Self-reported Insomnia Research Articles

Association between Sleep and Breast Cancer Incidence among Postmenopausal Women in the Women's Health Initiative

To determine whether the duration of sleep, sleep quality, insomnia, or sleep disturbance was associated with incident breast cancer in the Women's Health Initiative (WHI). Prospective cohort study. Women enrolled in one of the Clinical Trial (CT) arms or the Observational Study (OS) from the WHI conducted in the United States. This study included 110,011 women age 50 to 79 years with no history of cancer. Typical sleep duration, sleep quality, and other self-reported sleep measures over the past 4 weeks were assessed during the screening visits for both the CT and OS participants. The presence of insomnia and level of sleep disturbance was calculated from an index of the WHI Insomnia Rating Scale. The outcome for this study was primary, invasive breast cancer. A total of 5,149 incident cases of breast cancer were identified in this study. No statistically significant associations were found between sleep duration, sleep quality, insomnia, or level of sleep disturbance with the risk of breast cancer after multivariable adjustment. A positive trend was observed for increasing sleeping duration with the risk of estrogen receptor positive breast cancer, but the association estimates for each sleep duration category were weak and nonsignificant. This study does not provide strong support for an association between self-reported sleep duration, sleep quality, insomnia, or sleep disturbance with the risk of breast cancer.

Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: A randomized trial

Internet-delivered treatment is effective for insomnia, but little is known about the beneficial effects of support. The aim of the current study was to investigate the additional effects of low-intensity support to an internet-delivered treatment for insomnia. Two hundred and sixty-two participants were randomized to an internet-delivered intervention for insomnia with (n = 129) or without support (n = 133). All participants received an internet-delivered cognitive behavioral treatment for insomnia. In addition, the participants in the support condition received weekly emails. Assessments were at baseline, post-treatment, and 6-month follow-up. Both groups effectively ameliorated insomnia complaints. Adding support led to significantly higher effects on most sleep measures (d = 0.3–0.5; p < 0.05), self-reported insomnia severity (d = 0.4; p < 0.001), anxiety, and depressive symptoms (d = 0.4; p < 0.01). At the 6-month follow-up, these effects remained significant for sleep efficiency, sleep onset latency, insomnia symptoms, and depressive symptoms (d = 0.3–0.5; p < 0.05). Providing support significantly enhances the benefits of internet-delivered treatment for insomnia on several variables. It appears that motivational feedback increases the effect of the intervention and encourages more participants to complete the intervention, which in turn improves its effectiveness.

P.2.b.056 Time course of psychomotor performances, fatigue and cognitive function in stable in-patients with treatment resistant depression

as well as the average night sleep duration (ANSD) during this time period. Suicidal intent was recorded with the 15-item Beck’s Suicide Intent Scale (BSIS). BSIS score was sequentially regressed on AIS total score, specific AIS items, self-reported insomnia and ANSD after adjusting for gender, age and current depression or MDI score. Results: 102 subjects (63.7% females), aged 16−87 (43.8± 18.1) years were included. Assessments took place 4.2±4.4 days after the suicide attempt. 55.9% reported previous attempts. 50% had regular psychiatric consultations for mental health problems and had been previously diagnosed with affective disorder (26.5%), schizophrenia (7.8%), personality disorders (2.9%) or alcohol abuse (2%). 48% received psychotropic medication during the month preceding the attempt. Methods employed in the most recent suicide attempt included drug-overdose (80.4%), selfpoisoning (6.9%) and self-injury (12.7%). 38.2% of participants fulfilled DSM-IV-TR criteria of current major depressive episode. During the two-week time period before the attempt, 55.9% reported suffering from insomnia while 41.2% slept less than 5 hours per night on average. 35.3% of attempters scored high on BSIS (>=14) while 44.1% had intermediate scores (5−13). After adjusting for covariates in multiple regressions, BSIS was independently associated with AIS total score (p = 0.007), ANSD (p = 0.037) and ANSD 5hr (p = 0.025). Interactions of gender, age and current depression with sleep measures (AIS score, ANSD) tested non-significant. Out of specific AIS items, items 2 (night-time awakenings) (p = 0.007), 3 (late insomnia) (p = 0.001) and 4 (inadequate sleep duration) (p = 0.004) were significantly associated with BSIS, while item 8 (somnolence) was associated at a trend level (p = 0.08). Conclusions: In conclusion, suicide intent was found to be associated with the severity of insomnia and short self-reported sleep duration (less than 5 hours per night on average) during a two-week time period preceding the suicide attempt independently of the presence of a current major depressive episode. In specific, night-time awakenings (middle insomnia) and early arousal (late insomnia) were strongly associated with suicide intent.

