Onset Insomnia Research Articles

Types of Insomnia Mediate the Bidirectional Relation Between Anxiety and Depressive Symptoms Longitudinally in Older Adults.

The current study examined onset and maintenance insomnia as mediators of the bidirectional relation between anxiety and depressive symptoms over a three-year period. The sample included 3,415 US community-dwelling Medicare beneficiaries aged 66-103. Participants completed measures of types of insomnia, anxiety symptoms, and depressive symptoms at four time points. Analyses included two double mediation models adjusted for baseline depressive or anxiety symptoms, chronic health problem burden, use of sleep medications, age, and sex. Both covariate-adjusted models showed significant direct relations between anxiety and depressive symptoms, and these relations were modestly partially mediated by onset and maintenance insomnia. In older adults, onset and maintenance insomnia are distinct outcomes of both anxiety and depressive symptoms and also predictors of each symptom cluster. Further research testing these models is warranted and, if supported, may support prevention and treatment studies focused on primary and secondary prevention of these problems in older adults.

A randomized study on the effect of a wearable device using 0.75 Hz transcranial electrical stimulation on sleep onset insomnia.

The normal transition to sleep is characterized by a reduction in higher frequency activity and an increase in lower frequency activity in frontal brain regions. In sleep onset insomnia these changes in activity are weaker and may prolong the transition to sleep. Using a wearable device, we compared 30min of short duration repetitive transcranial electric stimulation (SDR-tES) at 0.75Hz, prior to going to bed, with an active control at 25Hz in the same individuals. Treatment with 0.75Hz significantly reduced sleep onset latency (SOL) by 53% when compared with pre-treatment baselines and was also significantly more effective than stimulation with 25Hz which reduced SOL by 30%. Reductions in SOL with 25Hz stimulation displayed order effects suggesting the possibility of placebo. No order effects were observed with 0.75Hz stimulation. The decrease in SOL with 0.75Hz treatment was proportional to an individual's baseline wherein those suffering from the longest pre-treated SOLs realized the greatest benefits. Changes in SOL were correlated with left/right frontal EEG signal coherence around the stimulation frequency, providing a possible mechanism and target for more focused treatment. Stimulation at both frequencies also decreased perceptions of insomnia symptoms measured with the Insomnia Severity Index, and comorbid anxiety measured with the State Trait Anxiety Index. Our study identifies a new potential treatment for sleep onset insomnia that is comparably effective to current state-of-practice options including pharmacotherapy and cognitive behavioral therapy and is safe, effective, and can be delivered in the home.

Discovery, synthesis and SAR of 2-acyl-1-biarylmethyl pyrazolidines, dual orexin receptor antagonists designed as fast and short-acting sleeping drugs

Dual orexin receptor antagonists (DORAs) are approved for the treatment of sleep onset and/or sleep maintenance insomnia. In the present disclosure, we report the discovery of a new class of DORAs designed to treat sleep disorders requiring a fast onset and a short duration of action (<4 h). We used early human pharmacokinetic-pharmacodynamic (PK-PD) predictions and in vivo experiments to identify DORAs eliciting this specific hypnotic profile. A high-throughput screening campaign revealed hits based on a rarely precedented tricyclic pyrazolidine scaffold. After unsuccessful structure–activity-relationship (SAR) studies on this hit series, a scaffold hopping exercise, aimed at reducing the molecular complexity of the tricyclic scaffold, resulted in the discovery of the 2-acyl-1-biarylmethylpyrazolidine series. SAR studies on this achiral series gave rise to the lead compound DORA 42. In vitro and in vivo parameters of DORA 42, and its PK-PD simulation for human use are detailed.

