Morning Awakening Research Articles

Association between household solid fuel use for cooking and sleep disturbance in rural China: findings from the China Kadoorie Biobank data

BackgroundSolid fuel use for cooking is a main source of household air pollution, particularly in rural China. Evidence on the association between household air pollution and sleep quality remains limited. This study aimed to examine the association between household solid fuels used for cooking and sleep disturbance. MethodsThe data of 283,170 adults from baseline survey of the China Kadoorie Biobank Study were included. Detailed information about exposure to solid fuels used for cooking were collected. Sleep disturbance was indicated as any of the three sleep disorders, including disorders of initiating and maintaining sleep, disorders of early morning awakening, and daytime dysfunction. Logistic regression analysis was used to examine the association between sleep disturbance and level of exposure to household solid fuels used for cooking. ResultsAbout 18% of participants reported sleep disturbance. Fully adjusted analysis indicated exposure to household solid fuels used for cooking was significantly associated with sleep disturbance. Compared to those with 0–3 years exposure (first tertile) to solid fuels used for cooking, the participants with 3–26 years exposure (second tertile) and >26 years exposure (third tertile) had greater odds of having sleep disturbance at 1.16 (95% CI: 1.12–1.19) and 1.33 (95% CI: 1.29–1.37) times, respectively. ConclusionsUse of household solid fuels is associated with prevalence of sleep disturbance; the longer duration of exposure to solid fuels use for cooking, the higher is the prevalence of sleep disturbance. Further study is warranted to examine the underlying mechanisms of the association.

Evaluating lemborexant for the treatment of insomnia

ABSTRACT Introduction Insomnia is a complex sleep disorder that compromises quality of life and affects approximately 10% of the general population. Insomnia, defined as trouble initiating or maintaining sleep associated with impaired daytime function or distress, is treated using a comprehensive approach comprised of cognitive behavioral therapy and pharmacotherapy. Lemborexant, a dual orexin receptor antagonist, is a new pharmacotherapeutic option recently approved for the treatment of insomnia. Areas covered Here, the authors describe lemborexant, assess its efficacy and safety profile in clinical trials, and evaluate its role in the current insomnia treatment landscape. Expert opinion Lemborexant may offer an improved treatment option compared with other pharmacotherapies for insomnia because it is effective both over the long term and over a wide range of outcome measures. Importantly, lemborexant improves latency to sleep onset and sleep maintenance and is able to help people who experience early morning awakenings. Safety data reveal that lemborexant has minimal residual effects on morning alertness or next day function, and that patients are able to respond to an external auditory stimulus in the middle of the night. In conclusion, lemborexant represents a new, effective, and well-tolerated medication for patients with insomnia.

Sleep and its Association With Pain and Depression in Nursing Home Patients With Advanced Dementia - a Cross-Sectional Study.

Objective: Previous research suggests a positive association between pain, depression and sleep. In this study, we investigate how sleep correlates with varying levels of pain and depression in nursing home (NH) patients with dementia.Materials and methods: Cross-sectional study (n = 141) with sleep-related data, derived from two multicenter studies conducted in Norway. We included NH patients with dementia according to the Mini-Mental State Examination (MMSE ≤ 20) from the COSMOS trial (n = 46) and the DEP.PAIN.DEM trial (n = 95) whose sleep was objectively measured with actigraphy. In the COSMOS trial, NH patients were included if they were ≥65 years of age and with life expectancy >6 months. In the DEP.PAIN.DEM trial, patients were included if they were ≥60 years and if they had depression according to the Cornell Scale for Depression in Dementia (CSDD ≥ 8). In both studies, pain was assessed with the Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale (MOBID-2), and depression with CSDD. Sleep parameters were total sleep time (TST), sleep efficiency (SE), sleep onset latency (SOL), wake after sleep onset (WASO), early morning awakening (EMA), daytime total sleep time (DTS) and time in bed (TiB). We registered use of sedatives, analgesics, opioids and antidepressants from patient health records and adjusted for these medications in the analyses.Results: Mean age was 86.2 years and 76.3% were female. Hierarchical regressions showed that pain was associated with higher TST and SE (p < 0.05), less WASO (p < 0.01) and more DTS (p < 0.01). More severe dementia was associated with more WASO (p < 0.05) and TiB (p < 0.01). More severe depression was associated with less TST (p < 0.05), less DTS (p < 0.01) and less TiB (p < 0.01). Use of sedative medications was associated with less TiB (p < 0.05).Conclusion: When sleep was measured with actigraphy, NH patients with dementia and pain slept more than patients without pain, in terms of higher total sleep time. Furthermore, their sleep efficiency was higher, indicating that the patients had more sleep within the time they spent in bed. Patients with more severe dementia spent more time awake during the time spent in bed. Furthermore, people with more severe depression slept less at daytime and had less total sleep time Controlling for concomitant medication use did not affect the obtained results.

