlili N, Najdi A. Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region. Diseases 2024; 12:89. [PMID: 38785744 PMCID: PMC11120586 DOI: 10.3390/diseases12050089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.
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Affiliation(s)
- Fadila Bousgheiri
- Department of Epidemiology, Public Health, and Social Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaâdi University (UAE), Tangier 93030, Morocco; (F.B.); (K.S.); (A.N.)
| | - Ali Allouch
- Higher Institute of Nursing and Health Techniques of Tetouan (ISPITS-T), Tetouan 93000, Morocco; (A.A.); (N.E.M.)
- Department of Biology and Health, Faculty of Sciences, University Abdelmalek Essaâdi, Tetouan 93000, Morocco;
| | - Karima Sammoud
- Department of Epidemiology, Public Health, and Social Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaâdi University (UAE), Tangier 93030, Morocco; (F.B.); (K.S.); (A.N.)
| | - Rut Navarro-Martínez
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (R.N.-M.); (V.I.-d.V.)
- Frailty and Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Vanessa Ibáñez-del Valle
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (R.N.-M.); (V.I.-d.V.)
- Frailty and Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Meftaha Senhaji
- Department of Biology and Health, Faculty of Sciences, University Abdelmalek Essaâdi, Tetouan 93000, Morocco;
| | - Omar Cauli
- Department of Nursing, Faculty of Nursing and Podiatry, University of Valencia, 46010 Valencia, Spain; (R.N.-M.); (V.I.-d.V.)
- Frailty and Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | - Nisrin El Mlili
- Higher Institute of Nursing and Health Techniques of Tetouan (ISPITS-T), Tetouan 93000, Morocco; (A.A.); (N.E.M.)
- Department of Biology and Health, Faculty of Sciences, University Abdelmalek Essaâdi, Tetouan 93000, Morocco;
| | - Adil Najdi
- Department of Epidemiology, Public Health, and Social Sciences, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaâdi University (UAE), Tangier 93030, Morocco; (F.B.); (K.S.); (A.N.)
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Hinrichsen GA, Leipzig RM. Implementation and Effectiveness of Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care. Clin Gerontol 2024; 47:507-514. [PMID: 35980259 DOI: 10.1080/07317115.2022.2104675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We evaluated a plan for implementation and effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in geriatric primary care by a geropsychologist. METHODS The flow of referrals to a geropsychologist was tracked and, among those eligible and interested in participating, success in deprescribing sleep medications and the effectiveness of CBT-I were documented. RESULTS Seventy patients were referred for evaluation of whom 62 were eligible for CBT-I; 34 began CBT-I and 29 completed a full course of treatment. Almost two-thirds of treatment completers were the "old old" (76-84 years) and "oldest old" (85-93 years) with multiple medical problems. Most treatment completers taking sleep medications had them deprescribed at the beginning of treatment and, one year after treatment, did not have them re-prescribed. After CBT-I, two-thirds of patients met the insomnia severity index criteria for response; and three-fifths for remission from insomnia. Further, most patients had sustained improvement in their target insomnia symptom(s) and sleep efficiency. CONCLUSIONS CBT-I can be implemented in geriatric primary care with successful deprescribing of sleep medications and meaningful improvement in symptoms of insomnia in a group of older adults of advanced age with multiple medical problems. CLINICAL IMPLICATIONS Clinical gerontologists can play an important role in improving late life insomnia.
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Affiliation(s)
- Gregory A Hinrichsen
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rosanne M Leipzig
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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Thakre VM, Deshmukh M, Gibbs J. Effectiveness of Brain Gym Exercises Over Cognitive Behavioural Therapy in Improving Sleep Quality Among Healthcare University Students: A Comparative Study. Cureus 2024; 16:e58463. [PMID: 38765356 PMCID: PMC11100550 DOI: 10.7759/cureus.58463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Background More than half of healthcare university students are believed to experience inadequate sleep. The application of brain gym exercises is a relatively new concept that has shown potential for addressing a variety of cognitive and perceptual deficits. Nevertheless, its use in managing sleep disorders is still in the early stages. Though cognitive behavioral therapy (CBT) is still the standard treatment for sleep management, recent research suggests that brain gym exercises may help with sleep disorders like insomnia. Independent studies have demonstrated the efficacy of CBT and brain gym activities in treating sleep disorders. Yet, there remains a paucity of studies directly comparing these two methods in treating individuals with sleep disturbances. Aim and objectives To ascertain the effectiveness of brain gym exercises over cognitive behavioral therapy in improving sleep quality among healthcare university students. Method The experimental study comparing brain gym exercises and cognitive behavioral therapy interventions was conducted in Wardha, Maharashtra, India, from March 2023 to December 2023, with 60 subjects selected after considering inclusion and exclusion criteria. The protocol was administered for 4 weeks for 30 minutes per day. The baseline outcome measures were the insomnia severity index (ISI) and the Pittsburgh sleep quality index (PSQI). The outcome measure was used before and after 4 weeks of interventions to evaluate the outcome of the protocol. The software used in the analysis was SPSS 27.0 version and GraphPad Prism 7.0 version, and p<0.05 was considered as the level of significance. Result Post-treatment, evidence was observed for ISI (20.55, P = 0.0001) and PSQI (18.09, P = 0.0001) in Group A. Post-rehabilitation evidence was observed in Group B for ISI (19, P=0.0001) and PSQI (16.64, P=0.0001). The findings revealed a significantly higher mean difference between Group A and Group B, showing a considerable improvement in outcome measure scores within Group A relative to Group B. Conclusion The statistical analysis demonstrates a notable improvement in the pre-and post-scores of the ISI and PSQI following four weeks of brain gym exercises. In comparison, cognitive behavioral therapy showed comparatively less effectiveness in addressing insomnia. The observed improvement in sleep quality among students highlights that brain gym exercises have the potential to be a non-pharmacological alternative for managing mild to moderate insomnia.
