The natural history of insomnia: evaluating illness severity from acute to chronic insomnia; is the first the worst?

STUDY OBJECTIVES

The 3P and 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst during acute onset. The 4P model suggests that illness severity crescendos with chronicity. The present analysis from an archival dataset assesses illness severity with new onset illness (i.e. from good sleep [GS] to acute insomnia [AI] to chronic insomnia [CI]). Illness severity is quantified in terms of total wake time (TWT).

METHODS

GSs (N = 934) were followed up to 1 year with digital sleep diaries, and classified as GS, AI, or CI. Data for CIs were anchored to the first of 14 days with insomnia so that day-to-day TWT was represented prior to and following AI onset. A similar graphic (+/-acute onset) was constructed for number of days per week with insomnia. GS data were temporally matched to CI data. Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS-to-AI period.

RESULTS

Twenty-three individuals transitioned to AI and then CI. Average TWT rose during the first 2 weeks of AI onset (b = 1.8, SE = 0.57, p = 0.001) and was then stable for 3 months (b = -0.02, SE = 0.04, p = 0.53). Average number of affected days was stable from AI to CI (b = 0.0005, SE = 0.002, p = 0.81). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident.

CONCLUSIONS

In our sample of CIs, primarily with middle insomnia, the average severity and number of affected days were worst with the onset of AI (worst is first) and stable thereafter.

Sex differences in response to cognitive behavioural therapy for insomnia: A chart review of 455 patients with chronic insomnia

BACKGROUND

Insomnia is more prevalent in females, however studies examining sex differences in response to insomnia treatment are scarce. This study assessed sex-specific differences in cognitive behavioural therapy for insomnia (CBT-I)-related changes in insomnia symptoms in a large clinical cohort.

METHODS

A chart review was conducted of a clinical cohort (females n = 305, males n = 150) referred to a sleep clinic. Participants had a registered psychologist confirm diagnosis of chronic insomnia according to DSM-IV/V criteria and a Level 1 or 2 sleep study. Daily sleep diaries and questionnaires including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), the Daytime Feelings and Functioning Scale (DFFS), and the Depression, Anxiety and Stress Scale-21 items (DASS), were administered at baseline, post-treatment, and three-month follow-up. Linear mixed models determined interactions between sex and timepoint on symptoms.

RESULTS

Mean (SD) age was 51.7 yrs (15.7, range = 18-90 yrs), and mean BMI was 26.3 kg/m2 (4.9), neither of which differed by sex. At pre-treatment, females demonstrated higher objective total sleep time (min) [343.5 (97.6) vs 323.8 min (92.1), p = 0.044], ISI [19.7 (4.2) vs 18.6 (4.4), p = 0.033], and FFS scores [19.2 (6.0) vs 16.9 (7.2), p = 0.003]. Compared to males, females experienced a greater reduction in FFS and DFFS scores and DASS depressive symptoms (p for interaction: 0.017, 0.043, 0.016 respectively) from baseline to follow-up. The greater reduction in depressive symptoms did not persist after controlling for age, BMI, and sleep apnea severity. Subjective total sleep time similarly increased across treatment for both males [baseline: 335.7 (15.1), post: 357.9 (15.5)] and females [baseline: 318.3 (10.4), post: 354.4 (10.7)], p for interaction: 0.22.

CONCLUSION

Females and males experience similar, substantial benefits from CBT-I after accounting for comorbidities, suggesting the same treatment can resolve insomnia in both sexes.

Comparative short-term safety and efficacy of hypnotics: A quantitative risk-benefit analysis

Several professional societies have provided recommendations for prescribing medications for insomnia. None has provided an integrative analysis that concurrently quantifies safety and efficacy (e.g., risk-benefit ratios). This represents an important gap for informing clinician decision-making. Accordingly, the aim of the present review is to provide such an analysis for five classes of sleep-promoting medications. Adverse event data values were extracted from the most recent FDA-approved package inserts and converted to an integer before being placebo-adjusted and standardized as a rate per 1000 (AEr). Efficacy data, pre-to-post self-reported data for active and placebo conditions were acquired from pivotal trials identified in "white papers" and systematic reviews/meta-analyses. Weighted effect sizes were calculated for subjective sleep latency, wake time after sleep onset and total sleep time, and then were averaged by medication class for each sleep continuity variable. Overall efficacy was represented by a single variable, SWT (sleep latency + wake time after sleep onset + total sleep time). Risk-benefit was represented using a simple ratio value. For safety, it was found that melatonin receptor agonists had the lowest adverse event rate (AEr = 43.1), and non-benzodiazepine benzodiazepine receptor agonists had the highest rate (AEr = 255.0). For efficacy, it was found that the pre-to-post placebo adjusted effect sizes were largest for benzodiazepines (effect size = 1.94) and smallest for melatonin receptor agonists (effect size = 0.109). For risk-benefit, histamine antagonist had the most favourable profile (risk-benefit = 69.5), while melatonin receptor agonist had the least favourable profile (risk-benefit = 395.7). Overall, the combined metric for risk-benefit suggests that treatment with a histamine antagonist is optimal and potentially represents the best first-line therapy for the medical management of insomnia.

The Assessment of Post-COVID Fatigue and Its Relationship to the Severity and Duration of Acute COVID Illness

Emerging data suggests that COVID-19 is associated with fatigue well beyond the acute illness period. The present analysis aimed to: (1) characterize the prevalence and incidence of high fatigue at baseline and follow-up; (2) examine the impact of COVID-19 diagnosis on fatigue level following acute illness; and (3) examine the impact of acute COVID-19 symptom severity and duration on fatigue at follow-up. Subjects (n = 1417; 81.0% female; 83.3% White; X¯age = 43.6 years) completed the PROMIS-Fatigue during the initial wave of the pandemic at baseline (April-June 2020) and 9-month follow-up (January-March 2021). A generalized linear model (binomial distribution) was used to examine whether COVID-19 positivity, severity, and duration were associated with higher fatigue level at follow-up. Prevalence of high fatigue at baseline was 21.88% and 22.16% at follow-up, with 8.12% new cases at follow-up. Testing positive for COVID-19 was significantly associated with higher fatigue at follow-up. COVID-19 symptom duration and severity were significantly associated with increased fatigue at follow-up. COVID-19 symptom duration and severity during acute illness may precipitate longer-term fatigue, which could have implications for treatment planning and future research. Future studies should further evaluate the relationship between symptom severity, duration, and fatigue.

