Insomnia Patient Research Articles

Mapping the insomnia patient journey in Europe and Canada.

Insomnia affects daily functioning and overall health, and is thus associated with significant individual, societal, and economic burden. The experience of patients living with insomnia, their perception of the condition, and its impact on their quality of life is not well documented. The objective of this study was to map the patient journey in insomnia and identify unmet needs. Participants were individuals with insomnia, and healthcare professionals (HCPs) who treat insomnia, in the United Kingdom, France, Germany, Italy, and Canada. Qualitative interviews (50 patients, 70 HCPs) and a quantitative survey (700 patients, 723 HCPs) were conducted to inform the patient-journey mapping and obtain information on the emotions, perceptions, and experiences of patients and HCPs. The patient journey comprises seven phases. The first defines the onset of insomnia symptoms. Phase 2 represents self-initiated behavior change to improve sleep (e.g., sleep hygiene, reducing caffeine, exercise). The next phase is characterized by use of over-the-counter (OTC) treatments, which generally fail to provide lasting relief. Phase 4 describes the first HCP consultation (occurring several months to several years after onset) and typically occurs at a crisis point for the patient; patients may be looking for an immediate solution (e.g., medication), which may not align with their HCP's recommendation. The following stage comprises sleep hygiene/behavioral changes (±OTC treatment) under HCP guidance for many patients, although offering prescription treatments without a sleep hygiene stage under supervision is more common in some countries. Phase 6 describes prescription medication initiation, where patients fluctuate between relief/hopefulness and a sense of failure, while HCPs try to balance the need to provide relief for the patient while maintaining best medical practice and minimizing adverse effects. The final phase (living with long-term insomnia) represents an indefinite period during which sleep issues remain unresolved for many patients, with most of them continuing to use prescription treatments for longer than indicated and creating their own variable, self-managed regimens combining multiple modalities. This patient journey analysis for insomnia revealed seven distinct phases, highlighting different touchpoints where insomnia management could be optimized.

0340 AASM Insomnia Summit 2022

Abstract Introduction Significant challenges exist in access to high-quality care for insomnia disorder. After the recent publication of clinical practice guidelines on behavioral/psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a virtual one-day summit in September 2022 to discuss improving care for patients with insomnia disorder. Methods Fifty attendees representing a variety of organizations (e.g., medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the Summit. Videos highlighting patient perspectives and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions: (1) barriers to care, (2) facilitators of high-quality care, and (3) future directions and innovations. After 3-4 brief topical presentations by content experts, summit participants divided into seven breakout groups to brainstorm and prioritize issues. Each breakout highlighted 3-5 priorities and reported back to the broader group following each thematic session. Results The top barriers to care for insomnia disorder identified by summit participants included (1) limited access to care, (2) limited awareness of insomnia treatment options, (3) limited treatment formats, (4) low perceived value of insomnia treatment, and (5) insufficient number of trained clinicians to provide care. The top facilitators of care included (1) increased education and awareness, (2) novel models to increase access to care, (3) developing and expanding the insomnia patient care workforce, (4) incorporating research into practice, and (5) increasing reimbursement. Top priorities for future directions included (1) increasing awareness among patients and healthcare providers, (2) increasing the number of skilled behavioral sleep medicine providers, (3) increasing advocacy efforts to address insurance issues (e.g., billing, reimbursement, and performance measures), and (4) working collaboratively with multidisciplinary organizations to achieve common goals for insomnia disorder care. Conclusion The AASM and participants from partnering organizations successfully engaged in a summit and identified prioritized strategies to improve access to high-quality care for insomnia disorder across diverse clinical settings (e.g., private practice, academic institutions, and rural areas). The priorities are to improve access to care for insomnia disorder, which require advocacy efforts to increase awareness of treatment options, improve reimbursement, and grow the skilled workforce for treating insomnia disorder. Support (if any) AASM

Insomnia Symptoms and Associated Factors in Caregivers of Adult Hospitalized Patients.

