Higher Levels Of Insomnia Research Articles

Exploring the interplay of atopic dermatitis severity with sleep and mental health: a case-control study in adult patients

ABSTRACT Objectives Atopic dermatitis (AD) is a chronic inflammatory skin disease often associated with non-atopic comorbidities. Recently, a severity-dependent relationship between AD and sleep/mental health diseases has been proposed. However, few studies investigated these comorbidities and their association with AD severity through validated questionnaires. This study aimed to use a set of validated instruments to assess the impact of AD on sleep and psychological disorders and estimate the association of itch and AD severity with sleep disorders and psychological symptoms, distinguishing between clinical-oriented and patient-oriented measures. Methods We conducted a case-control study, recruiting 57 adult AD patients (mean age ± std. dev. 34.28 years ± 13.07; 27 males) matched for age and sex with 57 healthy adults (34.39 years ± 13.09; 27 males). To investigate the differences in sleep quality, insomnia, depression, and anxiety between the two groups, we performed independent sample t-Tests. Moreover, we conducted univariate linear regression analyses to examine the relationship between itch and objective/subjective severity of AD and sleep quality, insomnia, and psychological symptoms. Results AD patients reported lower sleep quality (p = 0.002), more severe insomnia (p = 0.006) and depression (p = 0.013), and higher stress levels than healthy adults (p = 0.049). Itch intensity was linked to sleep disturbances and psychological symptoms (R2 range = 0.13–0.19, p range = 0.02–<0.001). Objective and subjective AD severity were similarly associated with worse sleep quality (R2 = 0.26, p < 0.001; R2 = 0.24, p < 0.001; respectively), anxiety (R2 = 0.15, p = 0.04; R2 = 0.17, p = 0.001; respectively), and self-perceived stress (R2 = 0.10, p = 0.02; R2 = 0.07, p = 0.049; respectively). However, subjective AD severity was more strongly associated with insomnia (R2 = 0.31, p < 0.001) and depression (R2 = 0.20, p < 0.001) than clinical-oriented AD severity (R2 = 0.19, p < 0.001; R2 = 0.05, p = 0.098; respectively). Conclusions The study demonstrated poor sleep quality and high levels of insomnia, depression, and stress in AD patients, with an aggravated psychological status for adults with more severe skin disease. We suggest implementing a multidisciplinary approach to AD management/treatment that considers objective and subjective measures of disease severity.

Impact of COVID-19-Induced Academic Stress on Insomnia and Suicidal Ideation among Taiwanese Health Trainees and Junior Doctors.

BACKGROUND Clinical training for allied health trainees (AHTs) and postgraduate-year (PGY) doctors needed to go online during the outbreak of coronavirus disease 2019 (COVID-19), which may have caused academic stress and consequent outcomes among this cohort. MATERIAL AND METHODS To evaluate academic-related stress, clinical confidence, psychological distress, and insomnia, an online survey-based study was conducted among Taiwanese AHTs and PGY doctors between July and December, 2022, during the COVID-19 pandemic. The survey included the 21-item Depression, Anxiety, and Stress Scale (DASS-21), the Insomnia Severity Index (ISI), and self-designed questions. It was distributed using convenience sampling and snowball sampling and was completed by 522 participants. RESULTS Structural equational modelling showed that academic stress was negatively associated with clinical confidence (standardized coefficient [ß]=-0.382, p<0.001). Clinical confidence was negatively associated with psychological distress (ß=-0.397, p<0.001), which was associated with insomnia (ß=0.648, p<0.001). Additionally, clinical confidence and psychological distress were the significant mediators. Results indicated that higher academic stress was associated with higher level of insomnia via the mediation of clinical confidence and psychological distress. CONCLUSIONS Academic stress related to changes in clinical training may have led to insomnia among AHTs and PGY doctors during the pandemic. Factors to reduce academic stress should be investigated to promote good mental health while providing sufficient clinical training, especially during events that can cause increased stress (eg, epidemics, pandemics).