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Affiliation(s)
- Vaishnavi M Thakre
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mitushi Deshmukh
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Joel Gibbs
- Psychology, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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20
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Himelfarb M, Shatkin JP. Pediatric Insomnia. Psychiatr Clin North Am 2024; 47:121-134. [PMID: 38302201 DOI: 10.1016/j.psc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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Affiliation(s)
- Madeline Himelfarb
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Jess P Shatkin
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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Daniel LC, Wang H, Brinkman TM, Ruble K, Zhou ES, Palesh O, Stremler R, Howell R, Mulrooney DA, Crabtree VM, Mostoufi-Moab S, Oeffinger K, Neglia J, Yasui Y, Armstrong GT, Krull K. Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report. JNCI Cancer Spectr 2024; 8:pkae010. [PMID: 38366608 PMCID: PMC10932943 DOI: 10.1093/jncics/pkae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. METHODS Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. RESULTS Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). CONCLUSIONS Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
| | - Huiqi Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathy Ruble
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Eric S Zhou
- Division of Sleep Medicine and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Robyn Stremler
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Rebecca Howell
- Department of Radiation Physics, MD Anderson, Houston, TX, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC, USA
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
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22
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Tussey EJ, Perez GR, Lynch SM. Sleepless behind bars: the connection between mental health, environment, and sleep among women in jail. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae012. [PMID: 38440256 PMCID: PMC10911691 DOI: 10.1093/sleepadvances/zpae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Indexed: 03/06/2024]
Abstract
Study Objectives Given the barriers to good sleep in corrections facilities and the lack of research in this area, the current study aimed to characterize sleep quality and insomnia incidence in women in jail. Furthermore, we aimed to investigate the relation of sleep to depression, posttraumatic stress disorder (PTSD), and trauma exposure in incarcerated women. Lastly, we examined self-reports of environmental and individual factors that impaired sleeping in this population. Methods Participants included 176 women incarcerated in two jails in southeast Idaho. Participants were randomly selected to complete several self-report questionnaires, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index, verbally administered by interviewers. Results A majority of participants endorsed poor sleep quality (76%) and subthreshold or higher levels of insomnia (70%). Multiple regression analyses found that depressive symptoms and PTSD symptoms were both significantly related to insomnia and poor sleep quality. Excessive noise, poor bedding, and mental health were commonly cited factors that disrupted sleep. Conclusions These results are consistent with previous literature that has examined these outcomes in prison populations and incarcerated populations in other countries. Correctional facilities can consider altering environmental factors that impair sleep to not only promote better overall health but also as a way to address common manifestations of poor mental health in their inmate populations. Screening for and treating mental health problems, namely depression and PTSD, is another way these facilities can improve inmate health and promote better sleep.
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Affiliation(s)
- Emma J Tussey
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Gabriela R Perez
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Shannon M Lynch
- Department of Psychology, Idaho State University, Pocatello, ID, USA
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23
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Lippman D, Stump M, Veazey E, Guimarães ST, Rosenfeld R, Kelly JH, Ornish D, Katz DL. Foundations of Lifestyle Medicine and its Evolution. Mayo Clin Proc Innov Qual Outcomes 2024; 8:97-111. [PMID: 38304165 PMCID: PMC10831813 DOI: 10.1016/j.mayocpiqo.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Lifestyle Medicine (LM) is a rapidly growing discipline that focuses on the role of lifestyle factors in preventing, managing, and reversing chronic disease. At this point in the field's evolution, there is strong evidence that the 6 pillars of LM-a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-are central in the creation and maintenance of health. Previous publications, many of them randomized controlled studies and meta-analyses, have solidified the evidence base for the use of the 6 pillars within the field of LM. As data emerged, so did its governing body, the American College of Lifestyle Medicine (ACLM), and with it a rich history began to unfold. Several articles have been written on the early history of the ACLM and the growth of the field; however, this review article explores the history and foundation of LM, aiming to provide a comprehensive understanding of its relevance and impact on health care. It underscores landmark studies that have defined the field and provides a road map detailing national and global barriers and areas of potential future growth.
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Affiliation(s)
| | - Mariah Stump
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Erica Veazey
- St. Mark’s Family Medicine Residency, Salt Lake City, UT
| | | | - Richard Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - John H. Kelly
- American College of Lifestyle Medicine, Chesterfield, MO
| | - Dean Ornish
- Preventive Medicine Research Institute, University of California, San Francisco, CA
| | - David L. Katz
- American College of Lifestyle Medicine, Chesterfield, MO
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24
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Davis JP, Prindle J, Saba SK, Castro CA, Hummer J, Canning L, Pedersen ER. Longitudinal associations between insomnia, cannabis use and stress among US veterans. J Sleep Res 2024; 33:e13945. [PMID: 37243415 PMCID: PMC10676445 DOI: 10.1111/jsr.13945] [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: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.
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Affiliation(s)
- Jordan P. Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - John Prindle
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Shaddy K. Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Carl A. Castro
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | | | - Liv Canning
- University of Southern California, Suzanne Dworak-Peck School of Social Work
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences
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25
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Waddell JT, Sasser J. Too Tired to Think: Within and Between-Person Relations Among Impulsive Traits, Sleep Duration, and Mental Health Outcomes. Int J Ment Health Addict 2024; 22:703-721. [PMID: 38414721 PMCID: PMC10896226 DOI: 10.1007/s11469-022-00899-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Heavier drinking and depression are common mental health concerns in the USA, yet few studies have sought to understand transdiagnostic risk factors for both. Two health-focused risk factors are impulsive personality traits and sleep duration, but research typically separates the two, precluding additive and interactive relations. The current study sought to test a theoretical model where risk conferred from impulsive traits is heightened when individuals have reduced sleep. Public-access data from the National Longitudinal Study on Adolescent to Adult Health (Add Health) were used to test study hypotheses. Participants reported on impulsive traits (i.e., lack of premeditation, sensation seeking), sleep duration, depression, and drinking across three waves spanning adolescence, emerging adulthood, and adulthood. Multilevel models distinguished risk processes at the between- vs. within-person level. At the between-person level, sensation seeking predicted drinking whereas premeditation predicted depression. Additionally, within-person deviations in both traits were associated with drinking, whereas within-person deviations in premeditation were associated with depression. Sleep duration was protective against outcomes at both levels. However, main effects were qualified by interactions at both levels, such that having below average sleep duration heightened the effects of premeditation at the between-person level, whereas within-person decreases in sleep heightened the effects of sensation seeking at the within-person level. Findings support a theoretical model where poor sleep exacerbates risk conferred from impulsive traits. Risk conferred from impulsive traits diverged based upon level of analysis, suggesting that global and just-in-time interventions may benefit from targeting specific impulsive traits as well as sleep.
