Complaints Of Poor Sleep Research Articles

An objective assessment of the impact of tendon retraction on sleep efficiency in patients with full-thickness rotator cuff tears: a prospective cohort study.

Sleep quality, quantity, and efficiency have all been demonstrated to be adversely affected by rotator cuff pathology. Previous measures of assessing the impact of rotator cuff pathology on sleep have been largely subjective in nature. This study was undertaken to objectively analyze this relationship through the use of activity monitors. Patients with full-thickness rotator cuff tears at a single institution were prospectively enrolled between 2018 and 2020. Waistworn accelerometers were provided for the patients to use each night for 14 days. Sleep efficiency was calculated using the ratio of the time spent sleeping to the total amount of time that was spent in bed. Retraction of the rotator cuff tear was classified using the Patte staging system. This study included 36 patients: 18 with Patte stage 1 disease, 14 with Patte stage 2 disease, and 4 patients with Patte stage 3 disease. During the study, 25 participants wore the monitor on multiple nights, and ultimately their data was used for the analysis. No difference in the median sleep efficiency was appreciated amongst these groups (P>0.1), with each cohort of patients demonstrating a generally high sleep efficiency. The severity of retraction of the rotator cuff tear did not appear to correlate with changes in sleep efficiency for patients (P>0.1). These findings can better inform providers on how to counsel their patients who present with complaints of poor sleep in the setting of full-thickness rotator cuff tears. Level of evidence: Level II.

Patients with IBD Want to Talk About Sleep and Treatments for Insomnia with Their Gastroenterologist.

Poor sleep may be prospectively associated with worse disease course in inflammatory bowel disease (IBD). Chronic insomnia is the most common cause of poor sleep complaints in IBD and is theorized to be maintained by dysfunctional thoughts and behavioral patterns. However, data characterizing patterns specific to insomnia in IBD are lacking. Understanding the nuances of insomnia and patients' preferences for treatment is critical for addressing this significant comorbidity in IBD. We conducted an anonymous, mixed-method online survey of people with IBD and asked questions about sleep patterns, thoughts, and behaviors related to sleep, treatment preferences, and barriers to treatment. 312 participants (60.9% Crohn's, 66.3% women, mean age of 48.62years) were included in this study. Participants with insomnia were significantly more concerned about the consequences of sleep loss, felt more helpless about their sleep, and were more likely to engage in behaviors known to perpetuate insomnia (e.g., spending time in bed in pain; ps ≤ 0.001) than those without insomnia. 70.3% of participants were interested in discussing sleep as part of IBD care, 63.5% were interested in receiving sleep recommendations from their gastroenterologist, and 84.6% of those with insomnia were interested in participating in sleep treatments. Participants with IBD and insomnia are interested in treatment and reported patterns that can be targeted in Cognitive Behavioral Therapy for Insomnia, as opposed to traditional sleep hygiene guidelines. Additionally, people with insomnia engaged in several sleep-interfering behaviors related to pain. Clinical trials that target insomnia in people with IBD should include pain management in the intervention.

The Cross-Sectional Association Between Tinnitus and Actigraphy-Estimated Sleep in a Population-Based Cohort of Middle-Aged and Elderly Persons.

Tinnitus is a common and burdensome disease, often accompanied by complaints of poor sleep. However, associations of tinnitus with objective estimates of sleep remain unclear, particularly in the general population. We assessed these associations in a population-based cohort of middle-aged and elderly persons. This study included 1456 participants (mean age: 65.0 ± 7.1 years, 52% women) from the population-based Rotterdam Study. Tinnitus was self-reported and in those who reported tinnitus daily, symptom severity was assessed with the Tinnitus Handicap Inventory. We used actigraphy to estimate sleep and 24-hour activity rhythms objectively and sleep diaries to assess self-reported sleep. We estimated the difference in sleep and 24-hour activity rhythms first between those with and those without tinnitus and secondly with tinnitus severity. Tinnitus, reported by 341 (23%) participants, and tinnitus severity, assessed in 194 participants with daily tinnitus, were not associated with actigraphy-estimated sleep or 24-hour activity rhythms, but were associated with a longer self-reported sleep onset latency (adjusted difference tinnitus = 2.36, 95% confidence interval [CI] = 0.95-3.78, adjusted difference tinnitus severity = 0.27, 95% CI = 0.013-0.54). After stratification for hearing loss, tinnitus was associated with longer self-reported sleep onset latency (adjusted difference = 2.26, 95% CI = 0.98-3.53) and less stable 24-hour activity rhythms (adjusted difference = -0.02, 95% CI = -0.04 to -0.00) in those with hearing loss. In those without hearing loss, tinnitus was associated with more stable rhythms (adjusted difference = 0.03, 95% CI = 0.01-0.05). Having tinnitus is associated with a longer self-reported sleep onset latency, but not with objective estimates of sleep, suggesting that the subjective experience of sleep may be particularly disturbed in those with tinnitus. In addition, hearing loss may modify the association of tinnitus and 24-hour activity rhythms.

