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Coelho J, Sanchez-Ortuño MM, Martin VP, Gauld C, Richaud A, Lopez R, Pelou M, Abi-Saab P, Philip P, Geoffroy PA, Palagini L, Micoulaud-Franchi JA. Content analysis of insomnia questionnaires: A step to better evaluate the complex and multifaceted construct of insomnia disorder. Psychiatry Res 2023; 330:115584. [PMID: 37944205 DOI: 10.1016/j.psychres.2023.115584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Insomnia disorder is a mental disorder that includes various types of symptoms (e.g., insomnia initiating, worries, mood disturbances) and impairments (e.g., distress related to sleep alterations). Self-report questionnaires are the most common method for assessing insomnia but no systematic quantified analysis of their content and overlap has been carried out. We used content analysis and a visualization method to better identify the different types of clinical manifestations that are investigated by nine commonly used insomnia questionnaires for adults and the Jaccard index to quantify the degree to which they overlap. Content analysis found and visualized 16 different clinical manifestations classified into five dimensions ("Insomnia symptoms", "Insomnia-related symptoms", "Daytime symptoms", "Insomnia-related impairments", "Sleep behaviors"). The average Jaccard Index was 0.409 (moderate overlap in content). There is a lack of distinction between symptoms and impairments, and the assessment of sleep duration and hyperarousal symptoms remains overlooked. This preliminary analysis makes it possible to visualize the content of each of the nine questionnaires and to select the most appropriate questionnaire based on the issue to be addressed. Suggestions are made regarding the development of future questionnaires to better distinguish symptoms and impairments, and the different phenotypes of insomnia disorder.
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Affiliation(s)
- Julien Coelho
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France.
| | - Maria Montserrat Sanchez-Ortuño
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; Department of Nursing, School of Nursing, University of Murcia, Murcia, Spain
| | - Vincent P Martin
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence F-33400, France
| | - Christophe Gauld
- Service Psychopathologie du Développement de l'Enfant et de l'Adolescent, Hospices Civils de Lyon & Université de Lyon 1, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon, France
| | - Alexandre Richaud
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, Montpellier 34000, France; Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, Montpellier 34000, France
| | - Marie Pelou
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Poeiti Abi-Saab
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Pierre Philip
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Pierre-Alexis Geoffroy
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, Paris 75018, France; GHU Paris-Psychiatry & Neurosciences, 1 Rue Cabanis, Université de Paris, NeuroDiderot, Inserm, Paris 75019, France
| | - Laura Palagini
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa 56126, Italy; Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara 44121, Italy
| | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
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2
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Wang S, Lan Y, Liu Z, Xu S, Wu X. Effects of different interventions on insomnia in adults: Systematic review and network meta-analysis. J Psychiatr Res 2023; 165:140-149. [PMID: 37499485 DOI: 10.1016/j.jpsychires.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/04/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Insomnia is a common sleep disorder. There are many clinical-intervention methods for treating this condition, but thus far, the most effective method has not been determined. METHODS We conducted a network meta-analysis by including random evidence of insomnia improvement in people over 18 years old, without other physical diseases. From January 1, 1990 to June 15, 2022, we searched multiple electronic databases for randomized controlled trials of different insomnia-related, clinical-intervention methods. R software was used to analyze 10 indices, in order to evaluate the effect of sleep improvement. Primary outcomes comprised Pittsburgh sleep quality-index (PSQI) scores and insomnia severity-index (ISI) scores. RESULTS Finally, 122 randomized controlled trials were included in our study. For the PSQI scores, we found the sequence of intervention measures by effect to be as follows: electroacupuncture, acupuncture, repetitive transcranial magnetic stimulation (rTMS), essential oils, herbal medicine, traditional Western medicine, Tai Chi and Baduanjin, music, supplements, cognitive behavioral therapy for insomnia (CBT-I), and exercise. The results for ISI were similar to those for PSQI, but with slight differences. CONCLUSION Our research results indicate that various measures have a certain effect on improving sleep, among which the effect of instruments is more prominent. The curative effect of placebo groups was better than that of blank control groups. There is essentially no statistical difference in detailed classification within the same intervention category.
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Affiliation(s)
- Shuwen Wang
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yueyan Lan
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zixiu Liu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Shuang Xu
- Library of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.
