Seasonal changes in sleep duration and sleep problems: A prospective study in Japanese community residents

Validity of self-reported sleep duration in the Cancer Prevention Study- 3

PURPOSE

We examined the one-year test re-test reliability and validity criterion of survey-assessed sleep duration collected from two separate questions.

METHODS

The Activity Validation Sub Study included 751 participants of the Cancer Prevention Study-3 study to further investigate rest/activity cycles. Sleep duration was collected using three methods: survey, Daysimeter device, and sleep diary. Survey-assessed sleep duration was collected using 2 different questions, each with different response options (categorical and continuous). Selected participants (n = 170) were asked to wear a Daysimeter device for seven consecutive days for two non-consecutive quarters. Participants were excluded from the current study due to incomplete/implausible survey or device data or reported working night shift. We calculated reliability of pre- and post-survey sleep duration for both survey question using Spearman correlation. We used the method of triads to estimate the validity coefficient (VC) between the three sleep duration measurements in the present study and the "true" latent sleep duration measure, and bootstrapping methods to calculate the 95% confidence intervals (95%CI).

RESULTS

Of 119 participants included in the study (52.10% male), test-retest correlation showed strong and moderate correlations for sleep duration collected continuously and categorically, respectively. The VC for survey-assessed continuous sleep duration was 0.82 (95%CI 0.71, 0.90) for weekday and 0.68 (95%CI 0.46, 0.83) for weekend. Performance of the VC was slightly weaker for survey-assessed categorical sleep duration (weekday VC = 0.57 95%CI 0.42, 0.71; weekend VC = 0.47 95%CI 0.29, 0.62).

CONCLUSION

The two survey-assessed sleep duration questions used in the AVSS and CPS-3 cohorts are valid approximations of sleep duration.

Reprint of: An assessment of a sleep aid and sleep promotion practices in hospitalized medical patients

BACKGROUND

Half of patients admitted to medicine units report sleep disruption, which increases the risk of sleep deprivation. Non-pharmacological interventions are the first step to improving sleep. However, utilization of sleep aids continues to be prevalent. Limited data are available on sleep aid prescribing practices across transitions of care.

OBJECTIVES

The aim of this study was to describe the current practices for assessing sleep and prescribing pharmacologic agents to promote sleep in the adult medicine population.

METHODS

This study was designed as a single-center, retrospective, observational cohort study of all patients discharged by the general medicine teams over a 3-month period (September 2019- November 2019). Prior to admission, inpatient and discharge prescriptions for sleep aids were recorded, and documentation of sleep assessments and non-pharmacological interventions were evaluated.

RESULTS

Of 754 patients included, 211 (28%) were prescribed a sleep aid while inpatient. During hospitalization, 124 (16%) patients had at least one documented sleep assessment, and only 22 (3%) were ordered the institutional non-pharmacological sleep promotion order set. The most prescribed sleep aid in inpatients was melatonin (50%), as well as prior to admission (35%) and at discharge (25%). Overall, the relative reduction in sleep aid prescriptions between admission and discharge was 67%.

CONCLUSION

Inpatient sleep aid prescribing is common in medical patients. Despite this, sleep assessments and the standard of care of non-pharmacological interventions are rarely utilized. Future efforts should focus on implementation of strategies to make sleep assessments and non-pharmacological sleep promotion routine and consistent in the inpatient setting.

Medical malpractice litigation and daylight saving time

STUDY OBJECTIVES

Daylight saving time (DST) constitutes a natural quasi-experiment to examine the influence of mild sleep loss and circadian misalignment. We investigated the acute effects of spring transition into DST and the chronic effects of DST (compared to standard time) on medical malpractice claims in the United States over 3 decades.

METHODS

We analyzed 288,432 malpractice claims from the National Practitioner Data Bank. To investigate the acute effects of spring DST transition, we compared medical malpractice incidents/decisions 1 week before spring DST transition, 1 week following spring DST transition, and the rest of the year. To investigate the chronic effects of DST months, we compared medical malpractice incidents/decisions averaged across the 7-8 months of DST vs the 4-5 months of standard time.

RESULTS

With regard to acute effects, spring DST transitions were significantly associated with higher payment decisions but not associated with the severity of medical incidents. With regard to chronic effects, the 7-8 DST months were associated with higher average payments and worse severity of incidents than the 4-5 standard time months.

CONCLUSIONS

The mild sleep loss and circadian misalignment associated with DST may influence the incidence of medical errors and decisions on medical malpractice payments both acutely and chronically.

CITATION

Gao C, Lage C, Scullin MK. Medical malpractice litigation and daylight saving time. J Clin Sleep Med. 2024;20(6):933-940.

An assessment of a sleep aid and sleep promotion practices in hospitalized medical patients

BACKGROUND

Half of patients admitted to medicine units report sleep disruption, which increases the risk of sleep deprivation. Non-pharmacological interventions are the first step to improving sleep. However, utilization of sleep aids continues to be prevalent. Limited data are available on sleep aid prescribing practices across transitions of care.

OBJECTIVES

The aim of this study was to describe the current practices for assessing sleep and prescribing pharmacologic agents to promote sleep in the adult medicine population.

METHODS

This study was designed as a single-center, retrospective, observational cohort study of all patients discharged by the general medicine teams over a 3-month period (September 2019- November 2019). Prior to admission, inpatient and discharge prescriptions for sleep aids were recorded, and documentation of sleep assessments and non-pharmacological interventions were evaluated.

RESULTS

Of 754 patients included, 211 (28%) were prescribed a sleep aid while inpatient. During hospitalization, 124 (16%) patients had at least one documented sleep assessment, and only 22 (3%) were ordered the institutional non-pharmacological sleep promotion order set. The most prescribed sleep aid in inpatients was melatonin (50%), as well as prior to admission (35%) and at discharge (25%). Overall, the relative reduction in sleep aid prescriptions between admission and discharge was 67%.

CONCLUSION

Inpatient sleep aid prescribing is common in medical patients. Despite this, sleep assessments and the standard of care of non-pharmacological interventions are rarely utilized. Future efforts should focus on implementation of strategies to make sleep assessments and non-pharmacological sleep promotion routine and consistent in the inpatient setting.

Temperature frequency and mortality: Assessing adaptation to local temperature

Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979-2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17-13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56-14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27-15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics.

