Daily Sleep Diaries Research Articles

0656 Evaluating the Interrelationship Between Insomnia, Sleep Apnea and Nightmares in Veterans With Posttraumatic Stress Disorder

Abstract Introduction Observational research demonstrates a strong association between nightmares, insomnia, and sleep apnea in veterans with posttraumatic stress disorder (PTSD), supportive of the notion of a “complex sleep disturbance”. Relations between sleep disturbances and PTSD are often bi-directional and disturbed sleep affects non-sleep PTSD outcomes. We aimed to examine relationships between nightmares, respiratory events, CPAP use, and insomnia in trauma-exposed veterans with frequent nightmares. Methods Three weeks of app-based daily sleep diaries and weekly insomnia severity index (ISI) reports were collected from 41 veterans with a history of trauma and frequent nightmares. Relationships between weekly nightmares (total number), CPAP use, sleep efficiency, and ISI scores were analyzed using linear regression with standard errors adjusted for clustering of weeks within participants. Of the 41 participants, a subset of 15 participants completed 6-9 nights of at-home objective sleep measurements (Sleep Profiler) to examine the relationship between apnea events and nightmare awakenings. Measurements involved EEG integrated with airflow, respiratory effort, oxygen saturation, and actigraphy with event marker for real-time reporting of nightmares preceding awakenings. Results 41 veterans (mean age 48 (SD=16), 30% female) participated. Higher prior week ISI score predicted reduced CPAP adherence (β=-.53, p=.005). In turn, increased frequency and duration of CPAP use was associated with a significant increase in sleep efficiency the same week (β=.53, p=.018 and β=.56, p=.026, respectively). Analysis of respiratory events indicates that 20 of the 64 nightmare awakenings (31%) were preceded (i.e., within seconds of awakening) by apnea or hypopnea events. Of these 20, 11 events were reported by participants with a diagnosis of OSA and a CPAP device. Amongst these 11 events, 7 (64%) occurred on nights during which the participant reported use of their CPAP. Conclusion Analyses demonstrated statistically significant and clinically meaningful relationships among insomnia, nightmares, respiratory events and CPAP adherence in our sample, highlighting their interrelationships in trauma subjects. These data support the hypothesis that OSA contributes to nightmare experiences by demonstrating an immediate temporal relationship between apnea/hypopnea events and nightmare awakenings, and they underscore the importance of detecting and adequately treating sleep apnea for the treatment of nightmares in veterans. Support (if any)

Effects of Low-Sodium Oxybate on 24-Hour Total Sleep Time: Data From a Phase 3 Clinical Study in Adults With Idiopathic Hypersomnia (P5-13.001)

<h3>Objective:</h3> Evaluate the effects of lower-sodium oxybate (LXB; Xywav^®) on total sleep time (TST) in idiopathic hypersomnia. <h3>Background:</h3> Idiopathic hypersomnia is a debilitating central hypersomnolence disorder. Efficacy and safety of LXB for idiopathic hypersomnia in adults were established in a double-blind randomized withdrawal study (NCT03533114). <h3>Design/Methods:</h3> Participants began LXB treatment in an open-label titration and optimization period (10–14 weeks), followed by a 2-week, open-label, stable-dose period (SDP), then were randomized to placebo or continued LXB during a 2-week, double-blind, randomized withdrawal period (DBRWP). Participant-recorded daily sleep diaries from week 2 of the screening and SDP periods were analyzed. Results are reported by baseline TST in groups with &lt;8, ≥8 to &lt;9, or ≥9 hours of sleep per 24 hours and by treatment at study entry (treatment naive or taking alerting agents [AAs; stimulants or wake-promoting agents]). <h3>Results:</h3> There were 154 participants (mean±SD age, 40±14 years; 68% female). From baseline to end of SDP, estimated median reductions were observed in participants with ≥8 hours of reported baseline sleep in 24-hour TST (≥8 to &lt;9 hours=42 minutes; ≥9 hours=115 minutes), nocturnal TST (≥8 to &lt;9 hours=15 minutes; ≥9 hours=81 minutes), and nap duration (≥8 to &lt;9 hours=2.5 minutes; ≥9 hours=45.2 minutes). Minimal changes were observed in 24-hour TST, nocturnal TST, and nap duration in participants with &lt;8 hours of TST at baseline (1, 0, and 1.0 minutes, respectively). Reductions in TST were observed regardless of taking concomitant AAs in 24-hour TST (without AAs=61 minutes; with AAs=28 minutes), nocturnal TST (without AAs=32 minutes; with AAs=23 minutes), and nap duration (without AAs=11.3 minutes; with AAs=8.4 minutes). Common treatment-emergent adverse events (excluding placebo data) were nausea, headache, dizziness, anxiety, and vomiting. <h3>Conclusions:</h3> Open-label LXB treatment reduced TST and nap duration in participants with ≥8 hours of TST at baseline, and regardless of taking concomitant AAs. <b>Disclosure:</b> The institution of Dr. Morse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jazz Pharmaceuticals, Harmony Biosciences, Avadel Pharmaceuticals, Takeda Pharmaceuticals, Alkermes, National Institute for Health, and Geisinger Health Plan. The institution of Dr. Morse has received research support from Harmony Biosciences, Avadel Pharmaceuticals, Takeda Pharmaceuticals, Alkermes, National Institute for Health, and Geisinger Health Plan. Ms. Chen has received personal compensation for serving as an employee of Jazz Pharmaceuticals. Ms. Chen has received stock or an ownership interest from Jazz Pharmaceuticals. Teresa Steininger has received personal compensation for serving as an employee of Jazz Pharmaceuticals. Teresa Steininger has stock in Jazz Pharmaceuticals. Dr. Macfadden has received personal compensation for serving as an employee of Jazz pharma. Dr. Macfadden has stock in Jazz pharma.