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Imhoff-Smith TP, Grupe DW. The impact of mindfulness training on posttraumatic stress disorder symptoms, subjective sleep quality, and objective sleep outcomes in police officers. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023:2024-02812-001. [PMID: 37650805 PMCID: PMC10902185 DOI: 10.1037/tra0001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Sleep disturbances cooccur with posttraumatic stress disorder (PTSD) and are often correlated with PTSD severity. Previous research has shown that sleep problems mediate the relationship between PTSD and negative physical and mental health outcomes but has relied on self-reported sleep quality. We tested the effects of mindfulness training-previously shown to improve sleep quality and reduce PTSD symptoms-on subjective and objective sleep metrics and relationships with reduced PTSD symptoms. METHOD Following baseline data collection in 114 law enforcement officers, we randomly assigned participants to either an 8-week mindfulness training group or a waitlist control group. We repeated assessments immediately posttraining and at 3-month follow-up. Self-reported PTSD symptoms and subjective sleep quality were measured at each visit with the PTSD checklist and Pittsburgh Sleep Quality Index (PSQI), respectively. Participants also wore a Fitbit Charge 2 continuously over the course of a 4- to 6-day work week following each visit, from which we extracted two distinct objective sleep metrics: total minutes of sleep and sleep efficiency. RESULTS At baseline, PTSD symptoms were correlated with PSQI scores but not objective Fitbit metrics. Relative to waitlist, mindfulness training led to improved subjective sleep quality and reduced PTSD symptoms. Reduced PTSD symptoms mediated the improvement in subjective sleep quality following mindfulness training. Neither objective sleep metric demonstrated improvements following mindfulness training, nor did these metrics mediate reduced PTSD symptoms. CONCLUSIONS This study provides evidence linking improved subjective sleep quality, but not objective sleep markers, to reductions in PTSD symptoms following mindfulness training. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Daniel W Grupe
- Center for Healthy Minds, University of Wisconsin-Madison
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4
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Stachura A, Hussaini F, Nadeau C. Mobile App for Cognitive Therapy Insomnia Management in Primary Care. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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5
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Liguori C, Mombelli S, Fernandes M, Zucconi M, Plazzi G, Ferini-Strambi L, Logroscino G, Mercuri NB, Filardi M. The evolving role of quantitative actigraphy in clinical sleep medicine. Sleep Med Rev 2023; 68:101762. [PMID: 36773596 DOI: 10.1016/j.smrv.2023.101762] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023]
Abstract
Actigraphy has a consolidated role in Insomnia and Circadian Rhythm Sleep-Wake Disorders (CRSWD) and recent studies have highlighted the use of actigraphy for narcolepsy and REM sleep behaviour disorder (RBD). This review aims at summarising the results of studies published over the last decade regarding the use of actigraphy. Thirty-five studies proved eligible, and results were analysed separately for insomnia, narcolepsy and RBD. Actigraphy showed to consistently differentiate insomnia patients from healthy controls. Furthermore, the application of advanced analytical techniques has been shown to provide both unique insights into the physiology of insomnia and sleep misperception and to improve the specificity of actigraphy in detecting wakefulness within sleep periods. Regarding narcolepsy, several studies showed that actigraphy can detect peculiar sleep/wake disruption and the effects of pharmacological treatments. Finally, although the number of studies in RBD patients is still limited, the available evidence indicates a reduced amplitude of the activity pattern, sleep-wake rhythm dysregulation and daytime sleepiness. Therefore, the potential use of these markers as predictors of phenoconversion should be further explored. In conclusion, quantitative actigraphy presents a renewed interest when considering the possibility of using actigraphy in clinical sleep medicine to diagnose, monitor, and follow sleep disorders other than CRSWD.
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Affiliation(s)
- Claudio Liguori
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.