A Case Study of Parasomnia with Concurrent Insomnia and Zolpidem Sensitivity

A 42-year-old male patient presenting to sleep clinic with 122-year history of sleep onset insomnia and soliloquy was studied. Following assessment, the patient was referred for CBTi therapy intervention. The all night polysomnogram did not capture the soliloquy but 3-4 episodes per week and more in times of stress were confirmed by the patient’s bed partner. Sleep log data indicated a reduction in insomnia by week six. Exposure therapy sessions were incorporated following two extreme stress conditions followed by repeated soliloquy episodes with increased wakefulness with an increase in the prescribed zolpidem prescription from 5mg HS to 10 mg HS

Multimodal neuroimaging exploration of the mechanisms of sleep quality deterioration after SARS-CoV-2 Omicron infection

BackgroundTo evaluate the neurological alterations induced by Omicron infection, to compare brain changes in chronic insomnia with those in exacerbated chronic insomnia in Omicron patients, and to examine individuals without insomnia alongside those with new-onset insomnia.MethodsIn this study, a total of 135 participants were recruited between January 11 and May 4, 2023, including 26 patients with chronic insomnia without exacerbation, 24 patients with chronic insomnia with exacerbation, 40 patients with no sleep disorder, and 30 patients with new-onset insomnia after infection with Omicron (a total of 120 participants with different sleep statuses after infection), as well as 15 healthy controls who were never infected with Omicron. Neuropsychiatric data, clinical symptoms, and multimodal magnetic resonance imaging data were collected. The gray matter thickness and T1, T2, proton density, and perivascular space values were analyzed. Associations between changes in multimodal magnetic resonance imaging findings and neuropsychiatric data were evaluated with correlation analyses.ResultsCompared with healthy controls, gray matter thickness changes were similar in the patients who have and do not have a history of chronic insomnia groups after infection, including an increase in cortical thickness near the parietal lobe and a reduction in cortical thickness in the frontal, occipital, and medial brain regions. Analyses showed a reduced gray matter thickness in patients with chronic insomnia compared with those with an aggravation of chronic insomnia post-Omicron infection, and a reduction was found in the right medial orbitofrontal region (mean [SD], 2.38 [0.17] vs. 2.67 [0.29] mm; P < 0.001). In the subgroups of Omicron patients experiencing sleep deterioration, patients with a history of chronic insomnia whose insomnia symptoms worsened after infection displayed heightened medial orbitofrontal cortical thickness and increased proton density values in various brain regions. Conversely, patients with good sleep quality who experienced a new onset of insomnia after infection exhibited reduced cortical thickness in pericalcarine regions and decreased proton density values. In new-onset insomnia patients post-Omicron infection, the thickness in the right pericalcarine was negatively correlated with the Self-rating Anxiety Scale (r = − 0.538, P = 0.002, PFDR = 0.004) and Self-rating Depression Scale (r = − 0.406, P = 0.026, PFDR = 0.026) scores.ConclusionsThese findings help us understand the pathophysiological mechanisms involved when Omicron invades the nervous system and induces various forms of insomnia after infection. In the future, we will continue to pay attention to the dynamic changes in the brain related to insomnia caused by Omicron infection.

Treatment strategies for insomnia in Japanese primary care physicians’ practice: A Web-based questionnaire survey

BackgroundIt is unclear how primary care physicians manage insomnia after the introduction of novel hypnotics such as orexin receptor antagonists and melatonin receptor agonists. This Web-based questionnaire survey aimed to examine treatment strategies for insomnia in Japanese primary care practice.MethodsOne-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = “unfamiliar”; 1 = “familiar”) and how they managed insomnia using a nine-point Likert scale (1 = “I never prescribe/perform it”; 9 = “I often prescribe/perform it”). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it.ResultsRegarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8–5.4 points and 4.0–4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5–1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48–74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points.ConclusionThis study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists.

A randomized controlled trial of alpha phase-locked auditory stimulation to treat symptoms of sleep onset insomnia