Development of a Reverse-Yield Factor Database Disaggregating Japanese Composite Foods into Raw Primary Commodity Ingredients Based on the Standard Tables of Food Composition in Japan

The reverse-yield factor (RF) database was developed for qualitatively and quantitatively disaggregating Japanese composite foods into raw primary commodity (RPC) ingredients. Representative equations for four types (dried, salted, fermented and mixed foods) were developed to calculate RFs using the food content and composition data for composite foods listed in the Standard Tables of Food Composition in Japan-2020-(STFCJ), published by the Ministry of Education, Culture, Sports, Science and Technology of Japan. Out of 1150 composite foods identified in the STFCJ, RFs for 54 dried, 41 salted, 40 fermented and 818 mixed foods were obtained. RFs for 197 mixed foods could not be calculated because these foods were produced from ingredients with no specified information and/or through complex processing. The content and composition of Japanese composite foods would be interpreted representatively by RFs in the developed database.

Individual sleep need is flexible and dynamically related to cognitive function

Given that sleep deprivation studies consistently show that short sleep causes neurocognitive deficits, the effects of insufficient sleep on brain health and cognition are of great interest and concern. Here we argue that experimentally restricted sleep is not a good model for understanding the normal functions of sleep in naturalistic settings. Cross-disciplinary research suggests that human sleep is remarkably dependent on environmental conditions and social norms, thus escaping universally applicable rules. Sleep need varies over time and differs between individuals, showing a complex relationship with neurocognitive function. This aspect of sleep is rarely addressed in experimental work and is not reflected in expert recommendations about sleep duration. We recommend focusing on the role of individual and environmental factors to improve our understanding of the relationship between human sleep and cognition.

Seasonal changes in positive airway pressure adherence

Through their effects on sleep duration, bedroom environments, and pollen allergies, seasonal variations may impact positive airway pressure (PAP) adherence. We analyzed daily PAP telemonitoring data from 25,846 adults (median age 64 years, 67.8% male) treated with PAP for at least 4 months [mean (standard deviation, SD) duration of PAP: 5.5 years (SD 4.1)] to examine seasonal changes in PAP adherence, leaks, and residual apnea-hypopnea index. We demonstrate a significant decrease in PAP adherence in June compared to January (mean (SD): 0.37 (1.54) h/night) that achieved the minimal clinically important difference (MCID) of 30 min in 13.9% of adults. Furthermore, we provide novel data supporting the association of rising temperatures with seasonal changes in PAP use. Indeed, the most pronounced decline in PAP adherence was observed during the hottest days, while PAP adherence was only slightly reduced during the coolest days of June. Clinicians should be aware of seasonal changes in PAP adherence that are likely to be exacerbated by climate change.

Poor sleep quality increases mortality risk: A population-based longitudinal prospective study in community-dwelling middle-aged and older adults

OBJECTIVES

To assess the association between sleep quality and all-cause mortality in community-dwelling adults living in rural Ecuador.

METHODS

Individuals aged ≥40years enrolled in the prospective population-based Three Villages Study cohort were included. Sleep quality was assessed by means of the Pittsburgh Sleep Quality Index. Study participants were evaluated at baseline and at every annual door-to-door survey until they remained enrolled in the study. Mixed models Poisson regression for repeated Pittsburgh Sleep Quality Index determinations and multivariate Cox-proportional hazards models were fitted to estimate mortality risk according to sleep quality.

RESULTS

Analysis included 1494 individuals (mean age: 56.6 ± 12.5years; 56% women) followed for a median of 6.3 ± 3.3years. At baseline, 978 (65%) individuals had good sleep quality and 516 (35%) had poor sleep quality. The effects of Pittsburgh Sleep Quality Index scores changing over time on mortality was confounded by the impact of the SARS-CoV-2 pandemic on both. One hundred ninety-five individuals (13%) died during the follow-up, resulting in a crude mortality rate of 1.58 per 100 person years (95% C.I.: 1.27-1.88) for individuals with good sleep quality, and 3.18 (95% C.I.: 2.53-3.82) for those with poor sleep quality at baseline. A multivariate Cox-proportional hazards model showed that individuals with poor sleep quality at baseline were 1.38 times (95% C.I.: 1.02-1.85) more likely to die compared to those with good sleep quality; in this model, increased age, poor physical activity, and high fasting glucose remained significant.

CONCLUSIONS

Poor sleep quality is associated with increased mortality risk among middle-aged and older adults.

Seasonal Variation in the Responsiveness of the Melanopsin System to Evening Light: Why We Should Report Season When Collecting Data in Human Sleep and Circadian Studies

It is well known that variations in light exposure during the day affect light sensitivity in the evening. More daylight reduces sensitivity, and less daylight increases it. On average days, we spend less time outdoors in winter and receive far less light than in summer. Therefore, it could be relevant when collecting research data on the non-image forming (NIF) effects of light on circadian rhythms and sleep. In fact, studies conducted only in winter may result in more pronounced NIF effects than in summer. Here, we systematically collected information on the extent to which studies on the NIF effects of evening light include information on season and/or light history. We found that more studies were conducted in winter than in summer and that reporting when a study was conducted or measuring individual light history is not currently a standard in sleep and circadian research. In addition, we sought to evaluate seasonal variations in a previously published dataset of 72 participants investigating circadian and sleep effects of evening light exposure in a laboratory protocol where daytime light history was not controlled. In this study, we selectively modulated melanopic irradiance at four different light levels (<90 lx). Here, we aimed to retrospectively evaluate seasonal variations in the responsiveness of the melanopsin system by combining all data sets in an exploratory manner. Our analyses suggest that light sensitivity is indeed reduced in summer compared to winter. Thus, to increase the reproducibility of NIF effects on sleep and circadian measures, we recommend an assessment of the light history and encourage standardization of reporting guidelines on the seasonal distribution of measurements.

Country differences in nocturnal sleep variability: Observations from a large-scale, long-term sleep wearable study

STUDY OBJECTIVES

Country or regional differences in sleep duration are well-known, but few large-scale studies have specifically evaluated sleep variability, either across the work week, or in terms of differences in weekday and weekend sleep.

