Early Awakening Research Articles

Positive Association Between Sleep Disturbance and Prevalence of Functional Dyspepsia in Japanese Young People.

Evidence regarding the association between sleep disturbance and functional dyspepsia (FD) remains limited in the young population. This study aimed to investigate the association between sleep disturbance and FD including subgroups among Japanese young people. Study subjects were 8923 university students. FD was defined according to the Rome III criteria. Subjects with FD were further categorized as having postprandial distress syndrome (PDS) or epigastric pain syndrome (EPS). Subjects completed a self-reported questionnaire assessing self-reported sleep duration, sleep disturbance, difficulty falling asleep, deep sleep disorder, nocturnal awakening, early awakening, and daytime sleepiness. The prevalence of FD was 1.9%. After adjustment, all types of sleep disturbances were independently positively associated with FD (total sleep disturbance: OR 4.11 [95% CI: 2.89-5.78], difficulty falling asleep: OR 3.97 [95% CI: 2.53-6.01], deep sleep disorder: OR 4.85 [95% CI: 3.06-7.40], nocturnal awakening: OR 4.35 [95% CI: 1.90-8.67], early awakening: OR 4.50 [95% CI: 1.97-8.97], and daytime sleepiness: OR 2.83 [95% CI: 1.25-5.56]). While nocturnal awakening and daytime sleepiness were not associated with EPS, the other types of sleep disturbance were independently positively associated with EPS and PDS. No association between self-reported sleep duration and FD was found. Sleep disturbance may be independently positively associated with the prevalence of FD among Japanese young people. Nocturnal awakening and daytime sleepiness were not associated with EPS; the other types of sleep disturbance were independently positively associated with EPS and PDS.

Assessment of Psychomotor Recovery after Etomidate and Propofol Induction: A Randomized Double-Blind Trial

Background: The very idea of faster recovery and early ambulation has prompted patients to opt for day care surgeries. The concept of ERAS (enhanced recovery after surgery) is the backbone to achieve this goal. We conducted this study with primary objective to compare the post-operative recovery with etomidate and propofol in terms of early recovery (awakening), intermediate recovery (psychomotor and cognitive recovery) and ambulation “home readiness” and secondary objective to study the adverse effects. Methods: 60 eligible patients scheduled for day care gynaecological procedures were randomised in two groups of 30 each. Group E received etomidate 0.2mg/kg and group P received propofol 2mg/kg. Early, intermediate and late postoperative recovery (ambulation) was studied in both groups. Results: Demography between the groups were comparable while hemodynamic fluctuations were more with propofol (p>0.05), early recovery was faster with etomidate (p = 0.07), psychomotor tests revealed better alertness with etomidate (p= 0.1) and patient could ambulate earlier in etomidate group. Conclusion: Both propofol and Etomidate facilitate early recovery but etomidate provides hemodynamic stability with early awakening, more alert patients and better ambulation and was found to be superior for day care surgeries.

Seasonal variations in sleep duration and sleep complaints: A Swedish cohort study in middle-aged and older individuals.

Subjective sleep reports are widely used research tools in epidemiology. Whether sleep reports can differ between seasons is less clear. Using multivariable binary or multinomial logistic regression analyses, in the present Swedish cross-sectional two-centre cohort study (N=19,254; mean age 61years), we found that participants surveyed during the summer (June-August) were more likely to report short sleep duration (defined as ≤ 6hr) compared with those interviewed during the autumn (odds ratio [95% confidence interval]=1.14 [1.04-1.25]). Individuals interviewed in the winter (December-February) were less likely to report early awakenings compared with participants surveyed in the autumn (September-November; odds ratio [95% confidence interval]=0.85 [0.75-0.96]). Complaints of difficulties in falling asleep and disturbed sleep were less common among participants interviewed during spring (March-May) compared with those interviewed during the autumn (odds ratio [95% confidence interval]=0.86 [0.74-0.99] and 0.88 [0.79-0.98], respectively). No seasonal variations in reports of long sleep, difficulty maintaining sleep, or feeling not rested after sleep were observed. Additional subgroup analysis revealed that summer participants were more likely to report short sleep duration and early morning awakenings than individuals surveyed in winter. In conclusion, this Swedish study indicates that self-reported sleep characteristics may vary across seasons. Further studies are needed to confirm our findings.