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study

ABSTRACT Objectives This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress. Methods Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary. Results Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β −3.0, 95%CI −5.2, −0.8, p = .01), and purpose in life (β −3.5, 95%CI −6.1, −0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05). Conclusions These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance.

Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance. In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861. 28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11). Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.

OLDER DYADS USING A WEARABLE PERSONAL SLEEP MONITORING DEVICE FOR SLEEP SELF-MANAGEMENT

Abstract Normally occurring changes in sleep patterns can affect behavior, safety, and function in older individuals. In addition, altered sleep of one partner can affect the functioning of the other. We tested a novel intervention using an off the shelf, wrist-worn actigraph as a personal sleep monitoring device (PSMD) with dyads comprised of individuals who were 70 years old or older, and slept in the same house. Aims included: 1) Establish the feasibility of sleep self-monitoring using PSMDs, as a self-management strategy. 2) Establish the feasibility of PSMD data sharing among members of the dyad to improve sleep self-management and improve sleep quality; and 3) Evaluate the usability of PSMDs and data sharing for dyads of older individuals. Over the course of a five-week trial, we used a mixed methods approach. Data were comprised of daily sleep diaries, data from the PSMD, weekly questionnaires regarding sleep patterns and function, and qualitative interviews focused on sleep, self-management within the dyad, and the usability of the PSMD. Data were analyzed using qualitative or statistical methods. The use of the PSMD increased awareness of sleep patterns at the individual and dyadic levels, but the limitations of the PSMD were frustrating. Participants valued having a graphic image of how their daily activities affected their sleep patterns. The dyadic approach was effective in improving sleep patterns for older individuals, and using over the counter activity monitoring devices provide a relatively inexpensive way to assist older adults to improve their sleep self-management.

Agreement between actigraphy and sleep diaries: A 28-day real-time monitoring study among suicidal adolescents following acute psychiatric care

ObjectiveTo examine the agreement between, and adherence to, wrist actigraphy and digital sleep diaries as methods for sleep assessment among high-risk adolescents in the 28 days following discharge from acute psychiatric care. Sleep parameters included: number of nighttime awakenings (NWAK), sleep efficiency (SE), sleep onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO). MethodsFifty-three adolescents (12–18 years) were recruited following discharge from acute psychiatric care for suicide risk. Adolescents completed a baseline assessment followed by a 28-day monitoring period with daily sleep diaries and continuous wrist actigraphy. Bland-Altman and multi-level models examined agreement. ResultsAdherence to actigraphy was high, but lower for sleep diaries; a similar pattern of adherence emerged on weekdays vs. weekends. Bland-Altman analyses revealed no clinically meaningful bias for sleep parameters (except NWAK), but the limits of agreement make interpretation ambiguous. Our base model indicated strong agreement between actigraphy and sleep diaries for TST (r = 0.850), moderate for SOL (r = 0.325) and SE (r = 0.322), and weak for WASO (r = −0.049) and NWAK (r = 0.114). A similar pattern emerged with the insomnia severity models with baseline insomnia influencing agreement on all parameters. There were significant weekday-weekend differences for WASO and NWAK, but not for SOL, SE, and TST. ConclusionResults suggest that it may be beneficial to find a modeling approach to account for the concordant and discordant information and relevant time-level variables.