Insomnia symptoms predict longer COVID-19 symptom duration

OBJECTIVE

/Background: The goal of the present study was to assess the prevalence and incidence of insomnia in the United States during the COVID-19 pandemic, and whether, among those that contracted COVID-19, insomnia predicted worse outcomes (e.g., symptoms of greater frequency, duration, or severity).

METHODS

A nationwide sample of 2980 adults living in the United States were surveyed online at two points during the COVID-19 pandemic (T1 = April-June 2020; T2 = January-March 2021). Insomnia symptoms were assessed at both time points using the Insomnia Severity Index (ISI). The T2 survey also asked questions regarding COVID-19 testing and symptoms.

RESULTS

The prevalence of insomnia (defined as ISI ≥15) was 15% at T1 and 13% at T2. The incidence rate of insomnia (i.e., new cases from T1 to T2) was 5.6%. Participants with insomnia were not more likely to contract COVID-19 relative to those participants without insomnia. Among those participants in our sample that contracted the virus during the study interval (n = 149), there were no significant group differences in COVID-19 symptom outcomes, with one exception, participants with insomnia were more likely to report a longer symptom duration (insomnia = 24.8 sick days, no insomnia = 16.1 sick days).

CONCLUSIONS

The present study suggests the prevalence of insomnia in the U.S. population remained high during the COVID-19 pandemic. The data also support that insomnia may be related to experiencing more chronic COVID-19 symptoms. These findings have more general implications for the role of sleep and insomnia on immune functioning.

Long-lasting memory of jasmonic acid-dependent immunity requires DNA demethylation and ARGONAUTE1

Stress can have long-lasting impacts on plants. Here we report the long-term effects of the stress hormone jasmonic acid (JA) on the defence phenotype, transcriptome and DNA methylome of Arabidopsis. Three weeks after transient JA signalling, 5-week-old plants retained induced resistance (IR) against herbivory but showed increased susceptibility to pathogens. Transcriptome analysis revealed long-term priming and/or upregulation of JA-dependent defence genes but repression of ethylene- and salicylic acid-dependent genes. Long-term JA-IR was associated with shifts in glucosinolate composition and required MYC2/3/4 transcription factors, RNA-directed DNA methylation, the DNA demethylase ROS1 and the small RNA (sRNA)-binding protein AGO1. Although methylome analysis did not reveal consistent changes in DNA methylation near MYC2/3/4-controlled genes, JA-treated plants were specifically enriched with hypomethylated ATREP2 transposable elements (TEs). Epigenomic characterization of mutants and transgenic lines revealed that ATREP2 TEs are regulated by RdDM and ROS1 and produce 21 nt sRNAs that bind to nuclear AGO1. Since ATREP2 TEs are enriched with sequences from IR-related defence genes, our results suggest that AGO1-associated sRNAs from hypomethylated ATREP2 TEs trans-regulate long-lasting memory of JA-dependent immunity.

Do Placebos Primarily Affect Subjective as Opposed to Objective Measures? A Meta-Analysis of Placebo Responses in Insomnia RCTs

INTRODUCTION

Little is known about the relative magnitude of placebo responses on objective and subjective measures of sleep continuity. To address this issue, the pre-post effects of placebos on objective and subjective measures (i.e., polysomnography [PSG] and sleep diaries) were evaluated meta-analytically. The guiding hypothesis was that large responses would be observed on sleep diary measures and small responses would be observed on PSG measures.

METHODS

PubMed searches, 1967-2016, yielded 329 possible articles, 17 of which met the inclusion and exclusion criteria for the present analysis (including 879 subjects with PSG data, 1,209 subjects with diary data, and six studies with both PSG and sleep diary data). Average change and weighted effect sizes (ESs) were computed via modeling for sleep latency (SL), wake after sleep onset (WASO) and total sleep time (TST).

RESULTS

Pre-to-post change on PSG measures were: SL -13.7 min., ES = -0.37; WASO -14.3 min., ES = -0.36; and TST 29.8 min., ES = 0.50. Pre-to-post change on sleep diary measures were: SL -13.5 min., ES = -0.36; WASO -13.3 min., ES = -0.20; and TST 25.5 min., ES = 0.36. The modeled average objective subjective difference per sleep continuity measure was less than 5 minutes. The modeled average objective subjective difference per sleep continuity measure (in effect sizes) was less than 0.17.

DISCUSSION

The observed outcomes of this analysis suggest that placebos produce comparable effects on objective and subjective measures of sleep continuity. Thus, objective measures do not appear to protect against placebo responses. This being the case and given the importance of the subjective experience of illness severity and recovery, such data suggests that prospectively sampled sleep continuity data (sleep diaries) may be the optimal data for clinical trials, particularly when only one measure is possible.

The natural history of insomnia: high sleep reactivity interacts with greater life stress to predict the onset of acute insomnia

STUDY OBJECTIVES

Prior research suggests that some individuals have a predisposition to experience insomnia following acute stressors (i.e. sleep reactivity). The present study was a proof of concept and specifically aimed to provide additional empirical evidence that the link between stressful life events and the onset of acute insomnia is moderated by sleep reactivity.

METHODS

About 1,225 adults with a history of good sleep (Mage = 53.2 years, 68% female, 83% white) were recruited nationwide for an online study on sleep health. Participants completed surveys to assess sleep reactivity (baseline), sleep patterns (daily sleep diary), and stressful life events (weekly survey). All daily and weekly measures were completed for a one-year period. Sleep diary data were used to identify sleep initiation/maintenance difficulties, including whether they met criteria for acute insomnia at any point during the one-year interval.

RESULTS

Participants with high sleep reactivity compared to low sleep reactivity were at 76% increased odds of developing acute insomnia during the one-year interval. In general, greater weekly stressful life events were associated with greater insomnia during the subsequent week. Those participants with high sleep reactivity demonstrated a stronger relationship between weekly stressful life events and insomnia, such that they reported the greatest levels of insomnia following weeks where they experienced a greater number of stressful life events.

CONCLUSIONS

These results further support the sleep reactivity model of insomnia, and specifically, provide evidence that sleep reactivity predicts the incidence of acute insomnia in a sample of participants with no history of insomnia.