Caregivers experience high levels of emotional stress and must cope with several clinical and hospital-related environmental factors that seriously impact their night's rest. The purpose of this study was to establish the prevalence of insomnia symptoms in a sample of caregivers of adult hospitalized patients and to examine the relationships between insomnia symptoms and patient and caregiver-associated factors. A total of 152 caregivers were enrolled from the two main hospitals in Granada, Spain. Sociodemographic, economic, and care-related data were collected. Insomnia symptoms, burden, anxiety and depression, social support, and resilience were assessed. Information on patients' hospital admission, dependence, and neuropsychiatric symptoms was also obtained. Most caregivers were middle-aged women caring for their spouses. Self-reported insomnia prevalence was set at 45.4%. Comparison analyses between caregivers suffering from insomnia symptoms and non-insomniacs showed significantly higher burden, anxiety and depression and patients' neuropsychiatric symptoms (p < 0.05) and lower resilience and social support in the former (p < 0.01). A regression analysis showed that anxiety (ORa = 1.15; p < 0.05) and higher caregiver education level (ORa = 5.50; p < 0.05) were factors significantly associated with insomnia symptoms. Patients' neuropsychiatric symptoms showed a trend toward statistical significance as well (ORa = 1.09; p = 0.06). There is an acute need to address, prevent and treat insomnia problems in caregivers.

Development and validation of the Japanese version of the Hyperarousal Scale

BackgroundThe objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as well as to calculate a cutoff score for the HAS-J and assess different levels of hyperarousal in insomnia patients and community dwellers.MethodsWe recruited 224 outpatients receiving insomnia treatment (56.3% women; mean age 51.7 ± 15.6 years) and 303 community dwellers aged 20 years or older (57.8% women; mean age 43.9 ± 15.2 years). Exploratory and confirmatory factor analysis was performed to examine the factor structure of the HAS-J. Cronbach’s α and McDonald’s ω were then used to test internal consistency. To examine the scale’s validity, we determined correlations between the HAS-J and other indexes and compared HAS-J scores between insomnia patients and community dwellers. We also compared HAS-J scores between two community-dweller groups (normal and poor sleepers) and two insomnia patient groups (with and without alleviation after treatment).ResultsFollowing exploratory and confirmatory factor analysis, a 20-item measure emerged comprising three factors: “Introspectiveness and Reactivity,” “Neuroticism,” and “Insomnia.” Confirmatory factor analysis showed a generally good fit for the model of the three-factor structure suggested by the exploratory factor analysis loadings (χ2 (163) = 327.423, (p < 0.001), CFI = 0.914, GFI = 0.872, AGFI = 0.835, RMSEA = 0.067). In insomnia patients, internal consistency indicated sufficient reliability of the HAS-J. Correlation analysis showed weak to moderate positive correlations of the HAS-J score with other indexes, indicating concurrent validity of the HAS-J. All HAS-J subscale scores were significantly higher in insomnia patients than in community dwellers. Additionally, the total score in patients with alleviation of insomnia was comparable to that in poor sleepers and significantly higher than that in normal sleepers.ConclusionsThis study demonstrated the reliability and validity of the HAS-J, indicating that it is useful as a clinical scale of hyperarousal. The high level of hyperarousal in insomnia patients who were assessed to be in remission by the Insomnia Severity Index suggests a risk of insomnia recurrence in these patients.

