Self-reported Total Sleep Time Research Articles

Daridorexant for patients with chronic insomnia disorder: number needed to treat, number needed to harm, and likelihood to be helped or harmed

ABSTRACT Objectives Appraise the evidence for daridorexant 50 mg and 25 mg versus placebo when treating chronic insomnia disorder in terms of number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH). Methods NNT, NNH, and LHH were calculated from a 3-month pivotal Phase 3 study (N = 930; randomized 1:1:1 to daridorexant 50 mg, daridorexant 25 mg, or placebo once nightly). Wakefulness after sleep onset, latency to persistent sleep, self-reported total sleep time, Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), and Insomnia Severity Index were used for the NNT efficacy analysis. NNH safety analysis was performed using rates of adverse events (AEs) occurring in >1% of the participants in any arm. LHH was assessed for all NNT estimates, contrasting them with NNH estimates for somnolence, headache, and fatigue AEs. Results NNT estimates for daridorexant 50 mg versus placebo were <10 for clinically meaningful thresholds across all outcomes. NNT estimates for daridorexant 25 mg versus placebo were not as robust as those observed for daridorexant 50 mg, with many values exceeding 10. NNH estimates for daridorexant 50 mg and 25 mg versus placebo did not show a statistically significant treatment difference except for falls, where NNH was negative for the daridorexant 50 mg group (−44 [95% CI −328; −21]; rate of falls was greater with placebo than for daridorexant 50 mg). All LHH ratios at Months 1 and 3 were >1 (except for daridorexant 25 mg for the IDSIQ alert/cognition domain), indicating that patients were more likely to respond to daridorexant 50 mg and 25 mg than to experience an AE of somnolence, headache, or fatigue. Conclusion Daridorexant 50 mg and 25 mg have a favorable benefit–risk ratio over 3 months. Daridorexant 50 mg demonstrated more robust (lower) NNT estimates versus placebo than daridorexant 25 mg.

Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations With Cognition and Insomnia.

This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). Older adults (N = 65, Mage = 68.72, SD = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p = .008) and lower sleep efficiency (p = .04) than PSG measured. In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.

Sleep-wake state discrepancy among cancer survivors with insomnia symptoms.

To evaluate the discrepancy and correlation between sleep-wake measures (i.e., time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE%)) reported on sleep diary and measured by actigraphy among cancer survivors with insomnia symptoms; and examine the influences of sociodemographic and clinical variables on these measurement differences. A heterogenous sample of cancer survivors with insomnia symptoms (n = 120; M age = 63.7 ± 10.1; female = 58.3%) was included. Seven consecutive days of sleep diary and actigraphic data were obtained along with information on demographic, sleep, and mental health symptoms. Bland-Altman plot, Pearson correlation coefficient, concordance correlation coefficient, and mixed linear model approach were used to conduct the analysis. Self-reported TIB, SOL, and WASO were longer than measured by actigraphy (TIB: 8.6min. (95% CI, 3.7, 13.5; p < .001); SOL: 14.8min. (95% CI, 9.4, 20.2; p < .0001); and WASO: 20.7min. (95% CI, 9.4, 20.2; p < .0001), respectively); and self-reported TST and SE% were shorter than measured by actigraphy (TST: 6.8min. (95% CI, -18.7, 5.13); and SE%: 0.7% (95%CI, -3.0, 2.0), respectively), but were not statistically significant. Sex, higher insomnia severity, and poor sleep quality were associated with discrepancy between several sleep-wake measures. Subjective and objective sleep-wake measures may present discrepant finding among cancer survivors with symptoms of insomnia. Future research is needed to validate appropriate sleep-wake assessment, and better understand factors that influence the discrepancy that exists between measures among this population. Clinical trials identifier: NCT03810365. Date of registration: January 14, 2019.

Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study.

Perfectionism is considered a predisposing and maintaining factor for insomnia disorder. However, previous studies were predominantly based on retrospective self-reports of sleep and have yielded mixed results. Here, we investigated associations between perfectionism, daily stress levels, pre-sleep arousal, and actigraphic and sleep diary-derived sleep in insomnia using an experience sampling design. Individuals with insomnia (n = 63) reported their trait perfectionism levels and completed assessments on seven consecutive days. Momentary stress levels were reported on mobile phones at three semirandom time points each day. Presleep arousal levels were rated each morning for the previous night. Sleep onset latency, total sleep time, wake after sleep onset, and sleep efficiency were assessed prospectively using actigraphic watches and sleep diaries. Perfectionism dimensions and daily stress levels did not predict self-reported or actigraphic sleep parameters. Higher levels of somatic and cognitive presleep arousal were robustly associated with indicators of poorer same-night sleep. The concern over mistakes and doubts dimension of perfectionism interacted with cognitive presleep arousal in predicting self-reported sleep parameters. In the presence of higher presleep arousal, participants with high concern over mistakes and doubts experienced shorter self-reported total sleep time and lower sleep efficiency (both Ps < .01) than on days with lower cognitive arousal. Taken together, our results did not indicate an impact of heightened perfectionism levels on sleep in individuals with insomnia, based on prospective sleep assessments. However, our findings provide further evidence for the role of somatic and cognitive presleep arousal, potentially interacting with perfectionism, in the perpetuation of insomnia symptoms. Küskens A, Stricker J, Hertrampf LS, Pietrowsky R, Gieselmann A. Perfectionism, perceived stress, and presleep arousal in insomnia: effects on sleep in a daily life study. J Clin Sleep Med. 2024;20(3):433-443.

