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Balter LJT, van Someren EJW, Axelsson J. Insomnia symptom severity and dynamics of arousal-related symptoms across the day. J Sleep Res 2024:e14276. [PMID: 38923646 DOI: 10.1111/jsr.14276] [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: 02/20/2024] [Revised: 05/19/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
Arousal is a central component of many emotional symptoms and can contribute to insomnia. Here we assessed how the timing and fluctuating nature of arousal-related symptoms over the course of the day relate to insomnia symptom severity. In this study, 361 participants (M age = 31.9 years, 282 women, 77 men, 2 non-binary individuals) completed the Insomnia Severity Index to assess severity of insomnia symptoms, followed by repeated ratings of anxiety or nervousness, stress, sleepiness, and feeling down via their mobile phone between ~08:00 hours and 00:00 hours across 1 day. Measures of dynamics included: mean levels across the day; variation (standard deviation); instability (mean squared successive differences); and resistance to change/inertia (first-order autocorrelation). Time-of-day patterns were modelled using generalized additive mixed effects models. Insomnia symptom severity (mean Insomnia Severity Index = 9.1, SD = 5.2, range 0-25) was associated with higher mean levels of all arousal-related symptoms, and increased instability and variation throughout the day in anxiety or nervousness, stress, and feeling down. Resistance to change (inertia) was not associated with insomnia symptom severity. Generalized additive mixed effects analyses showed that while individuals with more severe insomnia symptoms had elevated symptoms across the entire day, they were especially more anxious or nervous and sleepy in the early morning (~08:00 hours), anxious or nervous, stressed and sleepy in the late afternoon/early evening (~16:00 hours-21:00 hours), and anxious or nervous and stressed in the late evening (~22:00 hours). Remarkably, higher arousal occurred in the presence of high subjective sleepiness. Together these results indicate that insomnia symptom severity is associated with problems with daytime and evening arousal regulation.
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Affiliation(s)
- Leonie J T Balter
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Eus J W van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Department of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
| | - John Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
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2
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Meneo D, Samea F, Tahmasian M, Baglioni C. The emotional component of insomnia disorder: A focus on emotion regulation and affect dynamics in relation to sleep quality and insomnia. J Sleep Res 2023; 32:e13983. [PMID: 37394234 DOI: 10.1111/jsr.13983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
Theoretical models of insomnia disorder recognise an emotional component in the maintenance of the disorder. Nonetheless, the field of emotions is vast and different processes are involved in psychological well-being. The present narrative review focusses on emotion regulation and affect dynamics, synthesising some of the most recent and relevant evidence on emotions in relation to the quality of sleep and to insomnia disorder. The literature underlines the close association between impaired sleep quality and difficulties in regulating emotions. Impaired sleep quality is also associated with reduced positive affect and increased negative affect, but little evidence supports a bi-directional association between affective states and sleep. Affect variability in relation to sleep has been less investigated. Initial evidence suggests that high variability in positive affect has a negative impact on sleep. Neurobiological and behavioural evidence indicates that insomnia disorder is associated with emotion dysregulation, negative affect, and a distinct daily profile of affective states. More research is needed on the affective experience of patients with insomnia disorder, adopting multiple sampling of affect across the day and the week. Understanding how the unfolding of emotions over time interact with sleep alterations may help to improve the tailoring and monitoring of treatments addressing disturbed emotional processes in insomnia disorder.