Symptoms and survivorship needs differences between “good sleepers” and “bad sleepers” in survivors of breast and gynecologic cancers

IntroductionAlthough 80% of cancer survivors report symptoms of insomnia, only 28–43% meet DSM-5 criteria for this diagnosis. We sought to characterize the association between patient-reported insomnia symptoms, patient outcomes, and supportive care variables, as well as explore clinically meaningful insomnia thresholds in a sample of women diagnosed with breast and gynecologic cancers. MethodsFrom July 2018–March 2019, all breast and gynecologic cancer survivors seen at the Stanford Women's Cancer Center were approached and invited to participate in the study (15% declined). Of those who consented, 273 survivors completed an online survey related to their sleep (ISI), quality of life (FACT-G), distress (PHQ-4), supportive care needs (SCNS-SF34), and symptom severity (MDASI). Survivors who scored <8 on ISI were categorized as “good sleepers,” survivors with ISI ≥8 were categorized as “bad sleepers.” Results126 (46.2%) of survivors were “good sleepers,” 147 (53.8%) were “bad sleepers.” Good sleepers were older than bad sleepers (p < .05) but did not differ in any other demographic or any medical variables. Using hierarchical linear regression models, we found that good sleep (ISI <8) was associated with higher quality of life, lower psychological distress, increased social support, lower symptom severity, and lower supportive care needs, after accounting for demographic, medical, and treatment variables. The findings were largely replicated with an ISI cut off of 15. ConclusionsAmong women treated for breast and gynecologic cancers, survivors who were good sleepers had better psychosocial outcomes, fewer supportive care needs, and lower symptom severity compared to those who reported insomnia symptoms. Results also indicate that degree of sleep impairment, whether mild or severe, has similarly poor associations with most aspects of patient functioning and symptomatic burden. Further research is needed to determine causality of these findings.

Inflammatory Bowel Disease and Pain Interference: A Conceptual Model for the Role of Insomnia, Fatigue, and Pain Catastrophizing.

People with inflammatory bowel disease (IBD) commonly experience pain influenced by complex interactions among factors, including disease activity, sleep, psychopathology, and changes in pain processing pathways. Treatments for pain in IBD are limited, highlighting the need for research that explores modifiable factors linked to pain. The aim of this study was to investigate relationships among multiple patient factors and to construct a conceptual model for pain interference in IBD. A cross-sectional survey of adults with IBD. Study domains included demographic, comorbidity, psychological, IBD, insomnia, fatigue, and pain features. Structural equation modeling (SEM) was used to examine relationships and interactions among active IBD, insomnia, fatigue, pain experiences (severity, catastrophizing, and interference), and additional patient factors (demographics and psychological). One hundred and seventy-four participants, aged 18-85 years, reported the presence of pain. Combining the questionnaire data using SEM resulted in a final model with an excellent fit (χ 2(8) = 9.579, P = .297, χ 2/N = 1.197, CFIN = 0.997, TLI = 0.987, RMSEA = 0.034). The presence of anxiety and depression was the additional patient factors to be retained in the path analysis. SEM results indicated that greater pain interference was directly influenced by greater fatigue, worse pain catastrophizing, and worse pain severity. Pain interference was indirectly impacted by IBD activity, worse insomnia, and the presence of depression and anxiety. The proposed conceptual model highlights the role of multiple potentially modifiable factors, including insomnia, pain catastrophizing, and fatigue, contributing to worse pain interference in people with IBD.

Pulsed Radiofrequency Combined With Methylene Blue Paravertebral Nerve Block Effectively Treats Thoracic Postherpetic Neuralgia.

