Changes In Sleep Onset Latency Research Articles

CBT-I treatment attrition in patients with weekly nightmares.

This study's objective was to evaluate the effect of nightmares (NM) on attrition and symptom change following CBT-I treatment using data from a successful CBT-I randomized controlled trial (RCT) delivered to participants with recent interpersonal violence exposure. The study randomized 110 participants (107 women, mean age 35.5), to CBT-I or an attention control group. Participants were assessed at three time periods: Baseline, post-CBT-I (or attention control), and at T3 post-Cognitive Processing Therapy, received by all participants. NM reports were extracted from the Fear of Sleep Inventory. Participants with weekly NM were compared to those with fewer than weekly nightmares on outcomes including attrition, insomnia, PTSD, and depression. Change in NM frequency was examined. Participants with weekly NM (55%) were significantly more likely to be lost to follow up (LTF) post-CBT-I (37%), compared to 15.6% of participants with infrequent NM and were less likely to complete T3 (43%) than patients with less frequent NM (62.5%). NM were unrelated to differential treatment response in insomnia, depression or PTSD. Treatment with CBT-I was not associated with reduced NM frequency; however, change in sleep onset latency (SOL) from post-CBT-I to T3 predicted fewer nightmares at T3. Weekly NM were associated with attrition, but not a reduced change in insomnia symptoms following CBT-I. NM symptoms did not change as a function of CBT-I but change in SOL predicted lower NM frequency. CBT-I trials should screen for NM and consider augmenting CBT-I to specifically address NMs.

Network meta-analysis comparing the effectiveness of a prescription digital therapeutic for chronic insomnia to medications and face-to-face cognitive behavioral therapy in adults

Objective The purpose of this study was to compare the effectiveness of the only Food and Drug Administration-authorized prescription digital therapeutic (PDT) Somryst versus face-to-face cognitive behavioral therapy for insomnia (CBT-I), or FDA-approved prescription medications for insomnia. Methods A systematic literature review was undertaken to identify relevant studies. A Bayesian network meta-analysis (NMA) was conducted to examine (1) mean change in insomnia severity index (ISI); (2) proportional change in ISI remitters; (3) mean change in wake after sleep onset (WASO); and (4) mean change in sleep onset latency (SOL). Results Twenty studies provided data on the PDT, CBT-I, CBT-I in combination with self-help (SH), or two prescription medications (eszopiclone and zolpidem). The PDT was associated with significant mean change in ISI (–5.77, 95% Credible Interval [CrI] − 8.53, −3.07) and ISI remitters (OR 12.33; 95% CrI 2.28, 155.91) compared to placebo, and had the highest probability of being the most effective treatment overall for ISI mean change (56%), and ISI remitters (64%). All evaluated interventions significantly outperformed placebo for WASO but no significant differences were observed for SOL (five interventions). Sensitivity analyses excluding medications and meta-regression (assessing type, duration, delivery method for CBT-I) did not affect NMA results. Conclusions This network meta-analysis demonstrated that a PDT delivering CBT-I had the highest probability of being most effective compared to face-to-face CBT-I, prescription sleep medications, or placebo, as measured by reductions in mean ISI score from baseline and ISI-determined remittance.

Trajectories of sleep problems from adolescence to adulthood. Linking two population-based studies from Norway

Study objectiveThe aim of the study is to assess stability and predictors of insomnia and sleep duration from adolescence to early adulthood. MethodsA longitudinal sample of 1257 individuals from three age cohorts were assessed from linked population-based studies, the youth@hordaland study from 2012 (age 16–18) and the SHoT2018 study (age 22–25). Identical measures of insomnia symptoms and sleep duration were analysed. ResultsThe stability of insomnia was high from adolescence to young adulthood, 50% of those with insomnia symptoms in adolescence still had insomnia symptoms six years later (adjusted IRR = 2.01; (CI 95%; 1.5–2.44)). Short sleep duration was also stable, with 67.8% of the adolescents in the lowest sleep duration quartile still remaining in the lowest quartile six years later. The overall rate of insomnia symptoms, long wake after sleep onset (WASO), and oversleeping increased from adolescence to young adulthood. Also, we observed a reduction in sleep efficiency and later rise times. There was no significant change in sleep onset latency (SOL). ConclusionInsomnia symptoms and short sleep duration are prevalent during both adolescence and young adulthood. Considerable individual stability and a rising rate of insomnia symptoms were observed over time. These findings underscore the importance of early identification and timely interventions to prevent chronic sleep problems.

