Daytime Impairment Research Articles

0466 Living Alone as a Predictor of Symptom Change During Cognitive Behavioral Therapy for Insomnia

Abstract Introduction Interpersonal factors have implications for sleep quality. Research has begun to explore how such factors may play a role in cognitive behavioral therapy for insomnia (CBTI). This study investigated whether living alone predicts reductions in insomnia severity and sleep-related daytime impairment across the first two months of treatment in a trial of CBTI. Methods Participants were 224 middle-to-older-aged adults with insomnia (166 women, M age = 63.16) enrolled in the ongoing Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING). All study participants received CBTI, delivered either via a therapist or a validated software program. At baseline, participants indicated whether they lived alone or with at least one other person. The Insomnia Severity Index (ISI) and PROMIS Sleep-Related Impairment (SRI) short form were administered at baseline and two months after starting treatment. Mixed effects models assessed whether living alone predicted reduction in symptoms across the first two months of CBTI. Results Across the total sample, ISI scores decreased from baseline to two months (β=-3.52, SE=0.35, p<.001, 95% CI=-4.20, -2.84). Living alone was not associated with baseline ISI scores nor change in ISI score. A reduction in PROMIS SRI score was also observed in the total sample from baseline to two months (β=-4.18, SE=0.50, p<.001, 95% CI=-5.15, -3.21). Living alone was not associated with baseline SRI score, but it did predict reduction in SRI score (β=-3.23, SE=0.88, p=.001, 95% CI=1.31, 5.15). Participants living alone displayed less reduction in SRI compared to those living with at least one other person. Conclusion Participants undergoing CBTI who live alone experienced reduction in insomnia severity over the course of treatment, but they displayed less improvement in daytime sequalae of poor sleep compared to those living with others. Future studies should further explore how living status contributes to insomnia treatment response across both nighttime and daytime sleep symptomology. Regular engagement with others living in the home may be important for insomnia treatment to translate into perceived functional improvements during the day. Support (If Any) 1R01AG057500

MO864: Sleep Disorders in a Haemodialysis Unit

Abstract BACKGROUND AND AIMS There is a high prevalence of sleep disorders in patients with CKD. Sleep apnea, restless legs syndrome and daytime sleepiness are much more common in haemodialysis patients than the general population. OBJECTIVE To know the prevalence of sleep problems in patients in our hospital haemodialysis unit through surveys carried out on patients. METHOD We designed a cross-sectional study on the prevalence of sleep disorders. Exclusion criteria age under 18 years. We gave 4 questionnaires to the patients in our unit: restless legs, Epworth daytime sleepiness, Berlin and Pittsburg Sleep quality. We collected demographic and clinical variables, dialysis parameters and laboratory data that could be related. Student's t-test and X-squared were applied for qualitative variables. SSps Version 15.0. RESULTS Of those surveyed, 12 had criteria for restless leg syndrome. The difference between ferritin and CRP among the RLS group was striking. Excessive daytime sleepiness is met in 10 patients. Only the CRP values were significantly higher in the group with the normal test. When associating the Epworth test and the Berlin questionnaire, we had a total of 3 patients with high risk of OSAS. 15 patients meet the criteria for poor quality of sleep in the Pittsburg questionnaire where we assess: quality, latency, efficacy and duration of sleep as well as use of medication and daytime impairment. CONCLUSION Highlight the high prevalence of sleep disorders: 24% restless leg syndrome, 20% daytime sleepiness and 30% with poor sleep quality. We must assess sleep disorders in haemodialysis patients since they present a significant deterioration in quality of life.

Insomnia disorder diagnosed by resting-state fMRI-based SVM classifier

BackgroundThe main classification systems of sleep disorders are based on the subjective self-reported criteria. Objective measures are essential to characterize the nocturnal sleep disturbance, identify daytime impairment, and determine the course of these symptoms. The aim of this study was to establish a resting-state fMRI-based support vector machine (SVM) classifier to diagnose insomnia disorder. MethodsWe enrolled 20 patients with insomnia disorder and 21 healthy controls, and obtained their simultaneous polysomnographic electroencephalography and functional magnetic resonance imaging (EEG-fMRI) recordings. The SVM classifiers were trained to capture insomnia. Classifier performance was quantified by a 5-fold cross validation and on independent test dataset. ResultsThe fMRI-based SVM classifier was able to diagnose insomnia with an accuracy of 89.3% (sensitivity of 90.9%, specificity of 87.7%). The robustness of SVM classifier was encouraging. ConclusionsWe established an encouraging resting-state fMRI-based SVM classifier to automatically diagnose insomnia disorder. As an objective measure for assessing insomnia disorder, it would be of additional value to the current self-reported subjective criteria.