METHODS

Sleep measures, obtained over 50 million night's sleep from ∼220,000 wearable device users in 35 countries, were analysed. Each person contributed an average of ∼242 nights of data. Multiple regression was used to assess the impact country of residence had on sleep duration, timing, efficiency, weekday sleep variability, weekend sleep extension and social jetlag.

RESULTS

Nocturnal sleep was shorter and had a later onset in Asia than other regions. Despite this, sleep efficiency was lower and weekday sleep variability was higher. Weekend sleep extension was longer in Europe and the USA than in Asia, and was only partially related to weekday sleep duration. There were also cross-country differences in social jetlag although the regional differences were less distinct than for weekend sleep extension.

CONCLUSIONS

In addition to regional differences in sleep duration, cross-country differences in sleep variability and weekend sleep extension suggest that using the latter as an indicator of sleep debt may need to be reconsidered. In countries exhibiting both short sleep and high weekday sleep variability, a culturally different means of coping with inadequate sleep is likely. Country or region differences in culture, particularly those related to work, merit closer examination as factors influencing the variability in normative sleep patterns around the world.

Effects of Season and Daylight Saving Time Shifts on Sleep Symptoms: Canadian Longitudinal Study on Aging

BACKGROUND AND OBJECTIVES

There has been conflicting evidence regarding the association between seasonal changes and daylight saving time (DST) and sleep disorders. This topic is of particular interest currently because the United States and Canada are considering the elimination of seasonal clock changes. The aim of this study was to compare sleep symptoms among participants who were interviewed in different seasons and before/after the transition into DST and standard time (ST).

METHODS

A total of 30,097 people aged 45-85 years taking part in the Canadian Longitudinal Study on Aging were studied. Participants completed a questionnaire on sleep duration, satisfaction, sleep-onset insomnia, sleep-maintenance insomnia, and hypersomnolence symptoms. Sleep disorders were compared between participants who were interviewed during different seasons and at different times of the year (DST/ST). Data were analyzed using χ2, analysis of variance, binary logistic, and linear regression tests.

RESULTS

Among participants interviewed in different seasons, we found no difference in dissatisfaction with sleep, sleep onset, sleep maintenance, and hypersomnolence. Those interviewed in summer had slightly shorter sleep duration compared with those in winter (6.76 ± 1.2 vs 6.84 ± 1.3 hours). Participants interviewed 1 week before vs 1 week after DST transition showed no difference in sleep symptoms, except for a 9-minute decrease in sleep duration a week after transition. However, those who were interviewed a week after transition to ST compared with a week before reported more dissatisfaction with sleep (28% vs 22.6%, adjusted odds ratio [aOR] 1.34, 95% CI 1.02-1.76), higher sleep-onset insomnia (7.1% vs 3.3%, aOR 2.26, 95% CI 1.19-4.27), higher sleep-maintenance insomnia (12.9% vs 8.2%, aOR 1.64, 95% CI 1.02-2.66), and more hypersomnolence with adequate sleep (7.3% vs 3.6%, aOR 2.08, 95% CI 1.14-3.79).

DISCUSSION

We found small seasonal variations in sleep duration but no difference in other sleep symptoms. The transition from DST to ST was associated with a transient increase in sleep disorders.

Shorter sleep duration is associated with greater visceral fat mass in US adults: Findings from NHANES, 2011-2014

Habitual declines in sleep duration and increased rates of obesity are public health concerns worldwide. Accumulating evidence suggests a prominent link between reduced sleep duration and weight gain. Our cross-sectional study investigated the relationship between sleep duration and body fat distribution in US adults. We extracted data for 5151 participants (2575 men and 2576 women) aged 18-59 years from the US National Health and Nutrition Examination Survey 2011-2012 and 2013-2014. Weekday or workday night-time sleep duration was estimated using an in-home interview questionnaire. Dual-energy x-ray absorptiometry scans were used to determine regional body fat mass (arms, legs, trunk [android and gynoid], and abdominal [subcutaneous and visceral]). Multiple linear regression and restricted cubic spline analyses were performed after adjusting for several demographic, anthropometric, and nutritional covariates. There was a significant negative association between sleep duration and visceral fat mass overall (β: -12.139, P < 0.001) and by sex (men: β: -10.096, P < 0.001; women: β: -11.545, P = 0.038), after adjusting for age, ethnicity, body mass index, total body fat mass, daily energy and alcohol intake, sleep quality and sleep disorder status. Sleep duration and visceral fat appeared to plateau at ≥ 8 h of daily sleep. Sleep duration is negatively associated with visceral fat mass accumulation during adulthood with possibly no benefits beyond 8 h of sleep per day. Mechanistic and prospective studies are required to confirm the effect of sleep duration on visceral adiposity and determine its causes.

The Impact of Temperature on 24-Hour Movement Behaviors among Chinese Freshmen Students

BACKGROUND

Human populations worldwide have experienced substantial climate change issues. Gaps in scientific literature remain regarding the relationship between temperature and 24-hour movement behavior among people. The purpose of this study is to examine the impact of temperature on 24-hour movement behavior including physical activity (PA), sedentary behavior (SB) and sleep duration among university students living in Beijing, China.

METHODS

We conducted follow-up health surveys on 44,693 freshmen students enrolled at Tsinghua University from 2012 to 2018. PA and SB were measured by using the short version of the International Physical Activity Questionnaire (IPAQ-s); sleep duration was estimated by using The Pittsburgh Sleep Quality Index (CPSQI). Corresponding temperature data measured by the Beijing Meteorological Service were collected to include average daily temperature from the nearest weather station to Tsinghua university. The data were analyzed using linear individual fixed-effect regressions.

RESULTS

An increase in temperature (temperature range 2.29-28.73 °C) by 1 °C was associated with an increase in 0.66 weekly minutes of vigorous physical activity (VPA) (95% confidence interval [CI] = 0.49, 0.82), an increase in 0.56 weekly minutes of moderate physical activity (MPA)(95% CI = 0.32, 0.79), an increase in 1.21 weekly minutes of moderate to vigorous physical activity (MVPA) (95% CI = 0.90, 1.53), an increase in 0.55 weekly minutes of walking (95% CI = 0.31, 0.78), an increase in 1.76 weekly minutes of total PA (95% CI = 1.35, 2.17), and a reduction in 1.60 weekly minutes of sleeping (95% CI = -2.09, -1.11). There was no significant correlation between temperature and sedentary behavior among participants.

