Pre-Sleep Arousal Scale Research Articles

Effectiveness of one-week internet-delivered cognitive behavioral therapy for insomnia to prevent progression from acute to chronic insomnia: A two-arm, multi-center, randomized controlled trial

Acute insomnia is common and a substantial proportion of people with acute insomnia (i.e. 3 days to 3 months) transit into chronic insomnia (i.e. 3 months or longer). Therefore, early intervention for acute insomnia is vital to prevent chronicity. Previous trials with small sample sizes have shown that brief versions of both individual and group-based face-to-face cognitive behavioral therapy for insomnia (CBT-I) can improve insomnia symptoms among those with acute insomnia. However, it is unknown whether one-week internet-delivered cognitive behavioral therapy for insomnia (CBT-I) is effective in treating acute insomnia. This was a randomized controlled trial and 192 participants were randomly assigned to the CBT-I group (n = 95) or control group (n = 97). The primary outcome was the incidence of chronic insomnia, determined via a structured diagnostic questionnaire for insomnia disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Secondary outcomes were Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), Epworth Sleepiness Scale (ESS), Pre-sleep Arousal Scale (PSAS), Ford Insomnia Response to Stress Test (FIRST), Sleep Hygiene and Practices Scale (SHPS), Hospital Anxiety and Depression Scale (HADS), and Short-Form 12-Item Health Survey version 2 (SF-12v2). At week 12, the incidence of chronic insomnia was significantly lower in the CBT-I group compared with control group (33.3% [27/81] vs. 65.8% [52/79]). Participants in the CBT-I group achieved significantly more improvements in ISI, ESS, PSAS, FIRST, SHPS, HADS-Depression, and the mental component summary and physical component summary of SF-12v2 than control group, but not DBAS and HADS-Anxiety. This one-week internet-delivered CBT-I program is an effective tool to prevent the chronicity of acute insomnia.

Mediation analysis of chronotype, sleep-related factors, and depressive symptoms among workers: a cross-sectional study.

This study aimed to examine the impact of chronotype on depressive symptoms and explore the mediating effects of sleep quality, pre-sleep cognitive arousal, and social jetlag in a sample of wage earners. A total of 3,917 waged workers were surveyed online in July 2022. Logistic regression and mediation analysis were used to assess the relationship between chronotype (morningness, intermediate, and eveningness) and depressive symptoms (Patient Health Questionnaire ≥ 5), and the mediating effects of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Pre-Sleep Arousal Scale (PSAS). All analyses were adjusted for age, education level, income level, marital status, coffee consumption, alcohol consumption, physical activity, occupation, employment status, and working hours to calculate odds ratios (ORs). The chronotypes of all the participants were divided into morningness (4.7%), intermediate (93.5%), and eveningness (1.8%). Multiple logistic regression analysis showed an increased risk of depression in the eveningness chronotype (OR: 2.96; 95% confidence interval [CI]: 1.51, 5.86). Regarding the mediation analysis, ISI mediated 28.44% (95% CI: 16.39-40.5), PSQI for 31.25% (95% CI: 19.36, 43.15), and PSAS-Cognitive Score (PSAS-C) for 23.58% (95% CI: 10.66, 36.50) of the association between chronotype and depressive symptoms. However, social jetlag did not significantly mediate this relationship. (percentage mediated = 0.75%, 95% CI: -3.88, 5.39). Evening chronotypes exhibit an increased risk of depressive symptoms, which ISI, PSQI, and PSAS-C partially mediated. This suggests that interventions to improve sleep quality and maintain adequate sleep habits may effectively prevent and treat depression in employees with an eveningness chronotype.

A two-night polysomnography preliminary study in pregnant women with insomnia: suicidal ideation and nocturnal cognitive arousal prospectively predict objective nocturnal wakefulness.