#3115 Systematic review into the effects of sleep disorders on the development of PTSD

ObjectivesTo examine if sleep problems act as a risk factor for future PTSD development in military, child, and general adult demographics. We will also be examining specific sleep disorders, such as nightmares and insomnia, as well as examining general sleep complaints in a series of sub-sections (REM sleep, Sleep duration, quality, latency, and maintenance) to see if it is possible with the current literature to discover potential hints into the development of PTSD.MethodsSix databases (Medline, Embase, Web of Science, Psych info, AMED, and OpenGray) were searched with a standardised search strategy. The papers were then screened for relevance and quality controlled using the Ottowa-Newcastle Scale and the CASP cohort checklist by two reviewers until only relevant and high quality cohort studies remained. Relevant information and data was extracted from published sources and information on insomnia, nightmares, REM sleep, and 4 specific sleep subcategories (sleep duration, quality, latency, and maintenance) were gathered and examined. Nometa-analysis was planned.ResultsOut of the 1813 documents gathered from the various databases, 25 papers were deemed fit for narrative synthesis. 19 discussed insomnia or general sleep complaints, and found that those tended to correlate with development of future PTSD, with little distinction between if the insomnia appeared pre or post-trauma. 6 discussed nightmares and found that those too were predictive, and 2 discussed REM sleep and found that REM theta waves were potentially predictive.ConclusionIt is almost certain that complaints of poor sleep predict future PTSD development, with insomnia being predictive of many psychiatric conditions not just PTSD, and nightmares being more specific to the development of just PTSD. It has also been suggested that only subjectively (not objectively) poor sleep predicts PTSD. This would explain why specific sleep categories all have mostly mixed results, but the idea is not backed completely in the literature.

Event-related potentials in insomnia reflect altered perception of sleep.

Insomnia is defined by the subjective complaint of poor sleep as well as daytime impairments. Since polysomnography (PSG) typically shows only modest sleep impairment, some still unidentified property of sleep, not mirrored in PSG, may be modified in insomnia.One possible mechanistic hypothesis is that insomnia patients may be more sensitive to inevitably occurring internal or external stimuli during the night, causing brief sleep disruptions then perceived as wake time. Auditory event-related potentials (ERP) to low intensity (50 dB SPL) synthesized guitar tones played continuously throughout two nights of polysomnographically registered sleep were obtained in fifty patients with insomnia disorder (ID, without comorbidities) and 50 age- and sex-matched good sleeper controls (GSC) for each sleep stage and NREM/REM cycle. Phasic and tonic REM were treated as separate stages. Latencies and amplitudes of components P1, N1 and P2 were measured and analyzed by multivariate repeated-measures ANCOVA including effects of group, night, cycle, and age. ID showed reduced P2 amplitudes relative to GSC specifically in phasic REM sleep. The same reduction also correlated with the amount of sleep misperception across groups. Independent component analysis showed a frontal negativity to contribute most to this group difference. The present finding can be interpreted as increased mismatch negativity (MMN) in ID, reflecting automated detection of change in the auditory system and a concomitant orienting response. Specifically phasic REM sleep appears to be vulnerable to sensory afferences in ID patients, possibly contributing to the perception of being awake. Short name "PERSLEEP 2," URL https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00008965, Registration DRKS00008965.

