Investigate white matter alterations in chronic insomnia (CI) using Automated Fiber Quantification (AFQ). Diffusion tensor imaging data from 49 CI patients and 27 healthy controls were profiled for fractional anisotropy (FA), axial/mean/radial diffusivity (AD/MD/RD) across 100 nodes of 18 tracts. CI showed increased AD in bilateral anterior thalamic radiations, right inferior longitudinal fasciculus, right arcuate fasciculus; increased MD in bilateral anterior thalamic radiations, right corticospinal tract, forceps minor of the corpus callosum, and right inferior longitudinal fasciculus. Changes in specific segments correlated significantly with clinical scores. AFQ reveals fiber-specific abnormalities linked to clinical scores in CI.

A scalable framework for population-level precision health: Insights from sleep disorders.

To observe and evaluate the clinical efficacy of acupuncture combined with estazolam on chronic insomnia, so as to provide an effective intervention protocol for patients with chronic insomnia. Sixty-four patients with chronic insomnia were randomized into a treatment group and a control group, with 32 cases in each group. Patients in the control group received estazolam orally at bedtime every day and for consecutive 4 weeks according to the dosage recommended by experts. In the treatment group, on the basis of the treatment as the control group, acupuncture was delivered once every 2 days, 3 times a week and for consecutive 4 weeks. Before and after treatment, the scores of Pittsburgh sleep quality index inventory (PSQI) and self-anxiety scale (SAS), the objective sleep indicators (total sleep duration, sleep latency, and sleep efficiency), and the scores of Wechsler memory scale (WMS-RC) and traditional Chinese medicine (TCM) symptoms were evaluated in two groups. The clinical efficacy was assessed in each group. The total effective rate of the treatment group was 87.10%, higher than that of the control group (67.74%, P<0.05). In the intra-group comparison, compared with before treatment, the score of each item and the total score of PSQI, sleep latency, SAS score and TCM symptom score decreased (P<0.05);the total sleep duration, sleep efficiency, scores of long-term memory, transient memory, short-term memory, and memory quotient increased (P<0.05) after treatment in both groups. When compared with the control group after treatment, in the treatment group, sleep onset time score, the total score of PSQI, sleep latency, SAS score and TCM symptom score decreased (P<0.05) and the total sleep duration, sleep efficiency, scores of long-term memory and transient memory were elevated (P<0.05). Acupuncture combined with estazolam can remarkably improve the overall sleep quality, anxiety status, memory level, and TCM symptoms in patients with chronic insomnia. The combined treatment protocol is more superior to estazolam alone for chronic insomnia.

The phenomenon of decreased DTI-ALPS index has been reported in patients with chronic insomnia (CI) and has been associated with cognitive decline. Choroid plexus (ChP) volume is closely linked to glymphatic system function. However, the ChP volume in patients with CI and its relationship with both DTI-ALPS index and cognitive function remain unclear. The study included 107 patients diagnosed with CI and 68 healthy controls. All participants underwent brain MRI scans, sleep assessments, and a comprehensive assessment of cognitive function. The ChP volume was automatically segmented from 3D-T1WI and presented as a ratio to total intracranial volume. The DTI-ALPS index was calculated based on DTI and used to evaluate water diffusivity in specific white matter regions. Our findings demonstrated significant enlargement of ChP volume and reduction in the DTI-ALPS index among CI patients with declined cognition, compared to patients with normal cognition and healthy controls. The results of partial correlation analysis showed that ChP volume in CI patients with declined cognition was negatively correlated with the Montreal Cognitive Assessment (MoCA) (r = -0.350, P = 0.009) and the Digit Span Test (DST) (r = -0.273, P = 0.044). ChP volume was negatively correlated with DTI-ALPS index (r = -0.342, P = 0.011). Furthermore, DTI-ALPS index was positively correlated with MoCA (r = 0.295, P = 0.029) and DST (r = 0.269, P = 0.047). The results of receiver operating characteristic analysis showed that ChP volume is inadequate as a highly accurate (area under the curve: 0.65, 95% CI: 0.54-0.76, P = 0.009) imaging marker for distinguishing cognitive decline in patients with CI. Our study indicated an enlargement of ChP in CI patients with declined cognition. Enlarged ChP in CI patients with declined cognition was associated with lower DTI-ALPS index and cognitive decline.