Sleep disruption is common in pregnancy, manifesting as insomnia in half of pregnant women as well as increasing objective nocturnal wakefulness across gestation. Despite potential overlap between insomnia and objective sleep disturbances in pregnancy, objective nocturnal wakefulness and its potential contributing factors remain uncharacterized in prenatal insomnia. The present study described objective sleep disturbances in pregnant women with insomnia and identified insomnia-related predictors of objective nocturnal wakefulness. Eighteen pregnant women with clinically significant insomnia symptoms (n = 12/18 with DSM-5 insomnia disorder) underwent two overnight polysomnography (PSG) studies. Insomnia symptoms (Insomnia Severity Index), depression and suicidal ideation (Edinburgh Postnatal Depression Scale), and nocturnal cognitive arousal (Pre-Sleep Arousal Scale, Cognitive factor) were assessed before bedtime on each PSG night. Unique to Night 2, participants were awakened after 2 minutes of N2 sleep and reported their in-lab nocturnal (i.e. pre-sleep) cognitive arousal. Difficulty maintaining sleep was the most common objective sleep disturbance affecting 65%-67% of women across both nights, which contributed to short and inefficient sleep. Nocturnal cognitive arousal and suicidal ideation were the most robust predictors of objective nocturnal wakefulness. Preliminary evidence suggested nocturnal cognitive arousal mediates the effects of suicidal ideation and insomnia symptoms on objective nocturnal wakefulness. Nocturnal cognitive arousal may facilitate upstream effects of suicidal ideation and insomnia symptoms on objective nocturnal wakefulness. Insomnia therapeutics reducing nocturnal cognitive arousal may benefit objective sleep in pregnant women presenting with these symptoms.

Reducing cognitive arousal and sleep effort alleviates insomnia and depression in pregnant women with DSM-5 insomnia disorder treated with a mindfulness sleep program.

Combining mindfulness with behavioral sleep strategies has been found to alleviate symptoms of insomnia and depression during pregnancy, but mechanisms for this treatment approach remain unclear. The present study examined nocturnal cognitive arousal and sleep effort as potential treatment mechanisms for alleviating insomnia and depression via a mindfulness sleep program for pregnant women. Secondary analysis from a proof-of-concept trial of 12 pregnant women with DSM-5 insomnia disorder who were treated with Perinatal Understanding of Mindful Awareness for Sleep (PUMAS), which places behavioral sleep strategies within a mindfulness framework. Data were collected across eight weekly assessments: pretreatment, six sessions, and posttreatment. Measures included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC), and the Glasgow sleep effort scale (GSES). We used linear mixed modeling to test cognitive arousal and sleep effort as concurrent and prospective predictors of insomnia and depression. Most patients reported high cognitive arousal before PUMAS (75.0%), which decreased to 8.3% after treatment. All insomnia remitters reported low cognitive arousal after treatment, whereas half of nonremitters continued reporting high cognitive arousal. Both nocturnal cognitive arousal and sleep effort were associated with same-week changes in insomnia throughout treatment, and sleep effort yielded a prospective effect on insomnia. Lower levels of nocturnal cognitive arousal and sleep effort prospectively predicted reductions in depression. The present study offers preliminary evidence that reducing sleep effort and nocturnal cognitive arousal may serve as key mechanisms for alleviating insomnia and depression via mindfulness-based insomnia therapy. ClinicalTrials.gov ID: NCT04443959.

Sleep-related attentional bias: Development and validation of a Chinese version of the brief sleep-associated monitoring index in pregnant women

ObjectivesThis study aimed to develop a Chinese version of the brief Sleep-Associated Monitoring Index (SAMI-B), and examine its psychometric properties among pregnant women. MethodsThis cross-sectional study conveniently recruited 665 pregnant women from two tertiary hospitals in Shandong, China; 110 completed a retest survey within two or three weeks after completing the baseline questionnaires. The scale was developed following established guidelines. Participants completed the SAMI-B, SAMI, Insomnia Severity Index, Pittsburgh Sleep Quality Index, Pre-Sleep Arousal Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7 Scale. Psychometric evaluation included reliability (internal consistency, test–retest reliability) and validity (construct, item and concurrent validity; and diagnostic accuracy). ResultsThe Chinese SAMI-B demonstrated uni-dimensionality construct, appropriate item fit and functioning; acceptable internal consistency (McDonald's ω = 0.917) and test–retest reliability (intraclass correlation = 0.736). It was significantly correlated with the SAMI (correlation coefficient = 0.765，P < 0.001) and other sleep-related measurements (correlation coefficients = 0.412–0.638, Ps < 0.001). The SAMI-B displayed a comparable area under the curve (0.739, 95% CI: 0.703–0.772) with the SAMI in detecting insomnia symptoms. The optimal cutoff point (18) presented a sensitivity of 0.765 and a specificity of 0.615 in distinguishing individuals with and without insomnia symptoms. After controlling for general information, the differences in the SAMI-B scores between those with or without insomnia symptoms remained significant (OR = 1.16, 95% CI: 1.12–1.20). ConclusionThe SAMI-B may be an effective alternative for clinicians and researchers to screen or track vulnerable individuals for prenatal insomnia symptoms.