COVID-19 and sleep patterns in adolescents and young adults

ObjectiveIn March 2020, the world experienced a global pandemic, which involved the shutdown of schools or a transposition to remote teaching in most countries. The objective of the present study was to investigate the impact of the COVID-19 pandemic related lockdown on sleep patterns and sleep quality in adolescents and young adults. MethodsAn online survey was conducted in June 2020 with adolescents and young adults (n = 498) aged 12–25 years. Participants had to answer questions on sleep, first retrospectively, referring to the time prior to the pandemic, and then referring to the time during the pandemic. ResultsA pronounced shift towards later sleep combined with an increase in sleep duration was found during the pandemic. However, these changes in sleep habits were more pronounced in adolescents than in young adults and seem to occur mostly during weekdays compared to weekends. During the pandemic, teens also reported an improvement in daytime sleepiness and subjective sleep quality, while young adults reported an increase in sleep difficulties associated with sleep onset difficulties, nocturnal and early morning awakenings, and nightmares. ConclusionsThe COVID-19 related lockdown seems to have had a beneficial effect on sleep in adolescents. In young adults, benefits are not as obvious. These results support that later school start times would be beneficial for adolescents. However, in young adults it could be important to investigate the effects of other situational or interindividual factors (stress, lifestyle habits, employment, etc.).

Symptom-specific effects of cognitive therapy and behavior therapy for insomnia: A network intervention analysis.

Objective: Cognitive therapy (CT) and behavior therapy (BT) are both effective for insomnia but are expected to work via different pathways. Empirically, little is known about their symptom-specific effects. Method: This was a secondary analysis of a randomized controlled trial of online treatment for insomnia disorder (N = 219, 72.9% female, mean age = 52.5 years, SD = 13.9). Participants were randomized to CT (n = 72), BT (n = 73), or wait-list (n = 74). Network Intervention Analysis was used to investigate the symptom-specific treatment effects of CT and BT throughout treatment (wait-list was excluded from the current study). The networks included the Insomnia Severity Index items and the sleep diary-based sleep efficiency and were estimated biweekly from Week 0 until Week 10. Results: Participants in the BT condition showed symptom-specific effects compared to CT on "sleep efficiency" (Week 4-8, post-test), "difficulty maintaining sleep" (Week 4), and "dissatisfaction with sleep" (post-test). Participants in the CT showed symptom-specific effects compared to BT on "interference with daily functioning" (Week 8, post-test), "difficulty initiating sleep", "early morning awakenings," and "worry about sleep" (all post-test). Conclusions: This is the first study that observed specific differential treatment effects for BT and CT throughout the course of their treatment. These effects were more pronounced for BT than for CT and were in line with the theoretical background of these treatments. We think the embedment of the theoretical background of CT and BT in empirical data is of major importance to guide further treatment development. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Social capital and sleep disorders in Tibet, China

ObjectiveSleep plays an important role in the health and well-being of middle aged and elderly people, and social capital may be one of the important factors for sleep disorders. This study aimed to understand the relationship between social capital and sleep disorders in a unique region of China –Tibet that generally has the disadvantaged economic status compared to other parts of China.MethodsThe study was based on Tibetan data from The China Multi-Ethnic Cohort (CMEC) and was conducted from May 2018 to September 2019. A total of 3194 Tibetans aged > 50 were selected from the community population by multi-stage stratified cluster sampling. Social capital was measured using two validated health-related social capital scales, family/community and society.. Sleep disorders were measured as the presence of disorders of initiating and maintaining sleep, early morning awakening, or daytime dysfunction. Logistic regression models were applied to examine the association between social capital and sleep disorders.Results39.9% (1271/3194) of the participants had sleep disorders. In addition, after controlling for all potential variables, family social capital was significantly negatively associated with sleep disorders (OR = 0.95, P < 0.05), while community and society social capital was not associated with sleep disorders. Then, when we did all the sex-stratified analyses, the significant association between social capital and sleep disorders was found only in women (OR = 0.94, P < 0.05), while no association was found in males; neither males nor females showed any association with community and society social capital.ConclusionOur study would help to better understand the extent of health inequality in China, and guide future interventions, strategies and policies to promote sleep quality in low-income areas, taking into account both the role of Tibetan specific cultural traditions, lifestyles and religious beliefs in social capital and the gender differences in social capital.

