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Bauducco S, Pillion M, Bartel K, Reynolds C, Kahn M, Gradisar M. The difficult but crucial task of knowledge translation: The case of pre-sleep technology use. Reply to Reichenberger et al. and the National Sleep Foundation's screen use recommendations. Sleep Med Rev 2024; 76:101974. [PMID: 38996536 DOI: 10.1016/j.smrv.2024.101974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Serena Bauducco
- Örebro University, School of Behavioural, Social and Legal Sciences, Sweden; Flinders University, College of Education, Psychology and Social Work, Australia.
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Australia
| | - Kate Bartel
- WINK Sleep Pty Ltd, Adelaide, Australia; Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, Australia; Flinders University, College of Medicine and Public Health, Australia
| | - Chelsea Reynolds
- Flinders University, College of Education, Psychology and Social Work, Australia; WINK Sleep Pty Ltd, Adelaide, Australia
| | - Michal Kahn
- Tel Aviv University, School of Psychological Sciences, Israel
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia; Sleep Cycle AB, Gothenburg, Sweden
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2
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Anderson AR, Ostermiller L, Lastrapes M, Hales L. Does sunlight exposure predict next-night sleep? A daily diary study among U.S. adults. J Health Psychol 2024:13591053241262643. [PMID: 39077837 DOI: 10.1177/13591053241262643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Poor sleep is becoming increasingly prevalent and is associated with adverse health outcomes. Sunlight exposure may improve sleep by regulating circadian rhythms, increasing vitamin D, and influencing melatonin production. However, research on the sunlight-sleep association is limited, especially outside of cross-sectional designs. This study examined associations between daily self-reported sunlight exposure and next-night sleep quality in 103 adults for up to 70 days. The timing of sunlight exposure predicted next-night sleep quality. Specifically, morning sunlight exposure, relative to no sunlight, predicted better sleep quality based on responses to the brief Pittsburg Sleep Quality Index. Duration of sunlight exposure was generally not associated with sleep quality. Morning sunlight may regulate circadian rhythms, subsequently improving sleep. Findings have potential implications for sleep interventions and daylight savings time policies. Future research should test whether morning sunlight exposure can enhance the effectiveness of sleep interventions.
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Que J, Chen S, Chan NY, Wu S, Zhang L, Chen Y, Liu J, Chen M, Chen L, Li SX, Lin D, Liu F, Wing YK. Associations of evening-type and insomnia symptoms with depressive symptoms among youths. Sleep Med 2024; 118:81-87. [PMID: 38626648 DOI: 10.1016/j.sleep.2024.04.009] [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: 01/31/2024] [Revised: 03/23/2024] [Accepted: 04/06/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Evening-type and insomnia symptoms are significantly related to each other and independently associated with depressive symptoms, yet few studies have examined the potential interaction between these two conditions. Therefore, we aimed to examine the associations of evening-type and insomnia symptoms with depressive symptoms among Chinese youths, with a specific focus on the joint effects of the two conditions on depressive symptoms. METHODS Participants aged between 12 and 25 were invited to participate in an online survey from December 15, 2022, to May 26, 2023. Multivariate logistic regression models and additive interaction models were used to examine the independent and joint effects of chronotypes and insomnia symptoms on depressive symptoms, respectively. RESULTS Of the 6145 eligible youths, the prevalence of evening-type and insomnia symptoms were 24.9 % and 29.6 %, respectively. Both evening-type (adjusted OR, [AdjOR]: 3.21, 95 % CI: 2.80-3.67) and insomnia symptoms (AdjOR: 10.53, 95 % CI: 9.14-12.12) were associated with an increased risk of depressive symptoms. In addition, the additive interaction models showed that there is an enhanced risk of depression related to interaction between evening-type and insomnia symptoms (relative excess risk due to interaction, [RERI]: 11.66, 95 % CI: 7.21-16.11). CONCLUSIONS The present study provided additional evidence demonstrating the presence of interaction between evening-type and insomnia symptoms, which can lead to a higher risk of depressive symptoms. Our findings argue the need for addressing both sleep and circadian factors in the management of depressive symptoms in young people.
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Affiliation(s)
- Jianyu Que
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Sijing Chen
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China; Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Suying Wu
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Li Zhang
- Inner Mongolia Autonomous Region Mental Health Center, Hohhot, Inner Mongolia, China
| | - Yaoyi Chen
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China
| | - Jingrou Liu
- Xiamen University of Technology, Xiamen, Fujian, China
| | | | - Lixia Chen
- Inner Mongolia Autonomous Region Mental Health Center, Hohhot, Inner Mongolia, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong Special Administrative Region of China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Duoduo Lin
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China.
| | - Farong Liu
- Xiamen Xianyue Hospital, Xianyue Hospital Affiliated with Xiamen Medical College, Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Fujian, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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Bauducco S, Gardner LA, Smout S, Champion KE, Chapman C, Gamble A, Teesson M, Gradisar M, Newton NC. Adolescents' trajectories of depression and anxiety symptoms prior to and during the COVID-19 pandemic and their association with healthy sleep patterns. Sci Rep 2024; 14:10764. [PMID: 38730014 PMCID: PMC11087504 DOI: 10.1038/s41598-024-60974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
The COVID-19 pandemic has seen a rise in anxiety and depression among adolescents. This study aimed to investigate the longitudinal associations between sleep and mental health among a large sample of Australian adolescents and examine whether healthy sleep patterns were protective of mental health in the context of the COVID-19 pandemic. We used three waves of longitudinal control group data from the Health4Life cluster-randomized trial (N = 2781, baseline Mage = 12.6, SD = 0.51; 47% boys and 1.4% 'prefer not to say'). Latent class growth analyses across the 2 years period identified four trajectories of depressive symptoms: low-stable (64.3%), average-increasing (19.2%), high-decreasing (7.1%), moderate-increasing (9.4%), and three anxiety symptom trajectories: low-stable (74.8%), average-increasing (11.6%), high-decreasing (13.6%). We compared the trajectories on sociodemographic and sleep characteristics. Adolescents in low-risk trajectories were more likely to be boys and to report shorter sleep latency and wake after sleep onset, longer sleep duration, less sleepiness, and earlier chronotype. Where mental health improved or worsened, sleep patterns changed in the same direction. The subgroups analyses uncovered two important findings: (1) the majority of adolescents in the sample maintained good mental health and sleep habits (low-stable trajectories), (2) adolescents with worsening mental health also reported worsening sleep patterns and vice versa in the improving mental health trajectories. These distinct patterns of sleep and mental health would not be seen using mean-centred statistical approaches.
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Affiliation(s)
- Serena Bauducco
- Flinders University, Adelaide, Australia.
- Center for Health and Medical Psychology, Örebro University, Fakultetsgatan 1, 701 82, Örebro, Sweden.
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Scarlett Smout
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Amanda Gamble
- The Woolcock Institute, Macquarie University, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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5
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Rodríguez Ferrante G, Leone MJ. Solar clock and school start time effects on adolescents' chronotype and sleep: A review of a gap in the literature. J Sleep Res 2024; 33:e13974. [PMID: 37370220 DOI: 10.1111/jsr.13974] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
Circadian rhythms are entrained by external factors such as sunlight and social cues, but also depend on internal factors such as age. Adolescents exhibit late chronotypes, but worldwide school starts early in the morning leading to unhealthy sleep habits. Several studies reported that adolescents benefit from later school start times. However, the effect of later school start time on different outcomes varies between studies, and most previous literature only takes into consideration the social clock (i.e. local time of school starting time) but not the solar clock (e.g. the distance between school start time and sunrise). Thus, there is an important gap in the literature: when assessing the effect of a school start time on chronotype and sleep of adolescents at different locations and/or seasons, the solar clock might differ and, consistently, the obtained results. For example, the earliest school start time for adolescents has been suggested to be 08:30 hours, but this school start time might correspond to different solar times at different times of the year, longitudes and latitudes. Here, we describe the available literature comparing different school start times, considering important factors such as geographic position, nationality, and the local school start time and its distance to sunrise. Then, we described and contrasted the relative role of both social and solar clocks on the chronotype and sleep of adolescents. As a whole, we point and discuss a gap in literature, suggesting that both clocks are relevant when addressing the effect of school start time on adolescents' chronotype and sleep.