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Affiliation(s)
- Jack T. Waddell
- Department of Psychology, Arizona State University, 900 S McAllister, Tempe, AZ 85287-1104, USA
| | - Jeri Sasser
- Department of Psychology, Arizona State University, 900 S McAllister, Tempe, AZ 85287-1104, USA
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26
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Chung S, Cho IK, Kim J, Lee D, Cho E, Choi JM, Ha TK, Lee YJ, Kim JH, Choi JH. Efficacy and safety of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I): a pilot study. J Sleep Res 2024; 33:e14039. [PMID: 37704214 DOI: 10.1111/jsr.14039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
The aim of this study was to evaluate the safety and efficacy of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I) and compare them with those of digital application of Cognitive Behavioural Therapy for Insomnia (dCBT-I). This randomised prospective pilot study was conducted at the Asan Medical Center. A total of 50 patients with insomnia were recruited between December 2022 and January 2023 and randomly allocated to the dSIBT-I or dCBT-I group. The study was carried out for one month. The primary outcome was the significant reduction in Insomnia Severity Index score at Week 4 compared to baseline, while the secondary outcome was proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4. We performed linear mixed model and generalised estimating equation analyses. Both dSIBT-I and dCBT-I groups showed significant improvements in Insomnia Severity Index scores at Week 4. There was no significant difference between two groups in terms of Insomnia Severity Index scores at Week 4 (group × time effect, F = 1.07, p = 0.382) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4 (group × time effects, F = 1.80, p = 0.615). However, at Week 2, the dSIBT-I group showed better results than the dCBT-I group in terms of both Insomnia Severity Index scores (p = 0.044) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 (82.6% vs. 48.0%, p = 0.017). No treatment-emergent adverse events were reported in either group. The dSIBT-I is a safe and effective therapy for insomnia, with rapid treatment effects.
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Affiliation(s)
- Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jiyoung Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Mun Choi
- Department of Literature and Art Therapy, Graduate School of Konkuk University, Seoul, South Korea
| | - Tae Kyoung Ha
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Young Jun Lee
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Ji Hyun Kim
- Honeynaps Research and Development Center, Honeynaps Co. Ltd, Seoul, South Korea
| | - Ji Ho Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
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Zambelli Z, Halstead EJ, Fidalgo AR, Mangar S, Dimitriou D. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study. Front Psychol 2024; 14:1266368. [PMID: 38274683 PMCID: PMC10808483 DOI: 10.3389/fpsyg.2023.1266368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. Methods We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. Results The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Conclusion Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | | | - Stephen Mangar
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
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28
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Sankar K, Shanmugasundram N, Baskaran B, Anabalagan D, Sivaraman V, Santhiyagu X, Muhasaparur Ganesan R. Effectiveness of High-dose Clonazepam Versus Low-Dose Clonazepam With Cognitive Behavioral Therapy in Older Adults With Moderately Severe Insomnia: A Prospective Cohort Study. Clin Ther 2024; 46:69-73. [PMID: 37940498 DOI: 10.1016/j.clinthera.2023.10.010] [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] [Received: 04/03/2023] [Revised: 09/15/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE To evaluate the effectiveness of high-dose clonazepam (1 mg) versus low-dose clonazepam (0.5 mg) with cognitive behavioral therapy for insomnia (CBT-i) in older adults with moderately severe insomnia. METHODS A prospective cohort study was conducted in patients who did not respond to low-dose clonazepam for insomnia secondary to chronic medical conditions. After starting with 0.25 mg of clonazepam, their dose was increased to 0.5 mg, then to 1 mg (Group A), or to the same dose with additional CBT-i (Group B). They were followed for 24 weeks, and scores of the insomnia severity index (ISI) and subjective units of distress scale (SUDS) were recorded. Patient adverse drug reactions (ADRs) were documented and assessed for their causality. ISI and SUDS scores were considered primary outcome measures. FINDINGS Between-group analysis revealed a significant decline in the mean score of ISI at week 16 (P < 0.05) and for SUDS at week 20 (P < 0.05) in group B compared to group A. Similarly, within-group analysis also revealed a statistically significant reduction of the mean score in ISI and SUDS scores at week 4 and 8 (P < 0.05) in both groups. ADRs occurred more frequently in group A (14%) than in group B (5%). Assessments of causality showed that the majority of cases were possible. IMPLICATIONS For individuals who were resistant to 0.5 mg of clonazepam, adding CBT-i with low-dose clonazepam is a viable alternative to increasing the dose to 1 mg.
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Affiliation(s)
- Karthik Sankar
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Natrajan Shanmugasundram
- Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Balaswetha Baskaran
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Deepika Anabalagan
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Varadharajan Sivaraman
- Department of Clinical Psychology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Xavier Santhiyagu
- Department of Statistics, Loyola College, Chennai, Tamil Nadu, India
| | - Rajanandh Muhasaparur Ganesan
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India.
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29
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Treacy T, O'Meara Y, Galligan MC, Henry AL, Lensen SF, Higgins MJ, Hickey M, Brennan DJ. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024; 136:107337. [PMID: 37741507 DOI: 10.1016/j.cct.2023.107337] [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] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
AIMS This study will assess the efficacy of digital CBT for insomnia (dCBT-I) compared to sleep hygiene education (SHE) for the management of insomnia in women with cancer. BACKGROUND 30% of patients with cancer meet insomnia diagnostic criteria and this can be detrimental to health outcomes. Insomnia disorder comprises a dissatisfaction with sleep quantity or quality characterized by difficulty initiating sleep, frequent awakenings, or early morning wakening without the ability to return to sleep, at least 3 nights per week, for at least 3 months, causing significant impairment or distress in areas of functioning. METHODS We will recruit 308 women with a current or prior cancer diagnosis who are currently experiencing insomnia; defined as a score of 16 or less on the Sleep Condition Indicator (SCI). Participants will be randomised to dCBT-I or SHE. dCBT-I will be delivered online via 6 sessions. SHE will be provided in an online format. Assessments of sleep and other related parameters, through validated questionnaires, will be taken at 12 and 24 weeks following intervention. Once 24 week assessments are completed, participants will crossover to the alternate arm (either SHE or dCBT-I) and undergo a final assessment at week 36. OUTCOMES The primary outcome will be the mean continuous change in SCI score in the intervention arm compared to the control arm at 24 weeks. Additionally, the proportion of women with an SCI > 16 at 24 weeks will be assessed. Secondary outcomes include fatigue, sleep related quality of life, depression, anxiety, and hot flush interference. REGISTRATION This study is registered on ClinicalTrials.gov with number NCT05816460.