Impact of SARS-CoV-2 Infection and Vaccination on Migraine Symptoms during the COVID-19 Pandemic

Introduction: Studies have shown the worsening of migraine associated with the COVID-19 infection and the pandemic more broadly. COVID-19 vaccination has also been associated with symptomatic headache, with high frequency among migraineurs. We aimed to assess the impact of COVID-19 diagnosis and vaccine administration on migraine, during the SARS-CoV-2 pandemic. Methods: An online questionnaire was sent to migraine patients followed in a neurology outpatient clinic between March and November 2022. The survey inquired about migraine symptoms and treatment changes, as well as sleep changes, anxiety, and depressive symptoms during the pandemic, after a COVID-19 diagnosis and/or vaccination. Results: Out of the 185 patients included, 108 (58.4%) reported a change in headache pattern (intensity, frequency, and/or pain quality) and 47% reported higher intensity and frequency. The pattern changes occurred before the COVID-19 diagnosis in 41%. Of all the participants with headache changes 72.2% needed to intensify medication (abortive or prophylaxis), regardless of infection status. High levels of insomnia, anxiety, and depressive symptoms were found among patients with worsening migraine, irrespective of COVID-19 diagnosis. After vaccination, 49 (27.1%) described a change in headache pattern, with a worsening pattern in 29 (16%). In half, this change occurred for up to 3 weeks. Conclusion: Worsening of migraine was more likely associated with other factors related to the pandemic rather than COVID-19 diagnosis. COVID-19 vaccination might have acted as an additional but less relevant and temporary trigger for migraine worsening.

The role of suicide severity in the association between anxiety symptoms and suicidal ideation: a mediation analysis

IntroductionSuicide is one of the leading causes of death worldwide and scientific community investigates suicide risk factors relentlessly. Among these, anxiety symptoms were strongly related to suicidal ideation in several studies. Moreover, sleep and its disturbances are closely connected to mental well-being and psychiatric disorders in a bidirectional pathway.ObjectivesThe main purpose of the present study is to assess the relationship between anxiety symptoms and suicidal ideation in a sample of psychiatric patients and the mediational role of insomnia in this association.MethodsParticipants were 116 consecutive adult psychiatric inpatients (61 women and 55 men) enrolled to the psychiatric inpatient unit of Sant’Andrea Hospital in Rome. The measures used were a socio-anamnestic form, the Columbia Suicide Severity Rating Scale (C-SSRS), the Hamilton Anxiety Rating Scale (HAM-A), and the Insomnia Severity Index (ISI).Results Based on the results of statistical analysis, patients with suicidal ideation showed higher severity of insomnia and higher severity of anxiety symptoms than patients with no suicidal ideation. Moreover, the intensity of suicidal ideation was positively and significantly associated with the severity of anxiety symptoms and with the severity of insomnia. Finally, the mediation analysis showed that the effect of anxiety symptoms on suicidal ideation was completely mediated by insomnia severity.ConclusionsThe main result of the study indicates that patients who perceive more anxiety symptoms were more likely to experience higher suicidal ideation intensity through higher levels of insomnia. These findings implies that screening for sleep disturbances may help identify individuals at risk for suicide, and improving sleep quality through psychosocial and pharmacological treatments could mitigate the association between anxiety and suicidal ideation.Disclosure of InterestNone Declared

Sleepless behind bars: the connection between mental health, environment, and sleep among women in jail.

Given the barriers to good sleep in corrections facilities and the lack of research in this area, the current study aimed to characterize sleep quality and insomnia incidence in women in jail. Furthermore, we aimed to investigate the relation of sleep to depression, posttraumatic stress disorder (PTSD), and trauma exposure in incarcerated women. Lastly, we examined self-reports of environmental and individual factors that impaired sleeping in this population. Participants included 176 women incarcerated in two jails in southeast Idaho. Participants were randomly selected to complete several self-report questionnaires, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index, verbally administered by interviewers. A majority of participants endorsed poor sleep quality (76%) and subthreshold or higher levels of insomnia (70%). Multiple regression analyses found that depressive symptoms and PTSD symptoms were both significantly related to insomnia and poor sleep quality. Excessive noise, poor bedding, and mental health were commonly cited factors that disrupted sleep. These results are consistent with previous literature that has examined these outcomes in prison populations and incarcerated populations in other countries. Correctional facilities can consider altering environmental factors that impair sleep to not only promote better overall health but also as a way to address common manifestations of poor mental health in their inmate populations. Screening for and treating mental health problems, namely depression and PTSD, is another way these facilities can improve inmate health and promote better sleep.