Sleep Duration and Insomnia in the Elderly: Associations With Blood Pressure Variability and Carotid Artery Remodeling

Recent studies have shown that short and long sleep durations and insomnia are associated with increased home-measured blood pressure (BP) variability, which in turn has a relationship with arterial stiffness. However, the determinants for visit-to-visit systolic blood pressure (SBP) variability have rarely been investigated in relation to sleep duration, insomnia, and carotid arterial stiffness. The subjects were 201 elderly individuals (79.9±6.4 years old) with one or more cardiovascular risks. Based on 12 visits, visit-to-visit BP variability (expressed as a coefficient of variation [CV]) and δ (maximum - minimum) BP were measured. Self-reported sleep duration and insomnia questionnaires were used to classify the patients according to sleep duration period and insomnia status. After multivariable adjustment, long sleep duration (≥ 9 hours per night) had significant positive associations with SBP δ (P < 0.05), while persistent insomnia had significant positive associations with SBP CV (P < 0.05) and δ (P < 0.01). Additionally, significant interactions were found in terms of long sleep duration by carotid artery stiffness parameter β (P < 0.05), persistent insomnia by intima-media thickness (P < 0.01), and persistent insomnia by stiffness parameter β (P < 0.05) for SBP δ. In elderly patients at high risk for cardiovascular disease, long sleep duration as well as persistent insomnia were significantly associated with higher visit-to-visit BP variability. Long sleep duration and persistent insomnia each had synergetic interactions with carotid artery stiffness and with visit-to-visit BP variability.

Sleep Duration, Insomnia, and Coronary Heart Disease Among Postmenopausal Women in the Women's Health Initiative

Long and short sleep duration are associated with increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD); however, evidence is inconsistent. We sought to identify whether self-reported sleep duration and insomnia, based on a validated questionnaire, are associated with increased incident CHD and CVD among postmenopausal women. Women's Health Initiative Observational Study Participants (N=86,329; 50-79 years) who reported on sleep at baseline were followed for incident CVD events. Associations of sleep duration and insomnia with incident CHD and CVD were evaluated using Cox proportional hazards models over 10.3 years. Women with high insomnia scores had elevated risk of CHD (38%) and CVD (27%) after adjustment for age and race, and in fully adjusted models (hazard ratio [HR]=1.19, 95% confidence interval [CI] 1.09-1.30; 1.11 95% CI 1.03-2.00). Shorter (≤5 hours) and longer (≥10 hours) sleep duration demonstrated significantly higher incident CHD (25%) and CVD (19%) in age- and race-adjusted models, but this was not significant in fully adjusted models. Formal tests for interaction indicated significant interactions between sleep duration and insomnia for risk of CHD (p<0.01) and CVD (p=0.02). Women with high insomnia scores and long sleep demonstrated the greatest risk of incident CHD compared to midrange sleep duration (HR=1.93, 95% CI 1.06-3.51) in fully adjusted models. Sleep duration and insomnia are associated with CHD and CVD risk, and may interact to cause almost double the risk of CHD and CVD. Additional research is needed to understand how sleep quality modifies the association between prolonged sleep and cardiovascular outcomes.