Sleep onset insomnia is a pervasive problem that contributes significantly to the poor health outcomes associated with insufficient sleep. Auditory stimuli phase-locked to slow-wave sleep oscillations have been shown to augment deep sleep, but it is unknown whether a similar approach can be used to accelerate sleep onset. The present randomized controlled crossover trial enrolled adults with objectively verified sleep onset latencies (SOLs) greater than 30 min to test the effect of auditory stimuli delivered at specific phases of participants’ alpha oscillations prior to sleep onset. During the intervention week, participants wore an electroencephalogram (EEG)-enabled headband that delivered acoustic pulses timed to arrive anti-phase with alpha for 30 min (Stimulation). During the Sham week, the headband silently recorded EEG. The primary outcome was SOL determined by blinded scoring of EEG records. For the 21 subjects included in the analyses, stimulation had a significant effect on SOL according to a linear mixed effects model (p = 0.0019), and weekly average SOL decreased by 10.5 ± 15.9 min (29.3 ± 44.4%). These data suggest that phase-locked acoustic stimulation can be a viable alternative to pharmaceuticals to accelerate sleep onset in individuals with prolonged sleep onset latencies. Trial Registration: This trial was first registered on clinicaltrials.gov on 24/02/2023 under the name Sounds Locked to ElectroEncephalogram Phase For the Acceleration of Sleep Onset Time (SLEEPFAST), and assigned registry number NCT05743114.

Activity-Based Prospective Memory in Insomniacs.

To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia. A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2). Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls. The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.

Photophobia is associated with lower sleep quality in individuals with migraine: results from the American Registry for Migraine Research (ARMR)

BackgroundPatients with migraine often have poor sleep quality between and during migraine attacks. Furthermore, extensive research has identified photophobia as the most common and most bothersome symptom in individuals with migraine, second only to headache. Seeking the comfort of darkness is a common strategy for managing pain during an attack and preventing its recurrence between episodes. Given the well-established effects of daily light exposure on circadian activity rhythms and sleep quality, this study aimed to investigate the relationship between photophobia symptoms and sleep quality in a cohort of patients with migraine.MethodsA cross-sectional observational study was conducted using existing data extracted from the American Registry for Migraine Research (ARMR). Participants with a migraine diagnosis who had completed the baseline questionnaires (Photosensitivity Assessment Questionnaire (PAQ), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2)), and selected questions of the ARMR Sleep questionnaire were included. Models were created to describe the relationship of photophobia and photophilia with various sleep facets, including sleep quality (SQ), sleep disturbance (SDis), sleep onset latency (SOL), sleep-related impairments (SRI), and insomnia. Each model was controlled for age, sex, headache frequency, anxiety, and depression.ResultsA total of 852 patients meeting the inclusion criteria were included in the analysis (mean age (SD) = 49.8 (13.9), 86.6% (n = 738) female). Those with photophobia exhibited significantly poorer sleep quality compared to patients without photophobia (p < 0.001). Photophobia scores were associated with SQ (p < 0.001), SDis (p < 0.001), SOL (p = 0.011), SRI (p = 0.020), and insomnia (p = 0.005) after controlling for age, sex, headache frequency, depression, and anxiety, signifying that higher levels of photophobia were associated with worse sleep-related outcomes. Conversely, photophilia scores were associated with better sleep-related outcomes for SQ (p < 0.007), SOL (p = 0.010), and insomnia (p = 0.014).ConclusionResults suggest that photophobia is a significant predictor of poor sleep quality and sleep disturbances in migraine. These results underscore the necessity for comprehensive and systematic investigations into the intricate interplay between photophobia and sleep to enhance our understanding and develop tailored solutions for individuals with migraine.

Exploring the legacy of Ibn Imrân’s Treatise on melancholia in contemporary psychiatry