Insomnia disorder: State of the science and challenges for the future.

Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self-report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive-behavioural models to (epi-) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep-wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive-behavioural models of insomnia led to the conceptualization of cognitive-behavioural therapy for insomnia, which is now considered as first-line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive-behavioural therapy for insomnia merits widespread implementation, and digital cognitive-behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive-behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non-response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.

Insomnia Prevalence Varies with Symptom Criteria Used with Implications for Epidemiological Studies: Role of Anthropometrics, Sleep Habit, and Comorbidities.

IntroductionEstimating insomnia prevalence in epidemiological studies is hampered by variability in definitions and interpretation of criteria. We addressed the absence of a population-based estimate of insomnia in Australia using the widely accepted contemporary International Classification of Sleep Disorders (ICSD-3) criteria, which includes sleep opportunity, and has not been applied in studies to date. Consistent use of these criteria across epidemiological studies, however, requires evidence of the clinical utility of a sleep opportunity criterion for targeting strategies.MethodsA cross-sectional national on-line survey (2019 Sleep Health Foundation Insomnia Survey) of Australian adults (18–90 years, n = 2044) was conducted. Chronic insomnia was defined as sleep symptoms and daytime impairment experienced ≥3 times per week, and present for ≥3 months, with adequate sleep opportunity (time in bed (TIB) ≥7.5 hrs). Self-rated general health (SF-1) and ever diagnosed health conditions (including sleep disorders) were assessed.ResultsChronic difficulties initiating and maintaining sleep and daytime symptoms (n = 788) were more common in females (41.5%) than males (35.3%), p = 0.004. Excluding participants reporting frequent pain causing sleep disruption and TIB <7.5 hrs generated an insomnia disorder estimate of 25.2% (95% CI: 22.5–28.2) in females and 21.1% (18.4–23.9) in males [23.2% (21.2–25.2) overall]. This compares with 8.6% (7.3–10.0) with insomnia symptoms and TIB <7.5 hrs and 7.5% (6.4–8.7%) ever diagnosed with insomnia. Insomnia symptom groups with TIB <7.5 and ≥7.5 hours demonstrated similar odds of reporting fair/poor health [odds ratio (OR): 3.2 (95% CI: 2.1–4.8) and 2.9 (95% CI: 2.2–3.9) respectively], ≥1 mental health condition, ≥1 airway disease, and multimorbidity.ConclusionAdults with significant sleep and daytime symptomatology and TIB <7.5 hrs did not differ clinically from those with insomnia disorder. Consideration of criteria, particularly adequate sleep opportunity, is required to consistently identify insomnia, and establish health correlates in future epidemiological studies. Further evaluation of the clinical utility of the sleep opportunity criterion is also required.

Intraforaminal cervical gas cyst with vacuum disc treated by anterior cervical discectomy and fusion: illustrative case.

BACKGROUNDThe authors report an extremely rare presentation of a patient with an intraforaminal cervical gas cyst with radiculopathy. The patient’s condition was refractory to conservative treatment, and he was treated by anterior cervical discectomy and fusion (ACDF). Several intraspinal gas cysts with lumbar disc herniation have been treated surgically. However, no cases of intraforaminal cervical gas requiring ACDF have been reported.OBSERVATIONSA 70-year-old male patient presented with right-sided neck and shoulder pain, aggravating in the supine position. Cervical radiography showed vacuum disc phenomenon at C4–5, and multiplanar computed tomography showed intraforaminal gas along the right C5 nerve root. The patient experienced severe pain with impaired sleep and daytime fatigue. After confirming C5 radiculopathy using an echo-guided technique using ultrasonography guidance, the authors performed C4–5 ACDF. Postoperatively, the patient’s neck and shoulder pain disappeared immediately. There was no recurrence at the 2-year follow-up.LESSONSThis is the first case report of an intraspinal cervical gas cyst with radiculopathy treated by ACDF surgery. The vacuum disc had been implicated as the genesis of the intraforaminal cervical gas cyst, leading to radiculopathy. ACDF surgery provides favorable outcomes in cases of intraspinal gas refractory to conservative therapy.