| | - Samantha Mombelli
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Mariana Fernandes
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy; "Vita-Salute" San Raffaele University, Milan, Italy
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
| | - Nicola Biagio Mercuri
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, Bari, Italy; Center for Neurodegenerative Diseases and the Aging Brain, University of Bari Aldo Moro at Pia Fondazione "Card. G. Panico", Italy
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6
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Chen YC, Lu TH, Ku EN, Chen CT, Fang CJ, Lai PC, Liu CH. Efficacy of brief behavioural therapy for insomnia in older adults with chronic insomnia: a systematic review and meta-analysis from randomised trials. Age Ageing 2023; 52:6998048. [PMID: 36702516 DOI: 10.1093/ageing/afac333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/11/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND chronic insomnia is a highly prevalent and persistent health concern among older adults, and it has significant adverse effects on cognitive function and physical health. OBJECTIVES the study aimed to evaluate the efficacy of a brief 4-week behavioural therapy for insomnia (BBTi) on insomnia remission in older adults with chronic insomnia. DESIGN a systematic review and meta-analysis were conducted. SUBJECTS adults aged 60 years or older. METHODS eight electronic databases were systematically searched through the end of March 2022. Studies followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Statement. RESULTS four randomised controlled trials (190 subjects) were included. The mean age of the participants was 69.06 (65.10-71.65), and 29.9% (27.3-32.3%) were male. Older adults who received the BBTi showed a significant insomnia remission (standardised mean differences, -1.07; 95% confidence interval, -1.43 to -0.71; I2, 0%). Sleep parameters measured by actigraphy revealed that in older adults, the BBTi program significantly improved total sleep time, wake after sleep onset (WASO), sleep onset latency (SOL) and sleep efficacy (SE) compared to the controls. For the subjective sleep parameters measured the by sleep diary, older adults who received BBTi obtained a more effective improvement in WASO, SE and SOL. The overall risk of bias was mostly low or of some concern due to the difficulty of blinding participants and assessors. CONCLUSIONS a 4-week BBTi program can be considered an effective and nonselective intervention for insomnia remission among older adults with chronic insomnia and thereby has the potential to ameliorate WASO, SE and SOL.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Hua Lu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - En-Ni Ku
- Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Te Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Ching-Ju Fang
- Medical Library, National Cheng Kung University, Tainan, Taiwan.,Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Lai
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiu Liu
- Department of Gerontology and Geriatrics, National Cheng Kung University Hospital, Tainan, Taiwan
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7
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Sarfan LD, Gasperetti CE, Gumport NB, Harvey AG. Outcomes From the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for Midlife and Older Adults With Serious Mental Illness and Sleep and Circadian Dysfunction. Behav Ther 2022; 53:585-599. [PMID: 35697424 PMCID: PMC10927276 DOI: 10.1016/j.beth.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
Abstract
The present study tested outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) among midlife and older adults with serious mental illness (SMI). Further, we tested predictors-credibility, expectancy, usefulness, and utilization-that may affect TranS-C outcomes. Midlife and older participants from a community setting (>49 years, 62.3% female, 37.7% African American or Black) with sleep and circadian problems and SMI were randomized to receive TranS-C plus usual care (TranS-C+UC, n = 27) or usual care followed by delayed treatment with TranS-C (UC-DT, n = 26). Immediate and delayed TranS-C data were combined to increase power (combined n = 52). Outcomes were assessed at pretreatment, posttreatment, and 6-month follow-up. Credibility and expectancy were assessed during the second session. Usefulness and utilization of TranS-C skills were assessed at posttreatment and 6-month follow-up. TranS-C+UC, relative to UC-DT, was associated with improvements in depression symptoms, sleep disturbance, overall sleep health, and select sleep/wake outcomes, though not all improvements were sustained at 6-month follow-up. Lower usefulness of TranS-C skills predicted more severe sleep disturbance at posttreatment and daytime sleep-related impairment at posttreatment and 6-month follow-up. Lower utilization predicted more severe psychiatric symptoms at posttreatment, sleep disturbance at posttreatment and 6-month follow-up, and overall impairment and daytime sleep-related impairment at 6-month follow-up. Higher credibility and expectancy predicted greater usefulness of TranS-C skills at posttreatment and 6-month follow-up and greater utilization at 6-month follow-up. Together, findings highlight benefits of TranS-C for midlife and older adults with SMI. However, boosting credibility, expectancy, utilization, and usefulness may meaningfully improve TranS-C outcomes.
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8
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Williams-Cooke C, LeSuer L, Drerup M, Siengsukon C. The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis. Nat Sci Sleep 2021; 13:1865-1874. [PMID: 34675730 PMCID: PMC8520446 DOI: 10.2147/nss.s324879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE While studies indicate cognitive behavioral therapy for insomnia (CBT-I) improves self-report sleep outcomes from questionnaires in people with multiple sclerosis (MS), it is unclear if CBT-I improves outcomes from a sleep log or sleep assessed objectively via actigraphy in people with MS. This study aimed to determine if CBT-I improves sleep log and actigraphy outcomes in individuals with MS. PATIENTS AND METHODS Twenty-five participants (Mage = 53.04, SD= 10.90) were included in this secondary analysis of data from a pilot randomized control study to assess the feasibility and treatment effect of CBT-I in individuals with MS. Participants were asked to maintain a sleep log and wear an actigraph for a week at baseline and post-intervention. Participants were randomized into one of three groups (CBT-I, active control, or one-time brief education control group). One-way ANOVAs were used to assess for group differences and within group change in sleep latency, sleep efficiency (SE), time in bed, total sleep time (TST), wake after sleep onset, variability of SE, and variability of TST. RESULTS CBT-I resulted in an increase in sleep efficiency (SE) and decrease in time in bed (TIB) and variability of SE from the sleep log. The CBT-I group also experienced a decrease in TIB and total sleep time (TST) from actigraphy. The active control group demonstrated an increase in variability of SE from actigraphy. CONCLUSION This study indicates that individuals with MS may experience an improvement in sleep log and actigraphy sleep outcomes following CBT-I, but findings need to be replicated in a larger prospective study. The decrease in TST from actigraphy mirrors results from prior studies.