ObjectiveTo compare the effect, safety, and patient satisfaction of pulsed radiofrequency combined with methylene blue paravertebral nerve block and pulsed radiofrequency alone in the treatment of thoracic postherpetic neuralgia (PHN).MethodsA total of seventy-two patients with PHN diagnosed in the Department of Pain Management of Shengjing Hospital at China Medical University, from September 2019 to April 2021, were enrolled in the study. Patients were randomly divided into two groups. Group A (n = 36) received pulsed radiofrequency treatment. Group B (n = 36) received pulsed radiofrequency + methylene blue paravertebral nerve block. Patients were followed-up at 1 day, 1 week, 1 month, 3 months, and 6 months after treatment. Observation at each follow-up included basic patient characteristics, Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HAD), the Insomnia Severity Index (ISI), patient satisfaction, complications, and side effects.ResultsCompared with preoperative values, the VAS scores significantly decreased in both groups at each postoperative time point (1 day, 1 week, and 1, 3, and 6 months; all p < 0.05). Compared with group A, VAS scores in group B were significantly lower 1 week and 1 month after surgery (p < 0.05). Patients in group B had lower HAD scores than those in group A 1 week after surgery (p < 0.05). Patients in group B had lower ISI scores than those in group A 1 day, 1 week, and 1, 3, and 6 months after surgery (p < 0.05). The pregabalin dosage in group B was lower than that in group A at 1 and 6 months after surgery (p < 0.05). Patient satisfaction was higher in group B than in group A at 1 week and 6 months after surgery (p < 0.05). There were no serious complications or side effects in either group.ConclusionPulsed radiofrequency combined with methylene blue paravertebral nerve block is superior to pulsed radiofrequency alone in the treatment of thoracic PHN, which can significantly relieve PHN and improve the condition of sleep and emotional disorders. Therefore, it is a safe and effective treatment method.

Effect of Dexmedetomidine-Induced Sleep Balance Treatment on the Chronic Refractory Primary Insomnia Patients

Aim:To pilot study the therapeutic effect of dexmedetomidine-induced sleep balance treatment (DISBT) on the chronic refractory primary insomnia patients.&#x0D; Methods:Forty-two patients with chronic refractory primary insomnia were randomly divided into two groups by random number table. Patients in DISBT group were given DISBT for 3 days, while patients in the control group were given conventional treatment for 3 day. Pittsburgh sleep quality index (PSQI), the hyperarousal scale (HAS), and Hamilton anxiety scale (HAMA) were evaluated and compared between the pre-treatment and post-1-week-treatment. Sleep architecture and electroencephalogram (EEG) spectrum were also recorded and compared pre-treatment and post-treatment.&#x0D; Results:The scores of PSQI and HAMA in both groups after treatment were lower than those before treatment (P &lt; 0.05), DISBT group-reduced degree were higher than those of the control group (P &lt; 0.05). Sleep architecture of Stage 2 sleep proportion, EEG spectrum beta, and gamma relative power value in DISBT group were lower than those before treatment (P &lt; 0.05), Stage 3 sleep proportion and delta relative power value were higher than those before treatment (P &lt; 0.05); Sleep architecture of Stage 2 sleep proportion,beta, and gamma relative power value in control group were higher than those before treatment (P &lt; 0.05); rapid eye movement sleep, Stage 3 sleep proportion, and delta relative power value were lower than those before treatment (P &lt; 0.05). The total scores of the hyperarousal scale (HAS) in both groups after treatment were lower than those before treatment (P &lt; 0.05), DISBT group-reduced degree were higher than those of the control group (P &lt; 0.05), the extreme score, introspectiveness score, react score of HAS in control group after treatment had no statistical significance compared to those before treatment (P &gt; 0.05), the extreme score, introspectiveness score, react score of HAS in DISBT group after treatment were lower than those before treatment (P &lt; 0.05).&#x0D; Conclusion:DISBT effectively reduced the insomnia patient cortex hyperarousal level, corrected disorder of sleep-awakening pathways and easedup insomnia symptom. It is an effective method for chronic refractory primary insomnia.

Physical and mental impact of COVID-19 outbreak on fibromyalgia patients.