0570 Does CBT-I Dose effect Sleep Duration and Fatigue in Breast and Prostate Cancer Patients?

Introduction

Cancer-related fatigue (CRF) is highly prevalent during acute illness and survivorship, with almost 100% of cancer patients experiencing some level of CRF. While CRF commonly co-occurs with sleep disturbance during and/or after cancer treatment, CRF is defined as occurring independent of sleep considerations. The present analysis is based on an ongoing pilot study where CBT-I dose (4 & 8 [Low] vs 10 & 12 [High] sessions) is being assessed for whether improved sleep continuity and/or increased TST can improve CRF in subjects diagnosed with breast and prostate cancer.

Methods

This interim analyses includes seven adult subjects (6 females, mean age=57.1 yrs.; n=3 [Low dose], n=4 [High dose]). CBT-I was provided by a master CBT-I therapist via video conferencing (telehealth CBT-I). Subjects were asked to complete sleep diaries, and weekly measures of fatigue (FACIT) and insomnia severity (ISI) questionnaires.

Results

Subjects in the low dose group exhibited a 9% improvement and subjects in the high dose group had a 21% improvement on the FACIT. This corresponded to a 28% improvement on the ISI (low group) and a 68% improvement on the ISI (high group). With respect to TWT, subjects in the low dose group decreased their wake time by 36% and those in the high dose group decreased their wake time by 43%. Finally, TST decreased by 7% in the low dose group but increased by 12% in the high dose group.

Conclusion

Preliminary results indicate that a higher CBT-I dose may significantly decrease fatigue, stabilize sleep schedules, and improve sleep continuity in patients with CRF, where the high dose group showed more than double the improvement on the FACIT and ISI (as compared to the low dose group). Not surprisingly, TWT was roughly comparable between the groups while TST was more substantially impacted by high dose CBT-I. This study is ongoing.

Support (If Any)

Support: 5T32HL00795320;K24AG055602

0456 Comparative Safety and Efficacy of Hypnotics: A Quantitative Risk-Benefit Analysis

Introduction

Hypnotics continue to be preferentially used in practice for the treatment of chronic insomnia, yet the comparative safety and efficacy of medication options are unclear. While several position statements and network meta-analyses have provided some guidance, none have provided a quantitative assessment of risk-benefit. In the present analysis, each therapeutic class commonly used for chronic insomnia is quantitatively ranked with respect to safety, efficacy, and risk-benefit.

Methods

Safety data for FDA-approved hypnotics were extracted from the package insert adverse event tables and standardized to form a placebo-adjusted adverse event rate per 1000 (AEr). Efficacy data were extracted from randomized controlled trials identified in professional society position statements and published systematic reviews. The efficacy metric was computed from placebo adjusted pre-post change scores for self-reported sleep continuity (i.e., sleep latency [SL], wake after sleep onset [WASO], and total sleep time [TST]) and represented as a summed composite effect size score (SWT). Risk-benefit (R/B) was represented as a ratio between AEr and SWT. Comparative safety, efficacy, and risk-benefit metrics were calculated for five therapeutic classes: Benzodiazepines (BZs), non-benzodiazepine benzodiazepine receptor agonists (BZRAs), dual orexin receptor antagonists (DORAs), melatonin receptor agonists (MELAs), and sedating antidepressants (SADs).

Results

With respect to safety, MELAs had the lowest adverse event rate (AEr=43.1) and BZRAs had the highest rate (AEr=255.0). With respect to efficacy, BZs were the most efficacious (SWT=1.94, Mean ES=0.59) and MELAs were least efficacious (SWT=0.11, Mean ES=0.02). Overall, with respect to risk-benefit, SADs had the most favorable profile (R/B=69.5), while MELAs had the least favorable profile (R/B=395.7).

Conclusion

The optimal selection of hypnotics requires consideration of both risk and benefit. Findings suggest that SADs can be considered the first-line pharmacotherapeutic option due to the superior risk-benefit profile. If treatment responses are inadequate or if SADs are contraindicated, risk-benefit rankings may serve as a decision tree as part of a medical algorithm protocol to guide treatment selection for patients with chronic insomnia.

Support (If Any)

Sleep Research Society Mentor-Mentee Award (Cheung); K24AG055602 & R01AG054521 (Perlis)

0665 Mindfulness as a Protective Factor for Chronic Insomnia in College Students

Introduction

College students are at high risk for developing insomnia and co-morbid psychological distress. The aim of this research was to assess whether the lack of endogenous mindfulness was a risk factor for insomnia.

Methods

In order to address this issue, an archival analysis was conducted with a data set from MUN where the relationship between chronotype, mental health, sleep quality, and social support was assessed (n=3,160; 2,266 women; X̅age=22 years). The proband subsample of interest were subjects that completed the HADS, MEQ, the ISI, and the Mindful Attention Awareness Scale (MAAS). The MAAS is a 15 item self-report measure, where each item is scored on a six-point Likert scale. Scores range from 15-90, higher scores are indicative of greater mindfulness. In order to evaluate the relevance of mindfulness, the overall sample was split into two groups (endogenous mindfulness [average score of ≥4.2]): n=647; X̅age=22.4 years; nonendogenous mindfulness [average score of ≥4.2]: n=1,505; X̅age=22.04 years).

Results

Subjects (n=2,152) were between the ages of 18-35 (X̅=22+/- 3.72) and included primarily Caucasian individuals (86.6 %) and individuals who identified as female (71.7%). The means and ranges for the ISI, MAAS, and HADS were as follows: 9.0 + 5.6 (0-28), 3.7+.98 (1-6), and 5.3 + 3.9 (0-21), respectively. A correlation of -0.27 (p<0.001) was found for endogenous mindfulness (scale score range 1-6) and insomnia (scale score range 0-28) and -0.25 (p<0.001) for non-endogenous mindfulness (scale score range 1-6) and insomnia. Moderator analyses were conducted, and it was found that depression moderates the relationship between mindfulness and insomnia, (HADS depression, ΔR2 = .2, ΔF(3, 643)=57.6, p=.012, b=-.3, t(643)=-2.5 p< .05. Results should be interpreted with caution as the effect size was less than 0.1.

Conclusion

There was a relationship found, in both groups, between mindfulness and the ISI, where the scores on the ISI were lower when mindfulness was high. This suggests that there is a moderate linear relationship between mindfulness and insomnia. This association needs to be further evaluated in samples that have a broader range of ISI scores and with analyses that more carefully parse the moderating influence of depression. Analyses are ongoing.