The impact of social rhythm and sleep disruptions on waist circumference after job loss: A prospective 18-month study.

This study prospectively examined change in waist circumference (WC) as a function of daily social rhythms and sleep in the aftermath of involuntary job loss. It was hypothesized that disrupted social rhythms and fragmented/short sleep after job loss would independently predict gains in WC over 18 months and that resiliency to WC gain would be conferred by the converse. Eligible participants (n=191) completed six visits that included standardized measurements of WC. At the baseline visit, participants completed the social rhythm metric and daily sleep diary and wore an actigraph on their nondominant wrist each day for a period of 2 weeks. When controlling for obesity and other covariates, WC trajectories decreased for individuals with more consistent social rhythms, more activities in their sdiocial rhythms, and higher sleep quality after job loss. WC trajectories did not change for individuals with lower scores on these indicators. The frequency and consistency of social rhythms after job loss play a key role in WC loss. These findings support the implementation of social rhythm interventions after job loss, a potentially sensitive time for the establishment of new daily routines that have an impact on metabolic health.

Sleep patterns and intraindividual sleep variability in mothers and fathers at 6 months postpartum: a population-based, cross-sectional study

ObjectivesGiven that postpartum sleep is an important family process, further investigations including both mothers and fathers are necessary. The present study aimed to describe and compare sleep patterns and intraindividual...

Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles.

Nocturnal vasomotor symptoms (nVMS), depressive symptoms (DepSx), and female reproductive hormone changes contribute to perimenopause-associated disruption in sleep continuity. Hormonal changes underlie both nVMS and DepSx. However, their association with sleep continuity parameters resulting in perimenopause-associated sleep disruption remains unclear. We aimed to determine the association between female reproductive hormones and perimenopausal sleep discontinuity independent of nVMS and DepSx. Daily sleep and VMS diaries, and weekly serum assays of female reproductive hormones were obtained for 8 consecutive weeks in 45 perimenopausal women with mild DepSx but no primary sleep disorder. Generalized estimating equations were used to examine associations of estradiol, progesterone, and follicle stimulating hormone (FSH) with mean number of nightly awakenings, wakefulness after sleep onset (WASO) and sleep-onset latency (SOL) adjusting for nVMS and DepSx. Sleep disruption was common (median 1.5 awakenings/night, WASO 24.3 and SOL 20.0 minutes). More awakenings were associated with estradiol levels in the postmenopausal range (β = 0.14; 95% CI, 0.04 to 0.24; P = 0.007), and higher FSH levels (β [1-unit increase] = 0.12; 95% CI, 0.02 to 0.22; P = 0.02), but not with progesterone (β [1-unit increase] = -0.02; 95% CI, -0.06 to 0.01; P = 0.20) in adjusted models. Female reproductive hormones were not associated with WASO or SOL. Associations of more awakenings with lower estradiol and higher FSH levels provide support for a perimenopause-associated sleep discontinuity condition that is linked with female reproductive hormone changes, independent of nVMS and DepSx.

Analysis of Daily Sleep Diary Measures From Multilayer Extended-Release Methylphenidate (PRC-063) Studies in Children and Adults With ADHD

Objective: To compare the effect of a once-daily extended-release methylphenidate formulation (PRC-063) versus placebo on sleep, measured via daily electronic diary in two clinical trials in pediatric (6–12 years) and adult (≥18 years) patients with attention deficit hyperactivity disorder (ADHD). Method: A diary was completed by adult patients or parents/caregivers of pediatric patients during two randomized, double-blind, placebo-controlled laboratory classroom studies. Following dose optimization of PRC-063, patients were randomized to 1 week of double-blind treatment with PRC-063 or placebo before attending a full-day laboratory classroom session. Results: In the studies, 148 pediatric patients and 239 adult patients were randomized to either PRC-063 or placebo. When compared with the diaries of placebo patients, the sleep diaries in both pediatric and adult patients showed no statistical difference in total sleep time, efficiency, or latency. Conclusion: PRC-063 did not impact subjective measures of sleep versus placebo in pediatric and adult patients with ADHD.