Insomnia is highly prevalent in the general population and increases the risk of somatic and mental disorder. It leads to considerable strain on healthcare systems and contributes to societal burdens. Current recommended treatments for chronic insomnia are limited, and a proportion of patients do not respond adequately. Enhanced external counterpulsation (EECP) is an effective and noninvasive therapy for ischemic vascular disease. Findings from our previous pilot trial demonstrated its potential therapeutic effect on chronic insomnia. This current large-scale randomized controlled study aims to investigate the therapeutic efficacy of EECP in chronic insomnia, as well as its underlying mechanisms. This single-center, two-armed, randomized, single-blinded, parallel sham-controlled trial will enroll 98 participants with chronic insomnia aged 18-75 years. Based on a 1:2 ratio, participants will be randomly assigned to the sham EECP group (control) or the EECP group (experimental) to receive 45-minute sessions. Five sessions will be held per week for a total of 35 sessions. This trial will include six assessments (i.e., pre-intervention, mid-intervention [20th session], post-intervention [35th session], and 3-month, 6-month, and 12-month follow-ups) over 14 months. The primary outcome is the change in Pittsburgh Sleep Quality Index (PSQI) score post-intervention. Secondary outcomes include PSQI score changes at mid-intervention and at 3-, 6-, and 12-month follow-ups; sleep parameters (total sleep time, efficiency, latency, and awakenings); anxiety, depression and quality of life scores at mid-intervention, post-intervention, and follow-ups; along with peak oxygen uptake, heart rate at 1-minute recovery, vascular endothelial function, and blood biomarkers post-intervention. This study will report on the short-, medium-, and long-term efficacy of EECP in chronic insomnia, as well as its underlying mechanisms. The findings may offer a new treatment option for refractory patients and help improve productivity, reduce comorbidities, and lower healthcare costs. ChiCTR, ChiCTR2500101872 (URL: https//www.chictr.org.cn/). Registered on 30 April 2025.

Patients recovering from cardiac surgery in the intensive care unit (ICU) do not sleep well. Commonly used sedative-hypnotic medications can disrupt sleep architecture and increase the risk of delirium in critically ill patients after surgery. The orexin receptor antagonist suvorexant, improves sleep onset and duration in patients with chronic insomnia. We hypothesized that suvorexant improves sleep onset and duration while also reducing the incidence of delirium after cardiac surgery. This multicentric, double-blind, randomized controlled trial was conducted at two university-based cardiac ICUs. One hundred adult patients were enrolled after admission to the ICU following cardiac surgery. Enrollment occurred between March 2020 and February 2025. Participants were randomized to receive either a once daily oral dose of suvorexant 20mg or placebo. Treatment began on the first night after extubation and continued until hospital discharge or for a maximum of seven days, whichever occurred first. Sleep was recorded using an electroencephalography (EEG) monitor (SedLine, Masimo Corp., California, USA) on the first night after extubation and was scored blindly by an experienced registered polysomnographic technologist. The primary outcome was wakefulness after persistent sleep onset (WASO). Sleep onset was defined as the first 30-second epoch classified by rapid eye movement (REM) or non-REM stages 1, 2, 3 after lights off. Wakefulness was defined as an awake period of 30s or longer. Sleep questionnaires were administered and delirium screenings were conducted every morning until hospital discharge. One hundred patients were randomized to receive suvorexant (n = 49) or placebo (n = 51). EEG analysis indicated that neither the median [inter-quartile range] nighttime WASO (200.7 [112.1, 328.4] minutes vs. 184.2 [80.4, 304.2] minutes; p = 0.33) nor total sleep time (224.0 [112.0, 379.0] minutes vs. 253.0 [68.0, 420.0] minutes; p = 0.92) differed significantly between the groups. There was no significant difference in rescue medication (melatonin, dexmedetomidine, benzodiazepine) utilization between the groups. Subjective sleep quality, incidence of delirium, and delirium-free days did not differ between the two groups. Clinical Trials Registry no. NCT04092894, Registration Date 09/17/2019. Among patients recovering in the ICU who underwent cardiac surgery with cardiopulmonary bypass, the suvorexant treatment did not affect wakefulness after sleep onset or post-operative delirium.