Sex differences in associations between alcohol use and sleep in mid-to-late life

ObjectivesTo examine associations between alcohol use and sleep in middled-aged/older adults and to test sex as a moderator of this relationship. MethodsParticipants were 183 adults (46% female) ages 50 and above who consumed alcohol in the past year. Linear regressions tested sex as a moderator of associations between alcohol use and sleep parameters. Alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT). Overall sleep health and sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI), and pre-sleep arousal was assessed using the Pre-Sleep Arousal Scale. ResultsOverall, 11% of participants screened positive for hazardous drinking (AUDIT scores of 7+/8+ for women/men), and 59% reported poor overall sleep health (scores >5 on the PSQI). Alcohol use was not associated with overall sleep health (B = −0.25, p = .08) or pre-sleep arousal (B = 0.15, p = .64). However, contrary to hypotheses, more hazardous drinking was associated with better subjective sleep quality, only among women (B = −0.08, p = .009). Alcohol use was not associated with sleep quality among men (B = 0.01, p = .58). Associations remained significant when controlling for age, symptoms of anxiety and depression, body mass index, use of sleep medication, number of medical conditions, and chronic pain. ConclusionsAmong middle-aged and older adults, alcohol use is more strongly associated with sleep patterns among women than men, when assessed concurrently (i.e., at the same time point). Findings support the need for further consideration of sex differences in associations between alcohol use and sleep.

Dreaming and Sleep-Related Metacognitions in Patients with Sleep Disorders.

Sleep-related metacognitions play a role in the etiology of insomnia and are distressing while falling asleep. Although similar concepts, such as thought suppression, have been studied in the context of dreaming, the relationship between sleep-related metacognitions and more negatively toned dreaming due to stressful pre-sleep experiences has yet to be studied. Overall, 919 patients with various sleep disorders completed the Metacognitions Questionnaire-Insomnia (MCQ-I20), Arousal Disposition Scale (APS), and Pre-Sleep Arousal Scale (PSAS) and kept a sleep diary over seven days eliciting dream recall, nightmare frequency, and the emotional tone of their dreams. The regression analysis showed that the MCQ-I20 (small effect size) and the APS (medium effect size) were associated with nightmare frequency and negatively toned dream emotions. These findings suggest that dysfunctional sleep-related metacognitions that are active prior to sleep are also associated with more negatively toned dreaming and more nightmares—even after controlling for trait arousability. It would be very interesting to study where therapeutic strategies, such as metacognitive therapy explicitly targeting sleep-related metacognition, could also be beneficial with regard to dreams (more positive dreams and fewer nightmares).

Discordant Subjective Perception of Sleep in Patients with Obstructive Sleep Apnea and Insomnia: A Retrospective Study.

BackgroundFactors affecting subjective perception of sleep are unclear but clinically important. We investigated the differences in subjective sleep perception of patients with obstructive sleep apnea (OSA) and insomnia disorder (ID).Material/MethodsFrom our Sleep Medicine Center database, 33 patients with OSA and 69 with ID were selected and assessed with the Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder screen, Patient Health Questionnaire-9, Epworth Sleepiness Scale, Pre-sleep Arousal Scale (PSAS), and polysomnography.ResultsIn subjective sleep tests, PSQI total score, sleep quality, sleep onset latency (SOL), total sleep time, and sleep efficiency (SE) were higher in patients with ID. In objective sleep tests, patients with OSA had longer total sleep time, shorter SOL, lower percentage of stage N3, less SE, higher percentage of stage N1, more arousals, and higher arousal index. Hyperarousal state evaluation showed cognitive hyperarousal significantly higher with ID. Subjective sleep perception with OSA correlated positively with PSAS total score, cognitive hyperarousal, and percentage of stage N2 and negatively with percentage of REM, apnea-hypopnea index, and desaturation index. Subjective sleep perception of patients with ID correlated positively with PSAS total score, cognitive hyperarousal, SOL, N3 sleep latency, and REM sleep latency and negatively with SE.ConclusionsSubjective sleep perception of OSA patients was mainly related to sleep structure and respiratory events, and that of ID patients, to sleep latency. Individual cognitive hyperarousal levels may be involved in negative subjective sleep perception. Clinicians should be aware that OSA patients may not actually experience adequate sleep.