Insomnia moderates the association between psychotic-like experiences and suicidal ideation in a non-clinical population: a network analysis

Psychotic-like experiences (PLEs) have been associated with poor sleep quality and increased suicide risk. However, the association between PLEs, insomnia and suicide risk has not been thoroughly investigated in prior studies. In this study, we aimed to explore as to whether insomnia moderates the association between PLEs and suicidal ideation. The study was performed in 4203 young adults (aged 18–35 years, 63.8% females). Data were collected using self-reports. Moderation analysis demonstrated that PLEs are associated with higher levels of the current suicidal ideation only in participants with greater severity of insomnia (B = 0.003, p < 0.001). This analysis included age, gender, education, occupation and depressive symptoms as covariates. Moreover, the network analysis demonstrated that nodes representing PLEs are connected to the node of current suicidal ideation only in participants with greater severity of insomnia. The nodes of PLEs connected to the current suicidal ideation node captured PLEs representing deja vu experiences, auditory hallucination-like experiences and paranoia (edge weights between 0.011 and 0.083). Furthermore, nodes representing PLEs were the three most central nodes in the network analysis of individuals with higher levels of insomnia (strength centrality between 0.96 and 1.10). In turn, the three most central nodes were represented by depressive symptoms in the network analysis of individuals with lower levels of insomnia (strength centrality between 0.67 and 0.79). Findings from this study indicate that insomnia might be an important risk factor of suicide in people with PLEs, especially those reporting deja vu experiences, auditory hallucination-like experiences and paranoia.

Sleep disorders related to index and comorbid mental disorders and psychotropic drugs

PurposeMental disorders positively associate with sleep disorders. This study will explore the moderating influence of comorbid mental disorders and whether selected psychotropic drugs correlate with sleep disorders after adjusting for mental disorders.MethodsA retrospective cohort study design was employed using medical claim data from the Deseret Mutual Benefit Administrators (DMBA). Mental disorders, psychotropic drug use, and demographic data were extracted from claim files for ages 18–64, years 2016–2020.ResultsApproximately 11.7% filed one or more claims for a sleep disorder [insomnia (2.2%) and sleep apnea (9.7%)]. Rates for selected mental disorders ranged from 0.09% for schizophrenia to 8.4% for anxiety. The rate of insomnia is greater in those with bipolar disorder or schizophrenia than in other mental disorders. The rate of sleep apnea is greater in those with bipolar disorder and depression. There is a significantly positive association between mental disorders and insomnia and sleep apnea, more so for insomnia, especially if they had other comorbid mental disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants, explain much of the positive association between anxiety, depression, and bipolar disorder with insomnia. Psychotropic drugs with the largest effect on sleep disorders are sedatives (non-barbiturate) and psychostimulants for insomnia and psychostimulants and anticonvulsants for sleep apnea.ConclusionMental disorders positively correlate with insomnia and sleep apnea. The positive association is greater when multiple mental illness exists. Bipolar disorder and schizophrenia are most strongly associated with insomnia, and bipolar disorder and depression are most strongly associated with sleep disorders. Psychotropic drugs other than CNS stimulants, primarily sedatives (non-barbiturate) and psychostimulants for treating anxiety, depression, or bipolar disorder are associated with higher levels of insomnia and sleep apnea.

Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment.