The efficacy of ball blankets on insomnia in depression in outpatient clinics: study protocol for a randomized crossover multicentre trial

BackgroundDepression affects approx. 4% of the global population and is often accompanied by insomnia. Medications used to treat insomnia can have side effects such as development of tolerance and addiction. The Protac Ball Blanket™ (PBB) is a non-pharmacological supplement to sedatives and hypnotics, but evidence for the efficacy of PBB is needed before the treatment is implemented. The objective of this trial is to test the efficacy of PBB on insomnia caused by depression in a randomized controlled design.MethodsThis study is a multicentre, randomized crossover trial with planned inclusion of 45 patients. The randomization procedure is permuted-block randomization with varying block sizes. Patients are allocated into either a sequence “AB” or “BA” each lasting 4 weeks (28 nights). Patients randomized to the “AB” sequence receive treatment A (Protac Ball Blanket™) in the first 2 weeks and switch to treatment B (treatment as usual) in the second period, whereas patients who are randomized to the BA sequence receive treatment B in the first period and treatment A in the second period. The participants will serve as their own control in this design. The primary outcome is changes in total sleep time. Secondary outcome measures are changes in sleep onset latency, number of awakenings, wake after sleep onset, and use of sedatives and hypnotics. Furthermore, quality of sleep, insomnia severity status, and self-reported symptoms of depression, anxiety, interpersonal sensitivity, and neurasthenia will be measured. A paired, two-sided t test to compare the means of the differences in the outcomes will be performed.DiscussionThis clinical trial will assess the effect of PBB on depression-related insomnia. The outcomes are of high interest as the PBB is a potential non-pharmacological supplement to medical treatment of patients with insomnia due to depression.Trial registrationClinicalTrials.gov Identifier: NCT03730974. Registered on 5 November 2018.

Cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis: protocol for the randomised, single-blinded, parallel-group Sleep-RA trial

BackgroundMore than half of patients with rheumatoid arthritis complain of insomnia, which is predominantly treated with hypnotic drugs. However, cognitive behavioural therapy for insomnia is recommended as the first-line treatment in international guidelines on sleep. Patients with rheumatoid arthritis suffer from debilitating symptoms, such as fatigue and pain, which can also be linked to sleep disturbance. It remains to be determined whether cognitive behavioural therapy for insomnia can be effective in patients with rheumatoid arthritis. The aim of the Sleep-RA trial is to investigate the efficacy of cognitive behavioural therapy for insomnia on sleep and disease-related symptoms in patients with rheumatoid arthritis. The primary objective is to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep efficiency from baseline to week 7 in patients with rheumatoid arthritis. The key secondary objectives are to compare the effect of cognitive behavioural therapy for insomnia relative to usual care on changes in sleep onset latency, wake after sleep onset, total sleep time, insomnia, sleep quality, fatigue, impact of rheumatoid arthritis and depressive symptoms from baseline to week 26 in patients with rheumatoid arthritis.MethodsThe Sleep-RA trial is a randomised controlled trial with a two-group parallel design. Sixty patients with rheumatoid arthritis, insomnia and low-to-moderate disease activity will be allocated 1:1 to treatment with cognitive behavioural therapy for insomnia or usual care. Patients in the intervention group will receive nurse-led, group-based cognitive behavioural therapy for insomnia once a week for 6 weeks. Outcome assessments will be carried out at baseline, after treatment (week 7) and at follow-up (week 26).DiscussionData on treatment of insomnia in patients with rheumatoid arthritis are sparse. The Sleep-RA trial is the first randomised controlled trial to investigate the efficacy of cognitive behavioural therapy for insomnia in patients with rheumatoid arthritis. Because symptoms of rheumatoid arthritis and insomnia have many similarities, we also find it relevant to investigate the secondary effects of cognitive behavioural therapy for insomnia on fatigue, impact of rheumatoid arthritis, depressive symptoms, pain, functional status, health-related quality of life and disease activity.If we find cognitive behavioural therapy for insomnia to be effective in patients with rheumatoid arthritis this will add weight to the argument that evidence-based non-pharmacological treatment for insomnia in rheumatological outpatient clinics is eligible in accordance with the existing international guidelines on sleep.Trial registrationClinicalTrials.gov: NCT03766100. Registered on 30 November 2018.