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Affiliation(s)
- Debora Meneo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Fateme Samea
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Masoud Tahmasian
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Chiara Baglioni
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Clinic for Sleep Psychotherapy, School of Cognitive Psychotherapy, Rome, Italy
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Wickwire EM, Verceles AC, Chen S, Zhao Z, Rogers VE, Wilckens KA, Buysse DJ. Smart Phone/Ecological Momentary Assessment of Sleep and Daytime Symptoms Among Older Adults With Insomnia. Am J Geriatr Psychiatry 2023; 31:372-378. [PMID: 36813640 DOI: 10.1016/j.jagp.2023.01.020] [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: 08/28/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To employ smart phone/ecological momentary assessment (EMA) methods to evaluate the impact of insomnia on daytime symptoms among older adults. DESIGN Prospective cohort study SETTING: Academic medical center PARTICIPANTS: Twenty-nine older adults with insomnia (M age = 67.5 ± 6.6 years, 69% women) and 34 healthy sleepers (M age = 70.4 ± 5.6 years, 65% women). MEASUREMENTS Participants wore an actigraph, completed daily sleep diaries, and completed the Daytime Insomnia Symptoms Scale (DISS) via smart phone 4x/day for 2 weeks (i.e., 56 survey administrations across 14 days). RESULTS Relative to healthy sleepers, older adults with insomnia demonstrated more severe insomnia symptoms in all DISS domains (alert cognition, positive mood, negative mood, and fatigue/sleepiness). A series of mixed model analyses were performed using the Benjamini-Hochberg procedure for correcting false discovery rate (BH-FDR) and an adjusted p-value <0.05. Among older adults with insomnia, all five prior-night sleep diary variables (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and sleep quality) were significantly associated with next-day insomnia symptoms (i.e., all four DISS domains). The median, first and third quintiles of the effect sizes (R2) of the association analyses were 0.031 (95% confidence interval (CI: [0.011,0.432]), 0.042(CI: [0.014,0.270]), 0.091 (CI:[0.014,0.324]). CONCLUSION Results support the utility of smart phone/EMA assessment among older adults with insomnia. Clinical trials incorporating smart phone/EMA methods, including EMA as an outcome measure, are warranted.
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Affiliation(s)
- Emerson M Wickwire
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine (EMW, ACV), University of Maryland, Baltimore, MD; Department of Psychiatry (EMW, SC), University of Maryland, Baltimore, MD.
| | - Avelino C Verceles
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine (EMW, ACV), University of Maryland, Baltimore, MD
| | - Shuo Chen
- Department of Psychiatry (EMW, SC), University of Maryland, Baltimore, MD
| | - Zhiwei Zhao
- Department of Mathematics (ZZ), University of Maryland, College Park, MD
| | | | - Kristine A Wilckens
- Department of Psychiatry (KAW, DJB), University of Pittsburgh School of Medicine
| | - Daniel J Buysse
- Department of Psychiatry (KAW, DJB), University of Pittsburgh School of Medicine
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Leonard JA, Lydon-Staley DM, Sharp SDS, Liu HZ, Park AT, Bassett DS, Duckworth AL, Mackey AP. Daily fluctuations in young children's persistence. Child Dev 2022; 93:e222-e236. [PMID: 34904237 PMCID: PMC8930564 DOI: 10.1111/cdev.13717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children's behavior changes from day to day, but the factors that contribute to its variability are understudied. We developed a novel repeated measures paradigm to study children's persistence by capitalizing on a task that children complete every day: toothbrushing (N = 81; 48% female; 36-47 months; 80% white, 14% Multiracial, 10% Hispanic, 2% Asian, 1% Black; 1195 observations collected between January 2019 and March 2020). Children brushed longer on days when their parents used more praise (d = .23) and less instruction (d = -.22). Sensitivity to mood, sleep, and parent stress varied across children, suggesting that identifying the factors that shape an individual child's persistence could lead to personalized interventions.
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Affiliation(s)
- Julia A. Leonard
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Psychology, Yale University, New Haven, CT, 06511 USA,Corresponding author: Julia Leonard,
| | - David M. Lydon-Staley
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Sophie D. S. Sharp
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Hunter Z. Liu
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Anne T. Park
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Danielle S. Bassett
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Electrical & Systems Engineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Physics & Astronomy, College of Arts & Sciences, University of Pennsylvania, Philadelphia, PA 19104 USA,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA,Santa Fe Institute, Santa Fe, NM 87501 USA
| | - Angela L. Duckworth
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Allyson P. Mackey
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104 USA
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Lydon‐Staley DM, Zurn P, Bassett DS. Within-person variability in curiosity during daily life and associations with well-being. J Pers 2020; 88:625-641. [PMID: 31519052 PMCID: PMC7067659 DOI: 10.1111/jopy.12515] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Curiosity promotes engagement in novel situations and the accruement of resources that promote well-being. An open question is the extent to which curiosity lability, the degree to which curiosity fluctuates over short timescales, impacts well-being. METHOD We use data from a 21-day daily diary as well as trait measures in 167 participants (mean age = 25.37 years, SD = 7.34) to test (a) the importance of curiosity lability for depression, flourishing, and life satisfaction, (b) day-to-day associations among curiosity and happiness, depressed mood, anxiety, and physical activity, and (c) the role of day's mood as a mediator between physical activity and curiosity. RESULTS We observe positive associations among curiosity lability and depression, as well as negative associations among curiosity lability and both life satisfaction and flourishing. Curiosity is higher on days of greater happiness and physical activity, and lower on days of greater depressed mood. We find evidence consistent with day's depressed mood and happiness being mediators between physical activity and curiosity. CONCLUSIONS Greater consistency in curiosity is associated with well-being. We identify several potential sources of augmentation and blunting of curiosity in daily life and provide support for purported mechanisms linking physical activity to curiosity via mood.