0652 Associations Between Anhedonia and Maladaptive Beliefs About Sleep in Middle Age and Older Adults with Insomnia Disorder

Abstract Introduction Comorbid depression often exacerbates dysfunctional beliefs about sleep in those with insomnia disorder. Anhedonia, a core symptom of depression, may be mechanistic in this association. Previous research suggests that, when appraising potential decisions, individuals with anhedonia regularly overestimate the probability of negatively valenced outcomes and underestimate the likelihood of positive outcomes. This study explores the relationship between anhedonia and sleep-related cognitions in patients with insomnia disorder. Methods Adults 50 years and older (N = 241) who met DSM-5 criteria for insomnia disorder were enrolled in a randomized controlled trial assessing the effectiveness of a stepped care approach to delivering Cognitive Behavioral Therapy for Insomnia. At baseline, participants completed the Dysfunctional Beliefs and Attitudes about Sleep Scale, Pre-Sleep Arousal Scale (cognitive subscale), Beliefs about Medications Questionnaire (Subscales assess the belief that hypnotics are necessary and concern regarding consequences of use), and PROMIS sleep-related impairment short form. A t-test was used to compare participants who did and did not endorse anhedonia on the Geriatric Depression Scale (GDS). We also correlated the Patient Health Questionnaire-4 (PHQ-4) anhedonia item with sleep-related cognition measures. Results Participants reporting anhedonia (GDS) endorsed greater dysfunctional beliefs about sleep (p &amp;lt; .001, d = 0.44) and sleep-related impairment (p &amp;lt; .01, d = 0.39). Groups did not differ significantly regarding belief in the necessity of sleep medications and concern with hypnotic use, nor in pre-sleep arousal. Higher anhedonia (PHQ-4) was correlated with more severe dysfunctional beliefs about sleep (r = .20, p &amp;lt; .01), belief in the necessity of hypnotics to manage sleep disturbance (r = .22, p &amp;lt; .001), and greater pre-sleep arousal (r = .18, p &amp;lt; .01). Conclusion Endorsement of anhedonia was associated with stronger dysfunctional beliefs about sleep in this sample of middle age and older adults with insomnia disorder. Participants reporting anhedonia also reported greater sleep-related impairment. Exploring anhedonia as a transdiagnostic symptom that influences interpretation of sleep-related difficulties may elucidate underlying mechanisms that sustain maladaptive cognitions. Prospective, multi-method studies will be essential to clarify predictive interactions between reward system dysfunction and sleep-related beliefs in those with insomnia disorder. Support (If Any) 1R01AG057500

0465 Exploring Differences in Self-Report Sleep Measures in Adults with Insomnia who Use or Do Not Use Sleep Medication

Abstract Introduction Adults seeking non-pharmacological treatment for insomnia often present for care already taking prescription medication for sleep. Understanding how such patients differ from those who do not use medication could be useful for guiding treatment. This study examined associations between sleep medication use and measures of self-report sleep characteristics at baseline in an RCT of cognitive behavioral therapy for insomnia (CBTI). Methods We examined baseline data from 237 middle-to-older-aged adults with insomnia disorder (175 women, M age = 63.17) enrolled in the ongoing RCT on Effectiveness of Stepped-Care Sleep Therapy (RESTING). Participants were dichotomized by whether they reported taking at least one prescription medication for sleep. Sleep measures included the Insomnia Severity Index (ISI), PROMIS Sleep-Related Impairment short form, Epworth Sleepiness Scale (ESS), Cognitive Presleep Arousal Scale, Dysfunctional Attitudes and Beliefs About Sleep Scale, and two weeks of sleep diaries yielding average nightly sleep onset latency, wake time after sleep onset, total sleep time, and sleep quality ratings. MANOVA compared medication users and non-users across sleep measures. Results Seventy-seven (32.5%) participants reported taking at least one prescription medication for sleep at baseline. MANOVA results indicated that sleep measures collectively differed by medication use, F(9, 226) = 3.74, p &amp;lt; .001; Wilk’s Λ = .87, partial η-sqd = .13. Bonferroni-adjusted follow-up comparisons (p &amp;lt; .005) found that only ESS significantly differed between medication users and non-users, F(1, 234) = 15.17, p &amp;lt; .001; partial η-sqd = .06. Medication users had lower sleepiness scores (M = 5.86, SD = 4.68) than non-users (M = 8.46, SD = 4.84). The association between medication use and less daytime sleepiness was maintained after adjusting for ISI. Conclusion Sleep medication use displayed little association with sleep measures in adults about to undergo CBTI, excepting endorsement of less daytime sleepiness by medication users. While more research is needed to understand the implications of sleep medication use for adults engaging in CBTI, these initial findings suggest that CBTI therapists should be thoughtful about sleepiness in non-medication users, and the potential emergence of sleepiness among patients who engage in sleep medication taper while in treatment. Support (If Any) 1R01AG057500