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Affiliation(s)
- Guadalupe Rodríguez Ferrante
- Laboratorio de Neurociencia, Universidad Torcuato Di Tella, CONICET, Buenos Aires, Argentina
- Laboratorio de Cronobiología, Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, CONICET, Buenos Aires, Argentina
| | - María Juliana Leone
- Laboratorio de Neurociencia, Universidad Torcuato Di Tella, CONICET, Buenos Aires, Argentina
- Área de Educación, Escuela de Gobierno, Universidad Torcuato Di Tella, Buenos Aires, Argentina
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6
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Li SX, Cheung FTW, Chan NY, Chan JWY, Zhang J, Li AM, Espie CA, Gradisar M, Wing YK. Effects of cognitive behavioural therapy and bright light therapy for insomnia in youths with eveningness: study protocol for a randomised controlled trial. Trials 2024; 25:246. [PMID: 38594725 PMCID: PMC11005158 DOI: 10.1186/s13063-024-08090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Insomnia and eveningness are common and often comorbid conditions in youths. While cognitive behavioural therapy for insomnia (CBT-I) has been suggested as a promising intervention, it remains unclear whether it is sufficient to also address circadian issues in youths. In addition, despite that light has been shown to be effective in phase-shifting one's circadian rhythm, there has been limited data on the effects of bright light therapy and its combination with CBT-I on sleep and circadian outcomes in youths. The current protocol outlines a randomised controlled trial that examines the efficacy of CBT-I and CBT-I plus bright light therapy (BLT) in reducing insomnia severity, improving mood symptoms and daytime functioning (e.g. sleepiness, fatigue, cognitive function), and improving subjective and objective sleep and circadian measures compared to a waitlist control group. METHODS We will carry out a randomised controlled trial (RCT) with 150 youths aged 12-24 who meet the criteria of insomnia and eveningness. Participants will be randomised into one of three groups: CBT-I with bright light therapy, CBT-I with placebo light, and waitlist control. Six sessions of CBT-I will be delivered in a group format, while participants will be currently asked to use a portable light device for 30 min daily immediately after awakening throughout the intervention period for bright light therapy. The CBT-I with light therapy group will receive bright constant green light (506 lx) while the CBT-I with placebo light group will receive the modified light device with the LEDs emitting less than 10 lx. All participants will be assessed at baseline and post-treatment, while the two active treatment groups will be additionally followed up at 1 month and 6 months post-intervention. The primary outcome will be insomnia severity, as measured by the Insomnia Severity Index. Secondary outcomes include self-reported mood, circadian, daytime functioning, and quality of life measures, as well as sleep parameters derived from actigraphy and sleep diary and neurocognitive assessments. Objective measures of the circadian phase using dim-light melatonin onset assessment and sleep parameters using polysomnography will also be included as the secondary outcomes. DISCUSSION This study will be the first RCT to directly compare the effects of CBT-I and BLT in youths with insomnia and eveningness. Findings from the study will provide evidence to inform the clinical management of insomnia problems and eveningness in youths. TRIAL REGISTRATION ClinicalTrials.gov NCT04256915. Registered on 5 February 2020.
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Affiliation(s)
- Shirley Xin Li
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Forrest Tin Wai Cheung
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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7
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Psychiatr Clin North Am 2024; 47:179-197. [PMID: 38302206 DOI: 10.1016/j.psc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention Behavior and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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8
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Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Psychiatr Clin North Am 2024; 47:103-120. [PMID: 38302200 DOI: 10.1016/j.psc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry, Duke University School of Medicine, 2400 Pratt Street, Office 7036, 7th Floor, North Pavilion, Durham, NC 27705, USA.
| | - Tatyana Bidopia
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Leah Jackson
- HRC Behavioral Health & Psychiatry, PA, Chapel Hill, NC, USA
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9
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Feder MA, Baroni A. Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents. Psychiatr Clin North Am 2024; 47:163-178. [PMID: 38302205 DOI: 10.1016/j.psc.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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10
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Cheung FTW, Li X, Hui TK, Chan NY, Chan JW, Wing YK, Li SX. Circadian preference and mental health outcomes in youth: A systematic review and meta-analysis. Sleep Med Rev 2023; 72:101851. [PMID: 37793219 DOI: 10.1016/j.smrv.2023.101851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.
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Affiliation(s)
- Forrest Tin Wai Cheung
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Tsz Kwan Hui
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joey Wy Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong, Hong Kong; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
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11
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Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
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Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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12
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Asarnow LD, Soehner A, Dolsen E, Dong L, Harvey AG. Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms. J Child Psychol Psychiatry 2023; 64:1652-1664. [PMID: 37589403 PMCID: PMC10840628 DOI: 10.1111/jcpp.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/18/2023]
Abstract
STUDY OBJECTIVES An evening circadian preference is common among adolescents. It is characterized by a behavioral predilection for later sleep and wake timing and is associated with higher rates of Major Depressive Disorder (MDD). The present study aims to (a) test the effectiveness of a cognitive behavioral sleep intervention (Transdiagnostic Sleep and Circadian Intervention; TranS-C) in a sample of adolescents with an evening circadian preference and clinically significant depressive symptoms and (b) evaluate improved alignment between circadian biology and sleep-wake behavior as a potential mechanism in the relationship between sleep and depression symptom improvement. METHODS Adolescents with an evening circadian preference and clinically significant depressive symptoms were randomized to receive TranS-C (n = 24) or a psychoeducation condition (PE; n = 18). Alignment between circadian biology and sleep-wake behavior was measured using objective biological measurement. Measures of sleep and circadian rhythm were taken at pre- and posttreatment, and depression symptoms were measured at pre- and posttreatment and 6- and 12-month follow-up. RESULTS Mixed effects modeling revealed that compared with an active control condition, TranS-C resulted in a significant reduction in MDD severity at 12-month follow-up. A MacArthur mediation analysis conducted to explore alignment between circadian biology and sleep-wake behavior as a mediator of depression severity reduction through 12-month follow-up revealed a significant interaction between change in alignment between circadian biology and sleep-wake behavior and treatment arm, indicating that improved alignment between circadian biology and sleep-wake behavior at posttreatment was associated with improvements in depression outcomes at 12-month follow-up under the treatment condition. CONCLUSIONS These results provide novel evidence for improved alignment between circadian biology and sleep-wake behavior as a specific mechanism of depression improvement, provide key clues into the complex relationship between sleep and depression, and have significant clinical implications for adolescents with depression.
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Affiliation(s)
- Lauren D. Asarnow
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
| | - Adriane Soehner
- University of Pittsburgh, Department of Psychiatry and Behavioral Science
| | - Emily Dolsen
- University of California, San Francisco, Department of Psychiatry and Behavioral Science
- Department of Veterans Affairs, San Francisco, Department of Psychiatry
- Mental Illness Research Education and Clinical Centers, San Francisco VA Healthcare System
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13
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Takano Y, Ibata R, Machida N, Ubara A, Okajima I. Effect of cognitive behavioral therapy for insomnia in workers: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2023; 71:101839. [PMID: 37657127 DOI: 10.1016/j.smrv.2023.101839] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment, its efficacy for workers with insomnia remains unclear. This systematic review and meta-analysis aimed to determine the effectiveness of CBT-I in the management of insomnia symptoms in workers. We searched the literature in three electronic databases, namely PubMed, PsycINFO, and Embase, and included 21 studies in the meta-analysis. Compared with the control group, CBT-I overall resulted in significant improvements in terms of severity of insomnia (g = -0.91), sleep onset latency (g = -0.62), wakefulness after sleep onset (g = -0.60), early morning awakening (g = -0.58), and sleep efficiency (g = 0.71). However, there was no improvement in the total sleep time relative to that in the control group. Furthermore, CBT-I significantly alleviated depressive (g = -0.37) and anxiety (g = -0.35) symptoms and fatigue (g = -0.47) compared with the control group. Our study findings suggest that both web-based and face-to-face CBT-I are effective interventions for managing insomnia symptoms in daytime workers, although it is important to note that only face-to-face CBT-I achieved clinically meaningful changes. The effectiveness of CBT-I for shift workers could not be determined.
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Affiliation(s)
- Yuta Takano
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.
| | - Rui Ibata
- Graduate School of Psychological Science, Health Sciences University of Hokkaido, Hokkaido, Japan; Goryokai Medical Corporation, Hokkaido, Japan
| | - Naho Machida
- Osaka Counseling Center Bellflower, Osaka, Japan
| | | | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
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14
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Thangaleela S, Sivamaruthi BS, Kesika P, Mariappan S, Rashmi S, Choeisoongnern T, Sittiprapaporn P, Chaiyasut C. Neurological Insights into Sleep Disorders in Parkinson's Disease. Brain Sci 2023; 13:1202. [PMID: 37626558 PMCID: PMC10452387 DOI: 10.3390/brainsci13081202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Parkinson's disease (PD) is a common multidimensional neurological disorder characterized by motor and non-motor features and is more prevalent in the elderly. Sleep disorders and cognitive disturbances are also significant characteristics of PD. Sleep is an important physiological process for normal human cognition and physical functioning. Sleep deprivation negatively impacts human physical, mental, and behavioral functions. Sleep disturbances include problems falling asleep, disturbances occurring during sleep, abnormal movements during sleep, insufficient sleep, and excessive sleep. The most recognizable and known sleep disorders, such as rapid-eye-movement behavior disorder (RBD), insomnia, excessive daytime sleepiness (EDS), restless legs syndrome (RLS), sleep-related breathing disorders (SRBDs), and circadian-rhythm-related sleep-wake disorders (CRSWDs), have been associated with PD. RBD and associated emotional disorders are common non-motor symptoms of PD. In individuals, sleep disorders and cognitive impairment are important prognostic factors for predicting progressing neurodegeneration and developing dementia conditions in PD. Studies have focused on RBD and its associated neurological changes and functional deficits in PD patients. Other risks, such as cognitive decline, anxiety, and depression, are related to RBD. Sleep-disorder diagnosis is challenging, especially in identifying the essential factors that disturb the sleep-wake cycle and the co-existence of other concomitant sleep issues, motor symptoms, and breathing disorders. Focusing on sleep patterns and their disturbances, including genetic and other neurochemical changes, helps us to better understand the central causes of sleep alterations and cognitive functions in PD patients. Relations between α-synuclein aggregation in the brain and gender differences in sleep disorders have been reported. The existing correlation between sleep disorders and levels of α-synuclein in the cerebrospinal fluid indicates the risk of progression of synucleinopathies. Multidirectional approaches are required to correlate sleep disorders and neuropsychiatric symptoms and diagnose sensitive biomarkers for neurodegeneration. The evaluation of sleep pattern disturbances and cognitive impairment may aid in the development of novel and effective treatments for PD.