0256 Child Maltreatment and Multidimensional Sleep Health among Incoming First-Year College Students

Abstract Introduction Despite the growing body of evidence linking child maltreatment to compromised sleep health in adulthood, links in emerging adults are understudied. We examined associations between child maltreatment (CM) and multidimensional sleep health among emerging adults undergoing the major life transition of starting college. Methods First-year college students (N=682, 41% male, 48% Non-Hispanic White, 22% Non-Hispanic Asian, 15% Hispanic all races, 6% Non-Hispanic Black, and 9% Non-Hispanic other races) completed daily sleep diaries (DSDs) for 9 weeks, and completed the Childhood Trauma Questionnaire (CTQ), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) following DSD completion. We used linear regression models to examine associations between CTQ-derived CM (0=none, 1=any [moderate to severe emotional abuse/neglect, physical abuse/neglect, or sexual abuse]) and sleep health (Buysse, 2014) using a multidimensional score encompassing components from the RUSATED model (regularity [DSD sleep midpoint SD: 0= &amp;gt;1 hour, 1= ≤1 hour], satisfaction [PSQI sleep quality item: 0=fairly or very bad, 1=very or fairly good], alertness [ESS score: 0= &amp;gt;10, 1= ≤10], timing [DSD sleep midpoint: 0= &amp;lt;3:30 or &amp;gt;5:30, 1= ≥3:30 and ≤5:30], efficiency [DSD sleep efficiency: 0= &amp;lt;93%, 1= ≥93%], and duration [DSD sleep duration: 0= &amp;lt;7 hours or &amp;gt;10 hours, 1= ≥7 hours and ≤10 hours]. Results In the full sample 20.5% reported CM (within-group prevalences: females 21%, males 20%, Non-Hispanic Whites 12%, Non-Hispanic Asians 28%, Hispanics of all races 26%, Non-Hispanic Blacks 34%, and Non-Hispanics of other races 30%). Those with CM had significantly worse sleep health (B=-0.25, 95% CI=-0.46, -0.04) compared to those without CM, but not after adjustment for sex and race/ethnicity. In logistic regression models, the only individual sleep health component significantly associated with CM was sleep satisfaction. After adjustment for sex, race/ethnicity, and depressive symptoms, those who experienced CM had a 52% lower odds of reporting good sleep quality (OR=0.48, 95% CI=0.30, 0.76). Conclusion CM is associated with worse sleep satisfaction among first-year college students, which aligns with previous research in older adults. Additional research should examine neurophysiological correlates of sleep satisfaction in the context of child maltreatment and effects on subsequent health. Support (If Any) P206M139743, MH079179, T32HD101392.

0670 The role of social vigilance and hindrance-challenge stress in predicting nightmares among nurses

Abstract Introduction Increased exposure and reactivity to daytime stressors may heighten the frequency and severity of nightmares. Although research has examined the role of personality traits such as neuroticism in nightmares, it is unknown if other hypervigilance-related characteristics predict nightmares. Social vigilance, or monitoring one’s social environment for potential threats, is one factor that may influence stress reactivity and sleep. Nurses are one population who may be particularly susceptible to social vigilance and nightmares given their stressful work environments. The current study had two aims: 1) to examine the association between social vigilance and nightmares (assessed via retrospective questionnaire and via daily sleep diaries), and 2) to examine if perceived job stress strengthened the association between social vigilance and nightmares. Methods Participants were 464 nurses (mean age = 39.03 years, SD = 11.07 years, 91% female) recruited from two Dallas-area hospitals. At baseline, nurses completed the Social Vigilance Questionnaire (SVQ), the Nightmare Disorder Index (NDI; a newly validated scale measuring past-month nightmare frequency and severity), and the Challenge- and Hindrance-Related Self-Reported Stress Scale (CHRSS). Nurses then completed 14 days of sleep diaries to assess daily nightmare frequency, which were then summed across the 14 days. Multiple linear regression models were run to assess main effects of social vigilance and hindrance or challenge stress, as well as their interactions, on nightmares. Results Greater social vigilance (β = 0.10, p = 0.041) and greater hindrance stress (β = 0.13, p = 0.031) each predicted more nightmare symptoms as measured by the NDI, but not nightmare frequency as measured by the daily surveys. Only greater hindrance stress predicted greater daily nightmare frequency as measured by the daily surveys (β = 0.14, p = 0.015). Social vigilance did not interact with either hindrance or challenge stress to predict nightmares. Conclusion Results indicate nurses who report higher levels of social vigilance or hindrance stress at work experience more nightmare symptoms. Although more research is needed, supporting nurses who report high levels of stress and vigilance may help reduce their arousal and improve their sleep. Support (If Any) 1R01AI128359