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Affiliation(s)
- Cierra Williams-Cooke
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Leslie LeSuer
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Drerup
- Sleep Disorders Clinic, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
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9
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Dzierzewski JM, Donovan EK, Sabet SM. The Sleep Regularity Questionnaire: development and initial validation. Sleep Med 2021; 85:45-53. [PMID: 34274811 DOI: 10.1016/j.sleep.2021.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Sleep is a critically important behavior which influences diverse aspects of health, functioning, and longevity. An increasing literature suggests the importance of sleep regularity, also referred to as sleep inconsistency, sleep variability, or intraindividual variability in sleep. Given there is no brief, subjective measure of sleep regularity, the purpose of this study was to develop the Sleep Regularity Questionnaire (SRQ) and to begin the process of examining its psychometric properties using a construct-validation approach. PARTICIPANTS/METHODS In an online study of sleep and health, participants (n = 3249; Mage (SD) = 42.77 (16.73); 48.5% female; 77.3% white) completed the in-development SRQ, as well as the Insomnia Severity Index and the Pittsburgh Sleep Quality Index. RESULTS An exploratory factor analysis followed by a confirmatory factor analysis revealed a two factor structure, represented by circadian regularity and sleep continuity regularity, with good model fit indices (X2 = 50.9, df = 7, p < 0.001; RMSEA = 0.06; CFI = 0.99; NFI = 0.99; IFI = 0.99; TLI = 0.98). Test-retest reliability, as well as concurrent, convergent and incremental validity were examined, with promising results. CONCLUSIONS Preliminary psychometrics suggest that the SRQ is a valid and stable instrument for the assessment of sleep regularity in adults that is related to, but distinct from, other established sleep constructs. Future research will benefit from assessing the validity of the SRQ in various clinical samples and how it compares to measures of sleep regularity calculated from prospective daily assessments.
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Affiliation(s)
- Joseph M Dzierzewski
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., PO Box 842018, Richmond, VA, 23284-2018, USA.
| | - Emily K Donovan
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., PO Box 842018, Richmond, VA, 23284-2018, USA
| | - Sahar M Sabet
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St., PO Box 842018, Richmond, VA, 23284-2018, USA
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10
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Flaxer JM, Heyer A, Francois D. Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly. Am J Geriatr Psychiatry 2021; 29:585-603. [PMID: 33218915 DOI: 10.1016/j.jagp.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.
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Affiliation(s)
- Joseph M Flaxer
- Zucker School of Medicine at Hostra/Northwell (JMF), Glen Oaks, NY
| | - Arianna Heyer
- Sidney Kimmel Medical College (AH), Thomas Jefferson University, Philadelphia, PA
| | - Dimitry Francois
- Weill Cornell Medicine (DF), New York Presbyterian/Westchester, White Plains, NY.