Pacifist Prophet: Papunhank and the Quest for Peace in Early America

Pacifist Prophet: Papunhank and the Quest for Peace in Early America

Pacifist Prophet: Papunhank and the Quest for Peace in Early America

Pacifist Prophet: Papunhank and the Quest for Peace in Early America

Do sleep changes mediate the anti-depressive and anti-suicidal response of intravenous ketamine in treatment-resistant depression?

Sleep disturbances are commonly reported in patients with treatment-resistant depression (TRD). Available data have shown that intravenous (IV) ketamine is an effective treatment for patients with TRD and growing data suggest ketamine may improve overall sleep architecture. In the present study, we evaluated whether changes in sleep symptoms mediated the anti-depressive and/or anti-suicidal effects of IV ketamine and whether improvement in sleep correlated with a higher likelihood of achieving response or remission. Adults with TRD received four infusions of IV ketamine at a community-based clinic. Total depressive symptom severity was measured with the Quick Inventory Depressive Symptoms Self-Report 16-Item (QIDS-SR16 ) at baseline and was repeated across four infusions. Suicidal ideation (SI) and four sleep symptoms were measured using the SI item and the five sleep items on the QIDS-SR16 . A total of 323 patients with TRD received IV ketamine. Self-reported improvements in insomnia, night-time restlessness, hypersomnia, early morning waking, and total sleep were significant partial mediators to the improvements observed in depression severity. Similarly, insomnia, night-time restlessness, early morning waking and total sleep improvements mediated the reduction of IV ketamine on SI. All sleep items, except for hypersomnia, were associated with an increased likelihood of achieving response or remission. Notably, each point improvement in total sleep score was significantly associated with achieving responder/remitter status (odds ratio 3.29, 95% confidence interval 2.00-5.41). Insomnia, sleep restlessness, early morning waking and total sleep improvements were significant mediators of antidepressant and anti-suicidal improvements in patients with TRD receiving IV ketamine.

Association between sleep quality and type 2 diabetes at 20-year follow-up in the Southall and Brent REvisited (SABRE) cohort: a triethnic analysis

BackgroundThe risk of developing type 2 diabetes associated with poor sleep quality is comparable to other lifestyle factors (eg, overweight, physical inactivity). In the UK, these risk factors could not...

Optimization of light exposure and sleep schedule for circadian rhythm entrainment.

The circadian rhythm, called Process C, regulates a wide range of biological processes in humans including sleep, metabolism, body temperature, and hormone secretion. Light is the dominant synchronizer of the circadian rhythm—it has been used to regulate the circadian phase to cope with jet-lag, shift work, and sleep disorder. The homeostatic oscillation of the sleep drive is called Process S. Process C and Process S together determine the sleep-wake cycle in what is known as the two-process model. This paper addresses the regulation of both Process C and Process S by scheduling light exposure and sleep based on numerical simulations of circadian rhythm and sleep mathematical models. This is a significant step beyond the existing literature that only considers the entrainment of Process C. Regulation of the two-process model poses several unique features and challenges: 1. Process S is non-smooth, i.e., the homeostatic dynamics are different in the sleep and wake regimes; 2. Light only indirectly affects Process S through Process C; 3. Light does not affect Process C during sleep. We consider two scenarios: optimizing light intensity as the control input with spontaneous (i.e., unscheduled) sleep/wake times and jointly optimizing the light intensity and the sleep/wake times, which allows limited delayed sleep and early waking as part of the decision variables. We solve the time-optimal entrainment problem for the two-process model for both scenarios using an extension of the gradient descent algorithm to non-smooth systems. To illustrate the efficacy of our time-optimal entrainment strategies, we consider two common use cases: transmeridian travelers and shift workers. For transmeridian travelers, joint optimization of the two-process model avoids the unrealistic long wake duration when only Process C is considered. The entrainment time also decreases when both the light input and the sleep schedule are optimized compared to when only the light input is optimized. For shift workers, we show that the entrainment time is significantly shortened by optimizing the night shift working light.