Upper airway stimulation (UAS) is an alternative treatment for obstructive sleep apnea that must be activated nightly. Although the implanted device offsets the mask- or pressure-related side effects often associated with continuous positive airway pressure therapy, some UAS recipients do not use the therapy consistently. This study qualitatively explored factors associated with UAS usage in obstructive sleep apnea patients. Semistructured interviews were conducted with 24 obstructive sleep apnea patients who received UAS treatment. Twelve patients were categorized as high users with mean usage of ≥ 4 hours/night and 12 were categorized as low users with < 4 hours/night or nonuse. Interviews explored patients' experiences regarding barriers and facilitators to UAS use and their advice for new UAS recipients. Demographic and clinical data including the Insomnia Severity Index and Generalized Anxiety Disorder Scale were collected. Compared to high users, low users had higher levels of insomnia (mean Insomnia Severity Index: 3.6 vs 15.2, respectively) and anxiety (mean Generalized Anxiety Disorder Scale: 3.4 vs 6.9). High users reported more positive experiences with UAS treatment, such as improvements in symptoms and convenience of treatment, as facilitators of use. Low users tended to focus on the negative aspects of treatment, particularly stimulation-related discomfort and associated sleep disturbance. Insomnia with or without anxiety contributes to differing patient-reported experiences in high vs low user groups, with increased insomnia symptoms among low users. Improved understanding of the specific barrier and facilitators of UAS adherence may drive better long-term use and more personalized management strategies, including concomitant insomnia treatment. Registry: ClinicalTrials.gov; Name: Stimulation Therapy for Apnea: Reporting Thoughts (START); URL: https://clinicaltrials.gov/ct2/show/NCT04768543; Identifier: NCT04768543. Luyster FS, Ni Q, Lee K, etal. Factors affecting obstructive sleep apnea patients' use of upper airway stimulation treatment. J Clin Sleep Med. 2022;18(9):2207-2215.

Sleep, depression, anxiety and fatigue in women with premature ovarian insufficiency

Purpose To assess sleep disturbances, levels of anxiety, depression and fatigue in women with premature ovarian insufficiency (POI). Materials and methods The study included 62 women with POI and 62 age-matched controls. Women in both groups completed questionnaires. Pittsburgh Sleep Quality Index, Insomnia severity index, Epworth Sleepiness Scale, Hospital Anxiety and Depression Scale and Fatigue Severity Scale were used. Results We found poor sleep quality, higher levels of insomnia in women with POI than in controls. Depression was much more prevalent and severe in POI women. Total anxiety score, the severity of anxiety and fatigue did not differ significantly between the groups. According to the multivariable logistic regression analysis, being married and having POI were associated with worse quality of sleep, and having more children was associated with an increase in depression levels in the whole cohort. Backward analysis showed that when POI status was taken as a reference, married women were at 6.5 fold increased risk of poor sleep quality. Conclusions Women with premature ovarian failure are more likely to suffer from poor sleep quality, insomnia and depression than healthy women.

Attention-Deficit/Hyperactivity Disorder, Insomnia, and Sleepiness Symptoms among a Community Adult Sample: The Mediating Effect of Executive Behavioral Regulation and Metacognition Abilities.

Adult attention-deficit/hyperactivity disorder (ADHD) is characterized by a dysexecutive syndrome reflected in cognitive, emotional, and behavioral areas. Independently of a formal diagnosis of ADHD, higher ADHD symptoms are associated with higher levels of insomnia and sleepiness symptoms in adult population-based samples. Insomnia and sleepiness are sleep disorders that are both associated with deficits in several aspects of executive functions which in turn are likely to mimic a range of ADHD symptoms. Our objective was to explore the interrelationships between ADHD, insomnia, and sleepiness symptoms and executive functioning in community-dwelling adults. A total of 442 participants (18-89years, 56% females) underwent a semistructured clinical interview and completed questionnaires for insomnia, sleepiness, and everyday behaviors in which executive functions are implicated. Mediation Models were applied. Insomnia and sleepiness symptoms did not play a mediating role between ADHD symptoms and executive functioning. Conversely, our results highlighted a mediating effect of daytime insomnia consequences and sleepiness on ADHD symptoms via behavioral regulation executive symptoms (respectively, β = -0.32, p < .001, 95% CI [-0.46, -0.20]; β = 0.09, p < .05, 95% CI [0.02, 0.16]) and metacognitive executive symptoms (respectively, β = -0.30, p < .001, 95% CI [-0.44, -0.18]; β = 0.12, p < .01, 95% CI [0.04, 0.22]). Daytime insomnia consequences and sleepiness symptoms could lead to ADHD-like symptoms through their associated executive symptoms expressed in daily life. When faced with symptoms suggestive of ADHD in adults, insomnia and sleepiness should be systematically screened with standardized instruments.

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study

ABSTRACT Background Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood. Objective To assess insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood. Method Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia. Results Insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4. Conclusion Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20–30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching.

The Impact of the COVID-19 Pandemic on Students' Mental Health and Sleep in Saudi Arabia.