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11
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Vestergaard CL, Vedaa Ø, Simpson MR, Faaland P, Vethe D, Kjørstad K, Langsrud K, Ritterband LM, Sivertsen B, Stiles TC, Scott J, Kallestad H. The effect of sleep-wake intraindividial variability in digital cognitive behaviour therapy for insomnia: A mediation analysis of a large-scale RCT. Sleep 2021; 44:6272558. [PMID: 33964166 PMCID: PMC8503826 DOI: 10.1093/sleep/zsab118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Study Objectives Digital cognitive behavioral therapy for insomnia (dCBT-I) is an effective treatment for insomnia. However, less is known about mediators of its benefits. The aim of the present study was to test if intraindividual variability in sleep (IIV) was reduced with dCBT-I, and whether any identified reduction was a mediator of dCBT-I on insomnia severity and psychological distress. Methods In a two-arm randomized controlled trial (RCT), 1720 adults with insomnia (dCBT-I = 867; patient education about sleep = 853) completed the Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS) and sleep diaries, at baseline and 9-week follow-up. Changes in IIV were analyzed using linear mixed modeling followed by mediation analyses of ISI, HADS, and IIV in singular sleep metrics and composite measures (behavioral indices (BI-Z) and sleep disturbance indices (SI-Z)). Results dCBT-I was associated with reduced IIV across all singular sleep metrics, with the largest between-group effect sizes observed for sleep onset latency (SOL). Reduced IIV for SOL and wake after sleep onset had the overall greatest singular mediating effect. For composite measures, SI-Z mediated change in ISI (b = −0.74; 95% confidence interval (CI) −1.04 to −0.52; 13.3%) and HADS (b = −0.40; 95% CI −0.73 to −0.18; 29.2%), while BI-Z mediated minor changes. Conclusion Reductions in IIV in key sleep metrics mediate significant changes in insomnia severity and especially psychological distress when using dCBT-I. These findings offer important evidence regarding the therapeutic action of dCBT-I and may guide the future development of this intervention. Clinical trials Name: Overcoming Insomnia: Impact on Sleep, Health and Work of Online CBT-I Registration number: NCT02558647 URL: https://clinicaltrials.gov/ct2/show/NCT02558647?cond=NCT02558647&draw=2&rank=1
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Affiliation(s)
- Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Voss District Psychiatric Hospital, NKS Bjørkeli, Voss, Norway
| | - Melanie R Simpson
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Patrick Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Knut Langsrud
- St. Olavs University Hospital, Østmarka, Trondheim, Norway
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Børge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Norway
| | - Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,University of Newcastle, Newcastle, United Kingdom
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs University Hospital, Østmarka, Trondheim, Norway
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12
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Shaffer KM, Hedeker D, Morin CM, Ingersoll K, Thorndike F, Ritterband LM. Intraindividual variability in sleep schedule: effects of an internet-based cognitive-behavioral therapy for insomnia program and its relation with symptom remission. Sleep 2021; 43:5854702. [PMID: 32511726 DOI: 10.1093/sleep/zsaa115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/20/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Sleep schedule consistency is fundamental to cognitive-behavioral therapy for insomnia (CBT-I), although there is limited evidence suggesting whether it predicts treatment response. This analysis tested whether: (1) an Internet-based CBT-I program affects intraindividual variability (IIV) in sleep schedule and (2) sleep schedule IIV predicts insomnia symptom remission. METHODS This secondary analysis compares participants (N = 303) randomized to an Internet-based CBT-I program (SHUTi-Sleep Healthy Using the Internet) or Internet-based patient education (PE). Participants reported daily bedtimes and rising times on 10 online sleep diaries collected over 2 weeks at baseline and 9-week post-intervention assessment. Participants completed the Insomnia Severity Index (ISI) at post-assessment and 6-month follow-up; symptom remission was defined by ISI < 8. Mixed effects location scale modeling was used to examine the effect of SHUTi on bedtime and rising time IIV; a novel two-staged analysis examined the effect of bedtime and rising time IIV on insomnia symptom remission. RESULTS At post-assessment, SHUTi participants reported about 30% less bedtime and 32% less rising time variability compared to PE (ps < 0.03). Bedtime and rising time IIV was not independently associated with likelihood of insomnia symptom remission at the subsequent time point (ps > 0.18), nor did sleep schedule IIV moderate treatment response (ps > 0.12). CONCLUSIONS Findings demonstrate that an Internet-delivered CBT-I program can effectively increase users' sleep schedule consistency relative to an educational control. This consistency, however, was not related to treatment outcome when defined by insomnia symptom remission, suggesting that enforcing rigid sleep schedules for patients may not be necessary for treatment success. CLINICAL TRIAL REGISTRATION NCT00328250.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Charles M Morin
- Department of Psychology, Laval University, Québec, QC, Canada
| | - Karen Ingersoll
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA
| | | | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA
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13
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How does cognitive behavioural therapy for insomnia work? A systematic review and meta-analysis of mediators of change. Clin Psychol Rev 2021; 86:102027. [PMID: 33887655 DOI: 10.1016/j.cpr.2021.102027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/11/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
Insomnia is prevalent and debilitating, comprising sustained difficulties initiating or maintaining sleep. Cognitive-behavioural therapy for insomnia (CBT-I) is a multicomponent intervention recommended as the first-line treatment, but the mediators of change remain unclear. This systematic review and meta-analysis aimed to synthesise and evaluate the evidence for potential mediators of CBT-I. Searches were performed for studies published until February 2021, reporting on mediation analyses with CBT-I. Seventeen unique samples of adults with insomnia (20 studies, N = 3125) were included. Two-stage structural equation modelling was applied to the available data, where 7 studies examined the cognitive mediator, 'dysfunctional beliefs about sleep', 5 studies examined a hyperarousal mediator, and 3 studies examined the behavioural mediator, 'time in bed'. There was evidence in support of changes in dysfunctional beliefs as a cognitive mediator of insomnia symptom improvement following CBT-I. There was more limited evidence in support of changes in hyperarousal-related mediators, and no significant effect of time in bed as a mediator. Numerous studies recorded diary-based measures of potential behavioural mediators, but analyses of these variables were not typically conducted. The most serious limitation of the evidence base is that the temporal precedence of mediator changes cannot be established. Future studies should consider: i) using mid-treatment measurements of mediator changes; ii) reporting on mediator psychometric properties; and iii) explicitly stating analyses as pre-specified or exploratory.