A network analysis of rest-activity rhythms in young people with emerging bipolar disorders

AimsActigraphy studies of individuals with bipolar disorders (BD) suggest that illness progression may be associated with a range of progressive disruptions in 24-hour rest-activity rhythms (RAR). However, those longitudinal studies were undertaken in older adults with extended histories or illness and treatment rather than young people with emerging BD. To our knowledge, this is the first study to use network modelling to examine the statistical associations between clinical phenotypes of BD and different subsets of RAR markers. MethodsThis study of adolescents and young adults (mean age 22 years; 69% female) uses network modelling to examine which self-rated or actigraphic markers of RAR are more strongly associated with full threshold BD (referred to as Stage 2; N = 15) compared with BD-at risk syndromes (subthreshold presentations referred to as Stage 1; N = 25). ResultsNetwork analysis demonstrated that some RAR are associated with both stage of BD and a family history of BD (such as longer sleep duration and higher levels of daytime impairment). Markers of circadian rhythmicity indicated that regulation of this system is weaker in Stage 2 compared with Stage 1 of BD. LimitationsThe small subgroup samples may have undermined the ability to detect some associations between phenotypes and RAR. ConclusionsNetwork modelling may offer a useful strategy for visualizing and analysing patterns of association between RAR and clinical phenotypes defined by stage of illness, familial loading or symptom profile. This could prove useful in understanding the underlying pathophysiology of sleep-wake cycle and circadian rhythm disturbances in BD.

The association of co-morbid insomnia and sleep apnea with prevalent cardiovascular disease and incident cardiovascular events.

Insomnia and obstructive sleep apnea commonly co-occur (co-morbid insomnia and sleep apnea), and their co-occurrence has been associated with worse cardiometabolic and mental health. However, it remains unknown if people with co-morbid insomnia and sleep apnea are at a heightened risk of incident cardiovascular events. This study used longitudinal data from the Sleep Heart Health Study (N = 5803) to investigate potential associations between co-morbid insomnia and sleep apnea and cardiovascular disease prevalence at baseline and cardiovascular event incidence over ~11years follow-up. Insomnia was defined as self-reported difficulties initiating and/or maintaining sleep AND daytime impairment. Obstructive sleep apnea was defined as an apnea-hypopnea index ≥ 15 events per hr sleep. Co-morbid insomnia and sleep apnea was defined if both conditions were present. Data from 4160 participants were used for this analysis. The prevalence of no insomnia/obstructive sleep apnea, insomnia only, obstructive sleep apnea only and co-morbid insomnia and sleep apnea was 53.2%, 3.1%, 39.9% and 1.9%, respectively. Co-morbid insomnia and sleep apnea was associated with a 75% (odd ratios [95% confidence interval]; 1.75 [1.14, 2.67]) increase in likelihood of having cardiovascular disease at baseline after adjusting for pre-specified confounders. In the unadjusted model, co-morbid insomnia and sleep apnea was associated with a twofold increase (hazard ratio, 95% confidence interval: 2.00 [1.33, 2.99]) in risk of cardiovascular event incidence. However, after adjusting for pre-specified covariates, co-morbid insomnia and sleep apnea was not significantly associated with incident cardiovascular events (hazard ratio 1.38 [0.92, 2.07]). Comparable findings were obtained when an alternative definition of insomnia (difficulties initiating and/or maintaining sleep without daytime impairment) was used.

Self-administered acupressure for insomnia disorder: A randomized controlled trial

BackgroundInsomnia is a significant health problem in the community. Self-administered acupressure (SAA) may be an alternative strategy to alleviate insomnia. PurposeThis study is the first to investigate the effects of SAA delivered through a training course in alleviating insomnia disorder compared with sleep hygiene education (SHE). MethodsA randomized controlled trial was conducted on 200 participants with insomnia disorder. The eligible participants were randomized into the SAA or SHE group. Both groups attended the allocated training courses (two sessions, 2 h each) and then were followed up at weeks 4 and 8. The primary outcome was the severity of insomnia symptoms and related daytime impairment as measured by the Insomnia Severity Index (ISI). Other measures included a 7-day sleep diary and actigraphy, Hospital Anxiety and Depression Scale (HADS), and Short-Form Six-Dimension (SF6D). ResultsThe SAA group showed a significantly greater improvement in ISI score than the SHE group at week 4 (mean difference: -1.89 units, 95% CI: 0.85, 2.93; Cohen's d = 0.51, p < 0.001) and week 8 (mean difference: -2.89 units, 95% CI: 1.67, 4.11; d = 0.67, p < 0.001). In addition, the SAA group showed a greater reduction in the HADS anxiety score and HADS depression score and increase in SF6D at week 8. ConclusionsSAA taught in a short training course is a feasible and effective approach to improve sleep and related daytime impairment and mood problems in individuals with insomnia disorder.