Associations between longitudinal trajectories of insomnia symptoms and sleep duration with objective physical function in postmenopausal women: the Study of Women's Health Across the Nation.

Examine the association between trajectories of self-reported insomnia symptoms and sleep duration over 13 years with objective physical function. We utilized data from 1,627 Study of Women's Health Across the Nation participants, aged 61.9 ± 2.7 years at the end of the 13-year follow-up. Latent class growth models identified trajectories of insomnia symptoms (trouble falling asleep, frequent night-time awakenings, and/or early morning awakening) and sleep duration over 13 years. Physical function tests were performed at the end of the 13-year period: 40-ft walk, 4-m walk, repeated chair stand, grip strength, and balance. Multivariable regression analyses examined each physical function measure according to the insomnia symptom or sleep duration trajectory group. Five insomnia symptom trajectories and two sleep duration trajectories were identified. Women with a consistently high likelihood of insomnia symptoms and women with a decreased likelihood of insomnia symptoms (i.e. improving) had slower gait speed (3.5% slower 40-ft walk [consistently high], 3.7% slower 4-m walk [improving]; each p ≤ .05) than those with a consistently low likelihood of insomnia symptoms. In contrast, women with a steep increase in the likelihood of insomnia symptoms over time and women with persistent insufficient sleep duration had lower odds of having a balance problem (odds ratio [OR] = 0.36 and OR = 0.61, respectively; each p < .02) compared to those with a consistently low likelihood of insomnia symptoms and those with persistent sufficient sleep duration, respectively. These results suggest that women's sleep during midlife has important implications for maintaining physical function during the transition into older adulthood.

The case for investigating a bidirectional association between insomnia symptoms and eating disorder pathology.

Many people with eating disorders (EDs) report symptoms of insomnia (i.e., frequent difficulty falling asleep, staying asleep, and/or early morning wakening) and sleep problems have been linked to alterations in eating behaviors; however, mechanisms of these bidirectional associations remain poorly understood and under researched. This is a problem because higher insomnia symptom severity is a risk factor for the onset and perpetuation of anxiety, mood, trauma, and substance use disorders and, potentially, ED symptoms. Furthermore, insomnia symptoms may hinder recovery and increase relapse rates following successful psychotherapy. In this article, we describe potential mechanisms underlying bidirectional associations between insomnia and eating psychopathology that may contribute to the etiology and maintenance of both disorders. We suggest novel directions for future research to characterize the association between dysregulated sleep and ED symptoms and to evaluate impacts of insomnia symptoms on relapse and recovery for people with co-occurring pathology. Finally, we discuss options for testing the incorporation of existing evidence-based treatments for insomnia disorder (e.g., Cognitive-Behavioral Therapy for Insomnia) with ED care. Overall, insomnia symptoms present a promising intervention point for ED treatment that has not been systematically tested, yet would be highly feasible to address in routine clinical care.

Comorbid insomnia and sleep apnea: characterization of the syndrome and understanding its associations with comorbid sleep conditions

Obstructive sleep apnea (OSA) is traditionally associated with excessive daytime sleepiness. Insomnia is characterized by hyperarousal, and is seen as a predominant feature in a subgroup of patients with OSA. The aim of this study was to describe the prevalence of comorbid insomnia and sleep apnea (COMISA) in a sleep apnea population and to characterize its features. This was a chart review of patients who underwent overnight polysomnography (PSG). All patients completed questionnaires with the Epworth Sleepiness Scale (ESS), and symptoms of insomnia and other sleep-related comorbidities. Patients with OSA on the PSG were included. A total of 296 patients withOSA were included, of which 80% reported at least 1 major symptom of insomnia: 57% reported sleep onset insomnia, 68% sleep maintenance insomnia, and 48% had early morning awakenings. COMISA (OSA plus 2 or more major symptoms of insomnia) was seen in 63%. These patients were more likely to report an abnormal ESS score, gastroesophageal reflux (GER), and restless legs (RL) than those without; no difference was seen in self-reported sleep bruxism. Among the patients with COMISA, 85% reported at least 1 representative symptom of psychophysiological insomnia (PPI); each of the 5 PPI symptoms was present in at least 40% of patients with COMISA. Insomnia is extremely prevalent in our population of patients with OSA, accompanied by daytime sleepiness and symptoms of PPI, GER, and RL. Further study is needed to determine the interactions between symptoms and OSA treatments in these patients.