CONCLUSIONS

Temperature was significantly positively correlated with physical activity levels in the Chinese freshmen students, and significantly negatively correlated with sleep duration. Replication of this study is warranted among various populations within China. The evidence of this novel study focused on understanding the relationship between climate change and 24-hour movement behaviors among people for developing effective adaptation strategies to climate change to improve people's health behavior. This study has important implications for future study, as knowledge of the impact of temperature on movement behavior may help in the interpretation of their results and translate into improving people's health behavior.

Seasonal variation and sleep patterns in a hot climate Arab Region

PURPOSE

To describe the effect of seasonal variations on sleep patterns in a hot climate Arab region.

METHODS

This is a cross-sectional study that included healthy Omani subjects of both genders between ages 18 and 59 years. Data for sleep pattern identification in summer and winter were collected from participants using an actigraphy wristband.

RESULTS

Among 321 participants, in summer seasons, a polyphasic sleep pattern (40%) prevailed over other sleep patterns (P < 0.001). While in the winter season, monophasic sleep (31%) was the dominant pattern (P < 0.001). Subjects slept longer during the winter seasons with total hours of sleep during the day 48 min longer than in the summer, though the difference was not statistically significant (P > 0.05), while siesta duration in the summer was significantly longer (13 min, P < 0.01). In summer, the sleep quality was good (PSQI ≤ 5); however, it was poor (PSQI > 5) in winter (P < 0.05). Night sleep duration, daytime sleepiness, and sleep latency were not statistically different between the summer and winter seasons.

CONCLUSION

Sleep patterns may be influenced by seasonal changes. A polyphasic sleep pattern prevailed in summer while a monophasic pattern was the predominant sleep pattern in winter. In summer, the sleep quality was good and the siesta duration was longer compared to the winter.

Seasonality in nighttime blood pressure and its associations with target organ damage

There is some evidence that nighttime blood pressure varies between seasons. In the present analysis, we investigated the seasonal variation in ambulatory nighttime blood pressure and its associations with target organ damage. In 1054 untreated patients referred for ambulatory blood pressure monitoring, we performed measurements of urinary albumin-to-creatinine ratio (ACR, n = 1044), carotid-femoral pulse wave velocity (cfPWV, n = 1020) and left ventricular mass index (LVMI, n = 622). Patients referred in spring (n = 337, 32.0%), summer (n = 210, 19.9%), autumn (n = 196, 18.6%) and winter (n = 311, 29.5%) had similar 24-h ambulatory systolic/diastolic blood pressure (P ≥ 0.25). However, both before and after adjustment for confounding factors, nighttime systolic/diastolic blood pressure differed significantly between seasons (P < 0.001), being highest in summer and lowest in winter (adjusted mean values 117.0/75.3 mm Hg vs. 111.4/71.1 mm Hg). After adjustment for confounding factors, nighttime systolic/diastolic blood pressure were significantly and positively associated with ACR, cfPWV and LVMI (P < 0.006). In season-specific analyses, statistical significance was reached for all the associations of nighttime blood pressure with target organ damage in summer (P ≤ 0.02), and for some of the associations in spring, autumn and winter. The association between nighttime systolic blood pressure and ACR was significantly stronger in patients examined in summer than those in winter (standardized β, 0.31 vs 0.11 mg/mmol, P for interaction = 0.03). In conclusion, there is indeed seasonality in nighttime blood pressure level, as well as in its association with renal injury in terms of urinary albumin excretion. Our study shows that there is indeed seasonal variability in nighttime blood pressure, highest in summer and lowest in winter, and its association with renal injury in terms of urinary albumin excretion varies between summer and winter as well.

Loss of disability-adjusted life years due to heat-related sleep disturbance in the Japanese

The purpose of this study was to quantify the sleep disturbances caused by climate change using disability-adjusted life years (DALY). The revised sleep quality index for daily sleep (SQIDS2), a self-administered questionnaire for daily sleep quality, was developed to assess daily sleep disturbances. This questionnaire referenced and simplified the Pittsburgh Sleep Quality Index (PSQI). This study was conducted in Nagoya City in August 2011 and 2012. Sleep quality was measured using SQIDS2 and PSQI. A total of 574 participants in 2011 and 710 in 2012 responded to the survey. The sleep disturbance prevalence calculated from the SQIDS2 score was correlated with the daily minimum temperature (p = 0.0067). This score increased when the daily minimum temperature was above 24.8 °C. When correcting for the PSQI score, DALY loss due to heat-related sleep disturbances in Nagoya City (population: 2,266,851) was estimated to be 81.8 years in 2012. This value was comparable to the DALY loss due to heatstroke. Sleep disturbance due to climate change was quantified using the DALY based on the PSQI. Legislators must recognize the critical impact of the damage caused by sleep disturbances due to high temperatures at night. Additionally, a daily minimum temperature of 25 °C should be the starting point when establishing a goal or guideline for nighttime temperature.

Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey

PURPOSE

Psychotic-like experiences (PLEs) are prevalent among adolescents and are the most significant predictor of future mental disorders. This study aims to examine the cross-sectional and longitudinal associations between sleep disturbance and PLEs in a large cohort of adolescents.

METHODS

The 17,722 adolescents in our study were assessed from April 21 to May 12, 2021 (Time 1, T1) and again 6 months later from December 17 to 26, 2021 (Time 2, T2). The Youth Self Rating Insomnia Scale and 8-item Positive Subscale of the Community Assessment of Psychic Experiences were used to assess sleep and PLEs, respectively. Sample characteristics and depression were also evaluated at T1, and negative life events were measured at T2. Sleep duration ≤6 h per night was considered as sleep deprivation, and sleep disturbance was defined as having insomnia or poor sleep quality.

RESULTS

The prevalence of sleep disturbance and frequent PLEs at T1 were 14.1% and 14.5%, respectively. Sleep disturbance and sleep deprivation at T1 were significantly associated with increased risk for PLEs at T2 after adjusting for sample characteristics, depression, and negative life events. Furthermore, sleep disturbance and sleep deprivation also predicted the new onset and persistence of PLEs.