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Affiliation(s)
- Teresa Treacy
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Yvvonne O'Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Marie C Galligan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Sarah F Lensen
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Michaela J Higgins
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Donal J Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland; UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
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30
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Helaakoski V, Zellers S, Hublin C, Ollila HM, Latvala A. Associations between sleep medication use and alcohol consumption over 36 years in Finnish twins. Alcohol 2023:S0741-8329(23)00344-0. [PMID: 38101525 DOI: 10.1016/j.alcohol.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Sleep medication use is an indicator of underlying sleep problems that might be induced by various factors such as alcohol use. However, the longitudinal relationship between drinking and sleep problems remains poorly understood. We investigated associations between sleep medication and alcohol use throughout adulthood, and examined the role of familial and potential confounding factors contributing to these associations. METHODS We used information of zygosity and self-report questionnaire data over a follow-up period of 36 years from the Older Finnish Twin Cohort (N=13,851). RESULTS Logistic regression analyses suggested consistent associations between sleep medication use and heavy/binge drinking at all four time points (OR range =1.36-3.18, P <0.05), implying that increased drinking is associated with increased sleep medication use over time. Cross-lagged path analyses suggested that moderate/heavy and binge drinking predict sleep medication use at most time points (OR range = 1.15-1.94, P <0.05), whilst sleep medication use predicts subsequent abstaining from alcohol (OR range =2.26-2.47, P <0.05). Within-pair analyses implied that familial factors play a role, and quantitative genetic modelling estimated genetic factors to explain approximately 80% of the lifetime association of sleep medication use with moderate/heavy and binge drinking. CONCLUSIONS Drinking is associated with sleep medication use throughout adulthood. Further, our results suggest that drinking is likely to predict sleep medication use, thereby potentially constituting a risk factor for sleep problems, and that genetic factors contribute to the association. These findings are important in terms of better understanding the development of sleep and alcohol use disorders.
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Affiliation(s)
- Viola Helaakoski
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland.
| | - Stephanie Zellers
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland, HiLIFE, University of Helsinki, Helsinki, Finland; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, USA; Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
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31
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Pfeiffer PN, Ganoczy D, Zivin K, Gerlach L, Damschroder L, Ulmer CS. Guideline-concordant use of cognitive behavioral therapy for insomnia in the Veterans Health Administration. Sleep Health 2023; 9:893-896. [PMID: 37704561 DOI: 10.1016/j.sleh.2023.07.002] [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] [Received: 09/13/2022] [Revised: 07/03/2023] [Accepted: 07/08/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To characterize guideline-concordant use of cognitive behavioral therapy for insomnia vs. sleep medications among Veterans Health Administration patients. METHODS Cognitive behavioral therapy for insomnia was identified from the text of psychotherapy notes within the Veterans Health Administration's electronic medical record. Patients that received first-line cognitive behavioral therapy for insomnia (ie, no prior insomnia treatment) were compared to those who first received a sleep medication in fiscal year 2021. RESULTS Among 5,519,016 patients, first-line cognitive behavioral therapy for insomnia was received by 9313 (0.2%) whereas 225,618 (4.1%) were newly prescribed a sleep medication without prior cognitive behavioral therapy for insomnia. Patients over 60 years old and those with substance use disorders were less likely to receive first-line cognitive behavioral therapy for insomnia compared to other patients. CONCLUSIONS Adherence to practice guidelines to provide cognitive behavioral therapy for insomnia as first-line treatment for insomnia disorder remains a challenge, highlighting the need to better integrate effective implementation strategies within therapist training programs. Targeted strategies may be needed for older patients or those with substance use disorders.
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Affiliation(s)
- Paul N Pfeiffer
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
| | - Dara Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Kara Zivin
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Lauren Gerlach
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Laura Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Christi S Ulmer
- Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina, USA; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
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32
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Smyth A, Alam S, Pangerl S. Pilot feasibility and acceptability study evaluating use of group CBT-I in improving sleep and fatigue in older adults. Australas J Ageing 2023; 42:728-735. [PMID: 37641859 DOI: 10.1111/ajag.13233] [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: 03/11/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This paper describes a pilot study, in a small sample of older adults, designed to ascertain the feasibility, acceptability and potential effectiveness of group Cognitive Behavioural Therapy For Insomnia (CBT-I). METHODS Eleven older adults participated in a 3-week group CBT-I intervention with pre- and post-intervention outcome measures of sleep and fatigue. Acceptability was measured via post-intervention focus groups. Feasibility was measured via recruitment, retention and completion data. Subjective sleep outcomes were measured pre- and post-intervention using the Pittsburgh Sleep Quality Index. Fatigue was measured using the Fatigue Severity Index. Objective sleep outcome measures were obtained via pre- and post-intervention wrist actigraphy. RESULTS Feasibility and acceptability were confirmed in the pilot study. Retention and completion levels were high, with participants largely positive in the focus group feedback. Preliminary sleep outcome data supported the potential effectiveness of the intervention in significantly improving several measures of sleep and fatigue including a three-point reduction in the Global PSQI scores, an increase in total sleep time of almost an hour per night and these results were mirrored by a significant reduction of nine points in the overall measure of fatigue severity. CONCLUSIONS A group CBT-I intervention is a low-cost, low-risk intervention which improves subjective and objective measures of sleep in older adults. These positive sleep outcomes are translated into significantly decreased levels of fatigue. Future research should focus on a larger sample size with a randomised controlled trial design.
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Affiliation(s)
- Aisling Smyth
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Nursing & Midwifery, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Shehnas Alam
- ECU Psychological Services Centre, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sabine Pangerl
- Centre for Research in Aged Care, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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Vargas I, Egeler M, Walker J, Benitez DD. Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care. FRONTIERS IN SLEEP 2023; 2:1279903. [PMID: 39210962 PMCID: PMC11361330 DOI: 10.3389/frsle.2023.1279903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.