Prevalence and clinical correlates of insomnia symptoms and their association with quality of life in Chinese patients with HBV-related liver disease.

ObjectiveThis study aimed to describe the one-month prevalence of insomnia symptoms (insomnia hereafter) and the demographic and clinical correlates, and its association with quality of life (QOL) in Chinese patients with HBV-related liver disease.MethodA total of 689 patients with HBV-related liver disease in Beijing, China formed the study sample. Three forms of insomnia including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS) and early morning awakening (EMA) were assessed using standardized questions. QOL was measured using the Medical Outcomes Study Short Form 12 (SF-12).ResultsThe one-month prevalence of at least one type of insomnia was 69.5%, while DIS, DMS and EMA were 60.4%, 54.7% and 50.9%, respectively. Only 4.8% of patients suffering from insomnia received treatment. Multiple logistic regression analyses revealed that pre-existing medical conditions were positively associated with DIS and EMA; patients with more severe depressive symptoms were more likely to have DIS, DMS and EMA; local residents were less likely to have DIS; and those who were married and older were more likely to have DMS. Insomnia was not independently associated with QOL.ConclusionsInsomnia is common in Chinese patients with HBV-related liver disease with a very low rate of treatment. Greater attention should be given to identify and treat insomnia in this patient population.

Associations between the cortisol awakening response and patient-evaluated stress and mood instability in patients with bipolar disorder: an exploratory study

ObjectiveThe Cortisol Awakening Response (CAR) measured as the transient increase in cortisol levels following morning awakening appears to be a distinct feature of the HPA axis. Patients with bipolar disorder (BD) experience daily stress, mood instability (MI) and studies have shown disrupted HPA-axis dynamics. Aims: to evaluate (1) patient-evaluated stress against the CAR, (2) associations between the CAR and mood symptoms, and (3) the effect of smartphone-based treatment on the CAR.MethodsPatients with BD (n = 67) were randomized to the use of daily smartphone-based monitoring (the intervention group) or to the control group for six months. Clinically rated symptoms according to the Hamilton Depression Rating Scale 17-items (HDRS), the Young Mania Rating Scale (YMRS), patient-evaluated perceived stress using Cohen’s Perceived Stress Scale (PSS) and salivary awakening cortisol samples used for measuring the CAR were collected at baseline, after three and six months. In the intervention group, smartphone-based data on stress and MI were rated daily during the entire study period.ResultsSmartphone-based patient-evaluated stress (B: 134.14, 95% CI: 1.35; 266.92, p = 0.048) and MI (B: 430.23, 95% CI: 52.41; 808.04, p = 0.026) mapped onto increased CAR. No statistically significant associations between the CAR and patient-evaluated PSS or the HDRS and the YMRS, respectively were found. There was no statistically significant effect of smartphone-based treatment on the CAR.ConclusionOur data, of preliminary character, found smartphone-based patient-evaluations of stress and mood instability as read outs that reflect CAR dynamics. Smartphone-supported clinical care did not in itself appear to disturb CAR dynamics.

Cluster analysis of insomnia symptoms during COVID-19 pandemic: a general population web-based survey in Iran.

ObjectiveTo investigate the prevalence of insomnia and its different phenotypes as well as their association with fear of COVID-19 in the general population.Material and MethodsThis was a cross-sectional study conducted using an online survey (e-poll). All available participants who completed the online survey form were included in the current study. All individuals with a history of sleep problems were excluded. A questionnaire package consisted of insomnia severity index (ISI), and FCV-19 for corona fear was administered for all participants. Insomnia was defined as ISI≥8. Insomnia phenotypes were considered as: (a) DIS: difficulty initiating sleep; (b) DMS: difficulty maintaining sleep; (c) EMA: early morning awakening; and (d) combined insomnia.ResultsA total of 1,223 participants [827 (67.6%) female, mean age=39.82±10.75 years old], enrolled in the current survey. Based on ISI, 675 (55.2% [95%CI=52.40-57.98]) were categorized into the insomnia group. Insomnia was more prevalent in females (p=0.006), participants with 50 years old or higher (p=0.04), or high fear of COVID-19 (p<0.0001). Totally, 67.4%, 66.4%, and 55% of all participants had DIS, DMS, and EMA, respectively, in the current outbreak. Besides, 79% had impaired daily functioning, 51.6% had impaired quality of life, and 62% were worried about their sleep problem. Notably that a considerable percentage of individuals with normal ISI scores had at least one insomnia phenotype or impaired daily functioning and quality of life. Further analyses revealed a significant increasing trend in all four insomnia phenotypes prevalence with an increase in fear of COVID-19 (all p-values<0.0001).ConclusionIndividuals with higher age, female gender, or higher fear of COVID-19 are at higher risk of all types of insomnia as well as impaired daytime performance or quality of life.