Insomnia and the risk of incident heart failure: a population study

Insomnia is highly prevalent among heart failure patients, but only a few small studies have investigated insomnia symptoms and risk of heart failure. We aimed to assess the prospective association between self-reported insomnia symptoms and the risk of incident heart failure in a large Norwegian cohort. Baseline data on insomnia symptoms, including difficulty initiating sleep, difficulty maintaining sleep and having non-restorative sleep, socio-demographic variables, and health status, including established cardiovascular risk factors, were collected from 54 279 men and women 20-89 years of age who participated in the Nord-Trøndelag Health study (HUNT) between 1995 and 1997 and were free from known heart failure at baseline. The cohort was followed for incident heart failure from baseline through 2008. We used Cox proportional hazard models to assess the association of baseline insomnia symptoms with the risk of heart failure. A total of 1412 cases of heart failure occurred during a mean follow-up of 11.3 years (SD = 2.9 years), either identified at hospitals or by the National Cause of Death Registry. There was a dose-dependent association between the number of insomnia symptoms and risk of heart failure. The multi-adjusted hazard ratios were 0.96 (0.57-1.61), 1.35 (0.72-2.50), and 4.53 (1.99-10.31) for people with one, two, and three insomnia symptoms, compared with people with none of the symptoms (P for trend 0.021). Insomnia is associated with an increased risk of incident heart failure. If our results are confirmed by others and causation is proved, evaluation of insomnia symptoms might have consequences for cardiovascular prevention.

Insomnia, Daytime Sleepiness and Cardio-Cerebrovascular Diseases in the Elderly: A 6-Year Prospective Study

ObjectiveTo examine 1) the associations between history of cardio-cerebrovascular diseases (CVD) and insomnia complaints and excessive daytime sleepiness (EDS), and 2) the relationships between sleep complaints and future CVD in persons over 65.MethodsCVD was assessed at baseline and during two, four, and six-year follow-up in 5494 non-demented subjects. Self-reported insomnia complaints (poor sleep quality, difficulty in initiating sleep, difficulty in maintening sleep, and early morning awakening), EDS and sleep medication use were evaluated at baseline. Logistic regression models and Cox proportional hazard models, with delayed entry and age of participants as the time scale, were adjusted for socio-demographic, lifestyle and clinical variables.ResultsAt baseline, 748 participants had a past-history of CVD. A past-history of CVD was associated with EDS (OR = 1.28 95%CI = [1.05–1.57]) and the number of insomnia complaints (OR = 1.26 95%CI = [1.03–1.55] for 1–2 insomnia complaints; OR = 1.32 95%CI = [1.03–1.71] for ≥3 complaints). In longitudinal analyses, neither the four components of insomnia nor the number of insomnia complaints were significantly associated with first or recurrent CVD events (n = 391 events). EDS was independently associated with future CVD events even after adjusting for prescribed sleep medication and past-history of CVD (HR = 1.35 95%CI = [1.06–1.71]).ConclusionOur results suggest that the relationships between sleep complaints and CVD could be complex. Insomnia complaints are more likely a consequence of CVD, whereas EDS appears to be a determinant of CVD independently of past-history of CVD. EDS screening may thus constitute a means of detecting persons at high risk of CVD.

2004 – Perfectionism and insomnia in pregnancy

Socially prescribed perfectionism has been associated with long-term sleep disturbances (Azevedo et al. , 2010). To investigate the association between perfectionism dimensions and insomnia in pregnancy. 581 pregnant women, mean age 29.8 years (SD=4.5), average weeks of gestation 32.6 (SD=3.5), mostly married (75%) and nulliparae (64%) participated in the study. The multidimensional perfectionism scale (Hewitt and Flett, 1991; Soares et al ., 2003) was used to assess total levels of perfectionism, self-oriented perfectionism (SOP) and dimensions of socially prescribed perfectionism (SPP): others high expectations (OHE) and conditional acceptance (CA) (Macedo et al. , 2009). Insomnia symptoms and related daytime impairment were assessed with an insomnia questionnaire (Marques et al. , 2011). Objective estimations of sleep were obtained through actigraphy in a small group (n=60). In comparison to good sleepers, insomniacs showed higher levels of SPP (M=53.4, SD=13.0 versus M=49.6, SD=12.3, p < .05) and SPP-CA (M=19.6, SD=6.1, versus M=18.0, SD=5.5, p < .05). Women with difficulties initiating sleep reported higher levels of SPP-CA than good sleepers. Analyses of actigraphy revealed that SPP-CA was associated with less sleep time (r=-.45, p < .05), less sleep efficiency (r= -.34, p < .05), more time awake during sleep (r= .43, p < .05) and more mean activity asleep (r= .38, p < .05). Conditional acceptance is the SPP perfectionism sub-dimension particularly associated with self-reported insomnia and sleep alterations measured objectively with actigraphy in pregnancy. Portuguese foundation for science and technology (POCI/SAU-ESP/57068/2004).