Sleep as a biological rhythm: clinical aspects

Insomnia is a widespread disorder affecting not only sleep quantity and quality, but also daytime well-being and performance, as well as having a negative impact on physical and mental health. Many people have problems falling asleep and maintaining sleep that do not reach the clinical criteria of insomnia. For all the prevalence of such sleep disorders, specialists often overlook a fundamentally important factor that affects sleep and wakefulness cycle, ease of falling asleep and daytime performance. These are circadian rhythms of the body under the control of the biological clock.This review highlights the specifics of the human biological clock and its relationship to insomnia and complaints of poor sleep. The phenomenon of the human chronotype as a set of individual preferences in sleep-wake rhythm is considered. Late chronotype, tat tends to wake up late and be active in the evening turns out to be the most vulnerable to the appearance of complaints of poor sleep and development of insomnia. This result is typical for different age groups. The reason for problems sleep for the late chronotype is the need to adjust to social demands and to fall asleep and wake up too early relative to the phase of one’s own circadian rhythm.Circadian rhythms may contribute to the formation and maintenance of insomnia. Both chronic and acute insomnia may have a chronobiological component that is not always considered. Late chronotype may be a factor further exacerbating the course of insomnia. The regularity of circadian rhythms may also be impaired in insomnia.The importance of the biological clock in the regulation of sleep and wakefulness also explains the successful approach to insomnia treatment with melatonin, which plays an important signaling role in the circadian regulation of the body.

Comprendre les troubles du sommeil de patients adultes atteints d’une maladie de Crohn pris en charge en ambulatoire

ObjectivesResearch has shown that sleep disturbances can negatively influence the progression of chronic inflammatory diseases, including chronic inflammatory bowel disease (IBD). More specifically, poor sleep quality is strongly related to the clinical activity of the disease. Nevertheless, some patients suffer from sleep disorders even when the disease is clinically inactive. Psychological factors, such as depression and anxiety, are also known to contribute to poor sleep quality. Depression and anxiety are common in chronic diseases. In addition, while the link between depression or anxiety and sleep disorders is well-known, the link between sleep disorders and inflammation has only been studied recently. Sleep studies in IBD patients have generally excluded patients with clinically diagnosed depression or anxiety in order to neutralize their effects on the relationship between inflammation and sleep disorders. Nevertheless, there is no consensus on the relationship between depression and anxiety and the clinical activity of the disease. When a patient with chronic inflammatory bowel disease (Crohn's disease here) complains of fatigue or poor sleep, the subjective aspects of these complaints therefore lead the clinician to consider them simply as: a characteristic of IBD, exhaustion related to the chronicity of the disease, unsatisfactory sleep quality, a manifestation of a depressive mood, or a consequence of an anxious state. When a patient reports a subjective complaint of poor sleep or fatigue in a complex, multi-determined clinical situation, it can thus be difficult to identify its most likely cause and to establish the best possible therapeutic intervention. Patients, materials and methodsThe aim of this work was to determine which element (disease activity, inflammation, depression, anxiety) is most closely related to sleep disorders in patients with Crohn's disease (CD) referred for outpatient psychological assessment. Ninety-seven patients with CD participated in this study. Their mean age was 34.70 (±10.85) years. They were asked about their sleep (IQSP, ISI, ESD) and mood (HADS). They also provided details of clinical disease activity (Harvey–Bradshaw Index) and inflammation (CRP). In order to determine the nature and extent of the relationship between the variables, Spearman correlation coefficients were calculated, supplemented by multiple regression analyses to determine the variables that could explain the sleep disorders. ResultsThe results show that sleep quality (IQSP) was significantly predicted by the Harvey–Bradshaw score (β=0.21; β standardized=0.24; t=2.6; P=0.01) and depression (β=0.45; β standardized=0.41; t=4.55; P<0.001). The Harvey–Bradshaw score (β=26; β standardized=2; t=2.27; P=0.026) and depression score (β=75; β standardized=47; t=5.34; P<0.001) were related to the insomnia score (ISI). Finally, daytime sleepiness (DSA) was predicted by the depression score (β=42; β standardized=432; t=3.17; P=0.002) and by the CRP (β=−0.05; β standardized=−0.21; t=−2.13; P=0.036). The results show that the severity of clinical activity of the disease was associated with poor sleep quality and insomnia. However, there was a stronger association between the intensity of depression and sleep disturbances than between these variables and clinical disease activity. It therefore seems important that sleep disorders and their management should be considered first from the perspective of depression. However, it is important that CD is not assumed to be the sole cause of depression: other factors (dispositional or situational) should also be taken into consideration. Nevertheless, while our results show a weaker link between inflammation and sleep disorders than other studies, they confirm the link between sleep disorders and disease activity. ConclusionsIn order to predict the likelihood and nature of relapses, it seems important that future research should take into account not only disease activity and inflammation, but also disorders of arousal and nocturnal awakenings experienced by the patient.

(Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next?

Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep-wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep-anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.

Association of diabetic vascular complications with poor sleep complaints.

BackgroundLiteratures reported that poor sleep complaints were associated with a great deal of health outcomes. However, there are few studies on the association of poor sleep complaints with diabetic vascular complications.MethodsAiming on the association, a cross-sectional survey was conducted among 1220 diabetic patients in this study. Poor sleep complaints were composed of difficulty falling asleep, early final awakening, short sleep and long sleep. The diabetic vascular complications involved in the study were diagnosed according to the Standards of Medical Care in Diabetes (ADA 2016).ResultsOur findings indicated that short sleep remained independently associated with diabetic kidney disease (DKD) (OR > 1, P < 0.05) after the adjustments; long sleep independently associated with diabetic retinopathy (DR) (OR > 1, P < 0.05); early final awakening and short sleep independently associated with cardiovascular disease (OR > 1, P < 0.05); short sleep independently associated with peripheral arterial disease (OR > 1, P < 0.05); there was no association between poor sleep complaints and neuropathy (P > 0.05).ConclusionsThe study suggests that the poor sleep complaints were distinguishably associated with diabetic vascular complications. Clinicians should take poor sleep complaints into account in diabetes treatment.

Intelligence measures and stage 2 sleep in typically-developing and autistic children

The relationship between intelligence measures and 2 EEG measures of non-rapid eye movement sleep, sleep spindles and Sigma activity, was examined in 13 typically-developing (TD) and 13 autistic children with normal IQ and no complaints of poor sleep. Sleep spindles and Sigma EEG activity were computed for frontal (Fp1, Fp2) and central (C3, C4) recording sites. Time in stage 2 sleep and IQ was similar in both groups. Autistic children presented less spindles at Fp2 compared to the TD children. TD children showed negative correlation between verbal IQ and sleep spindle density at Fp2. In the autistic group, verbal and full-scale IQ scores correlated negatively with C3 sleep spindle density. The duration of sleep spindles at Fp1 was shorter in the autistic group than in the TD children. The duration of sleep spindles at C4 was positively correlated with verbal IQ only in the TD group. Fast Sigma EEG activity (13.25–15.75Hz) was lower at C3 and C4 in autistic children compared to the TD children, particularly in the latter part of the night. Only the TD group showed positive correlation between performance IQ and latter part of the night fast Sigma activity at C4. These results are consistent with a relationship between EEG activity during sleep and cognitive processing in children. The difference between TD and autistic children could derive from dissimilar cortical organization and information processing in these 2 groups.

Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.

Complaints of Poor Sleep and Risk of Traffic Accidents: A Population-Based Case-Control Study.

IntroductionThis study aimed to determine the sleepiness-related factors associated with road traffic accidents.MethodsA population based case-control study was conducted in 2 French agglomerations. 272 road accident cases hospitalized in emergency units and 272 control drivers matched by time of day and randomly stopped by police forces were included in the study. Odds ratios were calculated for the risk of road traffic accidents.ResultsAs expected, the main predictive factor for road traffic accidents was having a sleep episode at the wheel just before the accident (OR 9.97, CI 95%: 1.57–63.50, p<0.05). The increased risk of traffic accidents was 3.35 times higher in subjects who reported very poor quality sleep during the last 3 months (CI 95%: 1.30–8.63, p<0.05), 1.69 times higher in subjects reporting sleeping 6 hours or fewer per night during the last 3 months (CI 95%: 1.00–2.85, p<0.05), 2.02 times higher in subjects reporting symptoms of anxiety or nervousness in the previous day (CI 95%: 1.03–3.97, p<0.05), and 3.29 times higher in subjects reporting taking more than 2 medications in the last 24 h (CI 95%: 1.14–9.44, p<0.05). Chronic daytime sleepiness measured by the Epworth Sleepiness Scale, expressed heavy snoring and nocturnal leg movements did not explain traffic accidents.ConclusionPhysicians should be attentive to complaints of poor sleep quality and quantity, symptoms of anxiety-nervousness and/or drug consumption in regular car drivers.