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Affiliation(s)
- Subramanian Thangaleela
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
| | - Bhagavathi Sundaram Sivamaruthi
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
- Office of Research Administration, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Periyanaina Kesika
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
- Office of Research Administration, Chiang Mai University, Chiang Mai 50200, Thailand
| | | | - Subramanian Rashmi
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
| | - Thiwanya Choeisoongnern
- Neuropsychological Research Laboratory, Neuroscience Research Center, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok 10110, Thailand
| | - Phakkharawat Sittiprapaporn
- Neuropsychological Research Laboratory, Neuroscience Research Center, School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok 10110, Thailand
| | - Chaiyavat Chaiyasut
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai 50200, Thailand; (S.T.); (B.S.S.); (P.K.)
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15
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Wu A. Updates and confounding factors in delayed sleep-wake phase disorder. Sleep Biol Rhythms 2023; 21:279-287. [PMID: 37363638 PMCID: PMC9979143 DOI: 10.1007/s41105-023-00454-4] [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: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.
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Affiliation(s)
- Alexandra Wu
- Division of Biosciences, University College London, Gower Street, London, WC1E 6BT UK
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16
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Mombelli S, Bacaro V, Curati S, Berra F, Sforza M, Castronovo V, Ferini-Strambi L, Galbiati A, Baglioni C. Non-pharmacological and melatonin interventions for pediatric sleep initiation and maintenance problems: A systematic review and network meta-analysis. Sleep Med Rev 2023; 70:101806. [PMID: 37406497 DOI: 10.1016/j.smrv.2023.101806] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/07/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023]
Abstract
Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and maintenance problems in healthy pediatric populations. We included 30 studies in the systematic review and 15 in the meta-analysis. Three network meta-analyses were conducted for sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). For SOL variable, the results support greater effectiveness of light therapy and melatonin than evidence-based psychological interventions, whether implemented in combination with light therapy or not. Regarding WASO variable, evidence-based psychological interventions and a combination of those techniques plus light treatment were the most efficacious. Finally, for TST variable, a larger effect was shown for the combined treatment of evidence-based psychological intervention with light therapy in comparison to other interventions. In conclusion, we found a high variability between study protocols likely impacting the results of the meta-analysis. Future randomized control trials studies, stratified by pediatric age classes, are needed in order to provide clear suggestions in clinical settings.
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Bacaro
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy; Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Curati
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy
| | - Francesca Berra
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Chiara Baglioni
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, DE, Germany; Clinic for Sleep Psychotherapy, School of Cognitive Psychotherapy, SPC, Rome, Italy
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17
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Futenma K, Takaesu Y, Komada Y, Shimura A, Okajima I, Matsui K, Tanioka K, Inoue Y. Delayed sleep-wake phase disorder and its related sleep behaviors in the young generation. Front Psychiatry 2023; 14:1174719. [PMID: 37275982 PMCID: PMC10235460 DOI: 10.3389/fpsyt.2023.1174719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023] Open
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD.
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Affiliation(s)
- Kunihiro Futenma
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
| | - Yoko Komada
- Institute for Liberal Arts, Tokyo Institute of Technology, Tokyo, Japan
| | - Akiyoshi Shimura
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Kentaro Matsui
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kosuke Tanioka
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
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18
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Plekhanova T, Crawley E, Davies MJ, Gorely T, Harrington DM, Ioannidou E, Khunti K, Rowlands AV, Sherar LB, Yates T, Edwardson CL. Association between Chronotype and Physical Behaviours in Adolescent Girls. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050819. [PMID: 37238367 DOI: 10.3390/children10050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
The aim of this study was to (1) describe accelerometer-assessed physical behaviours by chronotype, and (2) examine the association between chronotype and accelerometer-assessed physical behaviours in a cohort of adolescent girls. Chronotype (single question) and physical behaviours (GENEActiv accelerometer on the non-dominant wrist) were assessed in 965 adolescent girls (13.9 ± 0.8 years). Linear mixed-effects models examined the relationships among chronotype and physical behaviours (time in bed, total sleep time, sleep efficiency, sedentary time, overall, light and moderate-to-vigorous physical activity) on weekdays and weekend days. Over the 24 h day, participants spent 46% sedentary, 20% in light activity, 3% in moderate-to-vigorous physical activity, and 31% in 'time in bed'. Seventy percent of participants identified as 'evening' chronotypes. Compared to evening chronotypes, morning chronotypes engaged in less sedentary time (10 min/day) and had higher overall physical activity (1.3 mg/day, ~30 min of slow walking) on weekdays. Most girls identified as evening chronotypes with a large proportion of their day spent sedentary and a small amount in physical activities which may be exacerbated in evening chronotypes on weekdays. The results maybe be important for programmes aiming to promote physical activity in adolescent girls.
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Affiliation(s)
- Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Emily Crawley
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Deirdre M Harrington
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Lauren B Sherar
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
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19
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Gusman E, Standlee J, Reid KJ, Wolfe LF. Work-Related Sleep Disorders: Causes and Impacts. Semin Respir Crit Care Med 2023; 44:385-395. [PMID: 37072022 DOI: 10.1055/s-0043-1767787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Insufficient sleep syndrome, shift work disorder, and obstructive sleep apnea (OSA) not only significantly impact the health of affected individuals, but also pose a threat to public safety. This article describes the clinical manifestations and impact of these sleep disorders, particularly as they pertain to workers' health and those with safety-sensitive positions. Sleep deprivation, circadian rhythm disruptions, and excessive daytime sleepiness-hallmarks of insufficient sleep, shift work disorder, and OSA, respectively-all lead to a series of cognitive deficits and impaired concentration that affect workers in a wide variety of fields. We describe the health consequences of these disorders along with treatment strategies, with a focus on current regulatory standards and the under-recognition of OSA in commercial drivers. Given its large scale, there is a need for improved guidelines and regulations for the screening, diagnosis, treatment, and long-term follow-up of OSA in commercial motor vehicle drivers. Increased recognition of the ways in which these sleep disorders impact workers will pave the way for significant improvements in occupational health and safety.
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Affiliation(s)
- Elen Gusman
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
| | - Jordan Standlee
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kathryn J Reid
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
| | - Lisa F Wolfe
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
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20
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Reddy A, Mansuri Z, Vadukapuram R, Shah K, Thootkur M, Trivedi C. Efficacy of Cognitive Behavioral Therapy for Insomnia for the Treatment of Child and Adolescent Anxiety and Depression: A Systematic Review From Randomized Controlled Trials. J Nerv Ment Dis 2023; 211:238-243. [PMID: 36827635 DOI: 10.1097/nmd.0000000000001613] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
ABSTRACT Cognitive behavioral therapy for insomnia (CBT-I) has shown promising results in the adult population. However, there is not enough evidence for children and adolescents. Hence, we evaluated the current evidence of CBT-I in the treatment of anxiety and depression in children and adolescents. Published randomized clinical trials published before June 2020 were searched from PubMed, Cochrane Library of database, clinicaltrials.gov, and Google Scholar. Out of seven included studies, six studies assessed the effect of CBT-I on depression, and five assessed the effect on anxiety. In this review, most studies in this review showed a strong effect of CBT-I on symptoms of depression. Although a positive effect of CBT-I on anxiety was noted, only a small number of studies have considered this management. These findings should be considered preliminary, and further large-scale studies are warranted to further explore this finding further.