CONCLUSION

Sleep disturbance predicts the development and persistence of PLEs. Early assessment and treatment of sleep disturbance may therefore contribute to a comprehensive strategy for the successful prevention and treatment of PLEs in adolescents.

Comparison of the Associations between Self-Reported Sleep Quality and Sleep Duration Concerning the Risk of Depression: A Nationwide Population-Based Study in Indonesia

There is substantial evidence that a lack of sleep quality and duration can increase the risk of depression in adults. Still, few studies have compared sleep quality and duration to the risk of depression in Indonesia. Therefore, this study aimed to compare the prevalence and risk of depression associated with both sleep quality and duration and identified those factors associated with sleep quality with sleep duration. This study was a cross-sectional study, and the data were obtained from the 2014 Indonesian Family Life Survey, with a total sample comprised of 19,675 respondents aged older than 15 years old. A self-reported questionnaire was used to assess sleep quality and duration. Depression was assessed using the Center for Epidemiologic Studies Depression (CESD-10) questionnaire. Logistic regression was used to examine the risk of depression, and multinomial logistic regression was used to examine the risk of poor sleep quality with consideration to sleep duration. The prevalence of depression was the highest in the poor sleep quality and long sleep duration groups (48.5%). After all variables associated with depression were adjusted, poor sleep quality was identified as a factor leading to a higher risk of depression (OR = 4.2; 95% CI: 3.7-4.6; p < 0.001) than long sleep duration (OR = 1.4; 95% CI: 1.2-1.6; p < 0.001). Furthermore, the interaction between poor sleep quality and long sleep duration gave the highest risk of depression (OR = 4.4; 95% CI: 3.6-5.3); p < 0.001). Multinomial logistic regression revealed that the factors leading to a significant increase in the risk of poor sleep quality, with consideration to sleep duration, in the population were age, gender, marital status, education, wealth index, physical activity, chronic illness, season, and urban area (p < 0.05). Sleep quality was found to be associated with a higher risk of depression than sleep duration. The findings of this study may be beneficial to healthcare professionals who develop health promotion strategies for reducing the incidence of depression in communities.

Does Daylength Affect Sleep and Mental Health Symptoms during Behavioral Interventions for Insomnia?

BACKGROUND

Approximately 11-33% of Australian adults experience Insomnia Disorder, which is associated with higher rates of psychiatric comorbidities, and lower quality of life. Non-pharmacological interventions are the front-line treatments for insomnia. Despite the known impact of light on the sleep/wake cycle via the circadian system, it is not yet known whether seasonal variations in environmental light levels (i.e., daylength) influence treatment outcome. We aimed to determine whether seasonal differences in daylength influenced baseline symptoms of Insomnia Disorder or treatment outcome.

PARTICIPANTS

One hundred treatment-seeking individuals with Insomnia Disorder (age: 49.3 ± 14.4y, range: 18-82 years; 58 F) enrolled in a Randomized Control Trial in Australia over a 29-month period.

METHODS

Clients completed a seven-session behavioral intervention for insomnia over a maximum of 12 weeks. Individuals completed questionnaires assessing insomnia symptoms, diurnal preference, depression and anxiety symptoms, and daily sleep diaries. Objective rest/activity patterns were monitored using wrist actigraphy for the duration of the treatment period.

RESULTS

Baseline daylength, sunset and sunrise times, and change in daylength over treatment, were not related to baseline insomnia severity or mental health symptoms. However, longer daylength at baseline predicted greater improvements in insomnia symptoms and anxiety, but not depression, symptoms. These improvements were also associated with later sunset and/or earlier sunrise at baseline.

CONCLUSIONS

Our results show, greater treatment-related improvements in subjective sleep and mental health symptoms during spring and summer months. This suggests that daylength could have a role to play in the outcomes of a behavioral insomnia treatment. Future research is needed to provide recommendations.

Healthy Sleep Every Day Keeps the Doctor Away

When one considers the big picture of their health, sufficient sleep may often go overlooked as a keystone element in this picture. Insufficient sleep in either quality or duration is a growing problem for our modern society. It is essential to look at what this means for our health because insufficient sleep increases our risks of innumerable lifechanging diseases. Beyond increasing the risk of developing these diseases, it also makes the symptoms and pathogenesis of many diseases worse. Additionally, consistent quality sleep can not only improve our physical health but has also been shown to improve mental health and overall quality of life. Substandard sleep health could be a root cause for numerous issues individuals may be facing in their lives. It is essential that physicians take the time to learn about how to educate their patients on sleep health and try to work with them on an individual level to help motivate lifestyle changes. Facilitating access to sleep education for their patients is one way in which physicians can help provide patients with the tools to improve their sleep health. Throughout this paper, we will review the mechanisms behind the relationship between insufficient sleep health and chronic disease and what the science says about how inadequate sleep health negatively impacts the overall health and the quality of our lives. We will also explain the lifechanging effects of sufficient sleep and how we can help patients get there.

Hypoxia Differentially Affects Healthy Men and Women During a Daytime Nap With a Dose-Response Relationship: a Randomized, Cross-Over Pilot Study

Context: The use of daytime napping as a countermeasure in sleep disturbances has been recommended but its physiological evaluation at high altitude is limited. Objective: To evaluate the neuroendocrine response to hypoxic stress during a daytime nap and its cognitive impact. Design, Subject, and Setting: Randomized, single-blind, three period cross-over pilot study conducted with 15 healthy lowlander subjects (8 women) with a mean (SD) age of 29(6) years (Clinicaltrials identifier: NCT04146857, https://clinicaltrials.gov/ct2/show/NCT04146857?cond=napping&draw=3&rank=12). Interventions: Volunteers underwent a polysomnography, hematological and cognitive evaluation around a 90 min midday nap, being allocated to a randomized sequence of three conditions: normobaric normoxia (NN), normobaric hypoxia at FiO2 14.7% (NH15) and 12.5% (NH13), with a washout period of 1 week between conditions. Results: Primary outcome was the interbeat period measured by the RR interval with electrocardiogram. Compared to normobaric normoxia, RR during napping was shortened by 57 and 206 ms under NH15 and NH13 conditions, respectively (p < 0.001). Sympathetic predominance was evident by heart rate variability analysis and increased epinephrine levels. Concomitantly, there were significant changes in endocrine parameters such as erythropoietin (∼6 UI/L) and cortisol (∼100 nmol/L) (NH13 vs. NN, p < 0.001). Cognitive evaluation revealed changes in the color-word Stroop test. Additionally, although sleep efficiency was preserved, polysomnography showed lesser deep sleep and REM sleep, and periodic breathing, predominantly in men. Conclusion: Although napping in simulated altitude does not appear to significantly affect cognitive performance, sex-dependent changes in cardiac autonomic modulation and respiratory pattern should be considered before napping is prescribed as a countermeasure.