Brief Insomnia and Quality of Sleep Scale (BIQSS): Reliability and validity in higher education students

Introduction The present work aims to characterize in higher education students the reliability and validity of a brief self-reported measure to assess insomnia complaints and perceived sleep quality (Gomes et al., 2001, 2005, 2011), used from more than a decade by our research team members, and henceforth labeled the Brief Insomnia and Quality of Sleep Scale (BIQSS). Materials and methods In study 1, the 7-items scale now termed BIQSS was developed, as part of a larger self-response questionnaire on higher education sleep-wake patterns, and its internal consistency and item homogeneity were analyzed based on the answers of 1654 undergraduates. In study 2, focused mainly on validity, 323 undergraduate and master degree students completed the BIQSS together with the PSQI (Buysse et al., 1989). Using an additional question on perceived sleep problems, item discriminative power and ROC analyses were also performed. Higher BIQSS scores equate to poorer sleep, and each item is rated in a 5 point scale from 0 to 4 (or in reversed way when appropriate), thus total score may range from 0 to 28. Results Internal consistency was assessed by Chronbach alpha, which was.73 in study 1 and .78 in study 2. Corrected item-total correlations ranged from .32 to .57 (study 1), and from .40 to .60 (study 2). All items contributed to the internal consistency of the scale, as shown by drops in Chronbach alpha values when excluding each item. As to validity (study 2), the correlation coefficient between the BIQSS and the PSQI score was r = 0.65 (p 0,001). Students that reported a sleep problem (n = 40) obtained significantly higher BIQSS scores in comparison to those who deny having any sleep problem, and all items were able to discriminate between them. In ROC analysis, the Area Under the Curve (AUC) was .832, indicating moderate precision/acuity. Conclusion The BIQSS is composed by a small number of items, is very easy to administer in higher education students, and seems to possess reasonable reliability, validity, and acuity. Therefore, it may constitute a convenient tool to screen for insomnia and poor sleep complaints, both for research purposes and in clinical settings. Further studies are now needed in other samples. Acknowledgements Successive research studies leading to the present work have been supported by different entities: Dep. of Education – Univ. Aveiro; Projects LEIES (FCG), SPASHE (FCT); Research Unit CCPSF and CIECC (FCT).

WITHDRAWN: Benzodiazepines and related drugs for insomnia in palliative care.

BACKGROUND: Insomnia, a subjective complaint of poor sleep and associated impairment in daytime function, is a common problem. Currently, benzodiazepines are the most used pharmacological treatment for this complaint. They are considered helpful for occasional short-term use up to four weeks but longer term use is not advised due to potential problems regarding tolerance, dosing escalation, psychological addiction and physical dependence. There is no consensus on their utility in patients with progressive incurable conditions who may require assistance with sleep for many weeks as their condition deteriorates. OBJECTIVES: To assess the effectiveness and safety of benzodiazepines or benzodiazepine receptor agonists such as Zolpidem, Zopiclone and Zaleplon for insomnia in palliative care. SEARCH METHODS: Several electronic databases were searched including Cochrane PaPaS Group specialized register, The Cochrane Library Issue 4, 2001, MEDLINE, EMBASE, BNI plus, CINAHL, BIOLOGICAL ABSTRACTS, PSYCINFO, CANCERLIT, HEALTHSTAR, WEB OF SCIENCE, SIGLE, Dissertation Abstracts, ZETOC and the MetaRegister of ongoing trials. These were searched from 1960 to 2001 or as much of this range as possible. SELECTION CRITERIA: Studies considered for inclusion were randomized controlled trials (RCTs) of adult patients in any setting, receiving palliative care or suffering an incurable progressive medical condition. (For example, cancers, AIDS, Motor Neurone Disease, Multiple Sclerosis, Parkinson's Disease, Chronic Obstructive Pulmonary Disease). There had to be an explicit complaint of insomnia in study participants, diagnosed by any of the three main classification systems (DSM-IV (APA 1994), ICSD (AASD 1990) or ICD (WHO 1992), or as described in the study if it involved a subjective complaint of poor sleep. Studies had to compare a benzodiazepine or Zolpidem or Zopiclone or Zaleplon with placebo or active control for the treatment of insomnia. Any duration of therapy were considered. DATA COLLECTION AND ANALYSIS: Abstracts were independently inspected by both review authors, full papers were obtained where necessary. Where there was uncertainty advice was sought by a third review author (PW). Data extraction and quality assessments were undertaken independently by both review authors. MAIN RESULTS: No RCTs were identified meeting the a priori inclusion criteria. Thirty-seven studies were considered but all were excluded from the review. AUTHORS' CONCLUSIONS: Despite a comprehensive search no evidence from RCTs was identified. It was not possible to draw any conclusions regarding the use of benzodiazepines in palliative care. Language: en