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Affiliation(s)
- Abhishek Reddy
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Ramu Vadukapuram
- Department of Psychiatry, The University of Texas Rio Grande Valley, Harlingen, Texas
| | - Kaushal Shah
- Department of Psychiatry, Griffin Memorial Hospital, Norman, Oklahoma
| | - Mounica Thootkur
- Department of Psychiatry, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Permian Basin, Midland, Texas
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21
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Crowley SJ, Velez SL, Killen LG, Cvengros JA, Fogg LF, Eastman CI. Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management. Sleep 2023; 46:zsac202. [PMID: 36006948 PMCID: PMC9832518 DOI: 10.1093/sleep/zsac202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVES Shift sleep onset earlier and extend school-night sleep duration of adolescents. METHODS Forty-six adolescents (14.5-17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the "Intervention" group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans ("Sleep RouTeen") were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy. RESULTS Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (-0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group. CONCLUSIONS This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light. CLINICAL TRIALS Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603.
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Affiliation(s)
- Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Sabrina L Velez
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Logan G Killen
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Jamie A Cvengros
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Louis F Fogg
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Charmane I Eastman
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
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22
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Nonpharmacological interventions for treating fatigue in adolescents: A systematic review and narrative synthesis of randomised controlled trials. J Psychosom Res 2022; 163:111070. [PMID: 36327529 DOI: 10.1016/j.jpsychores.2022.111070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Fatigue is common in adolescence and can be highly disabling if experienced persistently, with adverse psychosocial outcomes. There is a need to better understand what nonpharmacological treatments are available for adolescents suffering with persistent fatigue. The current review systematically identified, synthesised, and evaluated the evidence regarding nonpharmacological interventions for fatigue in adolescents, focusing on evaluating effectiveness, describing intervention components, and mapping interventions onto the behaviour change technique taxonomy (BCTT). METHODS CENTRAL, EMBASE, PsycINFO, PubMed, and Web of Science were systematically searched for articles including (1) adolescents aged 10-19 years old, (2) fatigue as a primary or secondary outcome, (3) nonpharmacological interventions, and (4) randomised controlled trials. Study screening, data extraction, quality assessment, and BCTT mapping were performed independently by two reviewers. Findings were presented as a narrative synthesis, with interventions ranked by promise. RESULTS 5626 papers were identified and double-screened, resulting in the inclusion of 21 articles reporting 16 trials. Five interventions were classified as likely promising. Interventions often involved psychoeducation, cognitive behavioural therapy, and/or physical activity, incorporating various BCTT domains, most commonly shaping knowledge, repetition and substitution, and goals and planning. However, there did not seem to be any observable differences between fatigue-targeted and non-fatigue-targeted interventions. Overall study quality was mixed, particularly in relation to power and outcome measures. CONCLUSION There are several promising nonpharmacological interventions for adolescent fatigue, although further work is needed to determine effectiveness. Future trials need to ensure design rigour, focusing on adequate powering, validated outcome measures, and adhering to best practice reporting guidelines.
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23
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Robbins R, Beebe DW, Byars KC, Grandner M, Hale L, Tapia IE, Wolfson AR, Owens JA. Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being. Sleep Health 2022; 8:632-639. [PMID: 36180345 PMCID: PMC9772111 DOI: 10.1016/j.sleh.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents. METHOD We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth. RESULTS Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) "Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time," reported by 74% of parents/caregivers; (2) "If school starts later, adolescents will stay up that much later," reported by 69% of parents/caregivers; and (3) "Melatonin supplements are safe for adolescents because they are natural," reported by 66% of parents/caregivers. CONCLUSION Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.
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Affiliation(s)
- Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
| | - Dean W Beebe
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Kelly C Byars
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Michael Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Program in Public Health, Stony Brook, NY, USA
| | - Ignacio E Tapia
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia. Philadelphia, PA, USA
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, MD, USA
| | - Judith A Owens
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Boston Children's Hospital, Boston, MA, USA
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Rynders CA, Bowen AE, Cooper E, Brinton JT, Higgins J, Nadeau KJ, Wright KP, Simon SL. A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19. J Biol Rhythms 2022; 37:690-699. [PMID: 36124632 PMCID: PMC9726638 DOI: 10.1177/07487304221123455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.
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Affiliation(s)
- Corey A. Rynders
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | | | - Emily Cooper
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John T. Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kenneth P. Wright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,University of Colorado Boulder, Boulder, Colorado
| | - Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Stacey L. Simon, Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Avenue, Box B395, Aurora, CO 80045, USA; e-mail:
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25
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Iwamoto BK, Decker KM, Byars KC, Van Dyk TR. Impact of Exogenous Melatonin on Sleep and Daytime Functioning in Healthy, Typically Developing Adolescents. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Faaland P, Vedaa Ø, Langsrud K, Sivertsen B, Lydersen S, Vestergaard CL, Kjørstad K, Vethe D, Ritterband LM, Harvey AG, Stiles TC, Scott J, Kallestad H. Digital cognitive behaviour therapy for insomnia (dCBT-I): Chronotype moderation on intervention outcomes. J Sleep Res 2022; 31:e13572. [PMID: 35224810 PMCID: PMC9787033 DOI: 10.1111/jsr.13572] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 12/30/2022]
Abstract
Using data from 1721 participants in a community-based randomized control trial of digital cognitive behavioural therapy for insomnia compared with patient education, we employed linear mixed modelling analyses to examine whether chronotype moderated the benefits of digital cognitive behavioural therapy for insomnia on self-reported levels of insomnia severity, fatigue and psychological distress. Baseline self-ratings on the reduced version of the Horne-Östberg Morningness-Eveningness Questionnaire were used to categorize the sample into three chronotypes: morning type (n = 345; 20%); intermediate type (n = 843; 49%); and evening type (n = 524; 30%). Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale were assessed pre- and post-intervention (9 weeks). For individuals with self-reported morning or intermediate chronotypes, digital cognitive behavioural therapy for insomnia was superior to patient education on all ratings (Insomnia Severity Index, Chalder Fatigue Questionnaire, and Hospital Anxiety and Depression Scale) at follow-up (p-values ≤ 0.05). For individuals with self-reported evening chronotype, digital cognitive behavioural therapy for insomnia was superior to patient education for Insomnia Severity Index and Chalder Fatigue Questionnaire, but not on the Hospital Anxiety and Depression Scale (p = 0.139). There were significant differences in the treatment effects between the three chronotypes on the Insomnia Severity Index (p = 0.023) estimated difference between evening and morning type of -1.70, 95% confidence interval: -2.96 to -0.45, p = 0.008, and estimated difference between evening and intermediate type -1.53, 95% confidence interval: -3.04 to -0.03, p = 0.046. There were no significant differences in the treatment effects between the three chronotypes on the Chalder Fatigue Questionnaire (p = 0.488) or the Hospital Anxiety and Depression Scale (p = 0.536). We conclude that self-reported chronotype moderates the effects of digital cognitive behavioural therapy for insomnia on insomnia severity, but not on psychological distress or fatigue.
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Affiliation(s)
- Patrick Faaland
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Øystein Vedaa
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Voss District Psychiatric HospitalNKS BjørkeliVossNorway,Department of Research and DevelopmentSt Olavs University HospitalTrondheimNorway
| | - Knut Langsrud
- St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Børge Sivertsen
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,Department of Health PromotionNorwegian Institute of Public HealthBergenNorway,Department of Research and InnovationFonna Health TrustHaugesundNorway
| | - Stian Lydersen
- Department of Mental HealthRegional Centre for Child and Youth Mental Health and Child WelfareNorwegian University of Science and TechnologyTrondheimNorway
| | - Cecilie L. Vestergaard
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Kaia Kjørstad
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Daniel Vethe
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
| | - Lee M. Ritterband
- Center for Behavioral Health and TechnologyDepartment of Psychiatry and Neurobehavioral SciencesUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Allison G. Harvey
- Department of PsychologyUniversity of CaliforniaBerkeleyCaliforniaUSA
| | - Tore C. Stiles
- Department of PsychologyNorwegian University of Science and TechnologyNorway
| | - Jan Scott
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,University of NewcastleNewcastleUK
| | - Håvard Kallestad
- Department of Mental HealthNorwegian University of Science and TechnologyTrondheimNorway,St Olavs University Hospital, ØstmarkaTrondheimNorway
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27
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Dewald-Kaufmann J, de Bruin E, Michael G. Cognitive Behavioral Therapy for Insomnia in School-Aged Children and Adolescents. Sleep Med Clin 2022; 17:355-365. [PMID: 36150799 DOI: 10.1016/j.jsmc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
One of the most prevalent sleep disorders in children and adolescents is "insomnia," which can be briefly described as problems with initiating and/or maintaining sleep with associated daytime consequences. These are typical insomnia symptoms, and when experienced for long enough and when they interfere with an important area of the young person's life (eg, schooling), then a diagnosis of an insomnia disorder may be warranted. The authors strongly urge the scientific community to conduct further controlled trials, including dismantling trials that evaluate the relative effectiveness of individual cognitive behavioral therapy for insomnia components.