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Affiliation(s)
- David M. Lydon‐Staley
- Department of BioengineeringSchool of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Perry Zurn
- Department of PhilosophyAmerican UniversityWashingtonDCUSA
| | - Danielle S. Bassett
- Department of BioengineeringSchool of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of Electrical & Systems EngineeringSchool of Engineering & Applied ScienceUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of NeurologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of Physics & AstronomyCollege of Arts & SciencesUniversity of PennsylvaniaPhiladelphiaPAUSA
- Department of PsychiatryPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
- Santa Fe InstituteSanta FeNMUSA
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Sato D, Yoshinaga N, Nagai E, Hanaoka H, Sato Y, Shimizu E. Randomised controlled trial on the effect of internet-delivered computerised cognitive-behavioural therapy on patients with insomnia who remain symptomatic following hypnotics: a study protocol. BMJ Open 2018; 8:e018220. [PMID: 29382675 PMCID: PMC5829590 DOI: 10.1136/bmjopen-2017-018220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Insomnia has severe consequences for health. Primary care physicians in Japan commonly provide hypnotics, which is far from optimal. The recommended treatment for insomnia is cognitive-behavioural therapy (CBT). Access to trained therapists, however, is limited. Rather than face-to-face CBT, several researchers have studied internet-delivered computerised CBT (ICBT). This paper describes the study protocol for a randomised controlled trial (RCT) to evaluate effectiveness and feasibility of our newly developed five-step ICBT as an adjunct to usual care (UC) compared with UC alone for patients with insomnia who remain symptomatic following hypnotics. METHODS AND ANALYSIS This proposed exploratory RCT comprises two parallel groups (ICBT+UC and UC alone) consisting of 15 participants each (n=30) diagnosed with insomnia who remain symptomatic after pharmacotherapy. We aim to evaluate the effectiveness of six intervention weeks. The primary outcome of insomnia severity will be the Pittsburgh Sleep Quality Index (PSQI) at week 6. Secondary outcomes include sleep onset latency, total sleep time, sleep efficiency extracted from PSQI, current feeling of refreshment and perceived soundness of sleep measured using visual analogue scale, number of awakenings, anxiety by Hospital Anxiety and Depression Scale, depression by Center for Epidemiologic Studies Depression Scale and quality of life by Euro Qol-5D. All measures will be assessed at weeks 0 (baseline), 6 (postintervention) and 12 (follow-up), and intention-to-treat analysis will be applied. The statistical analysis plan has been developed considering design of field materials. ETHICS AND DISSEMINATION This study will be conducted at the academic outpatient clinic of Chiba University Hospital, Japan. Ethics approval was granted by the Institutional Review Board of Chiba University Hospital. All participants will be required to provide written informed consent. The trial will be implemented and reported in accordance with Consolidated Standards of Reporting Trials recommendations. TRIAL REGISTRATION NUMBER UMIN000021509; Pre-results.