Understanding daytime functioning in insomnia: responder and correlation analyses in patients treated with daridorexant

BackgroundImproving daytime functioning is a key treatment goal for patients with insomnia disorder. In a phase 3 study, using the Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ), daridorexant 50 mg significantly improved daytime functioning in adults with insomnia, as well as sleep parameters. These data are further analyzed to evaluate the clinically meaningful changes in IDSIQ scores at weekly intervals and investigate the correlation between the effects of daridorexant on daytime functioning and on sleep quality and quantity.MethodsNine hundred thirty patients with insomnia randomized to daridorexant 25 mg (n = 310), 50 mg (n = 310) or placebo (n = 310) for 12 weeks were analyzed, with focus on daridorexant 50 mg and placebo. Patients recorded daily their daytime functioning using the IDSIQ and their self-reported total sleep time (sTST) and sleep quality using a sleep diary questionnaire; weekly mean changes from baseline were calculated. A clinically meaningful improvement (‘response’) at a given week was defined as a ≥ 20-point decrease in IDSIQ total score from baseline.ResultsWeekly responder rates increased over time in both groups but were consistently higher each week with daridorexant. Overall, 53% (n = 165/310) of patients in the daridorexant 50 mg group perceived a response for ≥ 1 week versus 41% in the placebo group (n = 126/310). This response, which could be achieved at any time during the 12 weeks of the study, was more often continuous on daridorexant and more often intermittent on placebo. Time-to-first response was significantly different between daridorexant and placebo (hazard ratio 1.55; 95% confidence intervals [CI] 1.22, 1.97; p = 0.0003) with shorter time observed in daridorexant. Patient perception of the response also lasted longer on daridorexant than placebo (mean number of continuous responder weeks; 9.2 vs. 7.9 respectively). A decrease in IDSIQ total score was correlated with an increase in sTST and sleep quality and a decrease in morning sleepiness, from Week 1 onwards.ConclusionPatients with insomnia are more likely to perceive a clinically meaningful improvement in their daytime functioning each week with daridorexant 50 mg than placebo. The response, which can fluctuate over time, is also perceived earlier and sustained for longer than placebo. The correlations between improved daytime functioning and improved sleep quantity and quality support the benefits of daridorexant on both the night and daytime symptoms in patients with insomnia disorder.Trial registrationClinicalTrials.gov: NCT03545191.

Daridorexant, an Orexin Receptor Antagonist for the Management of Insomnia.

Insomnia is a common sleep disorder that is diagnosed primarily by patients' subjective reported symptoms. Daridorexant is a new dual orexin receptor antagonist that was recently approved by Food and Drug Administration for insomnia characterized by difficulty falling asleep and/or maintaining sleep. The orexin neuropeptide signaling system plays a role in wakefulness, and blocking the wake-promoting neuropeptides results in diminished wake signaling, thus exerting a sedative effect using an entirely different mechanism of action than the classical sleep promoting agents. The drug has quick onset of action, high volume of distribution, and high protein binding. Pharmacokinetics and pharmacodynamic parameters were similar in patients of different sex and age and were not significantly affected by race, body size, or mild-to-moderate kidney impairment. Dose limitation to 25 mg in moderate liver impairment and no use in severe liver impairment are recommended. The drug undergoes hepatic CYP3A4 metabolism; thus, caution with strong CYP3A4 inhibitors and inducers is warranted. The drug was approved based on phase 3 trials involving study 1 and study 2. Study 1 noted daridorexant at doses of 25 and 50 mg demonstrated a statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time against placebo at months 1 and 3. Similarly in study 2, compared with placebo, the 25 mg dose demonstrated statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time at months 1 and 3. Treatment-emergent adverse events were similar for daridorexant and placebo, with nasopharyngitis and headache most frequently reported. Daridorexant is a novel agent with demonstrated efficacy in sleep onset and maintenance and decrease in daytime sedation. Preliminary results from a 1-year extension study note similar incidences of mild-to-moderate side effects as noted in previous trials. Further studies are needed to establish its place in the pharmacological treatment of insomnia.

Effectiveness of internet-based CBT-I for the treatment of chronic subthreshold to moderate insomnia.