216 Resilience, sleep difficulties, and subjective sleep quality during COVID-19

IntroductionWe have shown in a previous study that despite significant improvements in sleep patterns and sleep duration during COVID-19 in teens and young adults, only teens reported better sleep quality and satisfaction. Moreover, sleep difficulties seem to be more prominent in the older group during the pandemic, suggesting that there could be additional risk factors involved. The current study aimed to investigate the role of resilience in the association between changes in sleep and the subjective sleep quality (SSQ) in teens and young adults during COVID-19.Methods289 teens (12-17 years old) and 294 young adults (18-25 years old) completed the Connor-Davidson Resilience Scale-10 and an adapted version of the Pittsburgh Sleep Quality Index online. Teens and young adults were each divided into a resilient and less resilient group. Hierarchical regression models were conducted to examine the unique contribution of weekdays sleep duration, sleep difficulties, and resilience to SSQ. Sleep duration, sleep difficulties and SSQ before COVID-19, and gender were entered as controls.ResultsResults show that in less resilient teens, changes in sleep onset difficulties (β=-.285, p=.003), nocturnal and early awakenings (β=-.218, p=.019), and weekdays sleep duration (β=.282, p=.001) significantly predicted SSQ and explained 36.5% of the variance. In less resilient young adults, changes in nightmares (β=-.309, p=.027) and sleep onset difficulties (β=-.263, p=.012) significantly predicted SSQ and explained 24.1% of the variance. In resilient teens, changes in weekdays sleep duration (β=.296, p=.007) significantly predicted SSQ and explained 20.1% of the variance. In resilient adults, changes in sleep onset difficulties (β=-.325, p=.001), nocturnal and early awakenings (β=-.374, p=.000), and weekdays sleep duration (β=.192, p=.009) significantly predicted SSQ and explained 46.0% of the variance.ConclusionOur results suggest that resilience appears to be a protecting factor in the impacts of sleep difficulties on sleep quality, but only in adolescents. Indeed, in young adults, sleep difficulties seem to be a more important factor modulating sleep quality than changes in sleep duration. These results underline the importance of focusing on the intrinsic characteristics of each population to better target interventions.Support (if any):

328 Insomnia in older HIV patients: a systematic review

Abstract Introduction Insomnia is a common sleep disorder in elderly. Although the HIV-positive population have a similar life expectancy when compared to the general population, some factors may interact with immunity conditions and therefore contribute to a worse prognosis. Little is known however, about the frequency of insomnia in older HIV-positive patients. OBJECTIVE: To systematic review the prevalence of insomnia in older HIV-positive patients. Methods Systematic Review. Several databases were consulted (MEDLINE-PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, SciELO, LILACS, and VHL) and manual searches were performed. The terms used for the search were related to prevalence, HIV, insomnia, and advanced age. The inclusion criteria were: cross-sectional, cohort, and longitudinal studies. The accepted data were in patients with the previous diagnosis of HIV in advanced age, those over 50 years; studies that report the frequency of insomnia or insomnia symptoms (accepted symptoms: difficulty in starting sleep, difficulty in maintaining sleep, multiple awakenings during sleep and early awakening). The criteria for exclusion were: clinical trials, animal studies, letters, abstracts, conference proceedings, studies with other sleep scales that did not include insomnia. Results There were 2805 publications found in the database and a further 10 articles were included manually. Of this total, four were included in this review, resulting in a total of 2,227 participants. The prevalence of insomnia in HIV-positive patients over 50 years varied from 12.5% to 76.5%. Conclusion The frequency of insomnia was higher in the profile of the population studied than in the general population. This should be clinically relevant in order to adequately treat and impact on the prognosis of those patient. Support (if any):

537 Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators?

Abstract Introduction Alzheimer’s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations. Methods Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., “baseline”) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values. Results Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed. Conclusion Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD. Support (if any):

Impact of COVID-19 on eating habits, physical activity and sleep in Brazilian healthcare professionals.