Background: Mental health problems are prevalent among university students in Saudi Arabia. This study aimed to investigate the impact of the COVID-19 pandemic on university students’ mental health and sleep in Saudi Arabia. Method: A total of 582 undergraduate students from Saudi Arabia aged between 18 and 45 years old (M = 20.91, SD = 3.17) completed a cross-sectional online questionnaire measuring depression, anxiety, stress, resilience, and insomnia during the COVID-19 pandemic (2020). Analysis included an independent samples t-test, one-way ANOVA, and Hierarchical regression analysis. Results: Undergraduate students reported high levels of depression, anxiety, and perceived stress and low levels of resilience (p < 0.001) during the pandemic. In addition, students reported experiencing insomnia. A hierarchical regression analysis indicated that lower resilience, high levels of insomnia, having a pre-existing mental health condition, and learning difficulties (such as dyslexia, dyspraxia, or dyscalculia) were significantly associated with high levels of depression and stress. In addition, lower resilience, a high level of insomnia, and pre-existing mental health conditions were significantly associated with high levels of anxiety. Finally, a lower level of psychological resilience and a high level of insomnia were significantly associated with increased levels of depression, anxiety and stress within university students. Conclusion: This study has provided evidence that a lower level of psychological resilience and insomnia were associated with mental health problems among undergraduate students in Saudi Arabia, thus enhancing psychological resilience and interventions to support sleep and mental health are vital to support student well-being outcomes throughout the pandemic.

716 Loneliness and Lockdowns: The Effects of the COVID-19 Pandemic on Insomnia Symptoms

IntroductionInsomnia is a critical health issue that has serious consequences for both psychological and physical health. These consequences have become even more exacerbated during the course of the ongoing COVID-19 pandemic, as fears of the virus continue to grow and community lockdowns persist. Loneliness has also become a growing mental health concern as a result of the pandemic, and previous research has identified COVID-19 loneliness as a contributing factor to higher rates of insomnia. The current study aimed to investigate the relationship between insomnia, loneliness, and lockdown orders across the first 6-months of the pandemic. We hypothesized that being lonely and under lockdown would lead to greater insomnia, even after controlling for anxiety, and this would become more pronounced over the course of the pandemic.Methods6,101 English-speaking adults from across the U.S. (18–84 years old; 53.6% female) completed an online, monthly, cross-sectional (~1000 participants per month), battery of assessments that included the Insomnia Severity Index (ISI), UCLA Loneliness Scale – Version 3, Generalized Anxiety Disorder-7 scale (GAD 7), demographic questions, and a COVID-19 questionnaire between April 2020 and September 2020. A 2 (lonely vs. not lonely) x 2 (lockdown vs. no lockdown) x 2 (Time 1 April-June vs. Time 2 July-September) ANCOVA was conducted to determine the effects of these variables on insomnia, while also controlling for anxiety symptoms.ResultsSignificant main effects of lockdown status, F(1,8) = 22.72, p < .001, time, F(1,8) = 4.94, p = .026, and loneliness, F(1,8) = 65.18, p < .001, were observed, as a well as a significant interaction effect between lockdown status and time, F(1,8) = 8.47, p = .004, after controlling for anxiety.ConclusionOverall, lonely people under lockdown had the highest levels of insomnia at both Time 1 and Time 2. Non-lonely people consistently had lower levels of insomnia than lonely people across the 6-month period; however, being under lockdown also contributed to higher levels of insomnia regardless of loneliness, which increased with each passing month of the pandemic. Loneliness and lockdowns each appear to be independently associated with elevated insomnia during the COVID-19 pandemic.Support (if any):

Emotional and Behavioral Problems of Left-Behind Children in Impoverished Rural China: A Comparative Cross-Sectional Study of Fourth-Grade Children