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14
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Kwon CY, Lee B, Cheong MJ, Kim TH, Jang BH, Chung SY, Kim JW. Non-pharmacological Treatment for Elderly Individuals With Insomnia: A Systematic Review and Network Meta-Analysis. Front Psychiatry 2021; 11:608896. [PMID: 33584374 PMCID: PMC7876437 DOI: 10.3389/fpsyt.2020.608896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 01/25/2023] Open
Abstract
Background: Insomnia causes a huge socioeconomic burden among the elderly, and is not simply a health problem. This study aimed to determine the comparative advantage of the effectiveness and acceptability of non-pharmacological interventions available for elderly individuals with insomnia. Methods: Comprehensive searches in 13 medical databases were performed to find relevant randomized controlled trials (RCTs) up to August 2019. Two independent reviewers performed study selection, data extraction, and quality assessment of included RCTs using the Cochrane Collaboration's risk of bias. A network meta-analysis within the frequentist model was performed by combining direct and indirect evidence from all available RCTs. The primary outcomes were effectiveness as measured by the Pittsburgh Sleep Quality Index (PSQI) total score and acceptability by the incidence of all-cause drop-out. Results: Twenty-eight RCTs involving 2,391 participants were included. Compared to wait-list, acupuncture (standardized mean difference -4.37, 95% confidence interval -8.53 to -0.12), acupuncture combined with benzodiazepines (-5.20, -9.82 to -0.57), behavioral therapy (-10.44, -17.31 to -3.58), benzodiazepines (-4.28, -8.45 to -0.11), benzodiazepines combined with cognitive behavioral therapy (CBT) (-7.18, -12.17 to -2.19), and CBT (-4.93, -8.63 to -1.22) showed significant superiority in their effectiveness. No significant comparative superiority or inferiority was found in terms of acceptability. Conclusions: In terms of effectiveness as indicated by the PSQI total score, compared to wait-list, superior benefits were observed for acupuncture, acupuncture combined with benzodiazepines, behavioral treatment, benzodiazepines, benzodiazepines combined with CBT, and CBT. Importantly, combined treatments, including benzodiazepines combined with CBT or with acupuncture, were generally superior to other monotherapies. In terms of acceptability, there was not enough data to draw conclusions. However, most RCTs included had methodological problems related to the lack of blinding procedure, suggesting a risk of effect size overestimation. Registration: CRD42019145518.
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Affiliation(s)
- Chan-Young Kwon
- Department of Oriental Neuropsychiatry, Dong-eui University College of Korean Medicine, Busan, South Korea
| | - Boram Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Moon Joo Cheong
- Education Graduate of Wonkwang University, Iksan-si, South Korea
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, South Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
| | - Sun Yong Chung
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
| | - Jong Woo Kim
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, South Korea
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15
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McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Berry RB, McCoy KM, Marsiske M. Effects of Brief Behavioral Treatment for Insomnia on Daily Associations between Self-Reported Sleep and Objective Cognitive Performance in Older Adults. Behav Sleep Med 2020; 18:577-588. [PMID: 31203649 PMCID: PMC7981847 DOI: 10.1080/15402002.2019.1632201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behavioral treatments for insomnia improve sleep in older adults, but research documenting their effects on cognitive performance is mixed. We explored whether a brief behavioral treatment for insomnia (BBTi) impacts daily associations between sleep parameters and next day cognition. METHODS Sixty-two older adults (Mage = 69.45 years, SD = 7.71) with insomnia completed either 4 weeks of BBTi or self-monitoring control (SMC). At baseline, post-treatment, and 3 month follow-up, participants completed 14 days of diaries measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), as well as daily cognitive tests measuring processing speed (i.e., symbol digit modalities test, SDMT), and reasoning (i.e., letter series). At each time period, associations between sleep parameters and daily cognition, controlling for age, education, insomnia duration, use of sleep medications, and depression (i.e., Beck Depression Inventory-2nd Edition scores), were examined through multilevel modeling. RESULTS At post-treatment, we observed an interactive fixed effect of treatment condition (i.e., BBTi/SMC) and TST on daily SDMT and letter series performance. For BBTi, longer TST was associated with better letter series performance, and did not predict SDMT performance. For SMC, longer TST was associated with worse SDMT, and was not associated with letter series performance. Greater WASO (regardless of group) was associated with better SDMT performance at post-treatment. Associations were not maintained at follow-up. CONCLUSIONS Sleep duration may play an important role in BBTi-related improvements in daily higher order cognition. Maintenance of these associations may be facilitated by booster sessions following post-treatment. CLINICAL TRIAL IDENTIFIER NCT02967185.