Acute or chronic stress may trigger or aggravate symptoms of fibromyalgia (FM). We aimed to evaluate the physical and mental health of fibromyalgia patients during the COVID 19 outbreak and identify protective/risk factors. An online survey was published in May 2020, following two months of lockdown due to the COVID 19 outbreak, including questionnaires regarding demographic characteristics, access to medical services, anxiety, depression, life approach, coping strategies, perception of social support, widespread pain index (WPI) and symptoms severity scale (SSS), insomnia severity index (ISI) and patient global assessment. Of the 233 patients included in the study, 98% were forced to discontinue complementary or alternative treatments during lockdown. Up to 30% of responders who had been treated with medical cannabis had to stop due to logistic difficulties and this was associated with significantly higher scores of WPI/SSS (p=0.024). Higher levels of anxiety and depression were significantly correlated with higher levels of pain, sleep disorders and subjective perception of deterioration (p=0.00). Higher scores of social support and positive life approach were correlated with less anxiety and depression (p<0.01), lower levels of pain (p<0.05) and less sleep disturbances (p<0.01). Avoidant coping style was strongly associated to higher levels of pain, sleep disturbances, anxiety, depression, and subjective perception of worsening (p<0.01). Fibromyalgia patients reported adverse mental and physical outcomes during the COVID-19 outbreak. Factors such as stopping current treatments may play a central role. Social support and a positive life approach appear to be protective.

PENGARUH PEMBERIAN AROMA TERAPI LAVENDER TERHADAP INSOMNIA PADA LANSIA DI DESA KOTO TUO WILAYAH KERJA PUSKESMAS 2 XIII KOTO KAMPAR

Background Insomnia is a condition in which someone who experiences difficulty sleeping or sleep often wakes up at night or wakes up too early. There are several therapies that can be used are lavender aromatherapy. Inhaling lavender increases the frequency of alpha waves and this state is associated with relaxing (relaxation) so it can treat insomnia. Lavender also helps balance the body's health which is very useful in relieving headaches, premenstrual syndrome, stress, tension, muscle spasms and heart regulation. The purpose of this study was to determine the effect of lavender aroma therapy on reducing insomnia in the elderly in Koto Tuo Village, the working area of Puskesmas 2 XIII Koto Kampar. This research method is experimental, using a Quasy-experimental research design with 24 elderly people, data analysis using statistical t test. The results of this study showed that there was a decrease in insomnia. The statistical results of the t test showed that the value of p = 0.00, where there was an effect of lavender therapy on the quality of sleep in the elderly in Koto Tuo Village, the Work Area of Puskesmas 2 XII Koto Kampar. The conclusion that the average insomnia sufferer before giving lavender aromatherapy is 47.78 with a standard deviation of 7.55, and the average insomnia patient after giving lavender aroma therapy is 43.00 with a standard deviation of 8.714, and a p value of 0.00 (p. <0.05). Suggestions Health education is expected to continue to be carried out by health workers and as an alternative therapy that can be used to treat insomnia so that it can become a priority for the Puskesmas program to be able to mobilize more education or education about insomnia management.

Prevalence of RLS among subjects with chronic liver disease and its effect on sleep and mood

BackgroundEarlier studies have shown that prevalence of RLS among patients with chronic liver disease (CLD) ranges between 6.6% and 100%. However, most of these studies had used questionnaires to diagnose RLS reported contradictory findings regarding risk factors for RLS. This study was planned to assess prevalence, severity and correlates of RLS among patients with CLD. We also intend to assess effect of RLS on sleep and mood in this population. MethodsAdult population with CLD was included after excluding potential confounders. Etiology of CLD was investigated. Severity of liver disease was assessed using three variables- Child-Turcotte-Pugh (CTP) grade; Model for end-stage liver disease (MELD) score, and as presence of compensated or decompensated liver disease. Acute on chronic liver failure was also defined as per APASL criteria. RLS was diagnosed on clinical interview and examination. To assess the severity of RLS international RLS severity rating scale was used. Diagnosis of insomnia and depression was made using insomnia severity index and patient health questionnaire (PHQ-9) along with clinical examination, respectively. Sleep quality was assessed by Pittsburg Sleep Quality Index- Hindi version. ResultsThis sample had predominance of males (78.6%), average age of subjects was 48.70 + 12.31 years and 98.5% subjects had decompensated liver disease. RLS was reported by 19.1% subjects and 2.3% had positive family history of RLS. Subjects with RLS had lower serum iron and serum ferritin compared to subjects without RLS. Among subjects having RLS, 60% had moderately severe symptoms, 32% had severe symptoms and 4% had very severe RLS. Subjects with RLS had greater chances of having depression and poor sleep quality. ConclusionPresent study shows that prevalence of RLS among patients with CLD is greater than population prevalence. Iron deficiency increased risk for having RLS. Subjects with RLS had poorer sleep quality and RLS increased chances of having insomnia and depression.