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Affiliation(s)
- Julia Dewald-Kaufmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 7, Munich 80336, Germany; Hochschule Fresenius, University of Applied Sciences, Infanteriestr. 11a, Munich 80797, Germany.
| | - Ed de Bruin
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Amsterdam 1018 WS, the Netherlands
| | - Gradisar Michael
- School of Psychology, Flinders University, GPO Box 2100, Adelaide 5001, South Australia
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28
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Ricketts EJ, Joyce DS, Rissman AJ, Burgess HJ, Colwell CS, Lack LC, Gradisar M. Electric lighting, adolescent sleep and circadian outcomes, and recommendations for improving light health. Sleep Med Rev 2022; 64:101667. [PMID: 36064209 PMCID: PMC10693907 DOI: 10.1016/j.smrv.2022.101667] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 01/26/2023]
Abstract
Light is a potent circadian entraining agent. For many people, daily light exposure is fundamentally dysregulated with reduced light during the day and increased light into the late evening. This lighting schedule promotes chronic disruption to circadian physiology resulting in a myriad of impairments. Developmental changes in sleep-wake physiology suggest that such light exposure patterns may be particularly disruptive for adolescents and further compounded by lifestyle factors such as early school start times. This narrative review describes evidence that reduced light exposure during the school day delays the circadian clock, and longer exposure durations to light-emitting electronic devices in the evening suppress melatonin. While home lighting in the evening can suppress melatonin secretion and delay circadian phase, the patterning of light exposure across the day and evening can have moderating effects. Photic countermeasures may be flexibly and scalably implemented to support sleep-wake health; including manipulations of light intensity, spectra, duration and delivery modality across multiple contexts. An integrative approach addressing physiology, attitudes, and behaviors will support optimization of light-driven sleep-wake outcomes in adolescents.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States.
| | - Daniel S Joyce
- Department of Psychology, University of Nevada, Reno, NV, United States; School of Psychology and Wellbeing, The University of Southern Queensland, Ipswich, QLD, Australia
| | - Ariel J Rissman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Christopher S Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, United States
| | - Leon C Lack
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, SA, Australia; Sleep Cycle AB, Gothenburg, Sweden
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29
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Prediction of Dropout in a Randomized Controlled Trial of Adjunctive Light Treatment in Patients with Non-Seasonal Depression and Evening Chronotype. Clocks Sleep 2022; 4:346-357. [PMID: 35997383 PMCID: PMC9397075 DOI: 10.3390/clockssleep4030029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
The current study examined the possible predictors of dropout during a five-week light treatment (LT) with a gradual advance protocol in 93 patients with unipolar non-seasonal depression and evening chronotypes by comparing their clinical characteristics and performing a logistic regression analysis. Nineteen out of ninety-three (20%) subjects (80% female, 46.5 ± 11.7 years old) dropped out during the 5-week light treatment. Treatment non-adherence (i.e., receiving LT for less than 80% of the prescribed duration) over the first treatment week predicted a five-fold increase in risk of dropout during light therapy (OR: 5.85, CI: 1.41–24.21) after controlling for potential confounders, including age, gender, treatment group, rise time at the baseline, patient expectation, and treatment-emergent adverse events. There is a need to incorporate strategies to enhance treatment adherence and retention in both research and clinical settings. Chinese clinical trial registry (ChiCTR-IOR-15006937).
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30
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Gradisar M, Kahn M, Micic G, Short M, Reynolds C, Orchard F, Bauducco S, Bartel K, Richardson C. Sleep's role in the development and resolution of adolescent depression. NATURE REVIEWS PSYCHOLOGY 2022; 1:512-523. [PMID: 35754789 PMCID: PMC9208261 DOI: 10.1038/s44159-022-00074-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/03/2022]
Abstract
Two adolescent mental health fields - sleep and depression - have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.
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Affiliation(s)
- Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Michal Kahn
- School of Psychology, Flinders University, Adelaide, Australia
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gorica Micic
- School of Psychology, Flinders University, Adelaide, Australia
| | - Michelle Short
- School of Psychology, Flinders University, Adelaide, Australia
| | | | - Faith Orchard
- School of Psychology, University of East Sussex, Brighton, United Kingdom
| | - Serena Bauducco
- School of Psychology, Flinders University, Adelaide, Australia
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Kate Bartel
- School of Psychology, Flinders University, Adelaide, Australia
| | - Cele Richardson
- School of Psychological Science, University of Western Australia, Perth, Australia
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31
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Konishi N, Kumagai H, Sawatari H, Hoshino T, Murase Y, Yamaguchi M, Urabe A, Kiyohara Y, Arita A, Baku M, Sasanabe R, Shiomi T. Efficacy of a Combination Therapy for Difficulties Waking Up in Non-School-Attending Students. J Clin Med 2022; 11:jcm11123271. [PMID: 35743342 PMCID: PMC9225467 DOI: 10.3390/jcm11123271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
School non-attendance due to difficulties waking up is increasing in Japan, and affected students are commonly diagnosed with orthostatic dysregulation (OD); however, OD-associated sleep problems are overlooked. To date, no sleep-medicine-based treatment for wake-up difficulties in non-school-attending students has been established. This study aimed to assess the efficacy of a novel combination therapy for these students. We assessed the combined effect of sleep hygiene guidance, low-dose aripiprazole administration (3 mg/day), and blue-light exposure on wake-up difficulty in 21 non-school-attending teenage patients. The patients were evaluated using sleep studies and questionnaires before and after treatment. The average subjective total sleep time calculated from sleep diaries before treatment in the patients was 10.3 h. The therapy improved wake-up difficulty by 85.7% and further improved school non-attendance by 66.7%. The subjective sleep time significantly decreased by 9.5 h after treatment (p = 0.0004). The self-rating Depression Scale and mental component summary of the 36-item Short-Form Health Survey significantly improved after treatment (p = 0.002 and p = 0.01, respectively). Wake-up difficulties were caused by the addition of a delayed sleep phase to the patients’ long sleep times. The novel combination therapy was effective in improving wake-up difficulty and mental quality of life in non-school-attending teenage students.
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Affiliation(s)
- Noriyuki Konishi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Hajime Kumagai
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
- Correspondence: ; Tel.: +81-82-257-1922
| | - Hiroyuki Sawatari
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Tetsuro Hoshino
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Yoko Murase
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Maiko Yamaguchi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
| | - Ayako Urabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
| | - Yuka Kiyohara
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Aki Arita
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
| | - Masayo Baku
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
| | - Ryujiro Sasanabe
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
| | - Toshiaki Shiomi
- Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, Nagakute 4801195, Japan; (N.K.); (H.S.); (T.H.); (Y.M.); (M.Y.); (A.U.); (Y.K.); (A.A.); (M.B.); (R.S.); (T.S.)
- Department of Sleep Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 7348553, Japan
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32
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Faulkner SM, Drake RJ, Ogden M, Gardani M, Bee PE. A mixed methods expert opinion study on the optimal content and format for an occupational therapy intervention to improve sleep in schizophrenia spectrum disorders. PLoS One 2022; 17:e0269453. [PMID: 35666738 PMCID: PMC9170103 DOI: 10.1371/journal.pone.0269453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/22/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction People with schizophrenia spectrum disorder diagnoses commonly have poor sleep, which predicts various negative outcomes. The problems are diverse, including substantial circadian dysregulation, sleep-wake timing issues, hypersomnia (excessive sleep), and more classic insomnia. Methods This paper reports on a mixed methods expert opinion study based on the principles of Delphi methodology. The study examines and explores opinion on the optimal contents and format for an occupational therapy intervention to improve poor sleep in this population. Views of clinical and academic topic experts (n = 56), were elicited, examined and explored in three rounds, views from previous rounds being presented back to participants in subsequent rounds. Participants with relevant personal experience (n = 26) then rated and commented on suggestions, with a focus on acceptability. Descriptive statistics and graphs of ratings were triangulated with qualitative content analysis of free-text. Results Participants emphasised the central importance of intervention personalisation, although the manner and extent of personalisation suggested varied. Many components and domains were acknowledged as important, with the challenge being how to keep such an intervention simple, brief, and feasible for end-users, for sustainable implementation. The strongest consensus was to address evening routine, daytime activity, and environmental interventions. Relaxation, mindfulness, thermoregulation, sensory factors, and cognitive or psychological approaches were rated as less important. There was disagreement on whether to include time in bed restriction, and how to address napping, as well as how far to address medication timing. Clinicians and researchers advocated some version of stimulus control, but participants with personal experience reported low levels of acceptability for this, describing entirely negative experiences using ‘the 15-minute rule’ (part of stimulus control). Conclusion These results are informative for clinicians treating sleep problems in people with schizophrenia and related conditions, as well as for decision makers considering the potential contribution of the profession of occupational therapy toward sleep treatment.