Video Games and Sleep: An Overlooked Challenge

Background: Video games (VGs) are increasingly becoming the pastime of choice for American youth. Recent US surveys indicate that up to 99% of adolescents play VGs regularly. Caregivers and clinicians are appropriately concerned about the effects of VGs on children’s well being. Adolescents' play habits may expose them to negative effects associated with VG play on sleep. Methods: This article selectively reviews the literature documenting effects of video game play on sleep. A search of medical literature was carried out by using the keywords “video games” “computer games,” “sleep,” “mental health” and “adolescents.” Results: There is a small but growing body of literature examining the extent of VG play effects on sleep. Timing and duration of VG play are among the most significant circumstances that are associated with changes in sleep onset latency, total sleep duration and sleep efficiency. Findings on effects on sleep architecture are less consistent. Conclusions: VG play at night may lead to delay of sleep onset and interfere with sleep duration and efficiency. These effects appear to be particularly robust in children and young adolescents. Caregiver supervision is crucial in ensuring the appropriate use of VGs. Clinicians have a valuable opportunity to inform the public about these effects of VG play. More research focusing on mechanisms of these effects is needed. Keywords: Child and adolescent, computer games, internet, online, problematic internet use, problematic video game play, sleep, video games.

Effects of a Standardized Pamphlet on Insomnia in Children With Autism Spectrum Disorders

Sleep difficulties are common reasons why parents seek medical intervention in children with autism spectrum disorders (ASDs). We determined whether a pamphlet alone could be used by parents to help their child's insomnia. Thirty-six children with ASD, ages 2 to 10 years, were enrolled. All had prolonged sleep latency confirmed by actigraphy showing a mean sleep latency of 30 minutes or more. Parents were randomly assigned to receive the sleep education pamphlet or no intervention. Children wore an actigraphy device to record baseline sleep parameters, with the primary outcome variable being change in sleep latency. Actigraphy data were collected a second time 2 weeks after the parent received the randomization assignment and analyzed by using Student's t test. Parents were also asked a series of questions to gather information about the pamphlet and its usefulness. Although participants randomized to the 2 arms did not differ statistically in age, gender, socioeconomic status, total Children's Sleep Habits Questionnaire score, or actigraphy parameters, some differences may be large enough to affect results. Mean change in sleep-onset latency did not differ between the randomized groups (pamphlet versus no pamphlet). Parents commented that the pamphlet contained good information, but indicated that it would have been more useful to be given specific examples of how to take the information and put it into practice. A sleep education pamphlet did not appear to improve sleep latency in children with ASDs.