During the coronavirus disease 2019 (COVID-19) pandemic, Brazilian healthcare professionals could have been experiencing impacts on their routine, behavior and mental health. To investigate changes in the daily life and sleeping habits of healthcare professionals in Brazil. We conducted an observational and cross-sectional study from May to July 2020. A Google Forms questionnaire was made available to Brazilian healthcare professionals on the WhatsApp mobile application and through the website of the Brazilian Hospital Services Company. The sample (n=710) was mostly composed of women (80.8%), aged between 30 and 40 years old (46.6%), predominantly physicians (41.8%) and residing mostly in the state of Paraíba (66.9%), Brazil. Approximately two-thirds of the total sample had some sleep-related complaints, 25.8% due to difficulty initiating sleep, 29.6% due to difficulty staying asleep and 32.5% due to early morning waking. From the population studied, 28.7% (n=204) reported the use of insomnia medication, and 60.3% (n=123) of these were self-medicating. Some participants reported a change in diet (n=557; 78.5%), especially related to the increase in carbohydrate intake (n=174; 24.5%), and 27% (n=192) of the individuals reported an increase of the consumption of alcoholic beverages. Of the total, 561 (81.8%) reported a change in the practice of physical activity. In this study, Brazilian healthcare professionals showed aspects of quality of life that were more affected during the COVID-19 pandemic than the prevalence seen in surveys of international studies for the general population.

Hyperthymic traits, major depression and bipolar spectrum, review and case report

IntroductionAkiskal proposed the bipolar spectrum concept with the aim of including those patients with atypical depressive presentations and mood temperaments. Also Koukopoulos accepted this proposal in those patients with poor response to antidepressants or highly recurrent course. Concretely bipolar disorder type IV was defined as clinical depression based on a lifelong hyperthymic temperament. Some years after DSM-III several experts in bipolar disorder continued in this work line even though DSM-IV and most recent DSM-V not considered to include this concept as a new diagnostic category.ObjectivesTo present a theoretical and practical review about bipolar spectrum and its relationship with hyperthymic traits.MethodsWe carry out a literature review about bipolar spectrum, accompanied by the clinical description of one patient with major depressive disorder and hyperthymic traits base.Results45 years old female referred to our outpatient mental health service after episode of voluntary drug overdose. She presented long evolution depressive symptoms (sadness, apathy, anhedonia, anergy, irritability, anxiety, emotional lability, early awakening, social withdrawal, self-care neglect, hopelessness, cognitive failures, guilt feelings and death ideas) with onset in postpartum. She reported a previous depressive episode 9 years ago with good response to fluoxetine. Hyperthimic traits were described but no history of manic symptoms. An erratic evolution was observed with various antidepressant treatment and finally improved adding mood stabilizer.ConclusionsWe must propose to consider the diagnosis of bipolar spectrum in order to treat effectively patients with major depression dissorder and hyperthymic temperament in absence of manic symptoms.DisclosureNo significant relationships.

Insomnia in neurological diseases

Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia – namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems.This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia.The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.

Comparative evaluation of propofol and combination of propofol-dexmedetomidine in adjunct with topical airway anesthesia for rigid bronchoscopy: A randomized double-blinded prospective study.