Support (If Any)

Support: K24AG055602

0427 Having Insomnia vs. Identifying as an “Insomniac”: What is the role of insomnia severity?

Introduction

The present study sought to evaluate whether insomnia severity (i.e., sleep continuity disturbance) is worse in those who endorse insomnia identity (i.e., identify as an “insomniac”) vs. those who endorse “having insomnia.”

Methods

This study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area. This dataset (n=3,483) was comprised of adults between 18 and 90 years of age (X̅age=53.6±11.0; female [76.4%]; White [91.4%]). All subjects in this analysis endorsed sleep problems. Subjects answered questions regarding demographics, sleep continuity (in minutes), and insomnia identity (“Do you think of yourself as someone that has insomnia” and “do you think of yourself as an ‘insomniac’"?). For both questions, individuals were categorized by their answers: strongly agree, agree, undecided, disagree, strongly disagree. MANOVAs and two-way ANOVAs were conducted to assess group differences (α=.01).

Results

Most individuals endorsed “having insomnia” (n=2,301 [66.1%; strongly agree and agree]) but did NOT endorse being an ‘insomniac’ (n=1,981 [56.9%; undecided, disagree, and strongly disagree]). For all measures, except TST, the two groups did not differ with respect to insomnia severity (i.e., SL[55.4±48.5;60.5±52.1], WASO[45.1±51.7;47.6±55.3], EMA[71.8±51.6;72.9±52.4], and TST [328±75.5;319.6±76.4, p=.009]). The magnitude of the differences between these groups ranged from 1-10 minutes.

Conclusion

It was found that individuals are more likely to endorse ‘having insomnia’ than they are to endorse being an ‘insomniac.’ Despite the implicit differences in “having” something vs. “being” something, the groups did not differ appreciably with respect to sleep continuity. Thus, the tendency to have insomnia identity may not be related to insomnia severity considerations. It is possible, if not likely, that such differences may be related to frequency or chronicity of insomnia. Barring, or in addition to these things, insomnia identity may be related to the mismatch between sleep ability and need and/or related to other non-specific factors. Future directions include refining the group definitions to include forms of insomnia identity that occur with relatively normal sleep continuity (i.e., normal severity and/or frequency and/or chronicity). It will also be important to evaluate whether the various forms of insomnia identity vary with age, sex, or disease comorbidity.

Support (If Any)

K24AG055602

0569 COVID-19 and Fatigue: Does Fatigue Persist Beyond Diagnosis?

Introduction

While it is not surprising that COVID is associated with increased fatigue, there is emerging data that COVID-19 symptoms extend well beyond the acute illness period. This phenomenon, known as “Long COVID”, may include fatigue (persistent fatigue post viral infection). The present analysis was undertaken to evaluate fatigue in subjects with and without COVID-19 virus at two time points separated by ~ one year’s time.

Methods

The parent study was a large online study of subjects during the COVID lockdown which was designed to evaluate the effects of social distancing on mood and sleep (n=4052; 3,184 women; X̅age= 46.0 years). The proband subsample of interest was the subjects that reported having COVID as compared to matched controls (whole sample n=242; 195 women [80.6% female]; 206 identified primarily as white [85.1%]; X̅age=42.0 years). Subjects who reported testing positive for COVID-19 provided additional information on COVID-19 symptoms (e.g., severity and duration per symptom). The PROMIS Fatigue scale was administered at time one (T1: April-June 2020) and one year later (T2: January-March 2021). Control subjects were matched based on age, sex, and race to reduce potential confounding or effect modification by these variables.

Results

The mean PROMIS Fatigue scores for the COVID-19 group and Control groups at baseline (T1) were X̅=52.9 + 8.2 (n=121) and X̅=50.7 + 10.4, (n=121), p<0.06, respectively. The mean PROMIS scores for the COVID-19 group and Control groups at follow-up (T2) were X̅=55.3 + 8.7 (n=121) and X̅=52.6 + 8.4, (n=121), p<0.017, respectively. Overall, the groups were found to significantly differ at both time points, p<0.001. No group-by-time interaction was observed. Both groups exhibited a small increase in fatigue from T1 to T2, p<0.716.

Conclusion

As expected, there were significant differences in patient reported fatigue between the COVID-19 and the control group. The between group differences were modest. Significant and large scale group differences were not evident for T2 (during follow-up). This suggests that COVID is associated with increased fatigue but we did not detect “Long COVID” effects. This may be due to methodologic considerations. In order to observe “Long COVID” the data will need to be anchored to illness onset and offset.

Support (If Any)

Support: 5T32HL00795320;K24AG055602

0461 Does “TIB” Differentiate Between Good Sleepers and Subjects That Develop Acute or Chronic Insomnia? A 2nd Analyses

Introduction

According to the 3P model of insomnia, the variable that mediates the transition from acute to chronic insomnia is “sleep extension” (the behavioral tendency to expand sleep opportunity to compensate for sleep loss). Recently, this proposition was prospectively evaluated by assessing how Time-in-Bed (TIB) varied, week-by-week, relative to the incidence of acute insomnia in four groups, those that: maintained good sleep (GS,n=911), recovered good sleep (AI-REC,n=244); had persistent poor sleep (AI-PPS,n=65); and developed chronic insomnia (AI-CI,n=23)). Significant differences for pre-to-post acute insomnia TIB were not detected for the insomnia groups (as compared to one another or as compared to GSs). The observed trends suggested that the increases in TIB observed were minor (< 15 min overall, at 2 weeks, and at 12 weeks post AI). In the present analysis, a more granular evaluation was undertaken to assess whether sleep extension occurs on the nights following poor sleep bouts.

Methods

The same data set and subject groups were modeled for TIB occurring on the night following a poor night’s sleep (≥ 30 min for SL or WASO or EMA) for the post-acute insomnia interval (by weekday and weekend). Linear mixed effects model was used to account for up to 1 year of repeated nights per subject.

Results

During the weekdays, the groups did not differ with respect to TIB following a poor nights’ sleep. On average, the four groups (including good sleepers) did not vary TIB by more than 5 minutes. During the weekends, all four groups tended to restrict TIB. In this instance, AI-CI subjects restricted TIB the least (AI-CI -17.2[5.11]; (GS -25.7[SE 1.58]; AI-PPS -27.6[6.1]; AI-REC -32.3[1.9].