Effect of Eszopiclone on Sleep Disturbances and Daytime Fatigue in Multiple Sclerosis Patients

The prevalence of moderate-to-severe sleep problems is significantly higher among people with multiple sclerosis (MS) than in the general population. In 2002, we found a significant relationship between fatigue and disrupted sleep in patients with relapsing-remitting MS (RRMS). The objectives of this study were to determine whether eszopiclone (Lunesta; Sunovion Pharmaceuticals Inc, Marlborough, MA) was superior to placebo in improving sleep among patients with MS-related fatigue and sleep complaints (primary end point); and to assess the impact of improved sleep on daytime fatigue and functioning (secondary end point). This was a double-blind, placebo-controlled pilot trial lasting 7 weeks. Thirty ambulatory adults under age 65 years with RRMS, fatigue, and sleep disturbances were randomized to receive either eszopiclone or placebo. The outcome measures included subjective and objective changes in sleep-onset latency (SOL), total sleep time (TST), wakefulness after sleep onset (WASO), sleep efficiency (SE), fatigue scales, and neuropsychological measures of daytime functioning. Compared with placebo, eszopiclone was superior only in increasing TST. Fatigue improved in both groups, but there was no statistically significant correlation between increased TST and improved fatigue, and no statistically significant differences were observed between the two groups. Thus, in this study, eszopiclone did not improve sleep sufficiently to improve fatigue in MS patients. This result may be due to the multifactorial nature of sleep disturbances and fatigue in people with MS.

Effectiveness of Ramelteon for Insomnia Symptoms in Older Adults with Obstructive Sleep Apnea: A Randomized Placebo-Controlled Pilot Study

To evaluate the effectiveness of ramelteon, a melatonin receptor agonist, for the treatment of insomnia in older adults starting auto-titrating positive airway pressure (APAP) therapy for sleep apnea. A parallel group, randomized, double-blind, placebo-controlled pilot effectiveness clinical trial. The study enrolled 21 research study participants who were ≥ 60 years old and had obstructive sleep apnea, defined by an apnea-hypopnea index (AHI) ≥ 5 events/h, with complaints of insomnia. The primary outcome measure was change in sleep onset latency determined from polysomnography at 4 weeks. Research study participants, all of whom were starting on APAP, were randomized to ramelteon 8 mg (n = 8) or placebo (n = 13). Ramelteon treatment was associated with a statistically significant difference in sleep onset latency (SOL) as measured by polysomnography of 28.5 min (± 16.2 min) compared to placebo (95% C.I. 8.5 min to 48.6 min, effect size 1.35, p = 0.008). This was due to a 10.7 (± 17.0) min SOL reduction in the ramelteon arm and a 17.8 (± 23.5) min SOL increase in the placebo arm. No change was noted in subjective sleep onset latency (-1.3 min, ± 19.3 min, 95% C.I.: -21.4 min to 18.7 min). No statistically significant changes were noted in the AHI, sleep efficiency (polysomnography and self-report), APAP adherence, Pittsburgh Sleep Quality Index global score, or Epworth Sleepiness Scale score when comparing ramelteon vs. placebo. Four adverse events occurred in the ramelteon arm and 2 in the placebo arm; none were considered to be related to treatment. Ramelteon was effective in improving objective, but not subjective, sleep onset latency even in older adults who were starting APAP therapy for sleep apnea. Further research is warranted in examining the role of ramelteon in the care of older adults with insomnia symptoms and sleep apnea.

Influence of the glycemic load (GL) on subjective and objective measures of sleep quality in insomnia