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Affiliation(s)
- Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Mara Egeler
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Jamie Walker
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Dulce Diaz Benitez
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
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Hamilton NA, Russell JA, Youngren WA, Gallegos AM, Crean HF, Cerulli C, Bishop TM, Hamadah K, Schulte M, Pigeon WR, Heffner KL. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med 2023; 19:1913-1921. [PMID: 37421316 PMCID: PMC10620662 DOI: 10.5664/jcsm.10710] [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] [Received: 01/03/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES This study's objective was to evaluate the effect of nightmares (NMs) on attrition and symptom change following cognitive behavioral therapy for insomnia (CBT-I) treatment using data from a successful CBT-I randomized controlled trial delivered to participants with recent interpersonal violence exposure. METHODS The study randomized 110 participants (107 women; mean age: 35.5 years) to CBT-I or to an attention-control group. Participants were assessed at 3 time periods: baseline, post-CBT-I (or attention control), and at time 3 (T3) post-cognitive processing therapy received by all participants. NM reports were extracted from the Fear of Sleep Inventory. Participants with weekly NMs were compared with those with fewer than weekly NMs on outcomes including attrition, insomnia, posttraumatic stress disorder, and depression. Change in NM frequency was examined. RESULTS Participants with weekly NMs (55%) were significantly more likely to be lost to follow-up post-CBT-I (37%) compared with participants with infrequent NMs (15.6%) and were less likely to complete T3 (43%) than patients with less frequent NMs (62.5%). NMs were unrelated to differential treatment response in insomnia, depression, or posttraumatic stress disorder. Treatment with CBT-I was not associated with reduced NM frequency; however, change in sleep-onset latency from post-CBT-I to T3 predicted fewer NMs at T3. CONCLUSIONS Weekly NMs were associated with attrition but not a reduced change in insomnia symptoms following CBT-I. NM symptoms did not change as a function of CBT-I, but change in sleep-onset latency predicted lower NM frequency. CBT-I trials should screen for NMs and consider augmenting CBT-I to specifically address NMs. CITATION Hamilton NA, Russell JA, Youngren WA, et al. Cognitive behavioral therapy for insomnia treatment attrition in patients with weekly nightmares. J Clin Sleep Med. 2023;19(11):1913-1921.
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Affiliation(s)
| | | | - Westley A. Youngren
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Hugh F. Crean
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Susan B. Anthony Center and Laboratory of Interpersonal Violence and Victimization, University of Rochester Medical Center, Rochester, New York
| | - Todd M. Bishop
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | | | | | - Wilfred R. Pigeon
- U.S. Department of Veterans Affairs Center of Excellence for Suicide Prevention, Finger Lakes Health Care System, Canandaigua, New York
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Kathi L. Heffner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Elaine Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester Medical Center, Rochester, New York
- Division of Geriatrics & Aging, Department of Medicine, University of Rochester Medical Center, Rochester, New York
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Lin W, Li N, Yang L, Zhang Y. The efficacy of digital cognitive behavioral therapy for insomnia and depression: a systematic review and meta-analysis of randomized controlled trials. PeerJ 2023; 11:e16137. [PMID: 37927792 PMCID: PMC10624170 DOI: 10.7717/peerj.16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023] Open
Abstract
Background Insomnia and depression often co-occur. Cognitive behavioral therapy for insomnia (CBT-I) seems to be effective and safe for mitigating insomnia and depression. However, the efficacy of digitally-delivered CBT-I (dCBT-I) remains unclear. Therefore, this meta-analysis of randomized controlled trials (RCTs) was to systematically review and evaluate the efficacy of dCBT-I in adults with insomnia and depression. Methods A systematic search in PubMed, Cochrane, Embase, and Web of Science databases (as of June 5, 2022) was conducted for RCTs on dCBT-I. Statistical analyses were performed using Revan Manager. The effects of dCBT-I on insomnia and depression were expressed as standardized mean difference (SMD) with 95% confidence intervals (CIs). Results Seven studies involving 3,597 participants were included. This meta-analysis showed that dCBT-I reduced the severity of insomnia (SMD = -0.85, 95% CI [-1.00 to -0.69], p < 0.001) and depression (SMD = -0.47, 95% CI [-0.55 to -0.38], p < 0.001) in short terms, and also mitigated the severity of insomnia (SMD = -0.71, 95% CI [-1.00 to -0.44], p < 0.001) and depression (SMD = -0.42, 95% CI [-0.68 to -0.15], p = 0.002) in long terms. The effect of dCBT-I was comparable to that of traditional face-to-face CBT-I, and was generally maintained at follow-ups of 6 weeks to 6 months. Conclusion dCBT-I seems to be effective in alleviating insomnia and depression and might be considered as a viable treatment option for depression.
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Affiliation(s)
- Wenyao Lin
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Na Li
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Lili Yang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
| | - Yuqing Zhang
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academic of Sciences, Beijing, China
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Eigl ES, Hauser T, Topalidis PI, Schabus M. On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial. Clocks Sleep 2023; 5:590-603. [PMID: 37873840 PMCID: PMC10594462 DOI: 10.3390/clockssleep5040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
There is an urgent need for easily accessible treatment options for sleep problems to reduce the current treatment gap in receiving cognitive behavioral therapy for insomnia (CBT-I). Using a randomized controlled trial, we evaluated the efficacy of a CBT-I-based online program on sleep. Fifty-three volunteers (21-71 years; MAge = 44.6 ± 12.5; 27 female) suffering from impaired sleep were randomly allocated either to the experimental group (EG, n = 27) or to an active control group (CG, n = 26). The EG participated in a 6-week CBT-I-based online program, while the CG received psychoeducation and sleep hygiene instructions. Sleep was assessed both objectively via ambulatory polysomnography (PSG) as well as subjectively via questionnaires at three time points (baseline, pre- and post-intervention). A one-month follow-up assessment was performed using questionnaires. The EG showed small but reliable improvements from pre- to post-intervention in PSG-derived wake after sleep onset (from 58.6 min to 42.5 min; p < 0.05) and sleep efficiency (from 86.0% to 89.2%; p < 0.05). Furthermore, subjective sleep quality (assessed via Pittsburgh Sleep Quality Index) improved significantly during intervention (p = 0.011) and follow-up (p = 0.015) in the EG alone. The Insomnia Severity Index decreased from pre- to post-intervention in both groups (EG: p = 0.003, CG: p = 0.008), while it further improved during follow-up (p = 0.035) in the EG alone. We show that a CBT-I-based online program can improve sleep not only subjectively but also objectively and can be a viable alternative when face-to-face interventions are not available.