Context:Rigid bronchoscopy (RB) procedures require continuous vigilance and monitoring. Such procedures warrant proper ventilation strategy and titration of potent short-acting anesthetics.Aims:To compare propofol with the propofol-dexmedetomidine in conjunction with topical airway anesthesia in two groups during spontaneous assisted ventilation on peri-procedural hemodynamic stability.Settings and Design:This prospective, randomized, double-blinded study was done on 40 patients who were randomized in two groups, 20 patients in each group; PS (Propofol+ Normal saline) and PD (Propofol+ Dexmedetomidine) group. All patients in both groups were induced with 1% IV propofol (1–3 mg/kg), IV midazolam (0.05 mg/kg), and IV fentanyl (2 μ/kg). PS group received propofol infusion for maintenance along with saline infusion 10 min before induction, whereas PD group also received propofol infusion for maintenance along with Injection dexmedetomidine infusion 10 min before induction. Outcome measured were heart rate (HR), mean blood pressure (MBP), oxygen saturation (SpO2), and post-procedure awakening using Modified Observer's Assessment of Alertness/Sedation (MOAAS) scale and complications.Results:In both the groups, MBP decreased significantly from baseline, however, when MBP were compared at the same time points between the groups there were no significant differences. In PD group, HR remained significantly lower when compared with baseline and at 6, 12, 18, and 24 min time points when compared with PS group. Number of patients who developed hypotension requiring vasoactive drugs, their mean dose and duration of hypotension were more in PD group, and they awoke with significant delay.Conclusions:Propofol is better than combination of propofol and dexmedetomidine when given in adjunct with topical airway anesthesia for RB in view of early awakening, lesser duration of intra-procedural hypotension, and lesser requirement of vasoactive agents.

A randomised comparative study on intraoperative bispectral index monitoring vs. conventional monitoring on awakening time, extubatation time and early postoperative recovery from general anaesthesia using desflurane as inhalational anaesthetic during maintenance of anaesthesia in morbidly obese patients undergoing laparoscopic sleeve gastrectomy surgery

Introduction: In India incidence of obesity is in increasing trend. Anaesthetising morbidly obese patients is challenge to anaesthesiologist. Due to alteration in pharmacokinetics and pharmacodynamics in obese patients, drug dosing in these patients is different from patients with normal body mass index. This has led to lot of confusion in titration of anaesthetic drugs perioperatively. Any method which helps in perioperative drug titration may help in optimal intraoperative maintenance of anaesthesia, early awakening at the end of surgery and early postoperative recovery. We hypothesize that intraoperative Bispectral index (BIS) monitoring allows optimal titration of anaesthetic drugs intraoperatively and decrease awakening time, early postoperative recovery from general anaesthesia in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery. Materials and Methods: Two groups of 40 patients each were anaesthetized with the use of BIS monitoring in BIS- GROUP and in NON-BIS GROUP patients were anaesthetized without the using BIS monitoring. The heamodynamic parameters heart rate (HR) and mean arterial pressure (MAP) were recorded before induction, after induction at 1 minute (min), 3min, and 5min, after incision at 1min, 5min, 10min, 15min, 30min, 45min, 60min, and 70min were recorded. Awakening time (time to eye opening to verbal command) recorded every minute, time to extubation at 1min, 5 min, 15 min were recorded and time to achieve Modified Aldrete score ?9 were recorded. Results: Mean awakening time, time to extubate and Modified Aldrete score ?9 were significantly shorter in the BIS group as compared to the NON-BIS group (P 0.05). Conclusion: Without compromising the hemodynamic stability BIS monitoring was effective in early awakening, associated with early postoperative recovery in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery. Keywords: Morbid obesity, Bispectral index, Recovery.

The association between plasma metabolites and sleep quality in the Southall and Brent Revisited (SABRE) Study: A cross-sectional analysis.

We examined the association between plasma metabolites and abnormal sleep patterns using data from the Southall and Brent REvisited (SABRE) cohort. Nuclear magnetic resonance spectroscopy provided 146 circulating plasma metabolites. Sleep questionnaires identified the presence or absence of: difficulty falling asleep, early morning waking, waking up tired, and snoring. Metabolites were compared between the sleep quality categories using the t test, and then filtered using a false discovery rate of 0.05. Generalised linear models with logit‐link assessed the associations between filtered metabolites and sleep phenotypes. Adjustment was made for important demographic and health‐related covariates. In all, 2,718 participants were included in the analysis. After correcting for multiple testing, three metabolites remained for difficulty falling asleep, 59 for snoring, and none for early morning waking and waking up tired. After adjusting for sex, age, ethnicity and years of education, 1 standard deviation increase in serum histidine and valine associated with lower odds of difficulty falling asleep by 0.89–0.90 (95% confidence intervals [CIs] 0.80–0.99). Branched‐chain and aromatic amino acids (odds ratios [ORs] 1.19–1.25, 95% CIs 1.09–1.36) were positively associated with snoring. Total cholesterol in low‐density lipoprotein (OR 0.90, 95% CI 0.83–0.97) and high‐density lipoprotein (OR 0.88, 95% CI 0.81–0.95) associated with lower odds of snoring. In the fully adjusted model, most associations persisted. To conclude, histidine and valine associated with lower odds of difficulty falling asleep, while docosahexaenoic acid and cholesterol in low‐density lipoprotein and high‐density lipoprotein subfractions associated with lower odds of snoring. Identified metabolites could provide guidance on the metabolic pathways associated with adverse sleep quality.