Conclusion

As with the prior analysis, the transition to CI does not appear to be triggered by sleep extension. In the present analysis there is some evidence to support the notion that AI-CI subjects restrict TIB less. This counterintuitive finding needs to be further evaluated taking into account sleep timing. That is, time-to-bed and time-out-of-bed may vary (show the attempt to extend sleep opportunity) while TIB does not change appreciably (owing to limitations in sleep ability [plasticity]).

Support (If Any)

Support: R01AG041783;K24AG055602;R01AT003332

Does total sleep time substantially increase after CBT-I?

STUDY OBJECTIVES

In most standardized approaches to cognitive behavioral therapy for insomnia (CBT-I), it is commonly the case that total wake time reduces substantially during sleep restriction, but self-reported total sleep time (TST) is minimally affected. By follow-up, however, TST increases by almost 1 hour on average. A secondary analysis was undertaken to assess what percent of participants meet or appreciably exceed baseline TST after CBT-I.

METHODS

Data were drawn from a randomized controlled trial assessing acute and maintenance therapies for chronic insomnia (N=80). The present analyses assessed the percentage of participants that 1) reached (≥ 1 minute increase) and 2) appreciably exceeded (≥ 30 minute increase) baseline TST as assessed via daily Sleep Diaries at post treatment and 3, 6, 12, and 24 months following treatment.

RESULTS

45% of participants reached or exceeded baseline TST by the end of acute treatment. By 24 months follow up, this percentage increased to 86%. Only 17% of participants achieved a 30-minute increase in TST by the end of acute treatment, and this proportion only increased to 58% over time.

CONCLUSIONS

These findings suggest that CBT-I in its current form does not appreciably increase self-report TST in a significant proportion of insomnia patients. Whether participants would benefit from further increases in TST warrants investigation. The further titration of sleep opportunity may be useful to accelerate increases in TST, to extend the effect to a larger subset of patients, and/or to increase the magnitude of the TST increase.

We know CBT-I works, now what?

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be efficacious and now is considered the first-line treatment for insomnia for both uncomplicated insomnia and insomnia that occurs comorbidly with other chronic disorders (comorbid insomnia). The purposes of this review are to provide a comprehensive summary of the efficacy data (for example, efficacy overall and by clinical and demographic considerations and by CBT-I formulation) and to discuss the future of CBT-I (for example, what next steps should be taken in terms of research, dissemination, implementation, and practice).

Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment for insomnia that targets difficulties with initiating and/or maintaining sleep and is delivered over the course of six to eight sessions. The primary focus of CBT-I is to address the perpetuating factors (according to the three-factor model of insomnia) that contribute to the development of chronic insomnia. Chronic insomnia is the most prevalent sleep disorder, occurring in approximately 6-10% of the population, and is a risk factor for multiple medical and psychiatric disorders. Despite its prevalence and morbidity, the widespread dissemination of CBT-I is not commensurate with insomnia's overall public health impact. This is particularly surprising given its large evidence base and recent recommendation as the first line intervention for insomnia. The primary goal of this article is to provide a primer or brief introduction to CBT-I that is intended to be accessible to all clinicians and researchers, including non-sleep experts. Core components of CBT-I (i.e., Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy), relapse prevention strategies, multicultural considerations, adjuvants to traditional interventions, treatment adherence issues, efficacy, and further training options are described. A session-by-session outline is also provided.

Durability of treatment response to zolpidem using a partial reinforcement regimen: does this strategy require priming?

BACKGROUND

Previous research has shown that after one month of full dose nightly treatment with zolpidem (priming), subjects with chronic insomnia (CI) switched to intermittent dosing with medication and placebos were able to maintain their treatment responses. This approach to maintenance therapy is referred to as partial reinforcement. The present study sought to assess whether priming is required for partial reinforcement or whether intermittent dosing with placebos (50% placebos and 50% active medication) can, by itself, be used for both acute and extended treatment.

METHOD

55 CI subjects underwent a baseline evaluation (Phase-1) and then were randomized to one of two conditions in Phase-2 of the study: one month of (1) nightly medication use with standard-dose zolpidem (QHS [n = 39]) or (2) intermittent dosing with standard-dose zolpidem and placebos (IDwP [n = 16]). In Phase-3 (three months), the QHS group was re-randomized to either continued QHS full dose treatment (FD/FD) or to IDwP dose treatment (FD/VD). Treatment response rates and Total Wake Time (TWT = [SL + WASO + EMA]) were assessed during each phase of the study.

RESULTS

In Phase-2, 77% (QHS) and 50% (IDwP) subjects exhibited treatment responses (p = 0.09) where the average change in TWT was similar. In Phase-3, 73% (FD/FD), 57% (FD/VD), and 88% (VD/VD) of subjects exhibited continued treatment responses (p = 0.22) where the average improvement in TWT continued with FD/FD and remained stable for FD/VD and VD/VD (p < 0.01).

CONCLUSION

These results suggest that intermittent dosing with placebos can maintain effects but do not allow for the additional clinical gains afforded by continuous treatment.

Measuring the Effects of Social Isolation and Dissatisfaction on Depressive Symptoms during the COVID-19 Pandemic: The Moderating Role of Sleep and Physical Activity

Social distancing was universally implemented to reduce the spread of the COVID-19 virus. Long-term social distancing can lead to increased feelings of social isolation or dissatisfaction with one's daily interpersonal interactions, which can subsequently result in reduced psychological health (e.g., greater depression). The present study quantified this association, and the extent to which it was moderated by measures of sleep and physical activity, by surveying 3658 adults (mean age = 46.0 years) from across the United States. Participants answered questions related to their social experiences, sleep, physical activity, and depressive symptoms during the early stages of the pandemic (March-June 2020). Results showed that social isolation and social dissatisfaction were associated with greater depressive symptoms. As predicted, self-reported sleep quality and physical activity moderated these associations, such that lower sleep quality and physical activity exacerbated their effect on depressive symptoms.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

Introduction

Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late).

Methods

Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI &lt; 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI&gt;14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia.

Results

Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%).

Conclusion

According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general?

Support (if any)

Vargas: K23HL141581; Perlis: K24AG055602

368 Durability of Tx Response to Zolpidem using a Partial Reinforcement Regimen: Does this strategy require contingent reinforcement?