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Affiliation(s)
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri-Columbia,
Columbia, MO
| | | | | | | | - Ashley Stripling
- College of Psychology, Nova Southeastern University, Fort
Lauderdale, Florida,Department of Psychiatry, Geisel School of Medicine,
Dartmouth College, Hanover, NH
| | | | | | - Karin M. McCoy
- Neuropsychology Service, South Texas Veterans Health Care
System, San Antonio, TX
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL
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16
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Abstract
Purpose of Review To evaluate and summarize recent research articles pertaining to insomnia in older adults that can guide healthcare providers on factors to consider when assessing and managing insomnia. Recent Findings Up to 75% of older adults experience symptoms of insomnia. Insomnia is associated with socioeconomic status, racial and ethnic classification, family relationships, medical and mental health disorders, cognitive function, and dementia. Although one-fifth of older adults are still prescribed sleep medications, cognitive behavioral therapy for insomnia is the first line treatment for insomnia, resulting in short-term and long-term benefits. Summary To manage insomnia safely and effectively, healthcare providers need to consistently assess for insomnia during baseline and annual assessments, evaluate medical and social factors associated with insomnia, minimize the use of sleep medications, and provide referrals to and/or collaborate with providers who perform cognitive behavioral therapy for insomnia. Insomnia screening is important as it facilitates early intervention with behavioral management, reduces the potential for pharmacological management, which increases fall risk in older adults, and enables further assessment and early identification of outcomes such as cognitive impairment.
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17
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Galbiati A, Sforza M, Fasiello E, Castronovo V, Ferini-Strambi L. Impact Of Phenotypic Heterogeneity Of Insomnia On The Patients' Response To Cognitive-Behavioral Therapy For Insomnia: Current Perspectives. Nat Sci Sleep 2019; 11:367-376. [PMID: 31819690 PMCID: PMC6890191 DOI: 10.2147/nss.s198812] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Insomnia is one of the most common mental disorders and the most frequent sleep disorder encountered in clinical practice, with a prevalence of about 7% in the European population. Insomnia Disorder (ID) is defined as a disturbance of sleep initiation or maintenance, followed by a feeling of non-restorative sleep and several diurnal consequences ranging from occupational and social difficulties to cognitive impairment. Cognitive-Behavioral Therapy for Insomnia (CBT-I) is considered the first-choice therapy for this disorder because its effectiveness has been proven to be greater in the long term with fewer side effects in comparison to pharmacotherapy. Although its effectiveness has been well established, it has been reported that nearly 40% of patients do not achieve remission after treatment. This finding could be the consequence of heterogeneity of ID between patients. It has been proposed that this heterogeneity might be ascribable to indices that are not related to sleep quality and quantity, such as comorbidities, life events, and personality traits. However, several works focused on the role of sleep markers, in particular objective total sleep time, for the phenotypization of ID and treatment response. The aim of this work is to summarize the available scientific literature regarding the impact of ID subtype on CBT-I response.