Insomnia and Health Services Utilization in Middle-Aged and Older Adults: Results From the Health and Retirement Study

Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults. We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or ≥ 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics. Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.15-1.43, p < .001), use of home health care services (AOR = 1.29, 95% CI = 1.09-1.52, p = .004), and any health service use (AOR = 1.28, 95% CI = 1.15-1.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95% CI = 1.50-1.96, p < .001), use of home health care services (AOR = 1.64, 95% CI = 1.32-2.04, p < .001), nursing home use (AOR = 1.45, 95% CI = 1.10-1.90, p = .009), and any health service use (AOR = 1.72, 95% CI = 1.51-1.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates. In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.

Depression in the Spousally Bereaved Elderly: Correlations with Subjective Sleep Measures

Complaints of poor sleep and symptoms of depression are likely to coexist in the spousally bereaved elderly. This study was concerned with the correlation between depressive symptoms and various measures of subjectively reported sleep using questionnaire and diary instruments in 38 bereaved seniors (60y+). Correlations between the sleep measures and days since loss and grief intensity were also calculated. All sleep disruption measures correlated significantly with depression score, but only sleep duration correlated with grief intensity, and no sleep measure correlated with days since loss. Therapies which address both sleep and depression are likely to be of benefit to bereaved seniors.

Complaints of difficulty to fall asleep increase the risk of depression in later life: The health in men study

To determine if complaints of poor sleep are associated with incident depression in older men. Cohort study with an average follow up period of 6 years (range 3 months to 8.5 years). Participants were 5127 community-dwelling Western Australian older men aged 70-90 years who provided information about sleep problems. The primary outcome of interest of the study was a recorded diagnosis of depressive episode, recurrent depressive disorder or dysthymia in the Western Australian Data Linkage System. Participants completed a health questionnaire that included questions assessing difficulty falling asleep, remaining awake, as well as early morning awakening. Other measured factors included age, education, country of birth, living arrangements, social support, smoking, body mass index, and prevalent diabetes, hypertension, arthritis, chronic respiratory diseases, coronary artery disease, stroke, and cancer. Biochemical measurement of C-reactive protein, testosterone and plasma homocysteine were available for 3800 men. We found that 60% of men reported at least one sleep problem and that the unadjusted hazard ratio (HR) of depression was higher in men who complained of difficulties to initiate sleep (HR = 2.19, 95% confidence interval--95% CI = 1.47-3.27) or who remained awake most of the night (HR = 1.94, 95% CI = 1.15-3.27). There was no association between early morning awakening and incident depression. The association between incident depression and subjective difficulty falling asleep remained after the analyses were adjusted for other measured factors (HR = 1.83, 95% CI = 1.20-2.79). The association between depression and remaining awake was no longer significant once the analyses were adjusted for confounding (HR = 1.43, 95% CI = 0.81-2.53). A sensitivity analysis confirmed these results. The evaluation of the exposure (sleep disturbance) was limited to self-rating questions that were not externally validated. The diagnosis of depression was based on administrative record linkage rather than structure clinical interviews. The observational nature of the study limits our ability to ascribe a causal relationship between complaints of poor sleep and incident depression. Complaints of difficulty falling asleep increase the risk of incident depression in older men. Clarifying the mechanisms that underlie this association should become an international research priority, as they may contribute to guide interventions designed to decrease the burden of depression in later life.