0244 Associations among pre-sleep arousal, facets of emotion dysregulation, and sleep quality and efficiency during pregnancy

Abstract Introduction Pre-sleep arousal contributes to over 50% of pregnant people experiencing poor sleep quality and clinical insomnia. Given that poor sleep during pregnancy is associated with depression and suicide ideation, there is a critical need to identify intervention targets, such as difficulties with emotion regulation. However, emotion dysregulation is multifaceted and warrants further investigation in sleep research, particularly during pregnancy. Thus, the present study examined associations among pre-sleep arousal, various dimensions of emotion dysregulation, and sleep outcomes during pregnancy. Methods Participants (N = 62; Mage = 29.89, SD = 4.19 years) were recruited during pregnancy and enrolled to represent a range of scores on the Difficulties in Emotion Regulation Scale. For 7 days during the 3rd trimester, they wore CamNtech MotionWatch-8 wrist actigraphs and completed the Pre-Sleep Arousal Scale and Consensus Sleep Diary. Results Hierarchical linear regression analyses indicated that high pre-sleep arousal predicted low sleep efficiency (measured via actigraphy) above and beyond facets of emotion dysregulation (B = -.316, p = .026). High pre-sleep arousal also predicted poor sleep quality (measured via diary) above and beyond total emotion dysregulation (B = -.038, p = .010). However, an interaction emerged between pre-sleep arousal and one particular facet of emotion dysregulation: access to emotion regulation strategies (B = -.005, p = .023). Specifically, high pre-sleep arousal was associated with poor sleep quality only among those who reported limited abilities to use emotion regulation strategies. Among participants who reported that they could access effective emotion regulation strategies, pre-sleep arousal did not predict sleep quality. Conclusion This study indicates that high pre-sleep arousal may not always be associated with poor sleep quality during pregnancy. Equipping pregnant people with emotion regulation strategies may buffer this association and promote long-term health. It is recommended that perinatal sleep scientists continue investigating relations between facets of emotion dysregulation and sleep. Support (If Any) This project was supported by the National Institute of Mental Health under Awards R01MH119070 (MPIs Crowell &amp; Conradt) and F31MH124275 (PI Kaliush). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH.

A protocol of the study "Effectiveness of psychobehavioural interventions for sleep disturbances in undergraduate medical students"

Background: Medical students carry a huge academic load which can be a contributing factor in sleep disturbances. Studies have shown that the prevalence of sleep disturbance is comparatively higher in medical students than in non-medical students or the general population. Despite various psychological and behavioral interventions for sleep improvement, not much is known about their effectiveness in real-world scenarios. Our study aims to compare the effectiveness of psychobehavioural interventions on sleep disturbances compared to sleep hygiene for undergraduate medical students. Methods: A randomized trial will be used to assess the effectiveness of psychobehavioural interventions in improving sleep quality using the following tools: Semi-structured sociodemographic proforma, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Glasgow Sleep Effort (GSE) scale, Pre-sleep Arousal Scale (PAAS), and Kentucky Inventory of Mindfulness Skills (KIMS). Inclusion criteria: participants scoring 5 or higher on the PSQI will be recruited for psychobehavioural interventions after obtaining informed consent. The participants will be randomly assigned to intervention and control groups. Discussion: SPSS will be used to analyse the data. Descriptive statistics will be used to describe the sample. An intention-to-treat analysis will be performed to assess the effectiveness of the interventions. This study will provide valuable insights into the feasibility and effectiveness of non-pharmacological sleep interventions to address sleep difficulties among undergraduate medical students.

The platform development, adherence and efficacy to a digital Brief therapy for insomnia (dBTI) during the COVID-19 pandemic.

Brief therapy for insomnia (BTI) is a short-term cognitive behavioral therapy for insomnia. At present, there is no study combining BTI with digital technology. However, in the context of the outbreak of coronavirus disease 2019 (COVID-19), patients with acute insomnia may need an online treatment which can quickly improve insomnia symptoms. Our team built a digital BTI (dBTI) platform based on the WeChat mini program. This research provides a framework design and a course design of dBTI, and evaluates the system via recruiting participants suffering from acute insomnia in pandemic. What's more, it explores patients’ adherence, the efficiency of the system and their relationship. As the result demonstrates, 68% of participants have completed more than half of the course with medium to high adherence. Gender, pre-sleep arousal scale (PSAS) somatic score and insomnia severity index (ISI) score have affected participants’ adherence, and higher adherence has led to better improvement in the severity of insomnia and somatic pre-sleep arousal. It is proved that the platform we built is effective, which not only offers an entry point for the study of how to set up a dBTI platform, but also provides theoretical basis for its clinical application.