Abstract P6-08-10: Cancer as self: a novel assessment of patient identity as it relates to a cancer diagnosis

Abstract Introduction: Previous studies have demonstrated that an individual's attitude towards self may impact how one faces challenges. Those who view themselves as malleable (growth mindset) approach challenges and problems as a learning opportunity and an opportunity to improve and change. In contrast, those who are more fixed in their approach (fixed mindset) have difficulty with challenges or setbacks. In the present study, we applied this conceptual framework to a cohort of breast cancer patients to evaluate their attitudes towards the cancer diagnosis. The goal of this study is to test the internal validity of this questionnaire and to correlate its findings with patient-reported measures of depression, anxiety and insomnia. Methods: Twenty consecutive breast cancer patients undergoing radiation therapy completed an electronic survey consisting of 4 scales: the Hospital Anxiety and Depression Scale (HADS; 14 items), the Insomnia Severity Index (ISI; 7 items), a validated psychological questionnaire assessing fixed versus growth mindset (8 items), and an experimental questionnaire evaluating whether the patient views their disease as self-defining. Demographic and clinical variables were also collected. A principal components factor (PCF) analysis was used to examine the internal structure of the new questionnaire. Hierarchical linear regression analyses were performed to assess its relationship to other variables. Results: Twenty patients completed the survey during the first week of radiotherapy. Median age was 57 (range, 31–81). Five patients (25%) had Stage 0 disease, 9 (45%) Stage I, 0 (0%) Stage II, 5 (25%) Stage III, and 1 (5%) Stage IV. Seven patients (35%) received chemotherapy while 13 (65%) did not. Eleven patients (55%) had significant others while undergoing treatment and 9 (45%) were single. The PCF analysis confirmed that the items of the experimental questionnaire were internally consistent (α = .88), such that all were retained in the final scale for subsequent analyses. The extent to which patients saw cancer as self defining was statistically significantly associated with their reported levels of depression (r = .60, p &amp;lt; .005) and anxiety (r = .60, p &amp;lt; .005). There was a similar trend with reported levels of insomnia which was not statistically significant (p = 0.2). Of the demographic and clinical variables, only stage of cancer was associated with depression and anxiety. Conclusions: Patients undergoing treatment for breast cancer who view the cancer diagnosis as self-defining are more likely to self-report depression, anxiety, and insomnia. In this cohort, the experimental questionnaire demonstrated strong internal validity. An intervention that alters patients' perception of identity as it relates to the cancer diagnosis could be a promising compliment to the standard treatment of depression, anxiety, and insomnia. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-10.

Use of Relaxation Techniques and Complementary and Alternative Medicine by American Adults with Insomnia Symptoms: Results from a National Survey

Though relaxation training is recommended for insomnia, national patterns of use remain unknown. Similarly, rates of complementary and alternative medicine (CAM) use by adults with insomnia are not well established. We sought to elucidate the patterns and reasons for use of relaxation techniques and CAM use by adults with insomnia symptoms. We used the 2007 National Health Interview Survey (n = 23,358) to estimate prevalence of use among adults by self-reported insomnia symptom status. Among adults reporting insomnia symptoms (n = 4,415), we examined reasons for use and disclosure to medical professionals. We employed logistic regression to determine the adjusted associations between relaxation techniques use, CAM use, and insomnia symptoms. Among adults with insomnia symptoms, 23% used relaxation techniques and 45% used CAM annually. After adjustment, adults with insomnia symptoms had higher likelihood of using relaxation techniques (aOR 1.48, 95% CI 1.32, 1.66) and CAM (aOR 1.29, 95% CI 1.15, 1.44) compared with adults without insomnia. Deep breathing exercise was the most commonly used relaxation technique. Fewer than 2% of adults with insomnia used CAM specifically for insomnia. Only 26% of adults with insomnia symptoms disclosed their relaxation techniques use to medical professionals. Being male, lower educational and physical activity levels, income < $20,000, living in South, and hypertension were associated with lower likelihood of relaxation techniques use among adults with insomnia symptoms. While adults with insomnia symptoms commonly use relaxation techniques and CAM, few are using for their insomnia. Facilitating discussions about relaxation techniques may foster targeted use for insomnia.