Comorbid insomnia and sleep apnoea is associated with all-cause mortality.

Increased mortality has been reported in people with insomnia and in those with obstructive sleep apnoea (OSA). However, these conditions commonly co-occur and the combined effect of comorbid insomnia and sleep apnoea (COMISA) on mortality risk is unknown. This study used Sleep Heart Health Study (SHHS) data to assess associations between COMISA and all-cause mortality risk. Insomnia was defined as difficulties falling asleep, maintaining sleep and/or early morning awakenings from sleep ≥16 times per month, and daytime impairments. OSA was defined as an apnoea-hypopnoea index ≥15 events·h-1. COMISA was defined if both conditions were present. Multivariable adjusted Cox proportional hazards models were used to determine the association between COMISA and all-cause mortality (n=1210) over 15 years of follow-up. 5236 participants were included. 2708 (52%) did not have insomnia/OSA (reference group), 170 (3%) had insomnia-alone, 2221 (42%) had OSA-alone and 137 (3%) had COMISA. COMISA participants had a higher prevalence of hypertension (OR 2.00, 95% CI 1.39-2.90) and cardiovascular disease (CVD) (OR 1.70, 95% CI 1.11-2.61) compared with the reference group. Insomnia-alone and OSA-alone were associated with higher risk of hypertension but not CVD compared with the reference group. Compared with the reference group, COMISA was associated with a 47% (hazard ratio 1.47, 95% CI 1.06-2.07) increased risk of mortality. The association between COMISA and mortality was consistent across multiple definitions of OSA and insomnia. COMISA was associated with higher rates of hypertension and CVD at baseline, and an increased risk of all-cause mortality compared with no insomnia/OSA.

The negative health effects of having a combination of snoring and insomnia.

Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. The study population comprised 25,901 participants (16-75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported ≥ 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3-2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6-2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1-8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1-9.1) was highest for the group with both insomnia symptoms and snoring. Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia. Hägg SA, Ilieva E, Ljunggren M, etal. The negative health effects of having a combination of snoring and insomnia. J Clin Sleep Med. 2022;18(4):973-981.

Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up.

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. Frøjd LA, Papageorgiou C, Munkhaugen J, etal. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

P073 Co-morbid insomnia and obstructive sleep apnoea is associated with all-cause mortality and cardiovascular event risk

Abstract Introduction Co-morbid insomnia and sleep apnoea (COMISA) is a highly prevalent and debilitating condition. Previous studies have investigated associations between insomnia and mortality, and OSA and mortality, but not COMISA. Thus, this study investigated associations between OSA, insomnia and COMISA on mortality and cardiovascular event risks. Methods Sleep Heart Health Study data (n = 5803) were used to identify people with insomnia defined as difficulties falling asleep, maintaining sleep, and/or early morning awakenings from sleep at least 5 times a month and daytime impairment. OSA was defined as an apnoea-hypopnoea index ≥15 events/h. COMISA was defined if both conditions were present. Cox proportional hazard models were used to determine the association between COMISA and all-cause mortality (n = 1210) and cardiovascular events (N = 1243) over 15 years of follow-up. Results This analysis included 5236 participants. 2504 (47.8%) did not have insomnia/OSA, 374 (7.1%) had insomnia-alone, 2027 (38.7%) had OSA-alone, and 331 (6.3%) had COMISA. Compared to participants with no insomnia/OSA, COMISA was associated with a 32% (HR, 95%CI; 1.32 (1.06, 1.64)) and 38% (1.38 (1.11, 1.71)) increased risk of mortality and cardiovascular events, respectively. Insomnia-alone and OSA-alone were not associated with all-cause mortality or cardiovascular event risk. Conclusions Participants with COMISA have decreased longevity and increased cardiovascular event risks compared to participants with no insomnia or OSA. It remains to be determined if these associations are causal and whether treatment of insomnia, OSA, or combination treatment can effectively decrease mortality and/or cardiovascular event risks in individuals with COMISA.