0485 Verbal Hostility Moderates Parental and Child Sleep Onset Latency in Children with Autism Spectrum Disorder

Abstract Introduction Research indicates parent and child sleep onset latency (SOL) are positively correlated. In addition, parents who have difficulty sleeping may be more tired and report using negative parenting behaviors, such as verbal hostility. Experiencing verbal hostility may increase child anxiety and make it harder for them to fall asleep. Given that up to 80% of children with ASD experience sleep problems, it is important to understand potential relations among sleep and parenting behavior in this population. The current study examined whether verbal hostility moderated the relationship between parent and child SOL. Methods The sample (N=56) consisted of parents (90% female) reporting on their children aged 6-12 (M=8.63, SD = 2.00; 77% male) who expressed interest in a study exploring behavioral treatments for sleep. All children were diagnosed with ASD and had parent reported sleep complaints (e.g., difficulty falling asleep, waking up in the night). Baseline data were examined in the current analyses. Measures included an average of parent and child SOL on daily sleep diaries over 14 days of baseline. Verbal hostility was measured using the verbal hostility subscale on the Parenting Styles and Dimensions Questionnaire – Short Version. Covariates included child and parent age. Results Moderation analyses were conducted using SPSS PROCESS. Parent and child SOL were significantly correlated (r(55)=.28, p=.04). Parent nor child SOL were correlated with verbal hostility. The interaction between parent SOL and verbal hostility t (1, 55) = 5.34, p = .02 was significantly associated with child SOL, such that higher levels of verbal hostility exacerbated the association between greater parent and child SOL. Conclusion These results suggest that the association between parent and child SOL depends in part on the level of verbal hostility a parent uses to discipline their child with ASD. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships. In addition, teaching positive parenting techniques to parents of children with ASD may be an important component to behavioral sleep treatment so that both child sleep and disciplinary strategies are targeted. Support (If Any) United States Department of Defense USAMRAA Autism Research Program (McCrae, PI; CTA W81XWH2010399).

Does total sleep time substantially increase after cognitive behavioral therapy for insomnia?

In most standardized approaches to cognitive behavioral therapy for insomnia, it is commonly the case that total wake time is reduced 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 percentage of participants meet or appreciably exceed baseline TST after cognitive behavioral therapy for insomnia. 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 (≥ 0 minute increase) and 2) appreciably exceeded (≥ 30 minutes increase) baseline TST as assessed via daily sleep diaries at posttreatment and 3, 6, 12, and 24 months following treatment. By the end of acute treatment, 45% of participants reached or exceeded baseline TST. By 24 months follow-up, this percentage had 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. These findings suggest that cognitive behavioral therapy for insomnia in its current form does not appreciably increase self-reported TST in a significant proportion of patients with insomnia. 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 gain. Scott H, Cheung JMY, Muench A, etal. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? J Clin Sleep Med. 2022;18(7):1823-1829.