Neuropsychiatric Symptoms and the Use of Complementary and Alternative Medicine

To assess the prevalence of complementary and alternative medicine (CAM) use by U.S. adults reporting neuropsychiatric symptoms and whether this prevalence changes based on the number of symptoms reported. Additional objectives include identifying patterns of CAM use, reasons for use, and disclosure of use with conventional providers in U.S. adults with neuropsychiatric symptoms. Secondary database analysis of a prospective survey. A total of 23,393 U.S. adults from the 2007 National Health Interview Survey. We compared CAM use between adults with and without neuropsychiatric symptoms. Symptoms included self-reported anxiety, depression, insomnia, headaches, memory deficits, attention deficits, and excessive sleepiness. CAM use was defined as use of mind-body therapies (eg, meditation), biological therapies (eg, herbs), or manipulation therapies (eg, massage) or alternative medical systems (eg, Ayurveda). Statistical analysis included bivariable comparisons and multivariable logistical regression analyses. The prevalence of CAM use among adults with neuropsychiatric symptoms within the previous 12 months and the comparison of CAM use between those with and without neuropsychiatric symptoms. Adults with neuropsychiatric symptoms had a greater prevalence of CAM use compared with adults who did not have neuropsychiatric symptoms (43.8% versus 29.7%, P < .001); this prevalence increased with an increasing number of symptoms (trend, P < .001). Differences in the likelihood of CAM use as determined by the number of symptoms persisted after we adjusted for covariates. Twenty percent of patients used CAM because standard treatments were either too expensive or ineffective, and 25% used CAM because it was recommended by a conventional provider. Adults with at least one neuropsychiatric symptom were more likely to disclose the use of CAM to a conventional provider (47.9% versus 39.0%, P < .001). More than 40% of adults with neuropsychiatric symptoms commonly observed in many diagnoses use CAM; an increasing number of symptoms was associated with an increased likelihood of CAM use.

Socio-economic differences in self-reported insomnia and stress in Finland from 1979 to 2002: a population-based repeated cross-sectional survey

BackgroundOver the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland.MethodsThe data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress.ResultsThe overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002.ConclusionsSelf-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.

P04.42. Use of complementary and alternative medicine among adults with neuro-psychiatric symptoms common to mild traumatic brain injury

Methods We analyzed data from the 2007 National Health Interview Survey (n=23,393) to compare CAM use between adults with and without neuropsychiatric symptoms common to mTBI. Symptoms included self-reported anxiety, depression, insomnia, headaches, memory deficits, attentional deficits, and excessive sleepiness. CAM use was defined as use of mind-body (e.g., meditation), biological (e.g., herbs), manipulation (e.g., massage) therapies, and alternative medical systems (e.g., Ayurveda), within the past 12 months. We estimated prevalence and reasons for CAM use in patients with and without neuropsychiatric symptoms. We also explored variations in CAM use by the number of symptoms. Multivariable logistic regression was performed to examine the association between neuropsychiatric symptoms and CAM use after adjustment for sociodemographic characteristics, illness burden (e.g,. fibromyalgia, low back pain), access to care, and health habits.

The joint association of sleep duration and insomnia symptoms with disability retirement – a longitudinal, register-linked study