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Affiliation(s)
- Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Theresa Hauser
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Pavlos I. Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
- Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
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Neville HL, Shaw J, VanIderstine C, Burgess S, Dearing M, Isenor JE, Toombs K, Bowles SK. Environmental scan of current strategies to decrease sedative-hypnotic drug use and promote sleep in hospital patients. Int J Clin Pharm 2023; 45:1062-1073. [PMID: 37773305 DOI: 10.1007/s11096-023-01632-7] [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] [Received: 04/27/2023] [Accepted: 07/29/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Sedative-hypnotic drugs are often initiated in hospital to manage insomnia and anxiety. Guidelines discourage their use, particularly in older adults, due to risks of falls, fractures, and delirium. AIM To identify publicly available resources to decrease the use of sedative-hypnotic drugs and promote sleep in hospital. METHOD An advanced Google search with 6 search strategies was conducted. Key websites were also identified and searched. Hospital- or community-based resources using non-pharmacologic measures to reduce sedative-hypnotic drug use and/or to promote sleep were included if they were publicly available in English within the past 5 years. Full text screening and data extraction was performed independently by 2 reviewers; a third reviewer resolved disagreements by consensus. RESULTS A total of 79 resources met inclusion criteria, with 65 (82.3%) providing education and 31 (39.2%) describing sleep hygiene strategies. Other resources included deprescribing (17, 21.5%), relaxation training (13, 16.5%), cognitive behavioural therapy for insomnia (9, 11.4%), and policies (7, 8.9%). The resources primarily targeted patients (59, 74.7%) followed by healthcare providers (9, 11.4%). There were 9 resources (11.4%) that applied to both community and hospital settings, and another 2 (2.5%) designed specifically for hospital. CONCLUSION Many resources were available to patients and healthcare providers to reduce inappropriate or ineffective use of sedative-hypnotic drugs and promote better sleep. Specific resources for the hospital setting were infrequent and recommended that clinicians stop hospital-initiated sedatives when patients are discharged. Identified resources can be adapted by healthcare organizations to develop sedative-hypnotic prescribing programs and policies.
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Affiliation(s)
- Heather L Neville
- Nova Scotia Health Authority, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada.
| | - Jenna Shaw
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Carter VanIderstine
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | | | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kent Toombs
- Nova Scotia Health, Halifax, Nova Scotia, Canada
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Zhang Y, Murphy J, Lammers-van der Holst HM, Barger LK, Lai YJ, Duffy JF. Interventions to improve the sleep of nurses: A systematic review. Res Nurs Health 2023; 46:462-484. [PMID: 37710916 PMCID: PMC10539041 DOI: 10.1002/nur.22337] [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: 03/17/2023] [Revised: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Nurses are at a high risk for short sleep duration and poor sleep quality due to irregular work schedules and high occupational stress. Considering the effect of nurses' sleep on the safety and health of themselves and their patients, it is important to promote healthy sleep for nurses. We sought to synthesize the published experimental and quasi-experimental studies that address interventions to improve sleep in nurses. A systematic search was conducted for studies published in English up until May 15, 2023, using the databases PubMed, CINAHL, Academic Search Ultimate, and PsycINFO. In total, 38 articles were included, covering 22 experimental and 16 quasi-experimental studies with sample sizes ranging from 9 to 207. Studies were assessed using the Cochrane Risk of Bias tool and considered as low to medium quality. Thirty-six of the 38 studies reported positive findings for at least one sleep outcome. Intervention types included aroma therapy, dietary supplements, cognitive behavioral therapy, light therapy, mind-body therapy, sleep education, exercise, napping, shift schedule modification, and multicomponent intervention, all of which showed moderate effectiveness in promoting sleep outcomes of nurses. Comparing and contrasting studies on specific interventions for improving sleep in nurses is sparse and often equivocal. With the variations of research methodology and outcome measures, it is difficult to make a conclusion about each intervention's effectiveness on specific sleep outcomes. Additional high-quality research, including randomized controlled trials, is needed to evaluate strategies for improving sleep in this unique, safety-sensitive occupational group.
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Affiliation(s)
- Yuan Zhang
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jennifer Murphy
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | | | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
| | - Yun-Ju Lai
- Solomont School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854
| | - Jeanne F. Duffy
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA 02115
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115
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de Bergeyck R, Geoffroy PA. Insomnia in neurological disorders: Prevalence, mechanisms, impact and treatment approaches. Rev Neurol (Paris) 2023; 179:767-781. [PMID: 37620177 DOI: 10.1016/j.neurol.2023.08.008] [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] [Received: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
Insomnia is more prevalent in neurological disorders compared to the general population, with rates ranging from 11 to 74.2% in neurodegenerative disorders, 20 to 37% in vascular diseases, 13.3 to 50% in inflammatory diseases, 28.9 to 74.4% in epilepsy, and nearly 70% in migraines. Insomnia in neurological disorders stems from a variety of factors, encompassing physical and neuropsychiatric factors, behavioral patterns, and disruptions in the biological clock and circadian rhythm. There are bidirectional connections between neurological disorders and insomnia. Insomnia in neurological disorders worsens symptoms, resulting in heightened depressive symptoms, elevated mortality rates, reduced quality of life, and intensified acute symptoms. Managing comorbid sleep disorders, especially in the presence of psychiatric comorbidities, is crucial. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for insomnia management in neurological disorders. Other treatments are second-line strategies. Melatonin may demonstrate effectiveness in addressing insomnia, with soporific and chronobiotic effects. Furthermore, it has the potential to alleviate "sundowning" and behavioral disturbances, while generally being well-tolerated. Other treatment options that may be of interest include morning bright light therapy, sedative antidepressants, new orexin dual antagonists and levodopa specifically indicated for Parkinson's disease. Benzodiazepines and z-drugs can be used primarily during acute phases to prevent pharmacotolerance and minimize side effects. However, they should be avoided in patients with neurological disorders and not used in patients over 75 years old due to the risk of falls and confusion. In neurological disorders, insomnia has a profound impact on daytime functioning, making its management crucial. Effective treatment can result in improved outcomes, and additional research is necessary to investigate alternative therapeutic options and enhance patient care.
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Affiliation(s)
- R de Bergeyck
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France.
| | - P A Geoffroy
- Centre ChronoS, GHU Paris - Psychiatry Neurosciences, 1, rue Cabanis, 75014 Paris, France; Département de psychiatrie et d'addictologie, DMU Neurosciences, GHU Paris Nord, hôpital Bichat-Claude-Bernard, AP-HP, 75018 Paris, France; Université Paris Cité, NeuroDiderot, Inserm U1141, 75019 Paris, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5, rue Blaise-Pascal, 67000 Strasbourg, France
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Tadros M, Li S, Upton E, Newby J, Werner-Seidler A. Preferences of University Students for a Psychological Intervention Designed to Improve Sleep: Focus Group Study. JMIR Hum Factors 2023; 10:e44145. [PMID: 37616036 PMCID: PMC10485721 DOI: 10.2196/44145] [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] [Received: 11/08/2022] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Many university students have difficulties with sleep; therefore, effective psychological treatments are needed. Most research on psychological treatments to improve sleep has been conducted with middle-aged and older adults, which means it is unclear whether existing psychological treatments are helpful for young adult university students. OBJECTIVE This study aimed to discover university student preferences for a psychological intervention to improve sleep quality. METHODS Focus groups were conducted over 3 stages to examine students' views regarding content, format, and session duration for a psychological intervention to improve sleep. A thematic analysis was conducted to analyze participant responses. RESULTS In total, 30 participants attended small focus group discussions. Three key themes were identified: (1) program development, (2) help-seeking, and (3) student sleep characteristics. Program development subthemes were program format, program content, and engagement facilitators. Help-seeking subthemes were when to seek help, where to access help, stigma, and barriers. Student sleep characteristics subthemes were factors disturbing sleep and consequences of poor sleep. CONCLUSIONS Students emphasized the need for a sleep intervention with an in-person and social component, individualized content, and ways to monitor their progress. Participants did not think there was a stigma associated with seeking help for sleep problems. Students identified the lack of routine in their lifestyle, academic workload, and the pressure of multiple demands as key contributors to sleep difficulties.