Introduction

In 2015, partial reinforcement (PR) was assessed as an alternative approach to maintenance therapy with zolpidem. The method being: once a treatment response is obtained over the course of 1-month’s Tx with QHS dosing (Phase-1), Tx response can maintained over time with a PR regimen (Phase-2 [nightly pill/capsule use with 50% of capsules having medication and 50% having only inert filler]). In that study, it was assumed that Phase1 QHS dosing was required 1) to maximize treatment responding and 2) for the conditioning of pharmacologic responses to the medication vehicle (capsule). In the present study, these assumptions were tested by including both QHS and PR arms into Phase-1.

Methods

In Phase-1 (1 month), subjects were randomized to the QHS or PRS conditions (2QHS:1PRS). In Phase-2 (3 months), the PRS group continued forward without a change in the treatment regimen (variable dose [VD-VD]) and the QHS group was re-randomized to either continued QHS Tx (full dose [FD-FD]) or to PRS Tx [FD-VD]). Both study phases were evaluated for treatment responses rates and for average change in TWT (SL+WASO+EMA).

Results

55 subjects (age 61.2+/-8.1, 64% female, & 73% white) were enrolled into Phase-1; 39 were randomized to the QHS condition and 16 to the PRS condition. In Phase-1, 77% (QHS) and 50% (PRS) exhibited treatment responses (p=0.09) where the average change in TWT was similar by group (QHS was -43min [CI -76,-9] and PRS was -76min [CI -138,-14];p=0.35). In Phase-2, 73% (FD-FD), 57% (FD-VD), and 88% (VD-VD) exhibited continued treatment responses (p=0.22) where the average improvement of TWT continued with FD-FD and remained stable for FD-VD and VD-VD (p&lt;0.01).

Conclusion

These data, while preliminary, suggest that QHS (vs. PRS) dosing produces more treatment responders and similar initial effects on sleep continuity during Phase-1, comparable maintenance of treatment response over time, and continued improvement on sleep continuity during Phase-2. These results suggest that partial reinforcement can maintain effects but cannot allow for the additional clinical gains afforded by continuous treatment. Given this, it may be the case that the partial reinforcement technique could be improved upon by extending phase from 1 to 2–4 months.

Support (if any):

162 Age, sex, and sleep continuity disturbance: Does binary sex impact sleep continuity while co-varying for age across the lifespan?

Introduction

It is well-documented that insomnia symptoms can worsen with age and that women have a greater predisposition to insomnia symptoms than men. Additionally, it has been found that women are more likely to report insomnia symptoms across the lifespan (i.e., increased prevalence of insomnia regardless of age). The aim of the present study was to 1) confirm the finding that women are more likely to endorse having insomnia problems (specifically as they pertain to SL, WASO, and EMA) and 2) evaluate if there are binary sex differences with respect to sleep continuity disturbance (SCD) while accounting for age.

Methods

Sleep continuity (SL, WASO, EMA) duration (in minutes) and problem endorsement data was collected from individuals with insomnia complaints in an archival/community-based sample (n=1837;56.9% female; ages 18-87) (www.sleeplessinphilly.com). A multivariate analysis of covariance was conducted to determine a significant difference between sex (male, female) on SL, WASO, and EMA in minutes while controlling for age. Pearson correlations were run to determine relationships between age and SL, WASO, and EMA. Chi-Square tests were run to determine if there were sex differences in problem endorsement of SL, WASO, and EMA.

Results

Significant sex differences were observed in reports of SCDs as problematic, where more women endorsed SL (58.5%;p&lt;.001), WASO (58.1%;p&lt;.001), and EMA (56.9%;p&lt;.001) as a problem than men. There were no significant effects of binary sex on sleep continuity disturbances when controlling for age. Age was significantly negatively related to SL(p&lt;.001) and significantly positively related to WASO(p&lt;.001) and EMA(p&lt;.001).

Conclusion

These results confirm that women are more likely to report SCDs as a problem and that men and women experience similar levels of insomnia severity with respect to SL, WASO, and EMA. Clinically speaking, it may be important to evaluate insomnia with explicit questions about specific measures of SCD, followed by an inquiry regarding whether each SCD symptom “is a problem.” Future studies should consider gender identification as a relevant factor when evaluating for sleep continuity disturbances across the lifespan.

Support (if any):

654 Potential Longitudinal Association Between COVID-19 Infection Outcomes and Insomnia Symptoms

Introduction

The COVID-19 pandemic has had an unequivocal negative impact worldwide, including increases in stress related to social isolation, unemployment, grief, and fear of contracting the virus. This increased stress has likely led to a greater prevalence of sleep continuity disturbance (i.e., insomnia) in the general population. The goal of the present study was to assess the prevalence of sleep continuity disturbance (i.e., insomnia) in the United States during the initial months of the pandemic. In addition, longitudinal assessment is currently ongoing in order to further assess participant experiences with COVID-19. Specifically, these follow-up data will be used to assess whether, among those that contracted COVID-19, insomnia at baseline (Time 1) predicts worse outcomes (e.g., symptoms of greater frequency, duration, or severity) upon follow-up (Time 2).

Methods

A national survey was conducted from April-June 2020. Participants answered questions regarding social distancing practices, mood, sleep, physical activity, and COVID-19 symptoms. Insomnia symptom prevalence and severity were estimated with a retrospective sleep diary and the Insomnia Severity Index (ISI). A follow-up assessment is currently ongoing and will be completed in March 2021. The follow-up survey consists of similar questions and additional items regarding COVID-19 testing, symptoms [frequency, duration, and severity], and outcomes [outpatient treatment, incidence and duration of hospitalization, and incidence and type of respiratory assistance].

Results

4,133 adults (Mage = 45.8 years; range = 18 - 86 years; 78.7% female) completed the baseline survey. The prevalence of clinically significant sleep continuity disturbance (≥ 30 minutes) was 44.6% for sleep latency problems and 36.2% for wake after sleep onset problems. Nearly 34% of subjects reported average total sleep times of less than 7 hours. Over 17% of subjects (n = 719) reported total ISI scores in the clinical range (ISI total score ≥ 15).

Conclusion

The present study suggests the prevalence of clinically significant insomnia symptoms during COVID-19 remain high in the general population (17–45% depending on definition of insomnia). Similarly, the prevalence of short sleep is elevated. Whether these incident data are associated with COVID-19 outcomes remains to be determined and will be the subject of follow-up analyses in January/February 2021.