IntroductionMelancholia is a concept deeply intertwined with the history of mood disorders in psychiatry. Isháq Ibn Imrân, a prominent Arab-Muslim physician of the 12th century, contributed significantly to the understanding of melancholia in his era, its. His treatise is the oldest surviving work entirely dedicated to melancholia, making it a pivotal milestone in the history of psychiatry. It is noteworthy that Ibn Imrân’s work has often been overlooked in Western psychiatry. This oversight highlights the enduring relevance of his insights within the context of modern psychiatry.ObjectivesThe objective of this study is to assess the clinical and therapeutic aspects delineated by Ibn Imrân in his treatise on melancholia for their contemporary accuracy and relevance within the field of modern psychiatry.MethodsThe review method for the Isháq Ibn Imrân treatise involves a detailed analysis of the original Arabic text and its French translation by Adel Omrani and Radhi Jazi from the Tunisian Academy of Sciences, Letters, and Arts Beit el Hekma. This includes studying the content, structure, and historical context, as well as comparing the Arabic and French versions for accuracy.ResultsThe treatise is divided into two parts to clinical examination and treatment. While some of the terminology may differ from contemporary classifications, the core observations resonate with modern psychiatric knowledge. The clinical form is described as sadness, loss of pleasure, social withdrawal, dark thoughts, and loss of interest, along with somatic manifestations: sleep disturbances such as onset insomnia or hypersomnia, as well as weight loss. Additionally, perceptual disturbances, including elementary visual hallucinations (black silhouettes), are mentioned. Regarding etiologies, perinatal factors are mentioned in the treatise (“mood of the uterus”), along with six postnatal acquired causes that must be balanced in an individual: movement and rest, sleep and wakefulness, food and drink, depletion and retention, ambient air and location and psychological torment. A seasonal pattern is described, with an association between melancholia and autumn. Several clinical forms are described, with the most prominent being catatonia compared to epilepsy, in its two agitated and inhibited forms. The second part of his treatise is dedicated to treatment, focusing on individualized approaches such as talk therapy, music therapy, and dietary interventions. Ibn Imrân also describes mental strategies to correct false beliefs. For the pharmacological treatment, specific herbs has been used via oral, nasal, or intra-rectal.ConclusionsIn conclusion, Isháq Ibn Imrân’s treatise on melancholia represents a timeless cornerstone in the history of psychiatry. This historical treasure serves as a reminder of the enduring quest to understand and alleviate the complexities of mental health.Disclosure of InterestNone Declared

Relationship of Nocturnal Insomnia Symptoms and Outcomes After Hypoglossal Nerve Stimulation.

In patients undergoing hypoglossal nerve stimulation (HGNS), we examined the Insomnia Severity Index (ISI) to understand how baseline sleep onset insomnia (SOI), sleep maintenance insomnia (SMI), and early morning awakening (EMA) affected postsurgical outcomes. Observational. Multicenter registry. We included patients from the Adherence and Outcomes of Upper Airway Stimulation for Obstructive Sleep Apnea International Registry (ADHERE) with a baseline ISI from 2020 to 2023. Regression analysis examined the association of ISI question scores for SOI, SMI, and EMA and outcomes: Apnea-Hypopnea Index (AHI) reduction, device usage, changes in the Epworth Sleepiness Scale (ESS) and overall ISI score, final visit (FV) completion, and satisfaction. No relationship was noted between insomnia subtypes and AHI reduction or FV completion. In the subgroup of patients with baseline moderate/severe insomnia, patients with major impairment for SOI used their device 64 min/day longer than those with minimal impairment. Amongall patients, those with baseline major impairment for SOI had a 2.3 points greater improvement in ISI from baseline to FV compared to patients with minimal impairment, while patients with baseline major impairment for SMI had a 2.0 and 3.5 points greater improvement in the ESS and ISI than those with minimal impairment. Patients with EMA and moderate/severe baseline insomnia had decreased odds of being satisfied after surgery. In ADHERE, nocturnal symptoms of insomnia did not limit HGNS efficacy or therapy use. Conversely, those with worse insomnia subtype impairments at baseline had improved outcomes related to adherence, sleepiness, and insomnia at the FV.