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Affiliation(s)
- Daisuke Sato
- Departments of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Naoki Yoshinaga
- Organization for Promotion of Tenure Track, University of Miyazaki, Miyazaki, Japan
| | - Eiichi Nagai
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yasunori Sato
- Department of Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Departments of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan
- Cognitive Behavioral Therapy Center, Chiba University Hospital, Chiba, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
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7
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Espie CA, Luik AI, Cape J, Drake CL, Siriwardena AN, Ong JC, Gordon C, Bostock S, Hames P, Nisbet M, Sheaves B, G Foster R, Freeman D, Costa-Font J, Emsley R, Kyle SD. Digital Cognitive Behavioural Therapy for Insomnia versus sleep hygiene education: the impact of improved sleep on functional health, quality of life and psychological well-being. Study protocol for a randomised controlled trial. Trials 2016; 17:257. [PMID: 27216112 PMCID: PMC4877942 DOI: 10.1186/s13063-016-1364-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/24/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Previous research has demonstrated that digital CBT (dCBT), delivered via the Internet, is a scalable and effective intervention for treating insomnia in otherwise healthy adults and leads to significant improvements in primary outcomes relating to sleep. The majority of people with insomnia, however, seek help because of the functional impact and daytime consequences of poor sleep, not because of sleep discontinuity per se. Although some secondary analyses suggest that dCBT may have wider health benefits, no adequately powered study has investigated these as a primary endpoint. This study specifically aims to investigate the impact of dCBT for insomnia upon health and well-being, and will investigate sleep-related changes as mediating factors. METHODS/DESIGN We propose a pragmatic, parallel-group, randomised controlled trial of 1000 community participants meeting criteria for insomnia disorder. In the DIALS trial (Digital Insomnia therapy to Assist your Life as well as your Sleep), participants will be randomised to dCBT delivered using web and/or mobile channels (in addition to treatment as usual (TAU)) or to sleep hygiene education (SHE), comprising a website plus a downloadable booklet (in addition to TAU). Online assessments will take place at 0 (baseline), 4 (mid-treatment), 8 (post-treatment), and 24 (follow-up) weeks. At week 25 all participants allocated to SHE will be offered dCBT, at which point the controlled element of the trial will be complete. Naturalistic follow-up will be invited at weeks 36 and 48. Primary outcomes are functional health and well-being at 8 weeks. Secondary outcomes are mood, fatigue, sleepiness, cognitive function, productivity and social functioning. All main analyses will be carried out at the end of the final controlled follow-up assessments and will be based on the intention-to-treat principle. Further analyses will determine whether observed changes in functional health and well-being are mediated by changes in sleep. The trial is funded by Big Health Ltd. DISCUSSION This study will be the first large-scale, specifically designed investigation of the health and well-being benefits of CBT for insomnia, and the first examination of the association between CBT-mediated sleep improvement and health status. TRIAL REGISTRATION ISRCTN60530898 .
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Affiliation(s)
- Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK.
- Big Health Ltd., London, UK.
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
- Big Health Ltd., London, UK
| | - John Cape
- Big Health Ltd., London, UK
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Christopher L Drake
- Department of Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
| | | | - Jason C Ong
- Rush University Medical Center, Chicago, IL, USA
| | - Christopher Gordon
- CIRUS Centre for Integrated Research and Understanding of Sleep, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | | | | | | | - Bryony Sheaves
- Sleep and Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Russell G Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
| | - Daniel Freeman
- Sleep and Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Joan Costa-Font
- The London School of Economics and Political Science, London, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
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8
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Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, Spielman AJ, Kyle SD. The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev 2014; 18:415-24. [PMID: 24629826 DOI: 10.1016/j.smrv.2014.01.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/19/2014] [Accepted: 01/30/2014] [Indexed: 11/16/2022]
Abstract
Sleep restriction therapy is routinely used within cognitive behavioral therapy to treat chronic insomnia. However, the efficacy for sleep restriction therapy as a standalone intervention has yet to be comprehensively reviewed. This review evaluates the evidence for the use of sleep restriction therapy in the treatment of chronic insomnia. The literature was searched using web-based databases, finding 1344 studies. Twenty-one were accessed in full (1323 were deemed irrelevant to this review). Nine were considered relevant and evaluated in relation to study design using a standardized study checklist and levels of evidence. Four trials met adequate methodological strength to examine the efficacy of therapy for chronic insomnia. Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement. Standalone sleep restriction therapy is efficacious for the treatment of chronic insomnia for sleep diary continuity variables. Studies are insufficient to evaluate the full impact on objective sleep variables. Measures of daytime functioning in response to therapy are lacking. Variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy. A future research agenda is outlined.
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Affiliation(s)
- Christopher B Miller
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Australia; Institute of Neuroscience & Psychology, University of Glasgow, UK.