Association with Temperature Variability and Physical Activity, Sedentary Behavior, and Sleep in a Free-Living Population

The present study examines the temperature variability in physical activity (PA), sedentary behavior (SB), and sleep in a free-living population. A representative sample of 1235 adults (ages 21–70) from Iowa, U.S.A., wore a SenseWear Mini Armband (SWA) for a randomly assigned day. Koppen’s weather climate classification was used to precisely classify the temperature: cold (−13 to 32 °F), cool (32 to 50 °F), mild (50 to 64 °F), warm (64 to 73 °F), and hot (73 to 95 °F). The main effect of three-way ANOVA (age × gender × temperature) had differences for SB and sleep, with older adults having higher levels than younger adults (p < 0.05). However, moderate to vigorous PA (MVPA) did not vary systematically by age or gender, and contrary to expectations, the main effect of the weather was not significant for MVPA (p > 0.05). Participants spent more time participating in PA at cold than at hot temperatures. The results clarify the impact of temperature on shaping PA and SB patterns in adults. The variable impacts and differential patterns by age suggest that weather should be considered when interpreting differences in PA patterns in research or surveillance applications.

Seasonal Sleep Variations and Their Association With Meteorological Factors: A Japanese Population Study Using Large-Scale Body Acceleration Data

Seasonal changes in meteorological factors [e.g., ambient temperature (Ta), humidity, and sunlight] could significantly influence a person's sleep, possibly resulting in the seasonality of sleep properties (timing and quality). However, population-based studies on sleep seasonality or its association with meteorological factors remain limited, especially those using objective sleep data. Japan has clear seasonality with distinctive changes in meteorological variables among seasons, thereby suitable for examining sleep seasonality and the effects of meteorological factors. This study aimed to investigate seasonal variations in sleep properties in a Japanese population (68,604 individuals) and further identify meteorological factors contributing to sleep seasonality. Here we used large-scale objective sleep data estimated from body accelerations by machine learning. Sleep parameters such as total sleep time, sleep latency, sleep efficiency, and wake time after sleep onset demonstrated significant seasonal variations, showing that sleep quality in summer was worse than that in other seasons. While bedtime did not show clear seasonality, get-up time varied seasonally, with a nadir during summer, and positively correlated with the sunrise time. Estimated by the abovementioned sleep parameters, Ta had a practically meaningful association with sleep quality, indicating that sleep quality worsened with the increase of Ta. This association would partly explain seasonal variations in sleep quality among seasons. In conclusion, Ta had a principal role for seasonality in sleep quality, and the sunrise time chiefly determined the get-up time.

Sleep in adults from the UK during the first few months of the coronavirus outbreak

The coronavirus disease 2019 (COVID-19) outbreak emerged at the end of 2019 and quickly spread around the world. Measures to counter COVID-19, including social distancing and lockdowns, created an unusual situation that had the potential to impact a variety of behaviours, including sleep, which is crucial for health and well-being. Data were obtained through an online survey. The total sample comprised 19,482 participants from the UK. Participants were asked several questions regarding sleep quality and quantity. Each participant completed the questionnaires once during a data collection period spanning January 20 to March 31, 2020. Data provided by different participants during different weeks (spanning time-periods just before COVID-19 was identified in the UK and during the early weeks following its arrival) were compared using analysis of variance tests and regressions. Regression analyses controlling for age, sex and ethnicity revealed significant associations of small magnitude between date of survey completion and sleep quality, sleep latency, number of awakenings and composite score of poor sleep quality. These analyses also indicated small increases in eveningness tendency as the study progressed. There was no change in sleep duration or time spent awake at night. The COVID-19 outbreak did not appear to impact negatively sleep in a substantial manner during the early stages in the UK. The small increases in sleep quality variables (except for time spent awake at night and sleep duration) and eveningness are nonetheless of interest. Further research is needed to understand how best to provide support to those most in need of a good night's sleep during this unprecedented time.

Seasonal Changes in Sleep Patterns in Two Saskatchewan First Nation Communities

Sleep is crucial for maintaining the recovery and restoration of the body and brain. Less sleep is associated with poor mental and physical performance. Seasonal changes in sleep patterns can be observed. This paper examines seasonal effects on sleep timing, duration, and problems in two Cree First Nation communities in Saskatchewan, Canada. Data were available from a community survey of 588 adults aged 18 years and older (range: 18–78 years) with 44.2% males and 55.8% females. Results are presented using descriptive statistics and a binary logistic-regression model to identify the association between seasonal changes in sleep patterns, and demographic, social, and environmental factors. The participants reported sleeping the least during the spring and summer months and sleeping the most during the fall and winter months. This was further confirmed by sleep hours and the lower proportion of recommended hours of sleep during the spring and summer, and a higher proportion of longer sleep duration during the fall and winter months. There was no significant variation in sleeping onset and wake-up times by season. Overall, there were no significant differences in the prevalence of sleep deprivation, insomnia, and excessive daytime sleepiness by season. When stratified by age group and sex, some differences existed in the prevalence of sleep problems by season. More than two-thirds (68.6%) of the participants reported that there was a change in sleep patterns across seasons, and about 26.0% reported a very or extremely marked change in sleep patterns across seasons. Changes in sleep patterns by season were related to money left at the end of the month and damage caused by dampness in the house.