SLEEP TIGHT, STAY HEALTHY? MULTIDIMENSIONAL SLEEP HEALTH AND CHRONIC CONDITION DEVELOPMENT OVER ONE DECADE

Abstract Chronic conditions affect half of adults and are the leading cause of death in the United States. Healthy sleep is a modifiable risk factor, but greater information is needed about specific sleep experiences linked to chronic condition development. The present study aims to (1) identify within-person patterns of various sleep experiences (i.e., sleep health phenotypes describing sleep duration, regularity, sleep onset latency, insomnia symptoms, daytime tiredness, and nap frequency) and (2) understand the connection between transitions in sleep health phenotypes and chronic condition development. We use self-report data from a national sample of adults (N=5,026) taken from the Midlife in the United States (MIDUS) study across two waves (II and III) separated by about ten years. Latent transition analysis revealed four sleep phenotypes: good sleepers (optimal sleep across dimensions), insomnia sleepers (short duration, long sleep onset latency, high daytime tiredness, frequent insomnia symptoms), weekend catch-up sleepers (long sleep duration on weekends compared to weekdays), and nappers (frequent naps). For cardiovascular conditions, consistent insomnia sleepers (i.e., insomnia sleeper -&amp;gt; insomnia sleeper) were at 72% higher risk (CI:[1.04, 2.82]) than consistently good sleepers. For diabetes, consistent insomnia sleepers again were at higher risk (188%; CI:[1.72,4.79]) as were consistent nappers (128%; CI:[1.26,4.09]) and weekend catch-up sleepers -&amp;gt; nappers (137%; CI:[1.21,4.60]). For cancers, only nappers -&amp;gt; insomnia sleepers exhibited higher risk (45%; CI:[1.16,1.83]). We newly identify two sleep health phenotypes (napper and, especially, insomnia sleeper) as risks for developing life-threatening chronic conditions.

Experience with the use of a digital sleep diary in symptom management by individuals with insomnia -a pilot mixed method study

BackgroundInsomnia is the most common sleep disorder. The recommended treatment is cognitive behavioural therapy for insomnia (CBTi). A sleep diary is a core tool in CBTi. We have developed a digital sleep diary with a standardised feedback function. AimTo study feasibility of the digital sleep diary in participants of the Akershus Sleep Apnea (ASAP) cohorts with difficulties falling asleep or maintaining sleep. To describe sleep diary engagement and explore experiences with the digital sleep diary with potential influences in insomnia symptom management. Material and methodsTwenty participants were recruited from the ASAP. All filled out a digital sleep diary up to 12 weeks. Treatment options provided were a self-help book (N = 11) or electroencephalography neurofeedback (N = 9) in addition to the sleep diary standardised feedback function. We collected quantitative data from the sleep diary reports and we sub-divided insomnia by sleep onset insomnia and non-sleep onset insomnia. Finally, we performed qualitative interviews. ResultsThe median number of entries to the sleep diary was 81 (25th quartile: 26, 75th quartile 84). In the qualitative analysis, we identified two main themes; “structure and overview” and “usability and digital features”. ConclusionThe sleep diary was found to be feasible when distributed in combination with a self-help book or electroencephalography neurofeedback. The qualitative results emphasised the importance of a timely graphical overview and visualisations of self-recorded sleep.

Circadian aspects in the aetiology and pathophysiology of insomnia.

Because the endogenous circadian pacemaker is a very strong determinant of alertness/sleep propensity across the 24 h period, its mistiming may contribute to symptoms of insomnia (e.g., difficulties initiating sleep and maintaining sleep) and to the development of insomnia disorder. Despite the separation of insomnia and circadian rhythm disorders in diagnostic nosology implying independent pathophysiology, there is considerable evidence of co-morbidity and interaction between them. Sleep onset insomnia is associated with later timed circadian rhythms and can be treated with morning bright light to shift rhythms to an earlier timing. It is also possible that the causal link may go in both directions and that having a delayed circadian rhythm can result in enough experiences of delayed sleep onset to lead to some conditioned insomnia or insomnia disorder further exacerbating a delayed circadian rhythm. Early morning awakening insomnia is associated with an advanced circadian phase (early timing) and can be treated with evening bright light resulting in a delay of rhythms and an improved ability to sleep later in the morning and to obtain more sleep. There is some evidence suggesting that sleep maintenance insomnia is associated with a blunted amplitude of circadian rhythm that may be treated with increased regularity of sleep and light exposure timing. However, this is an insomnia phenotype that requires considerably more circadian research as well as further insomnia clinical research with the other insomnia phenotypes incorporating circadian timing measures and treatments.