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Affiliation(s)
- Michelle Tadros
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Sophie Li
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Emily Upton
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
| | - Jill Newby
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- The Black Dog Institute, The University of New South Wales, Randwick, Australia
- School of Psychology, The University of New South Wales, Sydney, Australia
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Lo YJ, Mishra VK, Lo HY, Dubey NK, Lo WC. Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective. Aging Dis 2023; 14:1038-1069. [PMID: 37163444 PMCID: PMC10389812 DOI: 10.14336/ad.2022.1203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 05/12/2023] Open
Abstract
Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.
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Affiliation(s)
| | | | | | - Navneet Kumar Dubey
- Victory Biotechnology Co., Ltd., Taipei 114757, Taiwan.
- ShiNeo Technology Co., Ltd., New Taipei City 24262, Taiwan.
| | - Wen-Cheng Lo
- Department of Surgery, Division of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei 11031, Taiwan.
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan.
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Kutscher S, Juang C. Insomnia. Continuum (Minneap Minn) 2023; 29:1167-1187. [PMID: 37590828 DOI: 10.1212/con.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides an overview of the current definitions, diagnostic tools, and overall management of insomnia. LATEST DEVELOPMENTS The treatment of insomnia has shifted over time, with a growing emphasis on nonpharmacologic therapies as a first-line intervention and the leveraging of technology to aid in the dissemination of these therapies. With this evolution, the definition of insomnia has changed to reflect a common treatment pathway. As pharmacologic treatment options have increased, so has concern about the dangerous short-term and long-term adverse effects of these treatment options. ESSENTIAL POINTS Insomnia is a common disorder, frequently overlapping with other neurologic and psychiatric disorders, which can cause significant distress and disruption to patients' lives. Nonpharmacologic therapies are highly effective and are now considered first-line treatments. Although efficacy is variable, numerous pharmacologic interventions are available, and many options come with considerable concern about adverse effects, particularly in populations over 65 years old.
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Myers JS, Siengsukon C, Sherman J, Shen X, Ptomey LT, Montgomery R, Bock K, Rice A, Parker WP, Maliski S. Androgen Deprivation and Sleep Disturbance: A Mixed Methods Pilot Study of Remote Assessment and Intervention. Cancer Nurs 2023; 46:259-269. [PMID: 35439217 PMCID: PMC9582038 DOI: 10.1097/ncc.0000000000001100] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy-related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes. OBJECTIVES The purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content. METHODS Fifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention. RESULTS Self-report of sleep quality improved ( P < .001) as did hot flash frequency ( P = .04) and bother ( P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes. CONCLUSIONS Remote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population. IMPLICATIONS FOR PRACTICE Preliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.
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Affiliation(s)
- Jamie S Myers
- Author Affiliations: University of Kansas School of Nursing (Drs Myers and Maliski); and Department of Physical Therapy and Rehabilitation Science and Athletic Training (Dr Siengsukon and Ms Bock), Department of Internal Medicine (Mr Sherman, Dr Ptomey, and Ms Rice), Department of Radiation Oncology (Dr Shen), Biostatistics and Data Science (Dr Montgomery), and Urologic Surgery (Dr Parker), University of Kansas Medical Center, Kansas City
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Holler E, Chekani F, Ai J, Meng W, Khandker RK, Ben Miled Z, Owora A, Dexter P, Campbell N, Solid C, Boustani M. Development and Temporal Validation of an Electronic Medical Record-Based Insomnia Prediction Model Using Data from a Statewide Health Information Exchange. J Clin Med 2023; 12:jcm12093286. [PMID: 37176726 PMCID: PMC10179562 DOI: 10.3390/jcm12093286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to develop and temporally validate an electronic medical record (EMR)-based insomnia prediction model. In this nested case-control study, we analyzed EMR data from 2011-2018 obtained from a statewide health information exchange. The study sample included 19,843 insomnia cases and 19,843 controls matched by age, sex, and race. Models using different ML techniques were trained to predict insomnia using demographics, diagnosis, and medication order data from two surveillance periods: -1 to -365 days and -180 to -365 days before the first documentation of insomnia. Separate models were also trained with patient data from three time periods (2011-2013, 2011-2015, and 2011-2017). After selecting the best model, predictive performance was evaluated on holdout patients as well as patients from subsequent years to assess the temporal validity of the models. An extreme gradient boosting (XGBoost) model outperformed all other classifiers. XGboost models trained on 2011-2017 data from -1 to -365 and -180 to -365 days before index had AUCs of 0.80 (SD 0.005) and 0.70 (SD 0.006), respectively, on the holdout set. On patients with data from subsequent years, a drop of at most 4% in AUC is observed for all models, even when there is a five-year difference between the collection period of the training and the temporal validation data. The proposed EMR-based prediction models can be used to identify insomnia up to six months before clinical detection. These models may provide an inexpensive, scalable, and longitudinally viable method to screen for individuals at high risk of insomnia.