A Short-Time Insomnia Detection System Based on Sleep EOG With RCMSE Analysis

Objective: Currently, the prevalence of insomnia in 30% of the population in the word. To diagnose sleep issues, all-night polysomnography is usually taken from the patients, and the recordings are scored by a clinical staff. Nevertheless, manual sleep scoring and diagnosis are time consuming and subjective. In this study, a short-time insomnia detection system based on single-channel sleep EOG with refined composite multiscale entropy (RCMSE) analysis was proposed, and the performance of the proposed system was assessed with the manual scoring based on polysomnography. Methods: The sleep data from 32 subjects were used to develop and evaluate the proposed system; one half was healthy individual and the other half was insomnia patient. The corresponding RCMSE was computed from the short time single-channel sleep EOG (<; 30 min). Then, the mean values of their RCMSEs were computed. Finally, the mean values were used as input to an SVM classifier for insomnia detection. Results: 16 subjects were used to train a classifier; one half was healthy individual and the other half was insomnia patient; and the others were used to test. The averaged accuracy, sensitivity, specificity, kappa coefficient, and F1 score of the proposed system were 89.31%, 96.63%, 82.00%, 0.79, and 90.04%, respectively. Conclusion: Our results showed that RCMSE is a useful and representative feature for short-time insomnia detection. In addition, the proposed method has high accuracy and is good homecare applicability because a single-channel sleep EOG is used. Significance: In the future, we can integrate the proposed system with an EOG eye mask and portable PSG system for sleep quality assessment or insomnia screening in the home environment.

A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects

AimTo evaluate the efficacy of mindfulness-based stress reduction on objective and subjective sleep parameters and hypnotic medication use of patients with insomnia secondary to cervical cancer. MethodsThis was a randomized controlled trial enrolled insomnia patient who were caused or worsened by cervical cancer. Seventy patients with insomnia caused or aggravated by cervical cancer were at random divided into either a usual care group or an 8-week mindfulness-based stress reduction group. Subjective sleep parameters, objective sleep parameters and hypnotic medication consumption were assessed at baseline, after the program, 6- and 12-month after finishing the interventions. ResultsThe results showed that mindfulness-based stress reduction had a positive effect on subjective sleep parameters (Total wake time: ∆ = 45.32, P < 0.05; Sleep efficacy: ∆ = 6.87, P < 0.05; Total sleep time: ∆ = 22.22, P < 0.01). Compared with control group, polysomnography data in mindfulness-based stress reduction group were not improved significantly. There were no associations between subjective sleep parameters and objective sleep parameters. ConclusionMindfulness-based stress reduction had a definite impact on patients with insomnia that was secondary to cervical cancer just after the intervention, but no long-term influences. Trial registrationChiCTR1800018571; 9/25/2018; retrospectively registered.

The Effect of Lithium Binding on Secondary and Tertiary Structure, Hydrophobicity, Thermodynamics, and Interactions with Interacting Partners of Dream