Decreased Transition Rate From Situational Insomnia to Chronic Insomnia by One-Week Internet Cognitive Behavioral Treatments for Insomnia During the COVID-19 Pandemic.

PurposeThe purpose of the study was to determine the long-term effects of one-week self-guided internet cognitive behavioral treatments for insomnia (CBTI) on situational insomnia during the COVID-19 pandemic.Patients and MethodsThe participants with situational insomnia (n = 194) were recruited from March 2020 to April 2020 in Guangzhou, China. The insomnia severity index (ISI), pre-sleep arousal scale (PSAS), and hospital anxiety and depression scale (HADS) were evaluated at baseline and a one-week internet CBTI program was delivered to all individuals. The participants were divided into the complete treatment group (the participants completed all seven modules of the CBTI course, n = 75), and the incomplete treatment group (the participants completed 0–6 modules of the CBTI course, n = 119). A total of 135 participants completed the post-intervention assessments. At 3 months follow-up, a total of 117 participants (complete treatment group: n = 51; incomplete treatment group: n = 66) completed the assessments of the ISI, PSAS and HADS. The transition rate from situational insomnia to chronic insomnia (duration of insomnia ≥ 3 months and ISI ≥ 8) was calculated in the two groups. Linear mixed effect model was used to investigate the effect of group (between the two groups), time (baseline vs. follow-up), and interaction (group x time) on various questionnaire score.ResultsThe transition rate from situational insomnia to chronic insomnia was significantly lower in the complete treatment group compared to the incomplete treatment group (27.5%, 14/51 vs. 48.5%, 32/66, p = 0.023). There were significant differences in group effect (p = 0.032), time effect (p = 0.000) and group × time effect (p = 0.048) between the two groups in the ISI total score. The ISI total scores decreased in both groups during follow-up compared to their baseline values, with a greater magnitude of decrease in the complete treatment group. There were no significant group x time effects between the two groups in the PSAS-total score, PSAS-somatic, PSAS-cognitive score, HADS total score, HADS anxiety score or HADS depression score.ConclusionOur results suggested that one-week self-guided internet CBTI prevented the development of chronic insomnia from situational insomnia during the COVID-19 pandemic.

Changed serum levels of CD62E+, angiotensin II and copeptin in patients with chronic insomnia disorder: a link between insomnia and stroke?

BackgroundEpidemiological and observational clinical studies have found that insomnia is a risk factor for stroke and that, accordingly, insomnia is likely to cause changes of stroke-related biomarkers. There is substantial evidence that stroke is closely related to endothelial dysfunction and hypertension. The aim of this study is to investigate whether there is alteration of endothelial dysfunction (CD62E+) and hypertension (angiotensin II and copeptin) biomarkers in patients with chronic insomnia disorder (CID). MethodsThe CID patients (N = 54) and the good sleepers (GS, N = 32) were enrolled. Pittsburgh sleep quality index (PSQI), pre-sleep arousal scale (PSAS) and polysomnography were used to assess their sleep and neuropsychological function. Serum levels of CD62E+, angiotensin II and copeptin were determined using a quantitative sandwich ELISA. ResultsThe CID group had higher serum levels of CD62E+, angiotensin II, and copeptin than the GS group. After controlling for sex, age, depression and apnea-hypopnea index, the partial correlation analysis revealed that the levels of CD62E+ and copeptin correlated positively with the PSAS score and negatively with the objective sleep quality. Angiotensin II levels negatively correlated with objective sleep onset latency. Moreover, there was a positive correlation between CD62E+ and angiotensin II. Principal components analysis revealed that CD62E+ and copeptin had a substantial correlation with parameters of subjective and objective sleep. ConclusionPatients with CID exhibit endothelial activation, over-activated renin-angiotensin system and increased sympathetic excitability, as indicated by increased serum levels of CD62E+, angiotensin II and copeptin, with linking to poor sleep quality.

DSM-5 insomnia disorder in pregnancy: associations with depression, suicidal ideation, and cognitive and somatic arousal, and identifying clinical cutoffs for detection.