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Affiliation(s)
- Sophie M. Faulkner
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
| | - Richard J. Drake
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Margaret Ogden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Maria Gardani
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Penny E. Bee
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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33
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Sun SY, Chen GH. Treatment of Circadian Rhythm Sleep-Wake Disorders. Curr Neuropharmacol 2022; 20:1022-1034. [PMID: 34493186 PMCID: PMC9886819 DOI: 10.2174/1570159x19666210907122933] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/09/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022] Open
Abstract
Circadian rhythm sleep-wake disorders (CRSWDs) are a distinct class of sleep disorders caused by alterations to the circadian time-keeping system, its entrainment mechanisms, or a mismatch between the endogenous circadian rhythm and the external environment. The main clinical manifestations are insomnia and excessive daytime sleepiness that often lead to clinically meaningful distress or cause mental, physical, social, occupational, educational, or other functional impairment. CRSWDs are easily mistaken for insomnia or early waking up, resulting in inappropriate treatment. CRSWDs can be roughly divided into two categories, namely, intrinsic CRSWDs, in which sleep disturbances are caused by alterations to the endogenous circadian rhythm system due to chronic changes in the regulation or capture mechanism of the biological clock, and extrinsic circadian rhythm sleep-wake disorders, in which sleep disorders, such as jet lag or shift-work disorder, result from environmental changes that cause a mismatch between sleep-wakefulness times and internal circadian rhythms. Sleep diaries, actigraphy, and determination of day and night phase markers (dim light melatonin onset and core body temperature minimum) have all become routine diagnostic methods for CRSWDs. Common treatments for CRSWD currently include sleep health education, time therapy, light therapy, melatonin, and hypnotic drug therapy. Here, we review the progress in the epidemiology, etiology, diagnostic evaluation, diagnostic criteria, and treatment of intrinsic CRSWD, with emphasis on the latter, in the hope of bolstering the clinical diagnosis and treatment of CRSWDs.
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Affiliation(s)
- Shi-Yu Sun
- Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan 232007, Anhui, People's Republic of China
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), the Affiliated Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, P.R. China;,Address correspondence to this author at the Department of Neurology (Sleep Disorders), the Affiliated Chaohu Hospital of Anhui Medical University, Hefei 238000, Anhui Province, P.R. China; Tel/Fax:+86-551-82324252; E-mail:
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Becker SP, Duraccio KM, Sidol CA, Fershtman CEM, Byars KC, Harvey AG. Impact of a Behavioral Sleep Intervention in Adolescents With ADHD: Feasibility, Acceptability, and Preliminary Effectiveness From a Pilot Open Trial. J Atten Disord 2022; 26:1051-1066. [PMID: 34738484 DOI: 10.1177/10870547211056965] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. METHOD Fourteen adolescents (ages 13-17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. RESULTS Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. CONCLUSION This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.
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Affiliation(s)
- Stephen P Becker
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
| | | | - Craig A Sidol
- Cincinnati Children's Hospital Medical Center, OH, USA
| | | | - Kelly C Byars
- Cincinnati Children's Hospital Medical Center, OH, USA.,University of Cincinnati College of Medicine, OH, USA
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Ishii M, Ito W, Karube Y, Ogawa Y, Tagawa A, Maeda S, Sato H, Takahashi T, Inomata N, Narisawa H, Takaesu Y, Watanabe K, Okajima I. Effects of transdiagnostic group treatment for sleep disturbances in adult attention-deficit/hyperactivity disorders and autistic spectrum disorder: a pilot study. Sleep Biol Rhythms 2022; 20:173-180. [PMID: 38469265 PMCID: PMC10899906 DOI: 10.1007/s41105-021-00351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Although adult patients with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) often have sleep problems, few studies have verified the effect of a psychological approach specific to sleep-wake rhythms on these sleep disturbances. Therefore, the aim of this pilot study was to develop a trans-diagnostic approach with sleep scheduling and regularity of sleep duration as core modules, and to examine the effect of the intervention in adult ADHD and/or ASD subjects with sleep disturbances. This was a within-group pilot study. Ten patients with adult ADHD and/or ASD with sleep disturbances (10 males, age: 27.4 ± 5.6 years) took part in a 90-min weekly group intervention for 5 weeks. All participants were assessed on scales for sleep complaints, anxiety, depression, and symptoms of ADHD and ASD before and after the intervention, and at 3-month follow-up. The results showed that the intervention significantly improved sleep disturbances at post-intervention (p = 0.003, d = 1.30, 95% CI 0.31-2.28) and at the 3-month follow-up (p = 0.035, d = 0.41, 95% CI - 0.48 to 1.30). In addition, attention switching for ASD symptoms was significantly reduced post-intervention (p = 0.031, d = 1.16, 95% CI 0.19-2.13). This is the first pilot study of a trans-diagnostic group approach for adult ADHD and/or ASD with sleep disturbances. The intervention primarily led to an improvement of sleep disturbances, followed by improvement of disease-specific symptoms in adult subjects with ADHD and ASD.
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Affiliation(s)
- Miho Ishii
- Department of Neuropsychiatry, School of Medicine, Kyorin University, Tokyo, Japan
- Senzoku Stress Coping Support Office, Tokyo, Japan
| | - Wakako Ito
- Institute of Neuropsychiatry, Tokyo, Japan
| | - Yuki Karube
- Department of Clinical Psychology, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
| | - Yuko Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Anna Tagawa
- Institute of Neuropsychiatry, Tokyo, Japan
- Department of Neuropsychiatry, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shunta Maeda
- Graduate School of Education, Tohoku University, Miyagi, Japan
| | - Hideki Sato
- Department of Disaster Psychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima, Japan
| | - Toru Takahashi
- Faculty of Human Sciences, Waseda University, Saitama, Japan
| | | | - Hajime Narisawa
- Department of Psychology, Aichi Shukutoku University, Aichi, Japan
| | - Yoshikazu Takaesu
- Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Koichiro Watanabe
- Department of Neuropsychiatry, School of Medicine, Kyorin University, Tokyo, Japan
| | - Isa Okajima
- Institute of Neuropsychiatry, Tokyo, Japan
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
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Bonnar D, Lee S, Roane BM, Blum DJ, Kahn M, Jang E, Dunican IC, Gradisar M, Suh S. Evaluation of a Brief Sleep Intervention Designed to Improve the Sleep, Mood, and Cognitive Performance of Esports Athletes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074146. [PMID: 35409833 PMCID: PMC8998799 DOI: 10.3390/ijerph19074146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 12/03/2022]
Abstract
This study evaluated a brief sleep intervention designed to improve the sleep, mood, and cognitive performance of professional electronic sports (esports) athletes from three major esports regions (i.e., Asia, North America, and Oceania). Fifty-six esports athletes from South Korea (N = 34), the United States (N = 7), and Australia (N = 15) completed the study. Participants completed an initial 2-week pre-intervention phase to establish a baseline, followed by a 2-week intervention phase that involved a group sleep education class, 1:1 session with a trained clinical psychologist, and daily biofeedback. A wrist activity monitor and daily sleep diary were used to monitor sleep during both phases, while at pre- and post-intervention, participants completed a battery of sleep and mood questionnaires and underwent cognitive performance testing. Sleep knowledge increased from pre- to post-intervention (d = 0.83 [95% CI −1.21, −0.43], p =< 0.001), while there were modest improvements in sleep diary estimates (i.e., sleep onset latency (Mdiff = −2.9 min, p = 0.02), sleep onset time (Mdiff = −12 min, p = 0.03), and sleep efficiency (Mdiff = 1.1%, p = 0.004)) and wrist activity monitor estimates (i.e., sleep onset time (Mdiff = −18 min, p = 0.01)). Insomnia severity scores decreased significantly (d = 0.47 [95% CI 0.08, 0.84], p = 0.001), while sleepiness scores increased but not meaningfully (d = 0.23 [95% CI −0.61, 0.14], p = 0.025). However, there was no significant change in mood (i.e., depression and anxiety) or cognitive performance scores (i.e., mean reaction time or lapses). Sleep interventions for esports athletes require further investigation. Future research should examine whether a stepped-care model, whereby increasing therapeutic input is provided as needed, can optimize sleep, mood, and cognitive performance outcomes.