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Affiliation(s)
- Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
| | - Elisabetta Fasiello
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Vincenza Castronovo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy
| | - Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, Milan, Italy.,Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy
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18
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Abad VC, Guilleminault C. Insomnia in Elderly Patients: Recommendations for Pharmacological Management. Drugs Aging 2018; 35:791-817. [PMID: 30058034 DOI: 10.1007/s40266-018-0569-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic insomnia affects 57% of the elderly in the United States, with impairment of quality of life, function, and health. Chronic insomnia burdens society with billions of dollars in direct and indirect costs of care. The main modalities in the treatment of insomnia in the elderly are psychological/behavioral therapies, pharmacological treatment, or a combination of both. Various specialty societies view psychological/behavioral therapies as the initial treatment intervention. Pharmacotherapy plays an adjunctive role when insomnia symptoms persist or when patients are unable to pursue cognitive behavioral therapies. Current drugs for insomnia fall into different classes: orexin agonists, histamine receptor antagonists, non-benzodiazepine gamma aminobutyric acid receptor agonists, and benzodiazepines. This review focuses on Food and Drug Administration (FDA)-approved drugs for insomnia, including suvorexant, low-dose doxepin, Z-drugs (eszopiclone, zolpidem, zaleplon), benzodiazepines (triazolam, temazepam), and ramelteon. We review the indications, dosing, efficacy, benefits, and harms of these drugs in the elderly, and discuss data on drugs that are commonly used off-label to treat insomnia, and those that are in clinical development. The choice of a hypnotic agent in the elderly is symptom-based. Ramelteon or short-acting Z-drugs can treat sleep-onset insomnia. Suvorexant or low-dose doxepin can improve sleep maintenance. Eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance. Low-dose zolpidem sublingual tablets or zaleplon can alleviate middle-of-the-night awakenings. Benzodiazepines should not be used routinely. Trazodone, a commonly used off-label drug for insomnia, improves sleep quality and sleep continuity but carries significant risks. Tiagabine, sometimes used off-label for insomnia, is not effective and should not be utilized. Non-FDA-approved hypnotic agents that are commonly used include melatonin, diphenhydramine, tryptophan, and valerian, despite limited data on benefits and harms. Melatonin slightly improves sleep onset and sleep duration, but product quality and efficacy may vary. Tryptophan decreases sleep onset in adults, but data in the elderly are not available. Valerian is relatively safe but has equivocal benefits on sleep quality. Phase II studies of dual orexin receptor antagonists (almorexant, lemborexant, and filorexant) have shown some improvement in sleep maintenance and sleep continuity. Piromelatine may improve sleep maintenance. Histamine receptor inverse agonists (APD-125, eplivanserin, and LY2624803) improve slow-wave sleep but, for various reasons, the drug companies withdrew their products.
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Affiliation(s)
- Vivien C Abad
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Outpatient Medical Center, Stanford University, 450 Broadway St. Pavilion C 2nd Floor MC 5704, Redwood City, CA, 94063, USA
| | - Christian Guilleminault
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Outpatient Medical Center, Stanford University, 450 Broadway St. Pavilion C 2nd Floor MC 5704, Redwood City, CA, 94063, USA.
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19
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Psychological Interventions for Late-life Insomnia: Current and Emerging Science. CURRENT SLEEP MEDICINE REPORTS 2018; 4:268-277. [PMID: 31106115 DOI: 10.1007/s40675-018-0129-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose of Review Late-life insomnia is a serious medical condition associated with many untoward consequences. The high prevalence of late-life insomnia, along with the concomitant risks inherent in the use of hypnotic medications in older adults necessitates non-pharmacological (i.e., psychological) treatment options. We aim to summarize and evaluate the state-of-the-science of psychological treatment options for late-life insomnia. Recent Findings Cumulative scientific evidence suggests the efficacy of psychological treatment of late-life insomnia. During the previous decade, trials of psychological treatments for insomnia have begun to test various modifications to treatments that have the potential to improve access for older adults, along with expanding their focus to include individuals with comorbid conditions that are common to older adults. While these modifications represent positive advances in the science of treatment for late-life insomnia, the evidence is still largely explanatory/efficacious in nature. Summary Psychological strategies represent the best approaches for the treatment of late-life insomnia. Future investigations would be wise to progressively move towards increasingly pragmatic/effectiveness investigations, adding to the literature base regarding the treatment of late-life insomnia under usual/real-world conditions as opposed to ideal/artificial conditions.
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20
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Tighe CA, Bramoweth AD. Recent Developments in the Management of Insomnia in Later Life. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:195-210. [PMID: 37560530 PMCID: PMC10411142 DOI: 10.1007/s40501-018-0145-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Purpose of review Insomnia impacts a significant proportion of older adults yet is not an inevitable consequence of aging and is amenable to intervention. The aim of this narrative review is to provide an overview of recent recommendations and empirical findings regarding the management of insomnia in older adults. Recent findings The treatment of insomnia with cognitive behavioral therapy for insomnia (CBT-I) continues to be empirically supported and the recommended first-line intervention for adults. Accumulating evidence indicates that other non-pharmacological therapies for insomnia, such as mindfulness-based therapies, light therapy, and physical activity interventions, as well as treatment delivered by non-clinician "sleep coaches" also positively impact insomnia symptoms. Finally, recent systematic reviews offer guidelines and recommendations for pharmacological management of insomnia. Summary CBT-I remains the recommended first-line treatment for insomnia across adult ages. There is a continued need to increase the availability and optimize the delivery of CBT-I and other therapies for older adults with insomnia to maximize treatment benefits. There is also evidence for some benefit of pharmacological agents to treat insomnia; however, these are not without risks, particularly in the geriatric population.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, USA
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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