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK
| | - Dana R Epstein
- Phoenix Veterans Affairs Health Care System, USA; Arizona State University College of Nursing and Health Innovation, USA
| | - Leah Friedman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | | | - Wilfred R Pigeon
- Sleep & Neurophysiology Research Lab, University of Rochester Medical Center, USA; Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, USA
| | - Arthur J Spielman
- Cognitive Neuroscience Doctoral Program, The City College of the City University of New York, USA; Weill Cornell Medical College, Center for Sleep Medicine, NY, USA
| | - Simon D Kyle
- School of Psychological Sciences, University of Manchester, UK
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MacDonald S, Kormi-Nouri R. The affective personality, sleep, and autobiographical memories. JOURNAL OF POSITIVE PSYCHOLOGY 2013. [DOI: 10.1080/17439760.2013.800904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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10
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Miller CB, Kyle SD, Marshall NS, Espie CA. Ecological momentary assessment of daytime symptoms during sleep restriction therapy for insomnia. J Sleep Res 2013; 22:266-72. [PMID: 23331712 PMCID: PMC3633616 DOI: 10.1111/jsr.12024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/25/2012] [Accepted: 11/16/2012] [Indexed: 11/30/2022]
Abstract
This study profiles changes in self-reported daytime functioning during sleep restriction therapy (SRT) for insomnia. Ecological momentary assessment (EMA) captured point-in-time symptomatology to map the time-course of symptoms. We hypothesized a deterioration (week 1) followed by improvements at week 3 of therapy relative to baseline. Nine patients with psychophysiological insomnia completed the Daytime Insomnia Symptom Scale (DISS) at rise-time, 12:00 hours, 18:00 hours and bedtime for 1 week before and 3 weeks during SRT. Four validated factors from the DISS were analyzed (alert cognition, positive mood, negative mood and sleepiness/fatigue) across 28 days yielding 17 170 data points. Factors evaluated week (baseline versus weeks 1 and 3) and time of day symptomatology. Insomnia Severity Index scores decreased significantly pre-to-post treatment (mean 18 versus 7). Reflecting acute effects of SRT, significant differences were found for all factors, except negative mood, between baseline and week 1 of SRT, suggesting adverse effects. By week 3, sleepiness/fatigue and negative mood decreased significantly compared to baseline, and positive mood showed a trend towards improvement (P = 0.06). Sleepiness/fatigue displayed a significant week × time of day interaction, explained by a reduction in sleepiness/fatigue at every daytime assessment point (except bedtime, which remained high). A significant interaction for alert cognition was associated with reduction in alertness at bedtime by week 3 and an increase in alertness at rise-time, suggesting that SRT not only improves sleep, but moderates alertness and sleepiness in therapeutic ways. Initial SRT is associated with an increase in sleepiness/fatigue and a decrease in alert cognition.
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11
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Mullin BC, Harvey AG, Hinshaw SP. A preliminary study of sleep in adolescents with bipolar disorder, ADHD, and non-patient controls. Bipolar Disord 2011; 13:425-32. [PMID: 21843282 PMCID: PMC3158129 DOI: 10.1111/j.1399-5618.2011.00933.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the sleep of adolescents with bipolar disorder (BD) to groups of adolescents with attention-deficit hyperactivity disorder-combined type (ADHD-C) and those without psychopathology. METHODS A sample of 13 adolescents diagnosed with BD who were not in the midst of a mood episode, 14 adolescents with ADHD-C, and 21 healthy controls, all between the ages of 11 and 17 years served as participants. They were psychiatrically evaluated using a structured diagnostic interview and completed four nights of in-home sleep monitoring using actigraphy and sleep diaries. RESULTS Sleep diary estimates of sleep indicated that participants with BD experienced more awakenings than their peers with ADHD, whereas actigraphic estimates revealed that participants with BD slept longer and with less wakefulness than their peers. CONCLUSIONS In between mood episodes, adolescents with BD experience their sleep as more fragmented than that of their peers but do not exhibit more disturbed sleep as estimated by actigraphy. The possible influence of psychotropic medication is an important consideration when assessing sleep in the context of BD.