Support (if any)

Vargas: K23HL141581; Perlis: K24AG055602

0152 Insomnia Severity and Daytime Complaints: What is to be Learned When These Domains are Discordant?

Introduction

If illness severity and daytime dysfunction are construed as categorical entities, it is possible to conceptualize the relationship between these variables in terms of a 2x2 matrix where the resultant cells represent a concordant dimension (quadrants 2 & 4 [high-high and low-low]) and a discordant dimension (quadrants 1 & 3 [high-low and low-high]). The question for the present analysis was, what percentage of subjects populate each quadrant and is it the case that the discordant dimension contains only a small percentage of subjects?

Methods

Illness severity and daytime dysfunction data was collected from individuals with sleep continuity complaints in archival/community-based sample (N = 4680; 60% female; Ages 18–89) (www.sleeplessinphilly.com). Illness severity was operationalized as Total Wake Time (TWT; [SL+WASO+EMA=TWT]) and daytime dysfunction was operationalized as the composite score of six daytime symptoms items. Median splits were calculated for each variable and subjects were typed accordingly (HH, LL, HL, & LH).

Results

Surprisingly, the sample was relatively equally distributed into the two dimensions; 38% and 23% for the concordant dimension and 13% and 26% for discordant dimension.

Conclusion

The 39% of subjects in the discordant groups might be thought of as complaining good sleepers (LH) and noncomplaining poor sleepers (HL). Other investigators have identified the LH subjects as individuals with “insomnia identity”. Alternatively, it is possible to characterize the whole dimension as being related to a mismatch between the individual’s sleep need and sleep ability. Those who need a lot, may suffer a lot, in the face of only a little (LH) whereas those who need a little, may suffer only a little, in the face of a lot (HL).

Support

 

0456 Natural History of Insomnia: Sleep Reactivity Predicts New-Onset Acute Insomnia

Introduction

Greater vulnerability to stress-related sleep disturbance (i.e., sleep reactivity) is a risk factor for chronic insomnia (CI). What has not been investigated is whether greater sleep reactivity, as assessed by the Ford Insomnia Response to Stress Test (FIRST), predicts the onset of acute insomnia (AI), and more, whether greater sleep reactivity predicts the transition from AI to CI.

Methods

A national cohort of 1,222 good sleeper subjects (68% female; mean age=53.2 years) were prospectively assessed to estimate the incidence of AI and CI. The FIRST was completed at baseline and sleep diaries were completed on a daily basis for a period of one year. Subjects were categorized based on their FIRST scores (high, FIRST&gt;16; low, FIRST≤16). Subjects were also grouped based on whether they developed AI (two consecutive weeks with a frequency of ≥ 3 nights per week of sleep initiation or maintenance problems) or maintained good sleep (GS; n=896). For those subjects that transitioned to AI (n=326), they were also grouped based on whether or not they developed CI (insomnia ≥ 3 nights/week for at least three months; n=23). Chi-square analyses were performed to determine if higher FIRST scores at baseline predicted the incidence of AI or CI.

Results

32.5% of subjects in the high FIRST group met criteria for AI at some point during the one-year interval, whereas 22.5% of subjects in the low FIRST group experienced AI (χ 2=15.2, p&lt;.001). In contrast, FIRST did not predict CI status (low FIRST, 8.5% CI, high FIRST, 5.6% CI; χ 2=1.1, p=.30).

Conclusion

Greater sleep reactivity predicted incident AI but not the onset of CI. While these findings suggest that sleep reactivity may be a predisposing factor for AI, data are not consistent with previous findings showing FIRST scores are predictive of the development of CI. It’s possible that the present study was underpowered to detect these differences, given that the incidence of CI was low (less than 2% of the total sample). Additional analyses are ongoing to evaluate the temporal association between stressful life events and AI in subjects with high and low FIRST scores.

Support

Perlis: NIH R01AG041783, K24AG055602

0464 Sleep Continuity by Neighborhood: Are There Differences?

Introduction

To our knowledge, no prior work has been conducted on whether sleep continuity disturbance (e.g., SL; WASO; EMA, etc.) varies by neighborhood. While differences on these metrics have been found by, e.g., race and socioeconomic status, it may also be that sleep continuity disturbance varies relative to where one lives and works. Accordingly, an analysis was undertaken to assess whether regional differences exist with respect to sleep continuity disturbance (SCD).

Methods

The study utilized a cross-sectional group design in an archival/community dataset that was collected in the Philadelphia area (www.sleeplessinphilly.com). This dataset (n = 2840) was comprised of adults between 18 and 89 years of age with self-reported sleep complaints (63.4% female; 36.6% male; average age 38). Study subjects who endorsed &gt;30 minutes on &gt;3 days/week on SL, WASO & EMA were categorized by zip code and into four regional groups: Center City (n=258); South Philadelphia (n=103); North & Northeast Philadelphia (n=400) and West Philadelphia (n=345). Contingency analyses and ANOVAS were used to assess for regional group differences.

Results

It was found that SCD rates significantly differed by region. Differences in percent endorsement by region were as follows, SL:, 64.1% (Northeast/North), 63.5 (South), 56.3% (West Philadelphia), & 48.7% (Center City); WASO: 45% (Northeast/North), 40% (South), 36.5% (West Philly), & 32.4% (Center City); EMA: 46.4% (South); 43.7 (Northeast/North); 43.7 (West Philly); 43.1 (Center City).

Conclusion

The Northeast/North region of Philadelphia had the highest rates, and center city had the lowest rates of SCD for the early part of the night (SL & WASO). Early morning SCD was most common for “South Philly and least common for Center City. Analyses are on-going in relation to other regional differences (demographic, income, crime stats, etc.) and those found to vary by region will be assessed for their predictive value.

Support

No support was provided for this abstract

1053 Sleep Duration And Timing Associated With History Of Breast Prostate And Skin Cancer: Data From A Nationally-representative Sample

Introduction

Sleep disturbances are a common problem among cancer survivors. Also, cancer patients can have altered circadian rhythms and these changes can continue to affect the patient long after the conclusion of their treatment. This analysis aims to investigate how the sleep and wake times of cancer survivors differ from the rest of the population, depending on the type of cancer.

Methods

Data from the 2015-2016 National Health and Nutrition Examination Survey were used. Population-weighted data on N=5,581 individuals provided complete data. History of breast, prostate, and skin cancer (melanoma or other) was self-reported. Sleep duration was self-reported in half-hour increments, and typical bedtime and waketime was self-reported. Covariates included age, sex, and race/ethnicity. Weighted linear regressions with sleep duration, bedtime and waketime were examined, with each cancer type as predictor.