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Affiliation(s)
- Daniel Bonnar
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA 5042, Australia; (D.B.); (M.K.)
| | - Sangha Lee
- Department of Psychiatry, Ajou University School of Medicine, Suwon 16499, Korea;
| | - Brandy M. Roane
- Department of Pharmacology and Neurosciences, UNT Health Science Centre, University of North Texas, Fort Worth, TX 76107, USA;
| | - Daniel J. Blum
- Department of Arts and Sciences, New York University Shanghai, Shanghai 200122, China;
| | - Michal Kahn
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, SA 5042, Australia; (D.B.); (M.K.)
| | - Eunhee Jang
- Department of Psychology, Sungshin Women’s University, Seoul 02844, Korea;
| | - Ian C. Dunican
- Centre for Sleep Science, School of Human Sciences, The University of Western Australia, Perth, WA 6009, Australia;
| | | | - Sooyeon Suh
- Department of Psychology, Sungshin Women’s University, Seoul 02844, Korea;
- Correspondence: ; Tel.: +82-2-920-7215
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Yu YA. Pediatric Sleep Medicine Cases. CURRENT SLEEP MEDICINE REPORTS 2022; 8:21-32. [PMID: 35345531 PMCID: PMC8943358 DOI: 10.1007/s40675-022-00223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/13/2022]
Abstract
Purpose of the Review In this review, we will discuss commonly encountered pediatric sleep disorders, their clinical presentations, evaluation, and management. Recent Findings Sleep problems are common complaints in the pediatric population with an estimated prevalence of at least 25%. This review examines frequently seen pediatric sleep disorders including insomnia, obstructive sleep apnea, hypersomnolence, circadian rhythm sleep–wake disorders, parasomnias, and movement disorders. Their clinical manifestations vary, but left untreated, these sleep disorders result in significant impairment. A detailed sleep history is key component in the evaluation process. Other useful tools include sleep diaries, questionnaires, and actigraphy. Polysomnography is often required for diagnosis. Treatment varies depending on the underlying sleep disorder. Pharmacologic treatment is often limited due to the lack of studies of safety and efficacy in the pediatric population. Summary Sleep disorders are commonly encountered in the pediatric population. Their clinical manifestations vary, though without treatment, many result in significant impairment. Detailed sleep history is an essential part of the evaluation process, though polysomnography is often required. Treatment depends on the underlying diagnosis.
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Affiliation(s)
- Yolanda A Yu
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
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How can light be used to optimize sleep and health in older adults? PROGRESS IN BRAIN RESEARCH 2022; 273:331-355. [DOI: 10.1016/bs.pbr.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lang C, Richardson C, Micic G, Gradisar M. Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity. Front Psychiatry 2022; 13:785079. [PMID: 35360141 PMCID: PMC8963423 DOI: 10.3389/fpsyt.2022.785079] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration. METHODS Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity. RESULTS On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights. CONCLUSIONS Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced sample are needed to confirm findings.
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Affiliation(s)
- Christin Lang
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Cele Richardson
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia.,Centre for Sleep Science, School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Gorica Micic
- Adelaide Institute for Sleep Health, Flinders Health & Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Okajima I, Honda Y, Semba O, Kiyota Y, Tani Y. Effects of COVID-19-Related Anxiety and Sleep Problems on Loneliness and Feelings of School Refusal in Adolescents. Front Psychiatry 2022; 13:918417. [PMID: 35774091 PMCID: PMC9237466 DOI: 10.3389/fpsyt.2022.918417] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND COVID-19-related anxiety, sleep problems, and loneliness may be risk factors for school refusal in children and adolescents. However, few studies have examined the mechanisms by which these risk factors cause school refusal. This study examined the process by which COVID-19-related anxiety, sleep problems, and loneliness cause school refusal, using structural equation modeling. METHODS In this cross-sectional questionnaire-based study, 256 (109 male, 147 female, mean age: 15.37 ± 0.48 years) senior high school students were asked to complete the Stress and Anxiety associated with Viral Epidemics-6 questionnaire to assess COVID-19-related anxiety, the Athens Insomnia Scale (AIS), Sleep Debt Index (SDI), and chronotype (MSFsc) to assess sleep problems, the Three-Item Loneliness Scale (TILS) to assess loneliness, and Feelings of School-Avoidance Scale (FSAS) to assess school refusal. RESULTS Structural equation modeling showed that sleep problems affected loneliness (β = 0.52) and feelings of school refusal (β = 0.37), and that loneliness affected feelings of school refusal (β = 0.47). There was no significant pathway of COVID-19-related anxiety on sleep problems, loneliness, or feelings of school refusal. The indirect effect of sleep problems on feelings of school refusal through loneliness was significant. The results of hierarchical multiple regression analysis showed that AIS (β = 0.30) and SDI (β = 0.13) scores were associated with TILS, and AIS (β = 0.26) and MSFsc (β = -0.14) scores were associated with FSAS scores. CONCLUSION The findings of this study showed that sleep problems affected feelings of school refusal via both direct and indirect pathways through the exacerbation of loneliness. To prevent school refusal in adolescents, addressing the indirect pathway via loneliness could be effective in improving insomnia and sleep debt, while addressing the direct pathway could be effective in improving insomnia and chronotype.
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Affiliation(s)
- Isa Okajima
- Behavioral Sleep Medicine and Sciences Laboratory, Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| | - Yukako Honda
- Graduate School of Human Life Sciences, Tokyo Kasei University, Tokyo, Japan
| | | | | | - Yasuo Tani
- Inochi and Future Strategy Headquarters Office, Policy Bureau, Kanagawa Prefectural Government, Kanagawa, Japan
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The effect of the transdiagnostic sleep and circadian intervention (TranS-C) on actigraphic estimates of sleep and rest-activity rhythms in adolescents with an evening circadian preference. Sleep Health 2021; 8:191-194. [PMID: 34924346 DOI: 10.1016/j.sleh.2021.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/18/2021] [Accepted: 10/09/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study evaluates whether the Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) improves objective sleep and rest-activity rhythms in a sample of youth with an evening circadian preference (ECP). METHODS Youth with an ECP aged 10-18 years were randomized to receive 6 sessions of TranS-C (n = 60) or Psychoeducation (PE; n = 58). For one week prior to beginning treatment and within 2 weeks of completing treatment, participants wore an actiwatch to assess objective sleep and rest-activity rhythms. RESULTS Among TranS-C participants, there were significant pre-post improvements in weeknight total sleep time (TST), weekend TST, and weeknight-weekend discrepancy in TST and sleep offset time. These changes were not significant in PE. There was no significant treatment by time interactions for the sleep or rest-activity outcomes. CONCLUSIONS For youth with an ECP, TranS-C improves select objective sleep but not rest-activity outcomes, though compared to PE, these benefits did not reach statistical significance.
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Adhikari P, Pradhan A, Zele AJ, Feigl B. Supplemental light exposure improves sleep architecture in people with type 2 diabetes. Acta Diabetol 2021; 58:1201-1208. [PMID: 33851274 DOI: 10.1007/s00592-021-01712-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
AIMS People with type 2 diabetes (T2D) suffer from sleep disorders, with the mechanism not clearly understood. In T2D, the light transducing retinal photoreceptors that regulate sleep behaviours are dysfunctional; hence, we determine here whether supplemental light exposure ameliorates sleep quality and daytime sleepiness in T2D. METHODS Supplemental light (10,000 Lux, polychromatic) was self-administered for 30 min every morning for 14 days by ten participants with T2D with no diabetic retinopathy (DR). The effectiveness of supplemental light was assessed by comparing subjective sleep questionnaire (PSQI and ESS) scores and salivary dim light melatonin onset (DLMO) before and after the light exposure as well as with a self-maintained sleep diary during the light exposure. RESULTS Compared to the baseline, supplemental light significantly improved the excessive daytime sleepiness score (p = 0.004) and phase-advanced the DLMO on average by ~ 23 min. Sleep diary analyses showed that afternoon nap duration significantly shortened over the first week of supplemental light exposure (p = 0.019). Afternoon naps and midnight awakening were significantly longer in diabetic participants with thinner perifoveal retina. CONCLUSIONS In this case series, we provide initial evidence that supplemental bright light improves daytime sleepiness in T2D with no DR, with the critical period of light exposure showing a beneficial effect after one week. We infer that supplemental light augments photoreceptor signalling in T2D and therefore optimises circadian photoentrainment leading to improved sleep. Our findings inform the development of tailored light therapy protocols in future clinical trials for improving sleep architecture in diabetes.
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Affiliation(s)
- Prakash Adhikari
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Asik Pradhan
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Andrew J Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- Queensland Eye Institute, Brisbane, Australia.
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Richardson C, Gradisar M. Depressed mood and repetitive negative thinking in Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers. J Sleep Res 2021; 31:e13452. [PMID: 34350657 DOI: 10.1111/jsr.13452] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
Circadian dysregulation and depressed mood commonly co-occur in young people, yet mechanisms linking Delayed Sleep-Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 'good' sleeping young people and 63 with DSWPD, with (n = 30) and without (n = 33) self-reported doctor-diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [SD] age of 15.9 [2.2] years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3 weeks. Cross-sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep-onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD individuals significantly improved after treatment (d = 0.47-0.65) and at the 1- (d = 0.43-1.00) and 3-month follow-up (d = 0.39-1.38), yet there were no differences between short- and long-wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost-effective strategy for young people experiencing delayed sleep phase and low mood.