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Affiliation(s)
- Benjamin C Mullin
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Stephen P Hinshaw
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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12
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Buman MP, Hekler EB, Bliwise DL, King AC. Exercise effects on night-to-night fluctuations in self-rated sleep among older adults with sleep complaints. J Sleep Res 2011; 20:28-37. [PMID: 20629937 PMCID: PMC2958223 DOI: 10.1111/j.1365-2869.2010.00866.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sleep interventions have rarely explored reductions in night-to-night fluctuations [i.e. intra-individual variability (IIV)] in sleep, despite the negative impacts of such fluctuations on affective states and cognitive and physical symptoms. In a community-based randomized controlled trial we evaluated whether physical exercise reduced IIV in self-rated sleep outcomes among middle-aged and older adults with sleep complaints. Under-active adults 55 years and older (n = 66, 67% women) with mild to moderate sleep complaints were randomized to 12 months of a moderate-intensity endurance exercise (n = 36) or a health education control group (n = 30). Daily sleep logs, Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic sleep recordings (PSG) were collected at baseline, 6 months and 12 months. Sleep log-derived means and IIV were computed for sleep-onset latency (SOL), time in bed, feeling rested in the morning, number of nighttime awakenings, and wake after final awakening (WAFA). Using intent-to-treat methods, at 6 months no differences in IIV were observed by group. At 12 months, SOL-based IIV was reduced in the exercise group compared with the control (difference = 23.11, 95% CI: 3.04-47.18, P = 0.025, Cohen's d = 0.57). This change occurred without mean-level or IIV changes in sleep-wake schedules. For all sleep variables, except SOL and WAFA, IIV changes and mean-level changes in each variable were negatively correlated (r = -0.312 to -0.691, P < 0.05). Sleep log-derived IIV changes were modestly correlated with mean-level PSQI and PSG-based changes at 12 months. Twelve months of moderate-intensity exercise reduced night-to-night fluctuations in self-rated time to fall asleep, and this relationship was independent of mean-level time to fall asleep.
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Affiliation(s)
- Matthew P Buman
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305-5411, USA.
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Sleep and emotions: a focus on insomnia. Sleep Med Rev 2010; 14:227-38. [PMID: 20137989 DOI: 10.1016/j.smrv.2009.10.007] [Citation(s) in RCA: 524] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 10/16/2009] [Accepted: 10/17/2009] [Indexed: 11/21/2022]
Abstract
Insomnia disorder is defined as difficulties in initiating/maintaining sleep and/or non-restorative sleep accompanied by decreased daytime functioning, persisting for at least four weeks. For many patients suffering from depression and anxiety, insomnia is a pervasive problem. Many of the aetiological theories of insomnia postulate that heightened emotional reactivity contributes to the maintenance of symptoms. This review focuses on the role of emotional reactivity in insomnia, and how the relationship between insomnia and depression and anxiety may be mediated by emotional reactivity. Furthermore, studies investigating the valence of emotions in insomnia are reviewed. Overall, there is empirical evidence that dysfunctional emotional reactivity might mediate the interaction between cognitive and autonomic hyperarousal, thus contributing to the maintenance of insomnia. Moreover, dysfunctions in sleep-wake regulating neural circuitries seem to be able to reinforce emotional disturbances. It seems plausible that dysfunctional emotional reactivity modulates the relationship between insomnia and depression and anxiety. Considering the interaction between sleep and emotional valence, poor sleep quality seems to correlate with high negative and low positive emotions, both in clinical and subclinical samples. Good sleep seems to be associated with high positive emotions, but not necessarily with low negative emotions. This review underlines the need for future research on emotions in insomnia.