Li+ is widely used for the treatment of manic-depressive illness. Studies on neuronal calcium sensor protein1 (NCS-1) have found that Li+ can inhibit the interaction between NCS-1 and inositol 1,4,5-triphosphate receptor protein, alleviating hyperarousal of insomnia patient. Li+ can have neuroprotective or neurotoxic effects depending on its concentration. In a rat model, chronic exposure to Li+ has shown a significant decrease in membrane-associated protein kinase C (PKC) in the hippocampus, suggesting potential clinical relevance. Here, we show that Li+ binds to a neuronal calcium sensor protein named Downstream Element Antagonist Modulator (DREAM), a protein homologous to NCS-1 and expressed in the hippocampus region of the brain. Li+ association results in a decrease in the emission intensity of tryptophan, suggesting rearrangements of the tertiary structure of the protein. Li+ binding also exposes hydrophobic cavity of the protein as evidenced by binding of the hydrophobic molecule 1,8-ANS. CD data reveal that Li+ binding alters the protein secondary structure. Tryptophan emission and CD data are further supported by steady-state lifetime data. Thermodynamic parameters for Li+ association to DREAM have been obtained through isothermal titration calorimetry (ITC) measurements. Li+-bound DREAM interactions with binding partners have been probed by titrating FITC-tagged presenilin-1 and potassium channel against Li+-bound DREAM. Findings of this project suggest potentials for the Li+-based compounds in the animal model to investigate whether acute and chronic exposure to Li+ has any effect on the expression level of DREAM and whether Li+-based compounds influence interactions between DREAM and intracellular partners.

Interview-based ratings of DSM-IV Axis II/DSM-5 Section II Personality Disorder symptoms in consecutively admitted insomnia patients: A comparison study with consecutively admitted psychotherapy patients matched on age and gender

BackgroundSelected personality features may represent important predisposing as well as perpetuating factors for insomnia, and previous studies stressed the importance to assess personality disorders in insomnia patients. MethodsIn order to evaluate the relationships between DSM-IV Axis II/DSM-5 Section II Personality Disorders (PDs) and insomnia, a sample of 171 consecutively admitted insomnia patients and a sample of 171 psychotherapy patients, matched on age and gender were administered the Italian translation of the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, Version 2.0 (SCID-II). Among insomnia patients, 52.0% (n = 89) received at least one DSM-IV Axis II/DSM-5 Section II PD diagnosis according to SCID-II assessment. ResultsAny PD base rate estimate in our insomnia patient sample was significantly and markedly higher than the median and mean base rate estimates for any PD in the general population. Within-group analyses showed that Narcissistic, Not otherwise specified PD, Histrionic PD, and Borderline PD represented the most frequently diagnosed-both dimensionally and categorically-DSM-IV Axis II/DSM-5 Section II PD features in our insomnia patient sample. When continuously-scored PDs were considered, insomnia patients showed a significantly lower number of Paranoid and Borderline PD features than psychotherapy patients; however, the corresponding effect size estimates suggested that these differences were modest. None of the categorically-scored PDs significantly differentiated insomnia patients from psychotherapy patients. ConclusionsAs a whole, our findings seemed to suggest that personality dysfunction may play a role in insomnia, while stressing the need for a dimensional approach to the assessment of maladaptive personality traits even in insomnia patients.

Inclusion and Exclusion Criteria of Clinical Trials for Insomnia.

Randomized controlled trials (RCTs) have eligibility criteria for the inclusion of participants. Ideally, the RCT sample would be representative for the patient population that will use the drug under investigation. However, external validity may be at stake when applying too many or too restrictive eligibility criteria. The current two-part study examined (1) the currently applied eligibility criteria in Phase II and III RCTs examining sleep medication; (2) how these criteria match with the insomnia population as a whole; and (3) how inclusion rates can be changed by an adaptation of these criteria. In the first study, insomnia RCTs were screened at www.clinicaltrials.gov, and relevant eligibility criteria were identified. The second study comprised a survey among self-reported insomnia patients. It was determined to what extent RCT eligibility criteria match the characteristics of this patient population. Of the n = 519 patients that completed the survey only n = 2 (0.4%) met all eligibility criteria of current RCTs. RCT enrolment criteria are not representative for the insomnia patient population as a whole. Being less rigorous in applying upper or lower criteria limits results in a significant increase in the number of eligible patients, and increases the representativeness of RCTs for the insomnia patient population as a whole. The current analysis demonstrates that is important to thoroughly reconsider the use eligibility criteria and their inclusion ranges, and to have a theoretical basis for using them.