P053 Management of insomnia by Australian psychologists

Abstract Introduction Insomnia is the most common sleep disorder, 10–30% of adults have regular difficulties falling and/or staying asleep that cause significant daytime impairments. General Practitioner (GP) clinical guidelines recommend Cognitive Behavioural Therapy for insomnia (CBTi) as the first-line treatment rather than medications. However, most GPs do not have the time or training to administer CBTi, and consequently, many patients are prescribed sedative-hypnotic medicines. Psychologists have training in CBT and may be well placed to deliver behavioural therapy for insomnia. However, the amount of sleep-specific training, and knowledge of CBTi among Australian psychologists remains unknown. Identifying key barriers and enablers in the management of insomnia within psychology provides a first step in engaging with psychologists about the delivery of evidence-based insomnia treatment. Methods This qualitative study used a pragmatic inductive approach. Semi-structured interviews were conducted with 26 Australian psychologists. Interviews included case study scenarios to provide an in-depth exploration of psychologists’ knowledge and skills in the management of insomnia, and attitudes towards further training in CBTi. Interview transcripts were analysed using thematic analysis to identify themes. Results Preliminary themes identified in the data include; psychologists believe sleep is important for general well-being, insomnia is usually seen as secondary to other co-morbid disorders such as depression and anxiety that are the focus of treatment, most psychologists surveyed lack training and knowledge in CBTi. Discussion Most Australian psychologists are not well prepared to manage insomnia effectively with CBTi. Along with other primary health care professionals, psychologists need training in the management of insomnia.

P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum

Abstract Introduction Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points. Methods Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p&amp;lt;.001); chronotype shifted progressively towards more morningness (p&amp;lt;.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values&amp;lt;.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values&amp;gt;0.65). Conclusions Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.

27.2 COGNITIVE-BEHAVIORAL INTERVENTION FOR INSOMNIA

Insomnia is a sleep disturbance characterized by prolonged sleep onset, frequent awakenings and arousals, reduced sleep efficiency, and related daytime impairment, occurring at least 3 nights a week for a period of 3 months. The prevalence of insomnia increases with the progression of puberty and therefore increases significantly in adolescence, reaching a reported prevalence of 23.8%. CBT for insomnia (CBT-I) is the first-line treatment for insomnia. The objectives of this presentation are to briefly describe when and for whom this treatment is indicated, the strong evidence for this treatment, and its behavioral and cognitive components.

Improvements in Sleep Quality and Duration Following a Meditation Retreat: an Open-Trial Pilot Study

PurposeDisturbed sleep and other sleep-related problems have a negative impact on the human mind and body. Meditation practices are reported to improve physiological functions and might also have a positive impact on regulating sleep. This research investigates the efficacy of an advanced mind–body medicine intervention, called Hollow and Empty Meditation (HEM), on improving sleep quality.MethodsThe study was a single-arm open-trial pilot study which assessed 413 adults who underwent a 4-day meditation retreat offered by the Art of Living, called the Advanced Meditation Program (AMP), and experienced a novel meditation—HEM. Results were measured using a self-report questionnaire, the Pittsburgh Sleep Quality Index (PSQI), which was administered to the participants thrice: on the first day of the program (pre-intervention), immediately after program (post-intervention/Day 4), and on Day 40 (D40) after the program.ResultsThere was a significant difference in pre–post and pre–D40 scores in the population. Both sleep quality and sleep duration showed an improvement immediately after the AMP (post), and the residual impact was still experienced at D40, especially with the group with age > 36 years.ConclusionsThe use of HEM resulted in improvement in sleep quality not just immediately after the program, but had longer-term effects that extended over several weeks, helping remediate sleep problems among younger adults as well as older ones. It resulted in improvement in sleep quality as well as reduction in sleep-related daytime impairment, which have substantial constructive implications for well-being, everyday functioning and quality of life.