Early starts and late finishes both reduce alertness and performance among short‐haul airline pilots

SummaryFlight crews are frequently required to work irregular schedules and, as a result, can experience sleep deficiency and fatigue. This study was conducted to determine whether perceived fatigue levels and objective performance varied by time of day, time awake, and prior night's sleep duration. Ninety‐five pilots (86 male, 9 female) aged 33 years (±8) volunteered for the study. Participants completed a daily sleep diary, Samn‐Perelli fatigue scale, and psychomotor vigilance task that were completed before and after each flight duty period and at the top‐of‐descent for each flight. Pilots experienced higher self‐reported fatigue (EMM = 3.92, SE = 0.09, p < 0.001) and worse performance (Response speed: EMM = 4.27, SE = 0.08, p = 0.004) for late‐finishing duties compared with early‐starting duties (Samn‐Perelli: EMM = 3.74, SE = 0.08; Response speed: EMM = 4.37, SE = 0.08), but had shorter sleep before early‐starting duties (early: EMM = 6.94, SE = 0.10; late: EMM = 8.47, SE = 0.14, p < 0.001). However, pre‐duty Samn‐Perelli and response speed were worse (z = 4.18, p < 0.001; z = 3.05, p = 0.03; respectively) for early starts compared with late finishes (EMM = 2.74, SE = 0.19), while post‐duty Samn‐Perelli was worse for late finishes (EMM = 4.74, SE = 0.19) compared with early starts (EMM = 4.05, SE = 0.12). The results confirm that duty time has a strong influence on self‐reported fatigue and performance. Thus, all flights that encroach on a biological night are targets for fatigue risk management oversight.

Impact of Recent Job Loss on Sleep, Energy Consumption and Diet.

Adequate sleep and self reported dietary recall data from the Assessing Daily Activity Patterns through Occupational Transitions (ADAPT) study was analysed. Primary sleep indices used were total sleep time, time spent in bed after final awakening, and sleep quality as measured by the Daily Sleep Diary (DSD). Mean Energy consumption (MEC) was the primary nutritional index. Secondary indices included diet quality using the Health Eating Index 2015 (HEI), and self-reported intake of protein, carbohydrates and fats. The study participants were comprised mainly of women (61%) and non-Hispanic white. The participants had at least 2 years of college education and mean body mass index of 30.2±8.08 (kg/m 2). The average time in bed was 541.8 (9.0 hrs) ±77.55 minutes and total sleep time was 461.1 (7.6 hrs) ±56.49 minutes. Mean sleep efficiency was 91±6%, self-reported sleep quality was 2.40±0.57 (0-4 scale, 4 = very good), and minutes earlier than planned morning awakening were 14.36±24.15. Mean HEI score was 47.41±10.92. Although the MEC was below national average for both men and women, male sex was associated with higher MEC. In a fully adjusted model sleep quality was positively associated with MEC. Daily overall assessments of sleep quality among recently unemployed persons were positively associated with mean energy consumption. Additionally, the diet quality of unemployed persons was found to be unhealthier than the average American and consistent with the relationship between poor socioeconomic status and lower diet quality.

Does chronotype explain daily timing of music behaviors?

ABSTRACT We addressed how circadian rhythms influence daily musical activities of performing musicians, who exhibit fine temporal control. Music performances often occur in the evening and late at night; evidence suggests that composing musicians tend to be later chronotypes than non-composing musicians. However, chronotype and daily music-making in performing musicians have yet to be investigated. The current study examined chronotype in actively practicing and/or performing musicians and non-musicians, and whether it was related to the daily timing of music performance. To test influences of daily changes due to the global COVID-19 pandemic, disruptions to musical, athletic, social, and sleep habits were also measured. Performing musicians, active (practicing but non-performing) musicians, inactive musicians, and non-musicians, residing in Canada, completed a 7-day online daily activity and sleep diary in Summer 2020. There were more evening chronotypes than morning chronotypes in the sample. Active/performing musicians tended to be earlier chronotypes than all other groups. Musicians’ chronotype, but not nightly sleep timing, predicted the time of day that musicians made music: Late chronotypes made music later in the day and early chronotypes made music earlier in the day. Music performance and practice amount decreased during the COVID-19 period, but the daily timing of these activities did not change. All participants reported later sleep onset during the COVID-19 period; the amount of social interaction decreased during the COVID-19 period, while exercise increased for some and decreased for others. No changes in the daily timing of exercise, social interaction, or morning wake-up were reported. These findings suggest that performing musicians may be slightly earlier chronotypes than non-performing musicians and non-musicians, despite music performances often occurring in the evening. Chronotype was related to the time of day of music-making independent of nightly sleep timing, suggesting that times of day for making music reflect an individual’s circadian rhythm.