Personal characteristics of paradoxical insomnia: A case-control study

To compare the personal characteristics between the patients with paradoxical insomnia and the patients with primary insomnia or the normal sleepers. Methods: A case-control study with the proportion at 1:1:1 was carried out. The patients with paradoxical insomnia were diagnosed in Sleep Medicine Center of West China Hospital of Sichuan University between March 2013 and December 2013. A case of paradoxical insomnia was matched with two controls: a primary insomnia patient and a normal sleeper. A total of 63 matched cases were collected. A face-to-face survey was conducted by using the following scales: General Data Scale and Eysenck Personality Questionnaire (EPQ). Results: The average scores of psychoticism, extraversion, and neuroticism for paradoxical insomnia cases were (52.1±10.2), (49.6±9.8), and (56.0±12.0), respectively. In general, 31.7% of paradoxical insomnia patients had psychoticism or psychoticism tendency in their personality, which were more obvious than those in primary insomnia patients (7.9%) (χ2=11.228, P<0.0125) and normal sleepers (0) (χ2=23.774, P<0.0125). Moreover, 19.0% of paradoxical insomnia patients had extroversion or extroversion tendency in their personality, which were more significant than those in primary insomnia patients (3.2%) (Z=-4.047, P<0.0125) but less obvious than those in normal sleepers (60.3%) (Z=-4.754, P<0.0125). Also, 46.0% of paradoxical insomnia patients had neuroticism or neuroticism tendency in their personality, which were more significant than those in normal sleepers (0) (χ2=37.670, P<0.0125) but similar to those in primary insomnia patients (52.4%) (χ2=0.508, P>0.0125). Conclusion: The personal characteristics for paradoxical insomnia patients did not reached obviously abnormal level. However, their psychoticism tendency, extroversion tendency and neuroticism tendency needed to be paid attention.

Mechanical Bed for Investigating Sleep-Inducing Vibration.

In running cars or trains, passengers often feel sleepy. Our study focuses on this physiological phenomenon. If a machine can reproduce this phenomenon, it is feasible to put a person, such as an insomnia patient or an infant, to sleep without any harmful effects. The results of our previous study suggest that low-frequency vibration induces sleep. This report describes a new mechanical bed for inducing sleep and discusses the effects of different vibration conditions. The new bed has two active DOFs in the vertical and horizontal directions to examine the anisotropy of sensation. The bed includes three main parts: a vertical driver unit, a horizontal driver unit, and a unique 2-DOF counterweight system to reduce driving force and noise. With regard to motion accuracy, the maximum motion error in the vertical direction lifting 75 kg load was only 0.06 mm with a 5.0 mm amplitude of a 0.5 Hz sinusoidal wave. The results of excitation experiments with 10 subjects showed a significant difference in sleep latency between the conditions with vibration and without vibration. Furthermore, the average latency with insensible vibration (amplitude = 2.4 mm) was shorter than that with sensible vibration (amplitude = 7.5 mm). These results suggest the ability of appropriate vibration to induce sleep.

A Case Report of Traditional Korean Medical Treatment for an Insomnia Patient Taking Zolpidem

The purpose of this study was to report a case of an insomnia patient treated with a traditional Korean medical treatment. The patient had suffered from insomnia for 4 months and had taken medicines such as Zolpidem. We diagnosed the patient as So-yang-in, according to the Sa-sang constitutional medicine. We prescribed medicine with herbs for So-yang-in and applied acupuncture for 9 days, and then we evaluated sleep time, quality, and awakening, based on the patient’s statement. The symptoms of insomnia were gradually improved during treatment. Therefore, traditional Korean medical treatment can help insomnia patients sleep well without Zolpidem. Keywords: insomnia, Zolpidem, So-yang-in, traditional Korean medicine

Sleep-wake time perception varies by direct or indirect query.

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information.