This pilot randomized controlled trial (RCT) evaluated feasibility, acceptability, and preliminary clinical benefits of ACTCOM-I, a novel intervention combining Acceptance and Commitment Therapy with behavioural strategies and self-compassion, compared with CBT-I. An analytic sample of 19 participants (63% women; M = 43.26 years, SD = 12.77) with chronic insomnia was randomized to ACTCOM-I (n = 10) or CBT-I (n = 9). Assessments occurred at baseline (T0), post-treatment (T1), 3-months (T2) and 6-months (T3) follow-ups. Measures included insomnia severity, beliefs, pre-sleep arousal, sleep effort, sleep diary, anxiety/depression, affect, quality of life, mindfulness, psychological flexibility, cognitive fusion, progress/obstructions to valued living, and self-compassion. Linear mixed models showed significant Time effects for insomnia severity (p < .001), with large within-group effect sizes maintained at follow-up. No significant between-group differences were found (p = .88), indicating similar improvement trajectories over time. Reliable change analysis (RCI) confirmed that 90% of ACTCOM-I and 89% of CBT-I participants achieved clinically significant improvements at post-treatment, with high response and remission rates. No participants deteriorated. Both interventions also led to comparable improvements in secondary sleep-related outcomes, anxiety/depression, and positive affect, while negative affect remained stable. Most process-related measures showed significant Time effects but no TimeXGroup interactions, further supporting similar patterns of change. Within-group analyses suggested greater improvements in psychological flexibility, cognitive fusion, obstructions to valued living and self-compassion in ACTCOM-I, particularly at follow-up. Despite high attrition, ACTCOM-I was feasible, well-accepted, and thematic analysis identified six overarching themes. Results suggest that ACTCOM-I is feasible, well-accepted, and preliminary findings support further studies on its potential as a complementary treatment to chronic insomnia.

Mounting evidence shows sex-based differences in sleep experiences and outcomes, including the prevalence of insomnia disorder. However, the impact of biological sex on brain oscillations during sleep remains poorly understood, especially in the context of insomnia disorder. This is a notable gap, given that neurophysiological aspects of sleep are associated with brain health and overall sleep quality. We systematically reviewed and meta-analysed data from studies reporting spindle and slow wave activity in adults with and without insomnia disorder. We conducted systematic searches in PubMed, Embase, Scopus, and PsycInfo. Risk of bias was evaluated using the Newcastle Ottawa and the PEDro scales. Forty-three studies met our inclusion criteria, with thirteen studies of normal sleepers (N = 668) reporting sufficient data for random-effects meta-analyses. Compared with males, female normal sleepers had higher spindle density, sigma and delta power. Most studies recruited individuals with primary insomnia, and data pooling for insomnia and mixed groups was not possible due to insufficient statistical reporting. Moreover, group-by-sex interactions were limited, inconsistent, and varied across studies and sample characteristics. Further research is needed to explore sex-specific differences in sleep microarchitecture and their role in normal sleep and the manifestation of insomnia disorder.

Clinical phenotyping of chronic insomnia in early childhood: family-history-informed vulnerability profiles in a retrospective chart review.

IntroductionSubjective sleep perception often differs from objective sleep measures in chronic insomnia, but the role of night-to-night sleep variability remains insufficiently understood. This study examined the effects of daily within-individual sleep fluctuations and between-individual sleep variability on subjective sleep perception in patients with chronic insomnia.MethodsFifty patients with chronic insomnia completed home-based sleep monitoring and sleep diaries for five to seven consecutive nights, yielding 312 valid nights. Sleep perception bias was defined as the difference between objective sleep parameters and subjective estimates. Sleep variability was quantified using the coefficient of variation. Linear mixed-effects models examined within-individual associations, between-individual variability effects, and cross-level interactions.ResultsNightly objective changes in total sleep time, sleep efficiency, wake after sleep onset, and sleep onset latency were significantly associated with corresponding subjective-objective discrepancies. Subjective perception changed less than objective sleep parameters, suggesting reduced subjective responsiveness to nightly sleep changes. Between individuals, lower total sleep time variability was associated with greater bias in perceived sleep duration and sleep efficiency. Higher N2 percentage variability was associated with greater wake after sleep onset perception bias and moderated the association between objective wake time and subjective perception.DiscussionThese findings suggest that subjective sleep perception in chronic insomnia is influenced by nightly objective sleep changes and longer-term sleep variability. N2-related findings should be interpreted cautiously given the exploratory sleep-stage-specific analyses and portable EEG monitoring.