0328 The Natural History of Insomnia: High Sleep Reactivity Interacts with Greater Life Stress to Predict the Onset of Acute Insomnia

Abstract Introduction Previous studies have shown that stressful life events are the primary trigger in the development of insomnia. One etiological model of insomnia suggests that sleep reactivity, or the vulnerability to stress-related sleep disturbance, may be an important moderator of this association. That is, some individuals have a predisposition to experience insomnia following acute stressors (i.e., sleep reactivity). The goal of the present study was to provide a proof of concept and, specifically, additional empirical evidence that the link between stressful life events and the onset of acute insomnia is moderated by sleep reactivity. Methods 1,225 adults with a history of good sleep (Mage = 53.2 years, 68% female, 83% white) were recruited nationwide for an online study on sleep health. Participants completed surveys to assess sleep reactivity (baseline), sleep patterns (daily sleep diaries), and stressful life events (weekly survey). This high-density data (daily/weekly measures) allowed for a close examination of whether sleep reactivity predicts acute insomnia and how the association between stressful life events and sleep disturbance varies as a function of sleep reactivity. Due to the high variability of stressful life events and sleep over time, frequent data points were needed to test this etiological model of insomnia. Sleep diary data were used to identify sleep initiation/maintenance difficulties, including whether they met criteria for acute insomnia at any point during the one-year interval. Results Participants with high sleep reactivity, compared to low sleep reactivity, were at 76% increased odds of developing acute insomnia during the one-year interval. In general, greater weekly stressful life events were associated with greater insomnia during the subsequent week. Additionally, those participants with high sleep reactivity demonstrated a stronger relationship between weekly stressful life events and insomnia, such that they reported the greatest levels of insomnia following weeks where they experienced a greater number of stressful life events. Conclusion These results further support the sleep reactivity model of insomnia, and specifically, provide evidence that sleep reactivity predicts the incidence of acute insomnia in a sample of participants with no history of insomnia. Support (if any) Perlis: R01AG041783, K24AG055602; Vargas: K23HL141581, R25HL10544

1022 Two Teenagers with New Onset Insomnia post COVID

Abstract Introduction Sleep disturbances are increasingly seen in COVID-19 infection. Multiple reports have described the onset of insomnia, excessive daytime sleepiness, and fatigue in patients with both acute COVID infection and long COVID syndrome. Most of these are limited to adults. We report the cases of 2 teenagers with new onset chronic insomnia post COVID-19 infection. Report of case(s) The first patient is a 14-year-old male who presented with sleep onset and sleep maintenance insomnia, excessive daytime sleepiness, difficulty concentrating, fatigue, and chronic cough, with onset five months prior presentation to the sleep clinic. He developed these symptoms after testing positive for COVID-19. He had significant impairment with multiple school absences and tardies for which he required accommodation. He completed a 2-week actigraphy test which showed prolonged sleep latencies and insufficient sleep. He was scheduled for polysomnography (PSG) followed by a multiple sleep latency test (MSLT) but could not proceed to MSLT due to insufficient sleep the night before. The PSG did not reveal either obstructive sleep apnea or periodic limb movements of sleep. His laboratory testing was significant for a low ferritin level of 21. He was referred for IV iron infusion due to intolerance for oral iron. He was started on melatonin without benefit. He was offered clonidine and trazodone but declined. The second patient, a 17-year-old male, presented with insomnia of 3 months duration which started after an acute COVID infection. In addition to insomnia, he had comorbid mood symptoms. He went from being engaged in school and work to being unmotivated and listless. His actigraphy testing revealed he was having sufficient sleep on several days during which he reported not getting any sleep. He failed trials of multiple medications including melatonin, trazodone, hydroxyzine, and gabapentin. He also denied benefit with CBT-I. Conclusion These case reports link COVID 19 and chronic insomnia in pediatric patients. While it is yet unclear whether the development of sleep disturbances post COVID is as a result of an intrinsic characteristic of the COVID-19 virus or the biopsychosocial effects of the pandemic, it is important to develop and implement targeted interventions focused on recognizing and treating insomnia early. Support (if any)