In the midnight hour: Cancer and nightmares. A review of theories and interventions in psycho-oncology

The purposes of this study were: (1) to explore cancer patients' complaints of poor sleep, which often involve a combination of somatic symptoms and nightmares; and (2) to understand these sleep disturbances in the light of modern dream theories and intervention modalities. The literature search originated with several major articles (Revonsuo, 2000; Krakow & Zadra, 2006; Hobson, 2009) which then opened up the search through their references. We also used the database PubMed, and employed the following key words: cancer, nightmares/dreams, sleep disturbances, and dream theory. The literature search covered the interval between 1900 (Freud, 1900) and 2009. Our criteria for selecting studies included the most recent major review articles on the neuroscience of sleep and dreams; articles reviewing sleep disturbances in cancer patients and relevant treatments; and articles reviewing interventions for traumatic dreams. Approximately 30 articles were deemed worthy of inclusion. Thirty article/books/chapters met the criteria for relevance related to key theories and clinical interventions related to nightmares and traumatic dreams of cancer patients. Key concepts involve threat simulation theory and imagery rehearsal therapy in regard to theoretical and interventional paradigms significantly generalizable to cancer patients. The dream material included in this article presents patients' attempts to deal with complex threats such as intense dependency/ loss of self-sufficiency, disfigurement, and death. This is especially true with regard to the doctor-patient relationship at all stages of the illness and disease. Imagery rehearsal can facilitate empowerment in light of highly threatening and conflictual cancer-related dreams in which the patient feels helpless and victimized. This review offers a new lens on current dream theories and understanding of sleep disturbance in cancer patients as well as their familes and medical caregivers. Modern theories lead to opportunities for intervention that can both relieve symptoms and improve communication between medical caregivers and patients and families.

Cognitive Behavioral Therapy for Insomnia in Older Adults

Insomnia is associated with significant morbidity and is often a persistent problem, particularly in older adults. It is important to attend to this complaint and not assume that it will remit spontaneously. In many cases, unfortunately, insomnia remains unrecognized and untreated, often because it is presumed that insomnia is an inevitable consequence of aging. Although the sleep structure naturally changes with advancing age, these changes are not necessarily associated with complaints of poor sleep, distress, or daytime consequences, while chronic insomnia clearly is. There is increasing evidence that cognitive behavioral therapy (CBT) is effective for the management of chronic insomnia in the elderly and that it is of significant benefit for insomnia comorbid with medical and psychological conditions, also more prevalent in older age. The aim of this article is to familiarize clinicians working with older adults with the different components of CBT for insomnia and how to adapt the treatment to this population. A clinical case and session-by-session implementation of CBT for insomnia are described to illustrate information and guidelines provided in this article.

Underexposure to light at work and its association to insomnia and sleepiness: A cross-sectional study of 13 296 workers of one transportation company

Background Light is a powerful synchronizer of the biological clock and of the sleep/wake cycle. Blind people have more sleep disturbances than people without eyesight problems. However, whether visually able people who are underexposed to bright natural light suffer from sleep wake disorders has never been examined. This study tried to assess the prevalence of sleep and wake disorders in subjects working in environments that are not exposed to natural light. Methodology A setting–controlled cross–sectional epidemiological study was carried out. A representative sample of 13 296 French employees of a single transportation company participated in the study. During working hours, 4635 subjects (34.9%) experienced no light exposure (NLE) and 8661 were partially or completely exposed (LE) to natural light. Sleep disorders, sleep quality, and sleepiness were assessed using subjective tools: the Sleep Disorders Questionnaire–French version (SDQFV) and the Epworth Sleepiness Scale (ESS). Light exposure was estimated on workers' schedules and by objective measurements of light intensity (lux meter). Principal findings On a univariate analysis, complaints of poor sleep and sleepiness were significantly higher in NLE workers compared to LE: nonrestorative sleep (36.8% vs. 29.5%; P<.0001), insomnia (28.8% vs. 24.8%; P<.0001), severe insomnia (14.1% vs. 10.9%; P<.0001), and daytime somnolence (6.8% vs. 4.3%; P<.0001). After multivariate analysis, NLE has shown more insomnia (OR=1.8, 95% CI 1.3–2.3, P<.01) and hypersomnia (OR=1.9, 95% CI=1.3–2.4, P<.01) than LE. Significance These data suggest that underexposure to natural light at work may significantly impair sleep and wake disorders in non–light-exposed workers.