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Affiliation(s)
- Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University Bloomington School of Public Health, Bloomington, IN 47405, USA
| | | | - Jizhou Ai
- Merck & Co., Inc., Rahway, NJ 07033, USA
| | | | | | - Zina Ben Miled
- Department of Electrical and Computer Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
- Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, Indiana University Bloomington School of Public Health, Bloomington, IN 47405, USA
| | - Paul Dexter
- Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Noll Campbell
- Regenstrief Institute, Indianapolis, IN 46202, USA
- College of Pharmacy and Health Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Craig Solid
- Solid Research Group, LLC, Saint Paul, MN 55104, USA
| | - Malaz Boustani
- Regenstrief Institute, Indianapolis, IN 46202, USA
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Fretz KM. Recommendations to bolster adherence in cognitive behavioral therapy for insomnia: a self-efficacy approach. Transl Behav Med 2023; 13:206-211. [PMID: 36688474 PMCID: PMC10105881 DOI: 10.1093/tbm/ibac104] [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] [Indexed: 01/24/2023] Open
Abstract
Lay SummaryThe safest and most effective treatment for chronic insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I). People sometimes struggle to adhere to, or follow the steps, involved in CBT-I because they are challenging (i.e., restricting time in bed to induce sleepiness, getting out of bed when not sleeping). These steps are based on sleep science and research shows that more closely adhering to them relates to better sleep improvements. One way that clinicians can help patients completing CBT-I improve their adherence to the difficult treatment steps is to promote their self-efficacy, or belief that they can effectively complete the treatment steps. Inspired by tried-and-true health promotion techniques rooted in Social Cognitive Theory, this paper describes concrete recommendations that clinicians can use to improve their patients’ self-efficacy when completing CBT-I. These recommendations include suggestions such as setting positive treatment expectations, discussing with patients how to set up for success when completing the treatment steps at home, and how to work with potential barriers to treatment. If clinicians can help boost patients’ self-efficacy, they may be able to carry out the treatment steps of CBT-I more effectively, and ultimately experience more benefits.
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46
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Butris N, Tang E, He D, Wang DX, Chung F. Sleep disruption in older surgical patients and its important implications. Int Anesthesiol Clin 2023; 61:47-54. [PMID: 36727706 DOI: 10.1097/aia.0000000000000391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nina Butris
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Evan Tang
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David He
- Department of Anesthesia and Pain Management, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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Hillman DR, Carlucci M, Charchaflieh JG, Cloward TV, Gali B, Gay PC, Lyons MM, McNeill MM, Singh M, Yilmaz M, Auckley DH. Society of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization. Anesth Analg 2023; 136:814-824. [PMID: 36745563 DOI: 10.1213/ane.0000000000006395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it.
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Affiliation(s)
- David R Hillman
- From the West Australian Sleep Disorders Research Institute, Centre for Sleep Science, University of Western Australia, Perth, Western Australia, Australia
| | - Melissa Carlucci
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jean G Charchaflieh
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut
| | - Tom V Cloward
- Division of Sleep Medicine, Intermountain Health Care and Division of Pulmonary, Critical Care and Sleep Medicine, University of Utah, Salt Lake City, Utah
| | - Bhargavi Gali
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Peter C Gay
- Division of Pulmonary, Critical Care, and Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - M Melanie Lyons
- Division of Pulmonary, Critical Care, and Sleep Medicine, the Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Mandeep Singh
- Department of Anesthesia, Women's College Hospital, and Toronto Western Hospital, University Health Network; University of Toronto, Toronto, Ontario, Canada
| | - Meltem Yilmaz
- Department of Anesthesiology, Northwestern University, Chicago, Illinois
| | - Dennis H Auckley
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
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Holler E, Campbell NL, Boustani M, Dexter P, Ben Miled Z, Owora A. Racial disparities in the pharmacological treatment of insomnia: A time-to-event analysis using real-world data. Sleep Health 2023; 9:128-135. [PMID: 36858835 DOI: 10.1016/j.sleh.2023.02.002] [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] [Received: 09/12/2022] [Revised: 12/19/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Examine the association between race and time to pharmacologic treatment of insomnia in a large multi-institutional cohort. METHODS Retrospective analysis of electronic medical records from a regional health information exchange. Eligible patients included adults with at least one healthcare visit per year from 2010 to 2019, a new insomnia diagnosis code during the study period, and no prior insomnia diagnosis codes or medications. A Cox frailty model was used to examine the association between race and time to an insomnia medication after diagnosis. RESULTS In total, 9557 patients were analyzed, 7773 (81.3%) of whom where White, 1294 (13.5%) Black, 238 (2.5%) Other, and 252 (2.6%) unknown race. About 6.2% of Black and 8% of Other race patients received an order for a Food and Drug Administration-approved insomnia medication after diagnosis compared with 13.5% of White patients. Black patients were significantly less likely to have an order for a Food and Drug Administration-approved insomnia medication at all time points (adjusted hazard ratio [aHR] range: 0.37-0.73), and patients reporting Other race were less likely to have received an order at 2 (aHR 0.51, 95% confidence interval [CI] 0.28-0.94), 3 (aHR 0.33, 95% CI 0.13-0.79), and 4 years (aHR 0.21, 95% CI 0.06-0.71) of follow-up. Similar results were observed in a sensitivity analysis including off-label medications. CONCLUSIONS Patients belonging to racial minority groups are less likely to be prescribed an insomnia medication than White patients after accounting for sociodemographic and clinical factors. Further research is needed to determine the extent to which patient preferences and physician perceptions affect these prescribing patterns and investigate potential disparities in nonpharmacologic treatment.
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Affiliation(s)
- Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA.
| | - Noll L Campbell
- College of Pharmacy and Health Sciences, Purdue University, West Lafayette, Indiana, USA; Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Center for Healthcare Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA
| | - Malaz Boustani
- Indiana University Center for Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA; Center for Healthcare Innovation and Implementation Science, Indiana University, Indianapolis, Indiana, USA; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul Dexter
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Zina Ben Miled
- Department of Electrical and Computer Engineering, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| | - Arthur Owora
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
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Vollert B, Müller L, Jacobi C, Trockel M, Beintner I. Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e39052. [PMID: 36943337 PMCID: PMC10131838 DOI: 10.2196/39052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. OBJECTIVE This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. METHODS In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. RESULTS We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. CONCLUSIONS An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. TRIAL REGISTRATION ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
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Affiliation(s)
- Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Luise Müller
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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50
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Deng W, M J J van der Kleij R, Shen H, Wei J, Brakema EA, Guldemond N, Song X, Li X, van Tol MJ, Aleman A, Chavannes NH. eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e39250. [PMID: 36917145 PMCID: PMC10131777 DOI: 10.2196/39250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. OBJECTIVE We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. METHODS We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health-related outcomes. RESULTS Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=-1.01, 95% CI -1.12 to -0.89; P<.001) and improved sleep quality (Hedges g=-0.58, 95% CI -0.75 to -0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI -0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. CONCLUSIONS eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy.
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Affiliation(s)
- Wenrui Deng
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Junjie Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Nick Guldemond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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