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BackgroundNausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.MethodsWomen attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011–2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.ResultsAccording to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79–8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20–9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .ConclusionsMore severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

Insomnia - A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges.

Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.

Identification of comprehensive geriatric assessment-based risk factors for insomnia in elderly Chinese hospitalized patients.

ObjectiveInsomnia is a common problem in older persons and is associated with poor prognosis from a functional or clinical perspective. The purpose of this study was to investigate the prevalence of insomnia and identify comprehensive geriatric assessment (CGA) based clinical factors associated with insomnia in elderly hospitalized patients.MethodsStandardized face‐to‐face interviews were conducted and CGA data were collected from 356 Chinese hospitalized patients aged 60 years or older. Insomnia was defined as self‐reported sleep poor quality according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐Ⅴ). Multivariate logistic regression analysis was applied to assess the association between patient clinical factors together with domains within the CGA and insomnia.ResultsAmong the 365 patients, insomnia was found in 48.31% of the participants. Difficulty in initiating sleep (DIS), early morning awakening (EMA), difficulty in maintaining sleep (DMS), and snoring were found in 33.99%, 9.55%, 13.48%, and 1.69% of patients, respectively. Significant associations were found between insomnia and several covariates: female gender (P = 0.034), depression (P = 0.001), activities of daily living (ADL) (P = 0.034), instrumental activities of daily living (IADL; P = 0.009), falling (P = 0.003), chronic pain (P = 0.001), and poor nutritional status (P = 0.038). According to the results of the adjustment multivariate logistic regression analysis, female sex (odds ratio [OR] = 2.057, confidence interval [CI] = 1.179‐3.588, P = 0.011), depression (OR = 1.889, CI = 1.080‐3.304, P = 0.026), and chronic pain (OR = 1.779, CI = 1.103‐2.868, P = 0.018) were significant independently predictors associated with insomnia.ConclusionsOur study revealed that female sex, depression, and chronic pain were independently predictors of insomnia in hospitalized patients. Early identification of elderly patients with these risk factors using the CGA may improve the quality of life and treatment outcomes.

A Day That Changed Lives.

Sighing with dejection, I rolled towards the window adjacent to my bed and stared into the sullen, rainy October night—another 4:00 am early morning awakening. This pattern had been ongoing for weeks and was becoming exhausting. For the next 2 hours I restlessly tossed, suffering random thoughts, obscured by fatigue and darkness; I cannot fully describe the disquiet inflicted upon me by these hours of unrest. Finally, at 6:00 am, the clock-radio alarm fulfilled its unnecessary duty, heralding the start of yet another day. This morning's Classic FM “arousing music to awaken” was “Jupiter” from The Planets orchestral suite by Holst. Try as I might, I could not feel inspired. I paused, staring at myself in the mirror. I looked tired and demoralized. I sighed again, and prepared for the day ahead.

Insomnia in Tinnitus Patients: A Prospective Study Finding a Significant Relationship.

Tinnitus is a highly prevalent medical disorder occurring in 10-30% of the general population. This disorder often becomes chronic and severe effecting quality of life contributing to significant psychiatric consequences; one that we have written about recently is comorbid insomnia. The latter can predispose effected persons to depressive episodes and a worsening of their total functioning. We have reported in the past that comorbid insomnia occurs in 10-80% of tinnitus patients with most reports finding over a 40% frequency. Unfortunately, these prior studies tended to evaluate only insomnia as a symptom and not as a diagnosis; therefore its seriousness and implications could not be assessed. Furthermore, most studies utilized only open-ended questionnaires with many being sent via the mail. Our study evaluated 72 tinnitus patients who were prospectively evaluated over the telephone for a tinnitus treatment study program at our center focusing on possible co-morbid insomnia symptoms as well as whether the insomnia satisfied a diagnosis with its accompanying dysfunctional state. The interview included questions regard a full range of questions assessing sleep onset, sleep continuity, early morning awakening, sleep duration as well as daytime consequences necessary for a diagnosis of insomnia. We found that not only were insomnia symptoms highly prevalent, but 60% of the tinnitus sample met strict diagnostic criteria (DSM-IV-TR) of insomnia secondary to a general medical condition, i.e., tinnitus. Alarmingly, only 4 % were being treated for their insomnia. In addition, our data suggests that tinnitus patients with co-morbid insomnia have a more severe form of tinnitus and thus, may need further care and treatment.