Evidence in healthy sleepers suggests the glycemic index (GI) can mediate changes in sleep onset latency, given the availability of tryptophan to the brain (i.e. TRP/LNAA ratio) is increased after high GI carbohydrate-only food. However, these meals have limited clinical application given the high glycemic load (GL) and insulin responses. Therefore, we investigated the efficacy of a mixed macronutrient high GI (MHGI) compared to an isoenergetic (∼1915 kJ) low GI (MLGI) meal taken three hours prior to habitual bedtime to improve sleep quality in participants meeting research diagnostic criteria for insomnia. Four men and four women (n=8) were randomized to the MHGI or MLGI meal for two consecutive nights. Blood samples were taken prior to the meal, and 60, 120, 180 min after eating. Subjective (sleep diary) and objective (polysomnography, PSG) sleep was also measured each night. The individual 10cm visual analogue scales indicate that meal palatability was identical for both meals; which were of good taste (average 7.8cm); meal satiety was maintained until bedtime after the MHGI meal (>5cm), whereas after the MLGI meal satiety ratings in men were low (<5cm); and the average meal energetic load (kJ/kg) was greater for women (33.0 ± 4.1) than men (25.4 ± 3.8; p<0.05). Postprandial measures indicate glucose was larger after the MHGI meal but there was no difference in insulin response; the peak percentage rise in plasma TRP/LNAA from baseline after the MHGI meal (17%) was substantially but only marginally different than the MLGI (8%) meal (p = 0.12); postprandial serotonin was unaltered. The participant group self-reported (5pt Likert scale) feeling more rested after the MHGI (2.8) compared to the MLGI meal (2.3; p<0.05); also ratings were higher in women (3.0) than in men (2.6; p<0.05). There were no differences in PSG sleep variables. This study demonstrates symptoms of insomnia are improved, especially in women, after a high GI mixed macronutrient meal. Given the present data, we suggest the possibility for a physiological threshold within the postprandial plasma TRP/LNAA response that must be surpassed in order to promote measurable changes to serotonin and PSG sleep. Further studies should evaluate the potential long-term risks and benefits of habitual mixed macronutrient high GI meals to improve sleep.

Cognitive Behavioral Treatment in Clinically Referred Chronic Insomniacs: Group Versus Individual Treatment

In this study, we compared the effect of group and cognitive behavioral treatment (CBT) in clinically referred patients with chronic insomnia. The participants were 32 individually treated primary insomniacs and 74 individuals with either primary or secondary insomnia treated in a group (5–7 patients per group). The primary outcome measures were subjective sleep, quality of life (QOL), and psychological well-being. CBT produced significant changes in sleep onset latency, total sleep time, sleep efficiency, and wake after sleep onset. For total sleep time and sleep efficiency, the improvements were maintained at follow-up as well. In the questionnaires, significant improvements from treatment were seen for the Sickness Impact Profile, Sleep Evaluation Form, and Dysfunctional Beliefs and Attitudes About Sleep. All these improvements remained significant at follow-up. We conclude that CBT for insomnia is effective for both individual and group treatment. Improvements were seen in subjective sleep parameters, QOL, attitudes about sleep, and sleep evaluation in general, both posttreatment and at follow-up.