O028 Effectiveness of digital brief behavioural therapy for insomnia with wearable technology: pilot randomized controlled trial

Abstract Objective This pilot trial aimed to test the effectiveness of integration of a wearable device with digital brief behavioural therapy for insomnia (dBBTi) on insomnia symptom severity, sleep metrics and therapy engagement. Participants and Methods One hundred and twenty-eight participants with insomnia symptoms were randomised to a 3-week dBBTi program with a wearable device enabling sleep data synchronization (dBBTi+wearable group; n = 62) or dBBTi alone (n = 66). We assessed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI; wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST)) at baseline and weeks 1, 2, 3, 6 and 12. Engagement was measured by the number of daily sleep diaries. Results There was no significant difference in ISI scores between the groups (d = 0.7, p = 0.061). The dBBTi+wearable group showed greater improvements in WASO (d = 0.8, p = 0.005) and TST (d = 0.3, p = 0.049) compared to the dBBTi group after 6 weeks. There was significantly greater engagement in the dBBTi+wearable group compared to the dBTi group (d =0.7, p = 0.010). Conclusions This pilot trial found that wearable device integration with a digital insomnia therapy led to improvements in WASO and TST and enhanced user engagement. We suggest that incorporation of adjunctive wearable technologies may improve digital insomnia therapy.

Greater time in bed and less physical activity associate with poorer cognitive functioning performance in Huntington's disease.

Objective: This study aimed to investigate how sleep and physical activity habits related to cognitive functioning, in naturalistic settings, in early Huntington's disease (HD). Method: Forty-two participants with the expanded HD repeat (20 manifest, 22 premanifest) and 29 healthy controls wore Fitbit One sleep and activity monitors for 7 days and 7 nights. They used a smartphone application to complete daily sleep and activity diaries, sleep and mood inventories, and a brief battery of cognitive tests, which were completed on Day 8 of the study. All data were collected in naturalistic home and community settings. Results: Amongst participants with the expanded HD repeat, greater time spent in bed, measured by Fitbit, was associated with poorer accuracy and response speed on a test of visual memory, whereas lower levels of physical activity, measured by Fitbit, were associated with poorer accuracy on a test involving a working memory component. Neither time in bed nor physical activity is associated with a test of psychomotor speed. Groups were mostly similar across a range of Fitbit and self-report measures of sleep and physical activity, although the Manifest-HD group spent more time in bed than the Premanifest-HD and Healthy Control groups and had better self-reported sleep quality and more self-reported time spent sitting than the Healthy Control group and the Premanifest-HD group, respectively. Conclusions: Sleep timing and physical activity relate to cognitive functioning in HD and may be important targets for management in behavioral intervention studies aimed at improving cognition in HD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial

ABSTRACT Objective This pilot trial aimed to provide evidence for whether the integration of a wearable device with digital behavioral therapy for insomnia (dBTi) improves treatment outcomes and engagement. Participants and Methods One hundred and twenty-eight participants with insomnia symptoms were randomized to a 3-week dBTi program (SleepFix®) with a wearable device enabling sleep data synchronization (dBTi+wearable group; n = 62) or dBTi alone (n = 66). Participants completed the Insomnia Severity Index (ISI) and modified Pittsburgh Sleep Quality Index (PSQI) parameters: wake-after-sleep-onset (WASO), sleep-onset-latency (SOL), and total sleep time (TST) at baseline and weeks 1, 2, 3, and primary endpoint of week 6 and follow-up at 12 weeks. Engagement was measured by the number of daily sleep diaries logged in the app. Results There was no difference in ISI change scores between the groups from pre- to post-treatment (Cohen’s d= 0.7, p= .061). The dBTi+wearable group showed greater improvements in WASO (d= 0.8, p = .005) and TST (d= 0.3, p= .049) compared to the dBTi group. Significantly greater engagement (sleep diary entries) was observed in the dBTi+wearable group (mean = 22.4, SD = 10.0) compared to the dBTi group (mean = 14.1, SD = 14.2) (p = .010). Conclusions This pilot trial found that integration of wearable device with a digital insomnia therapy enhanced user engagement and led to improvements in sleep parameters compared to dBTi alone. These findings suggest that adjunctive wearable technologies may improve digital insomnia therapy effectiveness.