Study ObjectivesThe study had three primary goals. First, we estimated survey-assessed DSM-5 insomnia disorder rates in pregnancy, and described associated sociodemographics, and sleep-wake and mental health symptoms. Second, we derived cutoffs for detecting DSM-5 insomnia disorder using common self-report measures of sleep symptoms. Third, we identified clinically relevant cut-points on measures of nocturnal cognitive and somatic arousal.MethodsNinety-nine women (85.9% in the 2nd trimester) completed online surveys including DSM-5 insomnia disorder criteria, the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Presleep Arousal Scale’s Cognitive (PSASC) and Somatic (PSASS) factors, and Edinburgh Postnatal Depression Scale.ResultsDSM-5 insomnia disorder rate was 19.2%. Insomnia was associated with depression, suicidality, nocturnal cognitive and somatic arousal, and daytime sleepiness. An ISI scoring method that aligns with DSM-5 criteria yielded excellent metrics for detecting insomnia disorder and good sleep. Regarding quantitative cutoffs, ISI ≥ 10 and ISI ≥ 11 (but not ISI ≥ 15) were supported for detecting DSM-5 insomnia, whereas ISI ≤ 7 and ISI ≤ 9 performed well for detecting good sleep. PSQI cutoff of 5 was supported for detecting insomnia and good sleep. The optimal cutoff for nocturnal cognitive arousal was PSASC ≥ 18, whereas the optimal cutoff for somatic arousal was PSASS ≥ 13.ConclusionsInsomnia disorder affects a large segment of pregnant women. Empirically derived cutoffs for insomnia, good sleep, cognitive arousal, and somatic arousal may inform case identification and future perinatal sleep research methodology.

Correlation between Serum Levels of Sympathetic Nerve Activity Markers and Sleep Quality and Cognitive Function in Patients with Chronic Insomnia Disorder

Objectives: To explore the changes of the serum levels of copeptin and α-amylase and the correlations with sleep quality and cognition function in the patients with chronic insomnia disorder (CID). Methods: Fifty-seven CID patients and thirty healthy controls were enrolled continuously. Pittsburgh Sleep Quality Index (PSQI), polysomnography (PSG) and Pre-Sleep Arousal Scale (PSAS) were used to assess the insomnia severity and cognitive and somatic manifestations of arousal experienced at bedtime. Montreal Cognitive Assessment scale (MoCA) and Nine-Box Maze were used to respectively assess general cognition and memories. The serum levels of copeptin and α-amylase were detected using Enzyme-Linked ImmunoSorbent Assay. Results: Compared to the controls, the CID patients had increased PSQI and PSAS scores (Z=‒7.678 and ‒7.350; Ps&lt;0.001), decreased MoCA score (t=‒4.625, P&lt;0.001), increased numbers of errors in the object working, spatial working and object recognition (Z=‒2.099, ‒3.935 and ‒2.266; Ps&lt;0.05) memories, and elevated serum levels of copeptin and α-amylase (t=5.414 and 5.597, P &lt;0.001). In the CID patients，the level of copeptin positively correlated with PSQI and PSAS scores (r=0.338 and 0.316; Ps&lt;0.05), and PSG sleep latency, wake time and N1% (r=0.324, 0.325 and 0.278, Ps&lt;0.05), and negatively correlated with PSG N 2% (r=‒0.279, Ps&lt;0.05). Alpha-amylase was positively correlated with waking numbers in PSG (r=0.293, P&lt; 0.05). Multiple linear regression analysis showed that copeptin level affected PSQI score and PSG sleep latency (P&lt;0.05). Conclusions: The serum levels of copeptin and α-amylase elevated in the CID patients, and the serum levels of copeptin may be associated with the poor sleep quality, especially in the individuals of initial sleep difficulties.

The effects of a sleep robot intervention on sleep, depression and anxiety in adults with insomnia – Study protocol of a randomized waitlist-controlled trial

Insomnia is a common sleep disorder characterized by difficulties initiating sleep, maintaining sleep and/or early-morning awakenings. Hyperarousal is a common causal and maintaining factor in insomnia models. Different techniques to decrease arousal have shown to be effective. Calm breathing can be one approach to enhance sleep. The Somnox sleep robot looks like a bean-shaped cushion to hug, and it gives physical and auditive guidance to calm down the users' breathing. There is currently no impartial empirical evidence of the sleep robot's effects on insomnia. This study is a randomized waitlist-controlled trial with a recruitment target of a minimum of 44 adults with insomnia and sleep disturbing arousal. Participants will complete pre-, mid- and post-intervention assessments, in addition to a 1-month follow-up. The primary outcome measure is the Insomnia Severity Index. Secondary sleep outcome measures are the Pre-Sleep Arousal Scale, a sleep diary and actigraphy. A secondary comorbid symptoms outcome measure is the Hospital Anxiety and Depression Scale. The main research question is whether treated participants have greater improvements regarding symptoms of insomnia post-intervention, compared with the waitlist control group. The analytic approach will be mixed-effects models. The current study will increase the knowledge on breath guidance as a way to reduce hyperarousal and enhance sleep. The sleep robot is a novel method and a potential treatment option for people with insomnia, when the recommended first-line treatments of Cognitive Behavioral Therapy and pharmaceuticals are inaccessible or undesirable. The ethics of healthcare robotics is discussed.