0424 Visualizing insomnia phenotypes using dimensionality reduction techniques

Abstract Introduction A large number of features can be extracted from a single hypnogram, such as stages durations, onsets, or transitions probabilities. Those numerous indicators can turn a collection of sleep records into a high dimension space. Dimensionality reduction techniques are then useful to reveal patterns in data. We used 3 dimensionality reduction techniques to visualize insomnia phenotypes from a dataset of insomnia and control sleep records: principal component analysis (PCA), t-distributed stochastic neighbor embedding (t-SNE) and uniform manifold approximation and projection (UMAP). Methods 519 sleep records have been included with the following diagnoses: 46 sleep onset insomnia, 83 sleep state misperception, 223 sleep maintenance insomnia, 117 sleep onset and maintenance insomnia and 50 controls (good sleep). We limited the feature extraction to the hypnogram as macrostructure constitute the primary source of information used for diagnosis in polysomnography. We used common macrostructure indicators such as wake after sleep onset (WASO), as well as more intricate features such as stages transitions probabilities. A first set of 54 features per hypnogram was computed. Those features were then projected in a 2 dimensional space using PCA, t-SNE and UMAP. Results Co-ranking matrix of the projections was computed for the 3 techniques (PCA: Kmax=103, Qlocal=0.38; tSNE: Kmax=20, Qlocal=0.44; UMAP: Kmax=160, Qlocal=0.44). UMAP was the technique that projected the hypnograms feature sets in the most meaningful way, by reflecting the individual diagnoses. Interestingly in the UMAP representation, group outliers, such as controls having nevertheless experienced nocturnal awakenings were projected next to similar insomnia subjects, which indicate a fine-grained capture of sleep quality at the individual level. Conclusion Dimensionality reduction and unsupervised techniques are promising methods when approaching high dimensionality spaces. A fine analysis of projected clusters could show subgroups in already known phenotypes. As literature showed robustness and applicability of those methods to larger datasets, dimensionality reduction of insomnia records could be improved by the addition of new features computed from hypnodensities generated by machine learning algorithms, or by spectral features extracted from polysomnographic signals. Support (if any) None

0382 Age at Onset in Adults with Insomnia: A Latent Profile Analysis

Abstract Introduction Research has sought to understand insomnia through identification of subtypes, yet age at onset (AAO) has received limited empirical attention. Across psychiatric disorders, early AAO is associated with higher clinical severity and burden, more persistent course, and greater familiality, whereas late AAO is associated with comorbid psychiatric and physical illness. We sought to detect clinically distinct AAO subgroups in adults with insomnia utilizing latent profile analysis (LPA). Methods Participants were 618 adults aged 18 to 71 years (M=28.94, SD=11.06) with insomnia, recruited through Prolific Academic. Participants completed an internet survey of demographics, medical/psychiatric history, family history, insomnia onset acuity, and course, causal attributions surrounding insomnia onset, and current insomnia severity and sleep-related impairment. LPA was performed on AAO of clinically significant insomnia (i.e., causing distress or daytime impairment and occurring 3 days per week for at least 3 months). Independent samples t-test and chi-squared test of independence were performed to compare resulting AAO subgroups on clinical outcomes. Results A two-class model (Class 1: n=547, 88.5%, Monset=19.2 years; Class 2: n=71, 11.5%, Monset=43.5 years) was optimal for forming insomnia AAO subgroups. The late onset group had higher relative insomnia severity, t=-2.78, p=.006, and sleep-related impairment, t=-3.75, p&amp;lt;.001. There were no group differences in lifetime prescription sleep medication, p=.569, lifetime diagnosis of psychiatric disorder(s), p=.189, family history of insomnia, p=.159, or insomnia onset acuity (i.e., sudden vs. gradual), p=.140. Late onset was associated with higher relative endorsement of hormonal factors, Χ2=12.81, p&amp;lt;.001, bodily arousal, Χ2=8.57, p=.003, scheduling, Χ2=9.08, p=.003, and childhood experiences and traumatic events, Χ2=5.67, p=.017). There were group differences in insomnia course, Χ2=16.35, p&amp;lt;.001, such that early onset was associated with higher relative endorsement of persistent insomnia and late onset was associated with higher relative endorsement of seasonal insomnia. Conclusion Findings suggest the presence of an early onset group with higher persistence, but not increased severity and impairment as anticipated, and a late onset group with more seasonal course, numerous causal attributions, and higher insomnia severity and impairment. Future replication is needed to determine the validity and treatment applications of these subgroups. Support (if any) NIMH K23MH113884