Sleep Experts Wake Up to Value Of CBT for Insomnia

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSleep Experts Wake Up to Value Of CBT for InsomniaJim RosackJim RosackSearch for more papers by this authorPublished Online:3 Dec 2004https://doi.org/10.1176/pn.39.23.00390032aResearchers at Harvard Medical School have shown that patients with chronic sleep-onset insomnia see greater improvement from a course of cognitive-behavioral therapy (CBT) than they do from the market-leading hypnotic medication zolpidem (Ambien).The study, reported in the September 27 Archives of Internal Medicine, was a randomized controlled trial involving 63 adults with chronic sleep-onset insomnia. The research was funded by grants from the National Institutes of Health and National Institute on Drug Abuse.Patients were randomly assigned to CBT, pharmacotherapy (with zolpidem), a combination of CBT and zolpidem, or placebo. Those in the CBT group received five 30-minute sessions over six weeks. The patients were given daily exercises to teach them to “recognize, challenge, and change stress-inducing thoughts,” according to the study's lead author, Gregg Jacobs, Ph.D., an assistant professor of psychiatry at Harvard and a researcher at the Harvard-affiliated Sleep Disorders Center at Beth Israel Deaconess Medical Center.Patients were taught techniques such as delaying time of going to bed or getting up to read if they were unable to fall asleep within about 20 minutes of going to bed, Jacobs said in a press release.Those assigned to receive zolpidem started with 10 mg a night for the first 28 nights (four weeks) of the eight-week treatment period. For the following seven days (week 5), they received 5 mg a night, and then 5 mg every other night for an additional week (week 6). No medication was taken during the final two weeks.Patients randomly assigned to receive placebo followed the same protocol as the medication group without any CBT or “sham therapy.”Jacobs was surprised at what he and his team found.“Sleeping pills are the most frequent treatment for insomnia, yet CBT techniques clearly were more successful in helping the majority of study participants to become normal sleepers. The pills were found to be only moderately effective compared with CBT, and lost their effectiveness soon after they were discontinued.”All patients kept sleep diaries for 14 days before treatment began, for 14 days at mid-treatment (weeks 3 and 4), and for 14 days after treatment ceased (the end of the protocol). In addition, patients underwent three nights of home-based “nightcap” recordings before and after treatment. The“ nightcap monitor” is a two-channel sleep monitor that measures sleep-onset latency as well as other measures of sleep by using eyelid- and head-movement sensors attached to a small, battery-operated recorder placed under the bed pillow.The CBT and the combination groups showed the greatest changes in sleep-onset latency at mid-treatment, with both groups showing a 44 percent reduction in the amount of time it took to fall asleep at bed time. Those taking zolpidem showed only a 29 percent reduction, and those on placebo had only a 10 percent reduction in sleep latency. By the end of week 8, the CBT and combined treatment group each yielded a 52 percent reduction in sleep onset. These significant improvements were maintained for the follow-up period of 18 months, whereas improvements seen in the zolpidem group were not maintained over the long term. In fact, Jacob pointed out, “by the end of the eight-week treatment phase, insomnia returned to baseline levels and did not differ from [those of] the placebo group.”Intriguingly, no significant differences emerged among the groups in terms of total sleep time, though each group exhibited some increase.“Our results suggest CBT should now be considered the first-line treatment for insomnia, which is experienced on a nightly basis by one-third of the nation's adult population,” Jacobs concluded.An abstract of “Cognitive-Behavior Therapy and Pharmacotherapy for Insomnia” is posted online at<http://archinte.ama-assn.org/cgi/content/abstract/164/17/1888>.▪ Arch Intern Med 2004 164 1888 ISSUES NewArchived

A longitudinal study of sleep stages in young women during pregnancy and postpartum.

We conducted a longitudinal polysomnographic study in five healthy primiparous subjects, whose sleep was first recorded between 8 and 16 weeks of gestation, then every 2 months until parturition and at 1 month postpartum. The first 6 hours of sleep were used for statistical analysis. In contrast to previous studies, we found no reduction in stage 4 sleep with pregnancy. Slow-wave sleep (comprising stages 3 and 4), was significantly higher at 27-39 weeks of gestation than at 8-16 weeks, as predicted by the restorative theory of sleep. There was no significant difference in rapid eye movement (REM) sleep time. When compared to a group of normal ovulating women, however, REM sleep time decreased during the last two months of pregnancy and, although there was no change in sleep onset latency, the time spent awake during the first six hours of sleep was increased. Future research into the effects of cortisol and progesterone is indicated.

Cluster analysis of insomniacs' MMPI profiles: relation of subtypes to sleep history and treatment outcome.

The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 100 insomniacs who presented for treatment at a university medical center were analyzed by a hierarchical clustering procedure. This analysis revealed two major personality types that accounted for 88% of the sample. The two types referred to as "Type 1" and "Type 2" insomniacs differed significantly in regard to sleep history questionnaire responses and responsivity to treatment. MMPI scales and sleep history questionnaire items suggested that Type 1 insomniacs were less defended, more aroused/activated, and had sleep histories characterized by more childhood sleep problems and greater difficulties with sleep-disruptive cognitions than did Type 2 patients. Further, Type 1 patients had a poorer response to behavioral treatment as measured by change in sleep-onset latency than did Type 2 patients. These results suggest that the MMPI may be useful in identifying distinctive personality subgroups among insomniacs. Treatment implications are discussed, and mechanisms underlying the group differences are considered.