The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial.

Sleep restriction therapy (SRT) effectively treats insomnia but mechanisms are poorly understood. Theoretical models suggest that potentiation of sleep pressure and reduction of arousal are key mechanisms of action. To our knowledge, this has never been directly tested. We designed a randomized controlled trial with embedded mechanistic measurement to investigate if SRT causally modifies multidimensional assessments of sleep pressure and arousal. Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were randomized to four weeks of SRT or time in bed regularization (TBR), a control intervention that involves prescription of a regular but not reduced time in bed. Sleep pressure was assessed through daily diary appraisal of morning and evening sleepiness, weekly Epworth sleepiness scale (ESS) scores, psychomotor vigilance, and non-rapid eye movement (NREM) delta power (0.75-4.5 Hz) from ambulatory polysomnographic recordings. Arousal was assessed through daily diary appraisal of cognitive arousal, the pre-sleep arousal scale (PSAS), and NREM beta power (15-32 Hz). Outcomes were assessed at baseline (2-week period prior to randomization), during the intervention phase (1-4 weeks post-randomization), and at 12-week follow-up. We performed intention-to-treat analyses using linear mixed models. For continuous daily measures, the treatment period was split into early (weeks 1-2) and late (weeks 3-4) treatment. Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). The SRT group showed enhanced sleep pressure relative to TBR, reflected in (1) enhanced sleepiness in the evening during early (d = 1.17) and late treatment (d = 0.92), and in the morning during early treatment (d = 0.47); (2) higher daytime sleepiness on the ESS at weeks-1 and -2 (d = 0.54, d = 0.45); and (3) reduced psychomotor vigilance at week-1 (d = 0.34). The SRT group also showed reduced arousal relative to TBR, reflected in lower levels of daily-monitored cognitive arousal during early treatment (d = 0.53) and decreased PSAS total score at week-4 and week-12 (ds ≥ 0.39). Power spectral analysis of all night NREM sleep revealed an increase in relative, but not absolute, EEG delta power at week-1 and week-4 (ds ≥ 0.52) and a decrease of relative EEG beta power at week-4 (d = 0.11). For the first time, we show that SRT increases sleep pressure and decreases arousal during acute implementation, providing support for mechanism-of-action.

A Randomized Controlled Trial to Examine the Feasibility and Preliminary Efficacy of a Digital Mindfulness-Based Therapy for Improving Insomnia Symptoms.

ObjectivesInsomnia has widespread negative implications for health and well-being. Online delivery of mindfulness-based therapy for insomnia (MBTI) has not previously been evaluated. This study investigated the feasibility and preliminary efficacy of a digital MBTI program for improving insomnia symptoms. It was hypothesized that a 6-week digital MBTI program would reduce insomnia symptoms and pre-sleep arousal and improve mood, compared to a waitlist control condition.MethodsTwenty-seven participants (M = 29.44, SD = 11.97 years) experiencing insomnia symptoms (insomnia severity index [ISI] ≥ 8) were randomized to either a 6-week intervention or waitlist condition. Participants completed the ISI, pre-sleep arousal scale (PSAS), and the positive and negative affect schedule at baseline, mid-, and post-study. Feasibility was assessed across four domains (acceptability, implementation, practicality, and preliminary efficacy) using self-reports, attrition, program completions, and module completions.ResultsFeasibility data for the intervention indicated that there was 22% attrition, and 79% of the modules were completed. There were significantly greater reductions in the severity of insomnia symptoms (p < .001) and both cognitive (p = .03) and somatic (p = .02) subscales of the PSAS, at post-intervention compared to the waitlist group. There were no significant group differences in mood.ConclusionsThis study provides preliminary evidence of the feasibility and efficacy of a digital MBTI, which may assist in the broader dissemination of insomnia treatment.Trial RegistrationAustralian and New Zealand Clinical Trials Registry: ACTRN12620000398909