PurposeChildren who are left behind when their parents migrate for work have a high prevalence of emotional and behavioral problems, which affect social function and increase family burden. To date, no national survey has been conducted on the emotional and behavioral problems of left-behind children (LBC) in China. This study aimed to investigate the emotional and behavioral outcomes of primary school LBC in the fourth grade in impoverished rural China and the possible influences of family environment and parenting practices. MethodsA cross-sectional study was carried out in 27 rural counties in the central and western parts of China from November 2016 to January 2017. The method of quota sampling was adopted to achieve a representative sample using postweighting adjustment. The survey sample was distributed proportionately across each county. LBC were defined as children aged <16 years who had two parents leave home to work or one parent leave home while the other lost the capacity to rear their children. The term “non–left-behind children” (NLBC) refers to children who have at least one parent who has not migrated for work. The Strengths and Difficulty Questionnaire (SDQ) was applied to measure children's emotional and behavioral problems. ResultsAfter the weighted calculations were performed, there were 1,147 LBC and 3,953 NLBC. The proportion of abnormal SDQ total scores (>17) was significantly higher in the LBC group than in the NLBC group (15.6% vs. 11.6%; p < .01). Binary regression analysis showed that high levels of insomnia (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04–2.27), loneliness (OR 1.65, 95% CI 1.13–2.43), and self-harm (OR 1.92, 95% CI 1.17–3.16) may increase the risk of abnormal SDQ total scores in LBC. ConclusionsLBC showed a higher prevalence of abnormal SDQ total scores than NLBC. Insomnia, loneliness, and self-harm behavior were associated with abnormal SDQ total scores in LBC.

Negative mood as a mediator of the association between insomnia severity and marijuana problems in college students.

Insomnia symptoms have been linked to problematic marijuana use among young adults, but the mechanism underlying this association and whether sex differences exist, remains unclear. Using cross-sectional data, this study examined negative mood as a mediator of the association between insomnia and marijuana problems among male and female college students. Undergraduate students (n=267; 61% female) reporting marijuana use in the past month completed an online survey assessing insomnia symptoms, negative mood and marijuana problems. Controlling for relevant covariates, negative mood was examined as a mediator of the association between insomnia and marijuana problems using bootstrapped significance tests for indirect effects (n-boot=1,000). Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems. In conclusion, insomnia symptoms are associated with more negative mood among college students who use marijuana, and this effect on negative mood accounts for a large part of the association of insomnia symptoms with marijuana-related problems. Research is needed to determine if these associations are maintained prospectively.

Adverse childhood experiences are common among medical patients enrolled in stress management training (SMT), are related to higher levels of insomnia and daytime symptoms of hyperarousal, benefit from SMT treatment, but are vulnerable to relapse by two month follow-up

Adverse childhood experiences are common among medical patients enrolled in stress management training (SMT), are related to higher levels of insomnia and daytime symptoms of hyperarousal, benefit from SMT treatment, but are vulnerable to relapse by two month follow-up

Depressive symptoms mediate the relationship between sleep disturbances and type 2 diabetes mellitus

The current study aimed at examining whether individuals diagnosed with type 2 diabetes mellitus (T2DM) have more severe sleep disturbances compared to individuals who are healthy or have prediabetes and whether depressive symptoms mediate the relationship between sleep disturbances and having T2DM. T2DM patients (n = 107) were compared to individuals with prediabetes (n = 48) and healthy individuals (n = 154) regarding the severity of depressive symptoms, measured via the Beck Depression Inventory-II (BDI-II), and sleep disturbances, measured via the Mini Sleep Questionnaire (MSQ). Mediation analysis examined whether depressive symptoms mediated the relationship between sleep disturbances and T2DM. Compared to healthy individuals and individuals with prediabetes, T2DM patients had more depressive symptoms and higher levels of insomnia, hypersomnia, and overall more sleep disturbances. The prediabetes group did not differ from the healthy control group on these measures, and these groups were thus combined for further analysis. Sleep disturbances were correlated with severity of depressive symptoms (r =0.43). After controlling for age, gender, and ethnic background, both severity of sleep disturbances (odds ratio [OR]: 1.04; 95% CI: 1.01-1.07, P <.001) and severity of depressive symptoms (OR: 8.54, 95% CI: 3.37-21.69, P <.001) predicted T2DM. Depression symptoms mediated the relationship between sleep disturbances and T2DM, whereas the direct relationship between sleep disturbances and T2DM was nonsignificant. The findings imply that sleep disturbances may contribute to the development and progression of T2DM by promoting depressive symptoms. Thus, treatments for the emotional distress associated with sleep disturbances may help reduce the risk for T2DM and the progression of the disease.