Seasonal variations in sleep duration and sleep complaints: A Swedish cohort study in middle-aged and older individuals

Subjective sleep reports are widely used research tools in epidemiology. Whether sleep reports can differ between seasons is less clear. Using multivariable binary or multinomial logistic regression analyses, in the present Swedish cross-sectional two-centre cohort study (N = 19,254; mean age 61 years), we found that participants surveyed during the summer (June-August) were more likely to report short sleep duration (defined as ≤ 6 hr) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 1.14 [1.04-1.25]). Individuals interviewed in the winter (December-February) were less likely to report early awakenings compared with participants surveyed in the autumn (September-November; odds ratio [95% confidence interval] = 0.85 [0.75-0.96]). Complaints of difficulties in falling asleep and disturbed sleep were less common among participants interviewed during spring (March-May) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 0.86 [0.74-0.99] and 0.88 [0.79-0.98], respectively). No seasonal variations in reports of long sleep, difficulty maintaining sleep, or feeling not rested after sleep were observed. Additional subgroup analysis revealed that summer participants were more likely to report short sleep duration and early morning awakenings than individuals surveyed in winter. In conclusion, this Swedish study indicates that self-reported sleep characteristics may vary across seasons. Further studies are needed to confirm our findings.

Thermal Comfort and Sleep Quality of Indonesian Students Living in Japan during Summer and Winter

Thermal comfort is crucial in satisfaction and maintaining quality sleep for occupants. In this study, we investigated the comfort temperature in the bedroom at night and sleep quality for Indonesian students during summer and winter. Eighteen male Indonesian students aged 29 ± 4 years participated in this study. The participants had stayed in Japan for about six months. We evaluated the sleep parameters using actigraphy performed during summer and winter. All participants completed the survey regarding thermal sensation, physical conditions, and subjective sleepiness before sleep. The temperature and relative humidity of participants’ bedrooms were also measured. We found that the duration on the bed during winter was significantly longer than that during summer. However, sleeping efficiency during winter was significantly worse than that during summer. The bedroom temperature of the participants was in the range of comfort temperature in Indonesia. With the average bedroom air temperature of 22.2 °C, most of the participants still preferred “warm” and felt “slightly comfortable” during winter. The average comfort temperature each season calculated using the Griffiths method was 28.1 °C during summer and 23.5 °C during winter. In conclusion, differences in adaptive action affect bedroom thermal conditions. Furthermore, habits encourage the sleep performance of Indonesian students.

Annual, seasonal, cultural and vacation patterns in sleep, sedentary behaviour and physical activity: a systematic review and meta-analysis

Background

Time spent in daily activities (sleep, sedentary behaviour and physical activity) has important consequences for health and wellbeing. The amount of time spent varies from day to day, yet little is known about the temporal nature of daily activity patterns in adults. The aim of this review is to identify the annual rhythms of daily activity behaviours in healthy adults and explore what temporal factors appear to influence these rhythms.

Methods

Six online databases were searched for cohort studies exploring within-year temporal patterns (e.g. season effects, vacation, cultural festivals) in sleep, sedentary behaviour or physical activity in healthy 18 to 65-year-old adults. Screening, data extraction, and risk of bias scoring were performed in duplicate. Extracted data was presented as mean daily minutes of each activity type, with transformations performed as needed. Where possible, meta-analyses were performed using random effect models to calculate standardised mean differences (SMD).

Results

Of the 7009 articles identified, 17 studies were included. Studies were published between 2003 and 2019, representing 14 countries and 1951 participants, addressing variation in daily activities across season (n = 11), Ramadan (n = 4), vacation (n = 1) and daylight savings time transitions (n = 1). Meta-analyses suggested evidence of seasonal variation in activity patterns, with sleep highest in autumn (+ 12 min); sedentary behaviour highest in winter (+ 19 min); light physical activity highest in summer (+ 19 min); and moderate-to-vigorous physical activity highest in summer (+ 2 min) when compared to the yearly mean. These trends were significant for light physical activity in winter (SMD = − 0.03, 95% CI − 0.58 to − 0.01, P = 0.04). Sleep appeared 64 min less during, compared to outside Ramadan (non-significant). Narrative analyses for the impact of vacation and daylight savings suggested that light physical activity is higher during vacation and that sleep increases after the spring daylight savings transition, and decreases after the autumn transition.

Conclusions

Research into temporal patterns in activity behaviours is scarce. Existing evidence suggests that seasonal changes and periodic changes to usual routine, such as observing religious events, may influence activity behaviours across the year. Further research measuring 24-h time use and exploring a wider variety of temporal factors is needed.

Age and gender differences in objective sleep properties using large-scale body acceleration data in a Japanese population

Using large-scale objective sleep data derived from body acceleration signals of 68,604 Japanese residents ranging from adolescents to the elderly (10-89 years old), we found significant age- and gender-related differences in sleep properties (timing, duration, and quality) in real-life settings. Time-in-bed and total sleep time (TST) showed a U-shaped association with age, indicating their decrease in adulthood following their increase in the elderly. There was a remarkable shift in sleep phase toward earlier bedtime and earlier wake time with increasing age (> 20 years), together with worsening of sleep quality, which is estimated by sleep efficiency (SE) and wake time after sleep onset. Gender comparisons showed that TST was shorter in women than in similarly aged men, which is much evident after the age of 30 years. This was associated with later bedtimes and greater age-related deterioration of sleep quality in women. Compared to men in the same age group, women over age 50 demonstrated a greater reduction in SE with aging, due mainly to increasing durations of nighttime awakening. These differences can be attributed to several intricately intertwined causes, including biological aging as well as socio-cultural and socio-familial factors in Japan. In conclusion, our findings provide valuable insights on the characteristics of Japanese sleep habits.

Spanish Version of the Bedtime Procrastination Scale: Cross-Cultural Adaptation and Psychometric Evaluation in a Sample of Nursing Students

A recent line of research concerns bedtime procrastination, its effects on sleep quality and duration, and the associated repercussions for health and wellbeing. The Bedtime Procrastination Scale is a brief, self-report instrument developed by Kroese et al. with the aim of evaluating this behavior and exploring its association with insufficient sleep, and hence with health. The aim was to develop and validate a Spanish version of the Bedtime Procrastination Scale (BPS-Sp) and to examine the relationship between bedtime procrastination and both general procrastination and self-control. The original BPS was translated from English into Spanish in accordance with international guidelines on the cross-cultural adaptation of measurement instruments. The sample for the validation study comprised 177 nursing students who completed a questionnaire requesting demographic data and which included the following instruments: the newly developed BPS-Sp, the Tuckman Procrastination Scale, and the Brief Self-Control Scale. Statistical analysis involved tests of normality (Kolmogorov-Smirnov), reliability (Cronbach's alpha, test-retest), construct validity, and confirmatory factor analysis. Scores on the BPS-Sp showed excellent internal consistency (α = .83) and temporal stability (test-retest r = .84), as well as significant correlations with general procrastination (r = .26; p < .01) and self-control (r = -.17; p < .05). Confirmatory factor analysis showed an adequate fit for the single-factor solution proposed by Kroese et al. The results suggest that the BPS-Sp is a valid and reliable instrument for assessing bedtime procrastination in the Spanish-speaking population.