The aim of this study was to examine the joint association of sleep duration and insomnia symptoms with subsequent disability retirement. Baseline survey data were collected in 2000-2002 from 40-60-year-old employees of the City of Helsinki, all working at baseline. Baseline data were linked with disability retirement data until the end of 2010, obtained from the Finnish Centre for Pensions registers (N=6042). Sleep duration and self-reported insomnia symptoms (non-restorative sleep and difficulties in initiating and maintaining sleep) were derived from the baseline surveys. All-cause disability retirement (N=561) and the most prevalent diagnostic groups - musculoskeletal diseases (43%) and mental disorders (26%) - were examined. Cox regression analysis was used to yield hazard ratios (HR) with 95% confidence intervals (95% CI). A joint association of sleep duration and insomnia symptoms with disability retirement was found, implying a higher risk for those with frequent insomnia symptoms. HR for all-cause disability retirement ranged among those with frequent symptoms from 2.02 (95% CI 1.53-2.68, sleeping 7 hours) to 3.92 (95% CI 2.57-5.97, sleeping ≤ 5 hours). Adjusting for sociodemographic, work, and health-related factors attenuated the associations, which nevertheless remained. The associations were similar for the two diagnostic groups, although stronger for those with mental disorders. Frequent insomnia symptoms dominate the joint association of sleep duration and insomnia symptoms with subsequent disability retirement. Examining exclusively sleep duration would provide an incomplete understanding of the consequences of poor sleep.

P-633 - Self-reported chronic insomnia and psychiatric symptoms: preliminary results from an online survey in romanian adults

According to various surveys, insomnia is found in 6–10% of the adults and more often when comorbid with a psychiatric disease. To find out how many adults meet the ICSD-2 criteria for chronic insomnia and DSM-IV-TR ones for depressive, panic, anxiety disorder, somatoform or eating disorders, as well as alcohol abuse and adult ADHD. To measure prevalence of chronic insomnia and common psychiatric disorders with validated screeners. Adults, recruited via online adverts, were invited to fill in a battery of surveys consisting in the Romanian translations of the Sleep Disorders Questionnaire, Patient Health Questionnaire and Adult ADHD Self-Report Scale 1.1. Completion was online on Surveygizmo and analysis was performed with Excel 2007. To date, one hundred sixty participants (114 females, 71%), aged 39 ± 13 were recruited. Chronic insomnia, somatoform disorder and alcohol abuse were suspected in 15% of the total respondents. Depressive symptomatology was found in up to 20%, anxiety and adult ADHD in 10%. Bulimia was likely in 3% (all women). Alcohol abuse was significantly more frequent among males (35% vs. 7%), while adult ADHD amongst females (10% vs. 6%). Moreover, except of chronic insomnia, bulimia and alcohol abuse, all of the screened disorders were more likely to be found in adults aged under 45. Adult ADHD, somatoform and depressive disorders were more likely to be comorbid with chronic insomnia in 20–40%. With the exception of eating disorders, all of the screened conditions were rather likely to be found in this population.

P-393 - Sex differences in self-reported insomnia complaints in hospitalized patients

Introduction Insomnia, the most common sleep disorder, is 40% more likely to occur in women than in men. However, insomnia often remains unnoticed in general hospitals and only scant data exists regarding insomnia's sex-differences in hospitalized patients. Objectives This study explored in medical inpatients potential sex differences in insomnia and investigated which, if any, self-reported insomnia-related complaints were most sex-differentiated. Methods Five-hundred patients admitted to medical wards of three general hospitals were randomly selected during 2010–2011. All patients completed the Athens Insomnia Scale (AIS), a standardized self-assessment instrument based on ICD-10 criteria for insomnia. A mixed regression model of ordinal data explored potential sex differences in specific AIS questions. Results As expected, total AIS scores, controlled for age, were significantly higher in hospitalized women, which were 1.5 times more likely to score above the AIS cut-off score than men. The statistical analysis indicated significant sex differences in self-reported insomnia complaints. In the entire patient sample, women were generally more likely to complain about frequent awakenings during the night, reduced sleep duration and quality, reduced functioning and well-being during the day and increased sleepiness. The observed sex differences specifically in awakenings during the night, reduced sleep quality and sleepiness during the day were also identified in the sample of patients who screened positively for insomnia. Conclusions Women admitted in general hospitals complain heavier than men regarding frequent awakenings during the night, reduced sleep quality and day sleepiness. These findings should be taken into account when assessing insomnia in medical inpatients.

Prevalence of insomnia and its impact on daily function amongst Malaysian primary care patients.