Peripheral vascular interventions (PVIs) are less invasive alternatives to surgical bypass. However, the impact of PVIs on the post-procedural quality of life of patients and workload of nurses remains unclear. Therefore, we conducted a questionnaire-based survey including patients and nurses. The patient questionnaire consisted of eight items, including intra-procedure access site pain, post-procedure access site pain, discomfort during rest time, difficulty eating, bathroom difficulties, difficulty sleeping, difficulty walking the following day, and overall procedure satisfaction. The nurses' workload questionnaire comprised seven items, including bathroom care, eating care, pain care, access-site care, post-procedure nurse call support, handling postoperative complications, and overall workload. Patients who underwent PVIs using the transradial approach expressed significantly less discomfort during the post-procedure rest time, difficulty eating, bathroom difficulties, difficulty sleeping, and difficulty walking the following day than those who underwent the transfemoral approach. Nurses found the post-procedural management of the transradial approach easier than that of the transfemoral approach, with significant differences in bathroom care, eating care, access-site care, and handling postoperative complications. Notably, the overall workload was significantly lower for the transradial approach than that for the transfemoral approach. Thus, the transradial arterial approach for PVI had advantages over the transfemoral approach in this study, including improved patient comfort and decreased nursing workload.

Women suffering fromhyperemesis gravidarum need timely and appropriate treatment to alleviate symptoms and prevent complications to the mother and fetus. The aim of this study was to identify and analyze treatment given prior to hospitalization to women included in the SUKK-P study. This study presents cross-sectional analyses at enrollment in the prospective SUKK-P cohort study of hyperemesis gravidarum (HG) treatment. Women hospitalized for HG were included from 11 departments within Norway between February 2021 and December 2023. Self-reported symptom severity and its impact on daily life at inclusion, treatment and health care received prior to hospitalization were collected by survey and chart review. The majority (89%) of the 214 women included in SUKK-P had sought health care for nausea and vomiting during pregnancy (NVP)/HG prior to hospitalization. Although 88% had used one or more antiemetics prior to hospitalization, 42% were on sick leave for nausea prior to being offered antiemetic treatment. The median PUQE-score at hospitalization was 14 (interquartile range (IQR) 12-15) with a median wellbeing score of 2 (IQR 1-3). The participants reported severe impact on daily life in terms of reduced ability to perform household chores, care for children, and socialize. Nearly all (99%) were feeling low or depressed to some degree, and nine of ten reported that the nausea impacted the relationship with their partners. Half of the women reported having thoughts about terminating the pregnancy. One or more additional symptoms were reported by 97% with headache and hopelessness or feeling low as the most frequent, closely followed by difficulty sleeping, acid reflux, and constipation. Women with hyperemesis gravidarum describe high level of distress, still there is a delay in being provided antiemetics as 42% reported provision of sick leave as first healthcare measure.

IntroductionCannabis use is common in the USA and is associated with adverse outcomes across many domains, including sleep difficulties. Targeting insomnia with an evidence-based treatment could improve sleep and reduce frequent cannabis use. This randomised controlled trial (RCT) will compare evidence-based telemedicine-delivered cognitive-behavioural therapy for insomnia for adults with frequent cannabis use (CBTi-CB) against an active comparator, sleep hygiene education (SHE), for improving insomnia/sleep, associated daytime symptoms and cannabis use. The study will also determine the effects of treatment on sleep mechanisms and their association with clinical outcomes.Methods and analysisThis is a single-site RCT with planned enrolment of 200 adults (21+ years of age) who meet criteria for both chronic insomnia and frequent cannabis use. Eligible participants will be randomised 1:1 to six sessions of CBTi-CB or SHE with clinical assessments conducted at pre-treatment, post-treatment and at 3 and 6 months post-treatment. Overnight polysomnography (PSG) will be conducted before and after treatment. Primary outcomes will include the Insomnia Severity Index, 12-item Short-Form Health Survey Mental Composite Score and cannabis use frequency as assessed by the interview-administered Timeline Follow Back. Electroencephalogram delta activity, derived from overnight PSG, will be the primary end point to assess the sleep homeostasis mechanism.Ethics and disseminationEthical approval for the study has been obtained from the Institutional Review Board of the University of Michigan Medical School (IRBMED #HUM00222302). The results of the investigation will be published in scientific papers. The data from the investigation will be made available through the National Institutes of Health (NIH) National Data Archive, which allows researchers on NIH grants to share and access raw data.Trial registration numberNCT05814822.