Annual rhythms in adults' lifestyle and health (ARIA): protocol for a 12-month longitudinal study examining temporal patterns in weight, activity, diet, and wellbeing in Australian adults

BACKGROUND

Almost one in three Australian adults are now obese, and the rate continues to rise. The causes of obesity are multifaceted and include environmental, cultural and lifestyle factors. Emerging evidence suggests there may be temporal patterns in weight gain related, for example, to season and major festivals such as Christmas, potentially due to changes in diet, daily activity patterns or both. The aim of this study is to track the annual rhythm in body weight, 24 h activity patterns, dietary patterns, and wellbeing in a cohort of Australian adults. In addition, through data linkage with a concurrent children's cohort study, we aim to examine whether changes in children's body mass index, activity and diet are related to those of their parents.

METHODS

A community-based sample of 375 parents aged 18 to 65 years old, residing in or near Adelaide, Australia, and who have access to a Bluetooth-enabled mobile device or a computer and home internet, will be recruited. Across a full year, daily activities (minutes of moderate to vigorous physical activity, light physical activity, sedentary behaviour and sleep) will be measured using wrist-worn accelerometry (Fitbit Charge 3). Body weight will be measured daily using Fitbit wifi scales. Self-reported dietary intake (Dietary Questionnaire for Epidemiological Studies V3.2), and psychological wellbeing (WHOQOL-BREF and DASS-21) will be assessed eight times throughout the 12-month period. Annual patterns in weight will be examined using Lowess curves. Associations between changes in weight and changes in activity and diet compositions will be examined using repeated measures multi-level models. The associations between parent's and children's weight, activity and diet will be investigated using multi-level models.

DISCUSSION

Temporal factors, such as day type (weekday or weekend day), cultural celebrations and season, may play a key role in weight gain. The aim is to identify critical opportunities for intervention to assist the prevention of weight gain. Family-based interventions may be an important intervention strategy.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12619001430123 . Prospectively registered on 16 October 2019.

Night-Time Urinary Frequency Is Increased after the Great East Japan Earthquake along with Seasonal Variation: A Five-Year Longitudinal Study in Kesennuma City

Disasters influence various health conditions; however, little has been reported about urinary symptoms. The objective of this study is to evaluate whether night-time urinary frequency was influenced by the Great East Japan Earthquake (GEJE) in March 2011. We also evaluated seasonal variation of night-time frequency, which may affect the primary objective. A retrospective chart review was conducted on 300 evaluable patients who resided in the impacted area: 263 men with benign prostatic hyperplasia and/or overactive bladder and 37 women with overactive bladder. Data concerning night-time frequency were collected repeatedly every three months from March 2009 until March 2014, then compared yearly and seasonally among same patients. In addition, night-time frequency was analyzed for potential relations to sex, age, comorbidities, and whether residences had been destroyed. There was a significant increase of night-time frequency during 2011-2013 when compared yearly with 2009 and 2010. In seasonal comparisons of the entire period, night-time frequency was greater during autumn and winter compared with summer. In quarterly comparisons, a sudden increase was not observed after the GEJE, but night-time frequency was increased significantly in spring, summer and autumn in 2011 when compared with the corresponding seasons in 2010. While hypertension was related to exacerbation of night-time frequency during winter, we did not find any factors associated with increase after the disaster out of sex, age, comorbidities or residential situations. In conclusion, night-time urinary frequency is increased shortly after the GEJE and remains elevated for the following three years along with seasonal variation.

Sleep in the land of the midnight sun and polar night: The Tromsø study

While some diseases and human behaviors fluctuate consistently with season, the extent of seasonal variations in sleep, especially at high latitudes, is less consistent. We used data from a geographic region (69º North) with extremely large seasonal differences in daylight that had the participants blinded for the current study's hypotheses. Data were derived from the Tromsø Study (2015-2016), an ongoing population-based study in Northern Norway comprising citizens aged 40 years and older (n = 21,083, participation = 64.7%). The sleep parameters included bedtime, rise time, sleep onset latency (SOL), and total sleep time. Insomnia was defined according to recent diagnostic criteria (International Classification of Sleep Disorders; ICSD-3). We found some evidence of monthly or seasonal variation in sleep problems. Insomnia was most common during the winter months among men, but not women. No seasonal or monthly effects were observed for sleep duration. SOL was slightly longer during the winter months, but the differences were small and hardly of any clinical relevance. The small or non-existing seasonal variation in sleep and sleep difficulties indicate that extreme seasonal variation in daylight is of little influence on sleep status. The city of Tromsø is a modern city with considerable level of artificial light, which may contribute to the observed rather stabile sleep patterns throughout the year.

Evaluation of the Effects of an Intervention Intended to Optimize the Sleep Environment Among the Elderly: An Exploratory Study

Purpose

The objective of this exploratory study was to evaluate the effects of a brief intervention intended to optimize the sleep environment in older people living in the community and to examine the way these effects change over time.

Methods

The sample was made up of 44 participants (19 men and 25 women) aged 65-85 years, with a mean age of 71.4. The intervention consisted in a group training session that covered the reasons for and ways to ("why" and "how") optimize a sleep environment. It comprises six themes: air quality and odors, luminosity, noises and sounds, comfort of the mattress, comfort of the pillow, and temperature. Participants completed a set of questionnaires before the intervention, and one month and four months later.

Results

Four months after the intervention, the replies to the questionnaires showed that the participants experienced reduced severity of insomnia, sleep latency and anxiety. The subjective quality of the participants' sleep along with their sleep efficacy also increased significantly during the same period.

Conclusion

A brief intervention intended to optimize the sleep environment appears promising as an addition or alternative to the two other sleep improvement options generally offered to older people: medication and cognitive behavioral therapy.