Associations of Insomnia Symptoms With Cognition in Persons With Heart Failure

Although cognitive impairment is common among persons with heart failure and negatively impacts self-care, hospitalization, and mortality, the associations between cognitive impairment and insomnia symptoms are not clearly understood. The purpose of this study was to explore these associations and examine if they are maintained after adjusting for relevant sociodemographic, clinical, and lifestyle factors. Guided by the Neurocognitive model of insomnia and sleep and the self-care conceptual model, a cross-sectional data analysis using parametric testing was conducted on the Health and Retirement Study wave 2016. Difficulty initiating sleep and early morning awakening, but not difficulty maintaining sleep were significantly associated with poorer cognitive performance in the bivariate and multivariate analysis. Our results are suggestive of different phenotypes of insomnia symptoms that may have different associations with cognition in persons with heart failure. Further research using objective measurements of insomnia symptoms and detailed neuropsychiatric testing of cognition is needed to confirm this conclusion.

АКТУАЛИЗАЦИЯ НАУЧНЫХ ИСТОЧНИКОВ ПО ФОЛЬКЛОРУ В ВОЗРОЖДЕНИИ ОБРЯДОВОЙ ПРАКТИКИ МАНСИ

The work is devoted to the most important ritual sphere of the traditional culture of the northern Mansi, associated with the worship of a bear, that lost a number of essential components in the XX century. The ritual folklore of Bear’s Holidays consists almost exclusively of songs, and exactly they were what was forgotten. These are “bear songs”, songs of farewell to a bear at night and its morning awakening, songs of the end of a holiday, and invocation songs for the spirits. The task of the study is to analyse the experience of updating the works of Russian and foreign researchers of Mansi folklore in the process of revival of a Bear’s Holiday. As a result, in this regard the most significant materials of A. Kannisto are identified, which are considered along scientific and practical lines. The first line is implemented in the form of Russian translations of texts with subsequent publication, combined with a version in the modern literary Mansi language. Samples of songs recorded on a phonograph in the form of notes and in a digital version on a disk have also been introduced into academic circulation. The practical line of updating was carried out in 1994–2020 in the form of lectures for the Mansi youth and joint learning of songs and scenes of a Bear’s Holiday according to these sources

In-Depth Characterization of Sleep Patterns Among People with Insomnia During the Pandemic of COVID-19.

Background. The effects of the COVID-19 pandemic on sleep duration and insomnia have been well studied in different studies. However, there is no study available on the characteristics of insomnia during the pandemic. This study aimed to evaluate the characteristics of insomnia experienced by the general Iranian population during the COVID-19 pandemic. Methods. A cross-sectional community-based study was designed. We designed an online questionnaire and sent it to Iranian people via available social platforms. The questionnaire contained questions on the socio-demographic characteristics of the participants. We used Fear of COVID-19 scale (FCV-19), Insomnia Severity Index (ISI), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder Scale-2 (GAD-2) for detailed characterization of insomnia and its symptoms. Results. In total, 675 people with insomnia with the mean age of 40.28 years (SD=11.15) participated in our study. Prevalence of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 91.4%, 86.7%, and 77%, respectively. DIS, DMS, and EMA were more common in people with depression and anxiety. FCV-19 score was higher in those with more severe types of DIS, DMS, and EMA (P<0.001). FCV-19 was a risk factor for all patterns of insomnia (OR=1.19, 1.12, 1.02 for DIS, DMS, and EMA, respectively). Conclusion. Fear of COVID-19 is a major contributing factor to insomnia patterns. Investigation of COVID-19 fear in people with insomnia and the addition of attributed relieving or management strategies to conventional management of insomnia are reasonable approaches to improve the sleep condition of people in the pandemic.