0413 Neuroticism interacts with stressful experiences during deployment to predict post-deployment insomnia

Abstract Introduction Negative affect traits, such as neuroticism, have been shown to be associated with greater risk for insomnia. These trait-based factors are theorized to increase stress reactivity, which can be a predisposing factor to insomnia. Military personnel represent a unique population that are subject to stressors as a nature of their occupations and may therefore be particularly vulnerable to the onset and persistence of insomnia. The present study examined prospective associations among trait-based emotional reactivity and neuroticism, exposure to stressful experiences during a combat deployment, and insomnia symptoms at 9-months post-deployment. Methods Data were obtained from the Army Study to Assess Risk and Resilience in Servicemembers Pre-Post Deployment Survey (PPDS). Soldiers included in these analyses (n = 1448) completed surveys prior to deployment to Afghanistan, immediately after deployment, and 9-month post-deployment. The survey included measures of insomnia symptoms, deployment-related stressors and trait-based personality measures. Logistic regression was used to examine the relationships among emotional reactivity, neuroticism and deployment stress with post-deployment insomnia. Results Higher trait-based neuroticism and greater exposure to deployment-related stressors were independently associated with greater risk of probable insomnia at 9-months post-deployment, but not trait-based emotional reactivity . However, there were significant interaction effects, such that among those with greater range of stressful events, neuroticism was associated with higher risk of post-deployment insomnia, while emotional reactivity was associated with lower risk. Conclusion A trait disposition for negative affect (i.e., neuroticism) may predispose individuals to chronic insomnia in the face of acute stressors . While neuroticism includes negative emotional reactivity, it also encompasses other characteristics (e.g., negative self-perception) that may be a stronger predictor of persistent insomnia symptoms. Service members with higher baseline neuroticism may benefit from pre-deployment skills trainings to better cope in the face of stressors and prevent/mitigate long-term problems. Support (if any) This study is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

0324 Protective and Risk Factors for Insomnia Over 5 Years in a Population-Based Sample of Adults

Abstract Introduction Insomnia is a major public health concern and one of the most prevalent health issues among adults. Identifying protective and risk factors for insomnia could help identify vulnerable populations and design public health interventions to prevent some adverse medical and mental health consequences. The study objective was to identify protective and risk factors for insomnia in a population-based sample of adults. Methods Data is from a large epidemiological cohort study on the natural course of insomnia conducted in Canada before the COVID-19 pandemic. Insomnia and potential protective and risk factors for insomnia were measured annually over 5 years with validated questionnaires (e.g., Insomnia Severity Index, Pittsburgh Sleep Quality Index, State-Trait Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, Coping Inventory for Stressful Situations, Ford Insomnia Response to Stress Test, Arousal Predisposition Scale, Life Experiences Survey). Risk factors for insomnia were divided as predisposing or precipitating factors. Results From a cohort of 3,413 participants 1,709 adults were identified as good sleepers at baseline and were included in the analyses. A total of 202 people developed an insomnia syndrome during the 5-year follow-up. Using survival analysis for discrete events, the following variables were significant predisposing factors for insomnia: anxiety (HR=1.037; p=0.018), depression (HR=1.082; p&amp;lt; 0.001), perceived stress (HR=1.073; p&amp;lt; 0.001), number of negative life events (HR=1.478; p=0.02), perceived worse general health (HR=1.606; p=0.006), pain (HR=1.475; p=0.002), vulnerability to stress (HR=1.089; p&amp;lt; 0.001), and maladaptive emotional coping (HR=1.044; p&amp;lt; 0.001). The following variables were identified as precipitating factors for insomnia: loss of income (HR=1.346; p=0.03), increased anxiety (HR=1.070, p&amp;lt; 0.001), depression (HR=1.119; p&amp;lt; 0.001) and perceived stress (HR=1.083; p=0.001), decline in perceived general health (HR=2.061; p=0.006), and increased pain (HR=1.353; p=0.013). Physical activity was not a significant protective factor for insomnia (p=0.54). Conclusion These results provide new information that could be helpful to prevent the onset and chronicity of insomnia by targeting specific precipitating factors, and people with predisposing factors for insomnia. This is important as insomnia tends to be a persistent condition and is known to increase adverse medical and mental health outcomes. Support (if any) This study was funded by the Canadian Institutes of Health Research.