Clinical features of isolated sleep paralysis

ObjectiveIsolated sleep paralysis (ISP) is a relatively common parasomnia often accompanied by fear and distress. However, little is known about the range and relative severities of typical ISP symptoms and accompanying hallucinations. Furthermore, there have been inconsistent findings with regard to demographic differences in ISP. Patients/MethodIn sum, 185 individuals with ISP (and 322 controls) were assessed for 27 symptoms and hallucinations using a clinical interview and trained diagnosticians. Insomnia symptoms were also assessed. ResultsRates of ISP did not differ according to gender or ethnic minority status, but higher levels of insomnia were associated with episodes. The participants with ISP reported a mean of 7.73 symptoms beyond atonia. Hallucinations of the presence of others were relatively common. Specifically, 57.84% of the sample sensed a presence in the room with them during ISP, and the majority believed it to be a non-human presence. In addition, 21.62% of the sample experienced visual hallucinations of others, with the majority perceiving strangers as opposed to known individuals. A panoply of supernatural/paranormal entities were reported by the 24.32% of participants who hallucinated non-human beings. A minority of individuals with ISP experienced clinically-significant distress (10.27%) and/or impairment (7.57%) as a result of episodes. ConclusionISP episodes were complex and often multisensorial experiences, and the majority of assessed symptoms were associated with clinically-significant levels of fear/distress. Vivid hallucinations of other people and entities were common as well, and it is recommended that ISP be assessed when patients report seemingly anomalous experiences.

Factors that Explain the Cancer-Related Insomnia.

A better understanding of cancer related insomnia and its relationship with other associated factors is necessary to improve its management. To clarify the relationship between insomnia and treatment related variables, sociodemographic data, health related fitness, pain, anxiety, and depression in breast cancer patients. One hundred twenty-three patients participated in this cross-sectional study. As a primary variable was insomnia using The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 version. Other variables included: stage of treatment, type of treatment, multiple sit to stand test, trunk curl test, 6-min walk test, back muscle strength test, the Brief Pain Inventory short form and the Hospital Anxiety and Depression Scale. Insomnia was negatively associated with the treatment stage (p = 0.01), the 6-min walk test (p = 0.01) and the back muscle strength test (p = 0.01), while it was positively associated with the type of treatment (p = 0.01) and the multiple sit-to-stand test (p = 0.05). In addition, higher levels of insomnia were associated with higher scores on the Brief Pain Inventory short form (p = 0.01) and the Hospital Anxiety and Depression Scale (p = 0.01). Anxiety, type of treatment, back muscle strength, pain severity and stage of treatment were predictors of insomnia, and when they were combined they explained 51.2% of insomnia in our sample. The variability in insomnia related breast cancer is explained by anxiety, type of treatment, pain, treatment stage, and back muscle strength. Clinicians should take these results into account when generating cancer care programs to control pain and health-related-fitness (Registration of Trials NCT01801527).

Insomnia and emotion dysregulation: Independent and interactive associations with posttraumatic stress symptoms among trauma-exposed smokers

IntroductionTraumatic event exposure is common among cigarette smokers, and elevated posttraumatic stress symptoms (PTSS) are associated with increased smoking levels. As such, the current study examined factors that may contribute to elevated PTSS among trauma-exposed smokers. Insomnia and emotion dysregulation may be particularly relevant among smokers, and are each associated with PTSS. However, it remains unclear whether these factors are associated with PTSS after accounting for the effects of dispositional factors and each other, and whether they may interact to predict PTSS. Thus, the current study sought to test whether insomnia and emotion dysregulation are independently associated with PTSS after accounting for negative affectivity and number of traumas experienced, and to investigate the potential interactive influence of these factors on PTSS. MethodHypotheses were tested cross-sectionally among a community sample of trauma-exposed individuals who presented for smoking cessation treatment (n=349). ResultsResults demonstrated that insomnia and emotion dysregulation each predicted elevated PTSS after controlling for the other, negative affectivity and number of traumas experienced. In addition, the interaction between insomnia and emotion dysregulation was significant, such that higher levels of insomnia and emotion dysregulation were associated with the most severe PTSS. LimitationsFuture research should examine these factors among a clinical sample of individuals with PTSD, as well as utilize prospective designs. ConclusionsFindings highlight the roles of insomnia and emotion dysregulation in contributing to elevated PTSS among trauma-exposed smokers, and the potential importance of targeting these factors in the context of PTSD treatment.