Few studies have explored the combined impact of physical activity (PA), sleep duration, and trouble sleeping on mortality outcomes in patients with cancer. We aimed to investigate the independent and combined prognostic effects of PA and sleep on mortality outcomes among cancer survivors in the United States. Using the National Health and Nutrition Examination Survey (2007-2018), data of 2651 cancer survivors were analyzed. Mortality was ascertained using the National Death Index. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate associations. Independent analyses demonstrated reduced mortality risk among survivors with sufficient PA (PA ≥ 600 metabolic equivalent minutes/week) and adequate sleep time (7-9 hours/d), whereas those reporting trouble sleeping showed elevated risk. Joint analyses demonstrated that survivors with sufficient PA and either adequate sleep time or without trouble sleeping had significantly lower all-cause mortality (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.39-0.64; HR: 0.48, 95% CI: 0.37-0.62, respectively) and cancer-specific mortality (HR: 0.56, 95% CI: 0.36-0.86; HR: 0.46, 95% CI: 0.30-0.70, respectively). Importantly, abnormal sleep time (<7 or >9 hours/d) and trouble sleeping were not associated with risk of all-cause or noncancer mortality among individuals who achieved sufficient PA. The combination of sufficient PA, adequate sleep time, and absence of trouble sleeping reduces mortality risk among cancer survivors. The harms of abnormal sleep time and trouble sleeping were offset by sufficient PA. Survivorship care should integrate the concurrent assessment and management of PA and sleep.

This systematic literature review evaluated the risks of using benzodiazepine medications for more than 3 months in adults with chronic insomnia. Chronic insomnia is defined as ongoing dissatisfaction with sleep quantity or quality, causing significant distress and impaired functioning during the day. Although benzodiazepine medications are often prescribed to treat insomnia, using them longer than 4 weeks raises concerns about dependence, negative side effects, and long-term health risks for patients. This review included 27 studies published between 1987 and 2023, focusing on adults with insomnia symptoms lasting at least 3 months. The main outcomes examined were sleep quality, safety issues such as risk of falls, mental health concerns including depression and anxiety, and overall quality of life. Five outcomes were deemed suitable for meta-analysis: severity of insomnia, sleep quality, incidence of falls, depression, and anxiety. The results showed that people taking benzodiazepine medications had more severe insomnia than healthy sleepers, but less severe than those who were not taking any medication. The risk of falls was similar between those using benzodiazepine medications and those who were not. However, people using these medications experienced significantly higher levels of depression and anxiety compared to healthy sleepers. This review highlights a lack of studies on the long-term use of benzodiazepine medications, but suggests that extended use may worsen sleep quality, mental health, and quality of life. The findings support guidelines recommending limited use and prioritizing behavioural therapy and alternative safer pharmacotherapies for insomnia.

ABSTRACT Objective Alcohol and cannabis are commonly used as sleep aids that inadvertently perpetuate symptoms of insomnia over time, but substance use is not a standard component of sleep assessments. This pre-registered study aimed to expand the validity and clinical utility of the Dysfunctional Beliefs about Sleep Scale (DBAS) by incorporating substance use expectancies for sleep. Method After using cognitive interviewing to improve the content validity of items (N = 24, age M = 33.3y, 83% female), iterative factor analyses and tests of external validation were used to refine and psychometrically evaluate the revised scale (full sample N = 966, age M = 42.6, 60% female, 65% with at least mild insomnia). Results The final set of 11 items was best represented by two factors (9 sleep and 2 substance use items; r = 0.15). The sleep subscale was strongly correlated with the DBAS-16 (r = 0.95, p < .001) and demonstrated measurement invariance across those who did (n = 309) and did not (n = 318) drink alcohol. The substance use subscale (β = 0.16, p < .001) accounted for a small but significant amount of unique variance in insomnia severity (sleep subscale β = 0.59, p < .001) and demonstrated concurrent and prospective associations with alcohol/cannabis use. Surprisingly, the single cannabis belief item was more strongly associated with cannabis use than longer validated scales of cannabis sleep expectancies. Conclusions The substance use version of the DBAS (DBAS-S) is a brief, reliable, and valid measure of dysfunctional sleep beliefs and substance use expectancies that will improve clinical practice by flagging substance use as a potential contributor to insomnia for clinicians.