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Affiliation(s)
- Cele Richardson
- School of Psychological Science, Centre for Sleep Science, University of Western Australia, Perth, WA, Australia.,Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Michael Gradisar
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
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Yennurajalingam S, Carmack C, Balachandran D, Eng C, Lim B, Delgado M, Guzman Gutierrez D, Raznahan M, Park M, Hess KR, Williams JL, Lu Z, Ochoa J, Bruera E. Sleep disturbance in patients with cancer: a feasibility study of multimodal therapy. BMJ Support Palliat Care 2021; 11:170-179. [PMID: 31924662 DOI: 10.1136/bmjspcare-2019-001877] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/06/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Our aim was to determine feasibility and effect sizes of bright light therapy (BLT), melatonin (MLT), methylphenidate (MP) and eight combinations (BLT+MLT+MP, BLT+MLT, BLT+MP, BLT alone, MLT+MP, MLT alone, MP alone, placebo for BLT, MLT and MP) defined as multimodal therapy (MMT), to improve sleep quality (SQ) (Pittsburgh Sleep Quality Index (PSQI)) from baseline to day 15. We also examined the effects of MMT on insomnia, fatigue, depression, quality of life and actigraphy. METHODS Patients with advanced cancer with poor SQ (PSQI ≥5) were eligible. Using a double-blind randomised factorial study design, patients were randomised into 1 of the 8 arms for 2 weeks. Feasibility and effect sizes were assessed. RESULTS 81% (54/67) of randomised patients completed the study. There were no differences in the demographics and SQ between groups. The adherence rates for BLT, MLT and MP were 93%, 100% and 100%, respectively. BLT+MLT+placebo of MP; BLT+placebo of MLT+placebo of MP; BLT+MLT+MP showed an effect size (Cohen's d) for change in PSQI scores of 0.64, 0.57 and 0.63, respectively. PSQI change using linear regression showed BLT (n=29) has effect size of 0.46, p=0.017; MLT (n=26), 0.24, p=0.20; MP (n=26), 0.06, p=0.46. No significant differences were observed in scores for insomnia, fatigue, depression, quality of life and actigraphy. There were no differences in adverse events by groups(p=0.80). CONCLUSIONS The use of MMT to treat SQ disturbance was feasible. BLT+MLT showed the most promising effect size in improvement in SQ, and additional larger studies are needed. TRIAL REGISTRATION NUMBER NCT01628029.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cindy Carmack
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dave Balachandran
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cathy Eng
- Department of Gastrointestinal Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Bora Lim
- Department of Breast Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin Delgado
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Diana Guzman Gutierrez
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Monica Raznahan
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Minjeong Park
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kenneth R Hess
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Janet L Williams
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhanni Lu
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jewel Ochoa
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
PURPOSE OF REVIEW This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders. RECENT FINDINGS Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk. SUMMARY It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.
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Micic G, Lovato N, Ferguson SA, Burgess HJ, Lack L. Circadian tau differences and rhythm associations in delayed sleep-wake phase disorder and sighted non-24-hour sleep-wake rhythm disorder. Sleep 2021; 44:5867108. [PMID: 32619243 DOI: 10.1093/sleep/zsaa132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES We investigated biological and behavioral rhythm period lengths (i.e. taus) of delayed sleep-wake phase disorder (DSWPD) and non-24-hour sleep-wake rhythm disorder (N24SWD). Based on circadian phase timing (temperature and dim light melatonin onset), DSWPD participants were dichotomized into a circadian-delayed and a circadian non-delayed group to investigate etiological differences. METHODS Participants with DSWPD (n = 26, 17 m, age: 21.85 ± 4.97 years), full-sighted N24SWD (n = 4, 3 m, age: 25.75 ± 4.99 years) and 18 controls (10 m, age: 23.72 ± 5.10 years) participated in an 80-h modified constant routine. An ultradian protocol of 1-h "days" in dim light, controlled conditions alternated 20-min sleep/dark periods with 40-min enforced wakefulness/light. Subjective sleepiness ratings were recorded prior to every sleep/dark opportunity and median reaction time (vigilance) was measured hourly. Obtained sleep (sleep propensity) was derived from 20-min sleep/dark opportunities to quantify hourly objective sleepiness. Hourly core body temperature was recorded, and salivary melatonin assayed to measure endogenous circadian rhythms. Rhythm data were curved using the two-component cosine model. RESULTS Patients with DSWPD and N24SWD had significantly longer melatonin and temperature taus compared to controls. Circadian non-delayed DSWPD had normally timed temperature and melatonin rhythms but were typically sleeping at relatively late circadian phases compared to those with circadian-delayed DSWPD. CONCLUSIONS People with DSWPD and N24SWD exhibit significantly longer biological circadian rhythm period lengths compared to controls. Approximately half of those diagnosed with DSWPD do not have abnormally delayed circadian rhythm timings suggesting abnormal phase relationship between biological rhythms and behavioral sleep period or potentially conditioned sleep-onset insomnia.
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Affiliation(s)
- Gorica Micic
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Nicole Lovato
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia
| | - Sally A Ferguson
- Appleton Institute, Central Queensland University, Adelaide, South Australia
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Leon Lack
- Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia.,College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
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Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Child Adolesc Psychiatr Clin N Am 2021; 30:175-193. [PMID: 33223061 DOI: 10.1016/j.chc.2020.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.
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Affiliation(s)
- Jenny Dimakos
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Faculty of Medicine, Integrated Program in Neuroscience, McGill University, Montréal, Quebec, Canada
| | - Gabrielle Gauthier-Gagné
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Lanyi Lin
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada
| | - Samantha Scholes
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Reut Gruber
- Attention, Behaviour and Sleep Lab, Douglas Mental Health University Institute, Montréal, Quebec H4H 1R3, Canada; Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
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48
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Feder MA, Baroni A. Just Let Me Sleep in: Identifying and Treating Delayed Sleep Phase Disorder in Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:159-174. [PMID: 33223060 DOI: 10.1016/j.chc.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals with delayed sleep phase disorder (DSPD) are unable to naturally fall asleep and awake at conventional times; for this reason, DSPD is often mistaken for insomnia. However, unlike many patients with insomnia, those with DSPD struggle to get up at appropriate times. DSPD is associated with school refusal, academic difficulties, and lower employment rate. DSPD in youth has prevalence as high as 16%, and is often comorbid with other psychiatric disorders. Treatments include appropriate light exposure during the day, melatonin use, developing an evening routine that minimizes arousal-increasing activities, and gradually shifting sleep-wake times toward more functional ones.
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Affiliation(s)
- Michael A Feder
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone, NYC H+H/Bellevue, New York, NY, USA; Child Study Center, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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49
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Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:101-116. [PMID: 33223055 PMCID: PMC7687719 DOI: 10.1016/j.chc.2020.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
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50
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Steele TA, St Louis EK, Videnovic A, Auger RR. Circadian Rhythm Sleep-Wake Disorders: a Contemporary Review of Neurobiology, Treatment, and Dysregulation in Neurodegenerative Disease. Neurotherapeutics 2021; 18:53-74. [PMID: 33844152 PMCID: PMC8116400 DOI: 10.1007/s13311-021-01031-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/22/2022] Open
Abstract
Circadian rhythms oscillate throughout a 24-h period and impact many physiological processes and aspects of daily life, including feeding behaviors, regulation of the sleep-wake cycle, and metabolic homeostasis. Misalignment between the endogenous biological clock and exogenous light-dark cycle can cause significant distress and dysfunction, and treatment aims for resynchronization with the external clock and environment. This article begins with a brief historical context of progress in the understanding of circadian rhythms, and then provides an overview of circadian neurobiology and the endogenous molecular clock. Various tools used in the diagnosis of circadian rhythm sleep-wake disorders, including sleep diaries and actigraphy monitoring, are then discussed, as are the therapeutic applications of strategically timed light therapy, melatonin, and other behavioral and pharmacological therapies including the melatonin agonist tasimelteon. Management strategies towards each major human circadian sleep-wake rhythm disorder, as outlined in the current International Classification of Sleep Disorders - Third Edition, including jet lag and shift work disorders, delayed and advanced sleep-wake phase rhythm disorders, non-24-h sleep-wake rhythm disorder, and irregular sleep-wake rhythm disorder are summarized. Last, an overview of chronotherapies and the circadian dysregulation of neurodegenerative diseases is reviewed.
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Affiliation(s)
- Tyler A Steele
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA
- Department of Neurology, Rochester, Minnesota, USA
- Rochester Technical and Community College, Rochester, Minnesota, USA
| | - Erik K St Louis
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA.
- Department of Neurology, Rochester, Minnesota, USA.
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rochester, Minnesota, USA.
- Mayo Clinic Health System, La Crosse, Wisconsin, USA.
| | - Aleksandar Videnovic
- Massachusetts General Hospital, Department of Neurology and Harvard Medical School, Boston, Massachusetts, USA
| | - R Robert Auger
- Mayo Center for Sleep Medicine, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rochester, Minnesota, USA
- Department of Psychiatry, Rochester, Minnesota, USA
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