Results

Prevalence was 1.7% for prostate cancer, 1.5% for breast cancer, 2.3% for non-melanoma skin cancer, and 0.8% for melanoma. In adjusted analyses, prostate cancer was associated with an additional 26.5 minutes of average total sleep (95%CI 2.2,50.9, p=0.03), a 23.1 bedtime minutes earlier (95%CI -40.4,-5.8, p=0.009), and no difference in waketime. Breast cancer was associated with a bedtime that was 41.1 minutes later (95%CI 10.3,72.0, p=0.009) and a waketime that was 48.7 minutes later (95%CI 12.5,84.9, p=0.008), but no difference in sleep duration. No statistically significant effects were seen for either type of skin cancer, melanoma or non-melanoma.

Conclusion

Prostate cancer was associated with an earlier bedtime and associated increased sleep time. Breast cancer, on the other hand, was associated with a phase delay of the sleep period but no change in sleep duration. Skin cancer was not associated with differences in sleep duration or timing. These findings may have implications for not only treatment of sleep problems in different types of cancer, but also possible circadian mechanisms.

Support

Dr. Grandner is supported by R01MD011600

0153 Patient-Defined Insomnia Severity: How Much Wakefulness is Problematic?

Introduction

While Insomnia Disorder is formally defined in the ICSD-3 and DSM-5, neither diagnostic system adopts quantitative criteria for illness severity. Interestingly, quantitative criteria are provided for frequency and chronicity (i.e., ≥ 3 days / week for ≥ 3 months). For research purposes, illness severity has long been defined using the “30 minute rule” (SL and/or WASO and/or EMA of ≥ 30 minutes is the threshold for clinical relevance). In the present analysis, this threshold was assessed for its significance to patients.

Methods

Sleep continuity disturbance (SCD; SL, WASO, and EMA) and problem endorsement data were collected from an archival/community-based sample (N = 4680; 60% female; Ages 18–89 years; www.sleeplessinphilly.com). Problem endorsement was evaluated through questions that included, “Do you consider this a problem?” after participants reported length of SL, WASO, and EMA. Problem endorsement percentages were calculated for 5 minute bins for between 0 and 65 minutes, with one additional bin for &gt; 65 minutes. The temporal bins were compared for significant deviations using absolute (percent of subjects at 0–5 and 5–10 minutes) and moving references (last significant percent).

Results

The first temporal bin to differ from the absolute reference for SL, WASO, and EMA was the 26–30 minute bin. At this threshold, 87%, 70%, and 94% of the subjects’ identifying SL, WASO and EMA as being problematic (and was deemed statistically different from “normal” [0–10 minute values]).

Conclusion

These data suggest that the “30 minute rule” (which is of unknown provenance) roughly corresponds to the level of illness severity (lowest common threshold) identified by patients as problematic. While the threshold for SL and EMA show a clear majority, the lower percentage of subjects for WASO suggests that people are more tolerant of middle of the night wakefulness.

Support

 

1111 Do Sleep Disorder Symptom Endorsements Differ Between ADHD Subtypes?

Introduction

To date, research on differences in sleep complaints between patients with different subtypes of ADHD has been mixed. On balance, the evidence tends towards ADHD-Combined Presentation (ADHD-C) being associated with more severe sleep and sleep-related daytime complaints than ADHD-Primarily Inattentive (ADHD-I). In order to further assess this issue a surveillance study was undertaken in an active ADHD clinic by adding a comprehensive sleep disorders screener (SDS-CL-25) to the clinical intake procedures. These data were used to ascertain whether the two subtypes differ for any of 13 sleep disorders symptoms.

Methods

Subjects (n = 132; 83 male, 49 female, mean age 32.8, age range 18-79), presenting to the clinic for evaluation for ADHD were given the SDS-CL-25. The SDS-CL-25 is a 25-item instrument developed to screen for multiple sleep disorders at one time (problems are endorsed on a Likert-scale; 0 = never and 4 = more than 5x/week). Endorsements greater than 3x/week were counted as positive for the symptom and less than three days per week was considered negative.

Percent per group was compared using Chi Square Analyses. Cumulative morbidity means were also analyzed using t-tests. The subtype, ADHD-I (n=71) and ADHD-C (N=61), was established using EMR records.

Results

No significant differences between patients with ADHD-I and ADHD-C were detected.

Conclusion

The lack of finding in the present analysis may reflect a lack of difference or a failure to detect differences based on the small sample sizes or lack of statistical control for likely confounders (age, sex, illness severity or chronicity, SES status, etc.). Analyses are ongoing.

Support

No support was provided for this abstract.

Acute and Chronic Insomnia: What Has Time and/or Hyperarousal Got to Do with It?

Nearly one-third of the population reports new onset or acute insomnia in a given year. Similarly, it is estimated that approximately 10% of the population endorses sleep initiation and maintenance problems consistent with diagnostic criteria for chronic insomnia. For decades, acute and chronic insomnia have been considered variations of the same condition or disorder, only really differentiated in terms of chronicity of symptoms (days/weeks versus months). Whether or not acute and chronic insomnia are part of the same phenomena is an important question, one that has yet to be empirically evaluated. The goal of the present theoretical review was to summarize the definitions of acute and chronic insomnia and discuss the role that hyperarousal may have in explaining how the pathophysiology of acute and chronic insomnia is likely different (i.e., what biopsychological factors precipitate and/or perpetuate acute insomnia, chronic insomnia, or both?).

Acute sleep deprivation and the selective consolidation of emotional memories

Research suggests that sleep preferentially consolidates the negative aspects of memories at the expense of the neutral aspects. However, the mechanisms by which sleep facilitates this emotional memory trade-off remain unknown. Although active processes associated with sleep-dependent memory consolidation have been proposed to underlie this effect, this trade-off may also be modulated by non-sleep-related processes, such as the circadian factors, stress-related factors, and/or mood congruent context effects involved in sleep deprivation. We sought to examine the potential role of these factors by randomizing 39 young adults into either a total sleep deprivation condition (26 consecutive hours awake) or a sleep condition (8 h sleep opportunity). Replicating the emotional memory trade-off effect, negative objects were better remembered than neutral objects or background images. However, in spite of generally worse memory performance (for neutral and background information), sleep-deprived participants showed similar recognition rates for negative emotional memories relative to participants who were given a full night of sleep.