Specific brain oscillations can be manipulated during sleep to improve sleep quality and memory performance. We previously demonstrated that continuous rocking stimulation (0.25 Hz, lateral movement) applied to good sleepers during sleep enhanced stable deep sleep, boosted NREM oscillations (spindles and slow waves) and memory consolidation. Here, we investigated whether nocturnal rocking could benefit individuals suffering from sleep difficulties. We recruited 16 young adults with subjective difficulties initiating and/or maintaining sleep and who presented with objective poor sleep quality. After a habituation night, each participant spent two nights of sleep at the laboratory, one rocking and one stationary, during which we assessed sleep and declarative memory consolidation. We found that a whole night of gentle rocking in individuals with poor sleep decreased sleep fragmentation, time spent awake and in light sleep (N1), with an associated increase in objective sleep efficiency and subjective sleep quality. Additionally, we replicated the neural entrainment or synchronising effect of the rocking motion, yielding a boost in NREM fast spindles and slow oscillations. Yet, these changes in sleep did not modulate overnight memory performance. By alleviating some difficulties encountered in this population of poor sleepers, these findings provide preliminary evidence that rocking may represent an alternative or complementary intervention for the management of some forms of chronic insomnia.

ABSTRACT Objectives Cognitive behavioral therapy for insomnia (CBT-I) is widely recommended, but access remains limited, particularly among rural adults. Medications to treat insomnia, including zolpidem and trazodone, are widely used but can have significant side effects. Empirical evidence remains sparse to support the choice of CBT-I, medication, or combined treatment in clinical practice. Method This paper describes the Comparative Effectiveness of Zolpidem/Trazodone and Cognitive Behavioral Therapy for Insomnia (COZI) study, which aimed to compare the effectiveness of medications and behavioral interventions for chronic insomnia. Results COZI was a multi-center randomized trial in rural adults (aged 18–80) with chronic insomnia. The effects of three insomnia treatments were compared: digital CBT-I (dCBT-I), medication (patient/provider choice of zolpidem or trazodone), and the combination of medication plus dCBT-I. Treatment outcomes were measured at 9 weeks, 6 months, and 12 months. The primary outcome was change in severity of insomnia symptoms (ISI) over 6 months. Secondary outcomes included change in insomnia symptom severity at 9 weeks and 12 months, adverse events, and other patient-centered outcomes. Conclusions Study results will provide support for clinical decision-making in insomnia treatment.

Insomnia and poor sleep quality are common sleep-related problems in adults and are associated with impaired quality of life, psychological distress, and increased physical health burden. Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line non-pharmacological treatment for chronic insomnia, internet-based Acceptance and Commitment Therapy (iACT) has increasingly been explored as an alternative or complementary digital psychological intervention for improving sleep-related outcomes. To systematically evaluate the effects of iACT on sleep quality and insomnia-related outcomes in adults. PubMed, Web of Science, Cochrane Library, CINAHL, and Embase were systematically searched from inception to December 6, 2025. We included randomized controlled trials evaluating internet-based Acceptance and Commitment Therapy in adults that reported validated outcomes for sleep quality or insomnia. Standardized mean differences were pooled using a random-effects model, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Eight randomized controlled trials met the inclusion criteria. Five studies were included in the meta-analysis of sleep quality outcomes and three in the meta-analysis of insomnia outcomes. Compared with passive control conditions, iACT was associated with better sleep quality outcomes (SMD = - 0.92, 95% CI - 1.45 to - 0.38; p < 0.001) and reduced insomnia symptoms (SMD = - 0.40, 95% CI - 0.64 to - 0.16; p < 0.001). Exploratory subgroup analyses suggested possible variation in sleep quality outcomes according to intervention duration, participant characteristics, and delivery format, although these findings should be interpreted cautiously. iACT may have potential to improve sleep quality and insomnia-related outcomes in adults. However, the available evidence remains limited by heterogeneous populations, intervention characteristics, delivery formats, and overall low certainty of evidence. Therefore, the findings should be considered preliminary rather than definitive.

Associations of adverse and positive childhood experiences with self-reported difficulty sleeping among urban caregivers in Philadelphia, Pennsylvania.