The efficacy of integrated cognitive behavioral therapy (CBT) and acupressure versus CBT for insomnia: a three-arm pilot randomized controlled trial

ObjectivesThis pilot study aimed to examine the efficacy of integrated cognitive behavioral therapy (CBT) and acupressure in treating insomnia and its daytime impairments in a Chinese adult population. Methods40 eligible participants with insomnia were randomly assigned to either the integrated CBT and acupressure (CBTAcup) group (n = 14), the CBT group (n = 13), or the waitlist control (WL) group (n = 13). Participants in the CBTAcup group attended a 2-hour integrated CBT and self-administered acupressure group treatment once per week for six consecutive weeks, while participants in the CBT group attended six weekly 2-hour CBT for insomnia. Sleep, mood, daytime impairments, quality of life, and treatment credibility and adherence were assessed at baseline, immediate post-treatment (Week 7), and 4-week post-treatment (Week 11). ResultsLinear mixed-effects models showed that both the CBTAcup and CBT groups had significantly lower insomnia severity (d = −1.74 and d = −2.61), dysfunctional beliefs related to sleep (d = −2.17 and −2.76), and mental fatigue (d = −1.43 and −1.60) compared with the WL group at Week 7. The CBTAcup group provided additional benefits in reducing total fatigue (d = −1.43) and physical fatigue (d = −1.45). Treatment credibility was found to be improved in the CBTAcup group from baseline to Week 7. ConclusionsIntegrated CBT and acupressure demonstrated comparable efficacy to pure CBT in treating insomnia symptoms, with additional advantages to improve fatigue symptoms and acceptability in the Chinese population. Further methodologically rigorous studies on a larger scale and longer follow-up are warranted to confirm these findings.

Clinical Characteristics of Older Adults Seeking Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is a common sleep disorder with numerous clinical correlates. Although effective treatments abound, patient acceptance and adherence is low. Hypoglossal nerve stimulation (HNS) is a surgical treatment alternative for the treatment of OSA; however, the demographic and clinical characteristics of individuals seeking HNS are not well categorized. This study sought to determine the clinical characteristics of older adults seeking HNS for the treatment of OSA. Self-report questionnaires were administered to all patients older than 50 years seeking a HNS consultation at a large university medical center. Questionnaires included validated National Institutes of Health Patient-Reported Outcomes Measurement Information System (NIH PROMIS) measures of physical functioning, sleep-related impairment, cognitive abilities, depression, anxiety, and anger along with the Information extracted from electronic medical records included age, sex, race, and apnea-hypopnea index (AHI). Patients included 113 adults (mean age 63.30 years, 57% male, 79% white) with severe OSA (AHI = 33.91, standard deviation = 20.63). Overall, 88% of patients reported elevated insomnia symptoms, 30% reported mild difficulty with physical functioning, and 36% indicated that they had experienced moderate-severe daytime impairments attributed to poor sleep. Additionally, we found 28% of sampled individuals reported moderate-severe depressive symptomology, over 19% reported moderate-severe anxiety, and over 17% reported moderate to severe anger issues. Approximately, 38% of the sample reported moderate to severe cognitive difficulties. The aim of the study was to better understand the clinical characteristics of older patients with OSA seeking HNS treatment. Utilizing NIH PROMIS questionnaires, we identified unique clinical and psychosocial correlates in this sample, which included higher rates of insomnia symptoms, physical dysfunction, cognitive deficits, and depressive symptoms than the general population. Future studies will be needed to investigate these relationships more thoroughly and throughout the course of the treatment.

Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies.

Chronic insomnia disorder, which affects 6–10% of the population, is diagnostically characterized by ongoing difficulties with initiating or maintaining sleep occurring at least three times per week, persisting for at least 3 months, and associated with daytime impairment. While chronic insomnia is often considered a condition primarily related to impaired sleep, the disorder can also adversely affect domains of physical and mental health, quality of life, and daytime function, which highlights the importance of treating the multidimensional sleep disorder. Owing to misperceptions about the safety and effectiveness of treatment options, many individuals with insomnia may not seek professional treatment, and alternatively use ineffective home remedies or over-the-counter medications to improve sleep. Some physicians may even believe that insomnia is remediated by simply having the patient “get more sleep”. Unfortunately, treatment of insomnia is not always that simple. The disorder’s complex underlying pathophysiology warrants consideration of different nonpharmacologic and pharmacologic treatment options. Indeed, recent insights gained from research into the pathophysiology of insomnia have facilitated development of newer treatment approaches with more efficacious outcomes. This narrative review provides a summary of the diagnostic criteria and pathophysiology of insomnia and its subtypes. Further, this review emphasizes new and emerging nonpharmacologic and pharmacologic treatments for chronic insomnia, including recent enhancements in approaches to cognitive behavioral therapy for insomnia (CBT-I) and the new dual orexin receptor antagonist (DORA) pharmacologics. These advances in treatment have expanded the treatment options and are likely to result in improved outcomes in patients with chronic insomnia.