Insomnia subtypes and clinical impairment in hospitalized children with autism spectrum disorder

Insomnia subtypes are not well understood in the most severely affected children with autism spectrum disorder. We examined length of hospital stay, autism severity, nonverbal intelligence quotient, and behavioral functioning across insomnia subtypes in 427 psychiatrically hospitalized children with autism spectrum disorder (mean age = 12.8 ± 3.4; 81.3% male). Per parent report, 60% (n = 257) of children had at least one type of insomnia. The distribution of subtypes was difficulty falling asleep (26.1%, n = 67), difficulty staying asleep (24.9%, n = 64), early morning awakening (4.3%, n = 11), and multiple insomnia symptoms (44.7%, n = 115). Difficulty staying asleep and early morning awakenings were associated with longer hospital stays. Early morning awakening was also associated with higher autism symptom severity. In general, children with difficulty staying asleep or multiple insomnia symptoms scored lower on adaptive behaviors (e.g. communication, self-care, socialization) and higher on maladaptive behaviors (e.g. irritability, hyperactivity, emotional reactivity, and emotional dysphoria). Difficulty staying asleep or having multiple insomnia symptoms appears to be most strongly related to impaired behavioral functioning. Conversely, early morning awakenings may be more closely tied with autism spectrum disorder itself. Further research is needed regarding insomnia subtypes at the severe end of the autism spectrum.

Applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems.

This discussion article considers applied behavior analysis measurement, assessment, and treatment of sleep and sleep-related problems among infants, children, and youth who are typically developing and have neurodevelopmental disabilities. Measurement has concentrated on designing practitioner-implemented methods and improving fidelity of data recording through sleep-monitoring instrumentation. The emphasis of assessment is identifying antecedent and consequence variables that promote sleep and evoke and maintain sleep-related problems. Treatment research has evaluated several effective interventions for problems such as delayed sleep-onset, night and early morning waking, bedtime resistance, and unwanted co-sleeping. Early and contemporary applied behavior analysis research is reviewed relative to function-based treatment formulation, intervention integrity, social validity, and research-to-practice translation.

The Relevance of Dual Diagnoses among Drug-Dependent Patients with Sleep Disorders.

Background: Sleep disorders are often associated with drug use. Nearly 70% of patients admitted for detoxification report sleep problems. Dual disorder (DD) is the comorbidity between mental disorders in general and disorders related to psychoactive substance use. The association between substance use and sleep disorders (SD) appears to be bidirectional. Our objective is to analyze the association between sleep disturbance history and drug use pattern (alcohol, cannabis, opioids, and cocaine). Methods: Analysis of data in the first interview at the Addictions Unit of the Department of Psychiatry at the University of Salamanca Health Care Complex between October 2017 and January 2020. The sample consists of 398 patients. We studied the association between different variables: origin of patients (Inpatient Dual Diagnosis Detoxification Unit (IDDDU) vs. Outpatient Drug Clinic (ODC), presence of affective disorder, psychotic disorder, type of drug used, and treatment. Results: Of patients with DD, 62% had more delayed sleep induction, sleep fragmentation, early awakening, and nightmares. Outpatients had more difficulty falling asleep because, in many cases, they had not previously sought any medical assistance. On the other hand, 67% of the patients with insomnia presented depression. Conclusions: There is evidence of a harmful association between DD and SD.