BackgroundInsomnia is a common public health problem and the prevalence and impact of insomnia in primary care attendees is not well documented in the Asian population.ObjectivesTo determine the prevalence of self-reported insomnia symptoms amongst adult primary care attendees and the association with socio-demographic factors; to ascertain the impact of insomnia on daily functioning and to describe the psychological profile of patients with insomnia.MethodsIn this cross-sectional survey, 2049 adult patients (≥18 year old) attending seven primary care clinics in Peninsular Malaysia, completed the questionnaire asking about symptoms of insomnia (defined according to the International Classification of Sleep Disorders and DSM IV criteria) daytime impairment and psychological symptoms (assessed by Hospital Anxiety and Depression Scale).ResultsThe response rate was 86.2%. A total of 60% reported insomnia symptoms, 38.9% had frequent insomnia symptoms (>3 times per week), 30.7% had chronic insomnia without daytime consequences and 28.6% had chronic insomnia with daytime dysfunction. Indian ethnicity (OR 1.79; 95%CI, 1.28-2.49), age ≥ 50 or older (OR 1.82; 95%CI, 1.10-3.01), anxiety symptoms (OR 1.65; 95%CI, 1.21-2.22) and depression symptoms (OR 1.65; 95%CI, 1.21-2.26) were risk factors for chronic insomnia with daytime dysfunction. Amongst those with chronic insomnia with daytime dysfunction, 47.8% had anxiety symptoms (OR, 2.01; 95%CI, 1.57-2.59) and 36.5% had depression symptoms (OR, 2.74; 95%CI, 2.04-3.68) based on HADs score. They also had tendency to doze off while driving and to be involved in road traffic accidents.ConclusionsA third of primary care attendees have insomnia symptoms and chronic insomnia, associated with significant daytime dysfunction and psychological morbidity. By identifying those at risk of having chronic insomnia, appropriate interventions can be commenced.

Insomnia, Nightmare Frequency, and Nightmare Distress in Victims of Sexual Abuse

In this study of victims of sexual abuse, the aim was to investigate the role of perceived social support and abuse characteristics in self-reported insomnia, nightmare frequency, and nightmare distress. Four hundred sixty Norwegian victims of sexual abuse completed a questionnaire assessing perceived social support, abuse characteristics, insomnia, nightmare frequency, and nightmare distress. Results show that higher levels of perceived social support were related to lower scores on all symptom outcome measures. Abuse involving oral, genital, or anal penetration was related to more insomnia symptoms. Longer duration of abuse and threatening conducted by the perpetrator were related to higher nightmare frequency, while threats and abuse involving penetration were related to higher degrees of distress associated with nightmares. In conclusion, the present study provides preliminary data indicating that perceived social support may affect the nature of sleep difficulties in sexual abuse victims. Also, more severe forms of sexual abuse are related to higher levels of sleep difficulties.

Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military

Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms. Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311). In support of a priori hypotheses, self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Self-reported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled. The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk. These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.

Variability in home-measured blood pressure and heart rate

Both self-reported sleep disorders and higher variability in home blood pressure (BP) and home heart rate (HR) have been associated with increased cardiovascular mortality. The objective of our study was to assess the associations of the variability in home-measured BP and HR with self-reported insomnia and sleep duration. We studied a representative sample of Finnish adult population with 1908 study participants aged 41-74 years. BP/HR measurements were performed on 7 consecutive days. The variability in home-measured BP/HR was defined as the standard deviation of morning - evening, day-by-day and first - second measurements. Self-reported insomnia and sleep duration questionnaires were used to classify participants with sleep disorders. Results from Finn-home study show that morning - evening, day-by-day (morning and evening) and first - second home BP variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Morning - evening, day-by-day, morning day-by-day and first - second measurements of home HR variability variables were significantly higher in participants with persistent insomnia than in those without insomnia. Systolic morning - evening, day-by-day and morning day-by-day variables of home BP variability were significantly higher in long sleepers and systolic morning day-by-day, diastolic day-by-day and diastolic first - second measurement of home BP variability variables were higher in short sleepers than in the reference group. Insomnia combined with short sleep duration further increases home BP/HR variability. As self-reported sleep disorders are associated with greater variability in home BP/HR and both have cardiovascular prognostic value, we encourage physicians to evaluate these easily obtainable measurements in clinical practice to help identify patients at risk.