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Roumelioti ME, Argyropoulos C, Buysse DJ, Nayar H, Weisbord SD, Unruh ML. Sleep quality, mood, alertness and their variability in CKD and ESRD. Nephron Clin Pract 2010; 114:c277-87. [PMID: 20090370 DOI: 10.1159/000276580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 09/22/2009] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/AIMS Little is known about the association of chronic kidney disease (CKD) with sleep quality, mood, and alertness. In this report, we assessed these symptoms among patients with advanced CKD (stages 4-5) and those with end-stage renal disease (ESRD) and compared them to healthy controls without known kidney disease. METHODS Patients were recruited from local dialysis units, outpatient nephrology clinics and the Thomas E. Starzl Transplant Institute. Healthy control subjects matched for age, gender and race were drawn from an archival database. Daily symptoms of sleep quality, mood, and alertness were assessed by visual analogue scales of the Pittsburgh Sleep Diary. Health-related quality of life was assessed by the Short Form-36 instrument. RESULTS Sixty-nine dialysis patients and 23patients with advanced CKD demonstrated worse scores in sleep quality, mood, and alertness (p < 0.001) than controls. In adjusted analyses, European-American race, dialysis dependency, younger age, and physical performance SF-36 components were significantly associated with poor sleep quality, mood and alertness (p < 0.05). The dialysis population demonstrated higher day-to-day variability in scores than either the advanced CKD patients or the controls. CONCLUSION Advanced CKD and dialysis dependency are associated with impaired and highly variable sleep quality, mood, and alertness.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pa. 15213, USA
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Kyle SD, Morgan K, Espie CA. Insomnia and health-related quality of life. Sleep Med Rev 2009; 14:69-82. [PMID: 19962922 DOI: 10.1016/j.smrv.2009.07.004] [Citation(s) in RCA: 328] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 07/15/2009] [Accepted: 07/15/2009] [Indexed: 11/12/2022]
Abstract
Health-related Quality of Life (HRQoL) has become an important construct in contemporary medicine and health care, permitting assessment of disorder burden and evaluation of interventions on various aspects of functioning, in a standardized manner. Here we review literature on the measurement of HRQoL in insomnia populations, and the extent to which insomnia treatment improves domains of HRQoL. It is concluded from the relatively small literature that insomnia impacts on diverse areas of HRQoL, and that both pharmacological and non-pharmacological interventions can produce, to varying degrees, improvements in domains spanning physical, social and emotional functioning. Limitations of the current literature are identified; with particular emphasis on measurement and conceptual shortcomings. Suggestions are made in relation to improving the quality of future research, and how to further shed light on the impact of insomnia - and treatment thereof - on both HRQoL and global quality of life.
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Affiliation(s)
- Simon D Kyle
- University of Glasgow Sleep Centre, Sackler Institute of Psychobiological Research, Faculty of Medicine, Southern General Hospital, Glasgow G51 4TF, Scotland.
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Depressive symptoms and baseline prefrontal EEG alpha activity: A study utilizing Ecological Momentary Assessment. Biol Psychol 2008; 77:237-40. [DOI: 10.1016/j.biopsycho.2007.10.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 09/12/2007] [Accepted: 10/16/2007] [Indexed: 11/19/2022]
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Buysse DJ, Thompson W, Scott J, Franzen PL, Germain A, Hall M, Moul DE, Nofzinger EA, Kupfer DJ. Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment. Sleep Med 2007; 8:198-208. [PMID: 17368098 PMCID: PMC1899354 DOI: 10.1016/j.sleep.2006.10.006] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Revised: 10/09/2006] [Accepted: 10/09/2006] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To prospectively characterize and compare daytime symptoms in primary insomnia (PI) and good sleeper control (GSC) subjects using ecological momentary assessment; to examine relationships between daytime symptom factors, retrospective psychological and sleep reports, and concurrent sleep diary reports. METHODS Subjects included 47 PI and 18 GSC. Retrospective self-reports of daytime and sleep symptoms were collected. Daytime symptoms and sleep diary information were then collected for 1 week on hand-held computers. The Daytime Insomnia Symptom Scale (DISS) consisted of 19 visual analog scales completed four times per day. Factors for the DISS were derived using functional principal components analysis. Nonparametric tests were used to contrast DISS, retrospective symptom ratings, and sleep diary results in PI and GSC subjects, and to examine relationships among them. RESULTS Four principal components were identified for the DISS: Alert Cognition, Negative Mood, Positive Mood, and Sleepiness/Fatigue. PI scored significantly worse than GSC on all four factors (p<0.0003 for each). Among PI subjects DISS scales and retrospective psychological symptoms were related to each other in plausible ways. DISS factors were also related to self-report measures of sleep, whereas retrospective psychological symptom measures were not. CONCLUSIONS Daytime symptom factors of alertness, positive and negative mood, and sleepiness/fatigue, collected with ecological momentary assessment, showed impairment in PI versus GSC. DISS factors showed stronger relationships to retrospective sleep symptoms and concurrent sleep diary reports than retrospective psychological symptoms. The diurnal pattern of symptoms may inform studies of the pathophysiology and treatment outcome of insomnia.
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Affiliation(s)
- Daniel J Buysse
- Neuroscience Clinical and Translational Research Center, Department of Psychiatry, University of Pittsburgh, School of Medicine, USA.
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