To study the effectiveness of the first internet-based cognitive behavioral therapy for insomnia (CBT-i) in Thailand, using the Nitra application, for chronic subthreshold to moderate insomnia treatment. An interventional study without a control group was conducted between January and June 2022. Participants were adults aged 18 years old and older with subthreshold to moderate severity of chronic insomnia (insomnia severity index (ISI) of 8-21) and had mean sleep efficiency <85% from baseline sleep diaries. Baseline sleep characteristics were obtained from questionnaires and sleep diaries from the Nitra application for 2 weeks. Eligible participants continued using the Nitra application for 4 weeks during the intervention period. Interventions including sleep restriction, stimulus control, cognitive restructuring, relaxation techniques, and sleep hygiene education were implemented via the pre-programmed Nitra application. Post-intervention sleep characteristics were also obtained from questionnaires and sleep diaries from the Nitra application for another 1 week. A total of 40 participants completed the study. All participants had a baseline sleep efficiency of less than 85% with the majority of the participants having a sleep-onset insomnia problem (98%). For the primary outcome, sleep efficiency was significantly improved after using the Nitra application (p < 0.001). Self-reported total sleep time, sleep onset latency, wake after sleep onset, early morning awakening, ISI, Pittsburgh Sleep Quality Index (PSQI), and average subjective sleep quality were also significantly improved (p < 0.001 for all parameters except p = 0.017 for total sleep time and p = 0.018 for wake after sleep onset). Participants who had a low baseline ISI and went to bed and woke up within 30 minutes of a designated bedtime and wake-up time recommended by the Nitra application for ≥70% of all nights demonstrated an increased chance of achieving normal sleep efficiency after using the Nitra application. This first internet-based CBT-i in Thailand, using the Nitra application, effectively improved sleep efficiency and other sleep parameters in chronic subthreshold to moderate insomnia.

Zolpidem, but lemborexant more consistently, showed self-reported and objective benefits compared with placebo in insomnia patients with sleep duration of less than 6 hours per night.

Zolpidem, but lemborexant more consistently, showed self-reported and objective benefits compared with placebo in insomnia patients with sleep duration of less than 6 hours per night.

Mobile app for personalized sleep-wake management for shift workers: A user testing trial.

Development of personalized sleep-wake management tools is critical to improving sleep and functional outcomes for shift workers. The objective of the current study was to test the performance, engagement and usability of a mobile app (SleepSync) for personalized sleep-wake management in shift workers that aid behavioural change and provide practical advice by providing personalized sleep scheduling recommendations and education. Shift workers (n = 27; 20 healthcare and 7 from other industries) trialled the mobile app for two weeks to determine performance, engagement and usability. Primary outcomes were self-reported total sleep time, ability to fall asleep, sleep quality and perception of overall recovery on days off. Secondary performance outcomes included sleep disturbances (insomnia and sleep hygiene symptoms, and sleep-related impairments) and mood (anxiety, stress and depression) pre- and post-app use. Satisfaction with schedule management, integration into daily routine and influence on behaviour were used to determine engagement, while the usability was assessed for functionality and ease of use of features. Total sleep time (P = .04), ability to fall asleep (P < .001), quality of sleep (P = .001), insomnia (P = .02), sleep hygiene (P = .01), sleep-related impairments (P = .001), anxiety (P = .001), and stress (P = .006) were all improved, with non-significant improvements in recovery on days off (P = .19) and depression (P = .07). All measures of engagement and usability were scored positively by the majority of users. This pilot trial provides preliminary evidence of the positive impact of the SleepSync app in improving sleep and mood outcomes in shift workers, and warrants confirmation in a larger controlled trial.

Efficacy and Safety of Daridorexant in Older and Younger Adults with Insomnia Disorder: A Secondary Analysis of a Randomised Placebo-Controlled Trial.

Background and ObjectiveThe dual orexin receptor antagonist daridorexant, studied in two phase III trials, dose-dependently improved objective and subjective sleep variables and daytime functioning in adults with insomnia. Because treatment of insomnia in older adults is challenging and has limited options, the purpose of the current analysis was to further analyse the phase III trial studying the higher doses of daridorexant, those that showed efficacy (daridorexant 50 mg, daridorexant 25 mg and placebo, nightly for 3 months), and compare the safety and efficacy of daridorexant in patients aged ≥ 65 (‘older adults’) to those aged < 65 years (‘younger adults’).MethodsAnalyses by age (≥ 65 years, n = 364; < 65 years, n = 566) were performed on data from the randomised, double-blind, placebo-controlled Trial 1 in adult patients with insomnia (NCT03545191). Efficacy endpoints included a change from baseline at month 1 and month 3 in polysomnography-measured wake after sleep onset (WASO) and latency to persistent sleep (LPS), self-reported total sleep time (sTST) and daytime functioning assessed using the validated Insomnia Daytime Symptoms and Impacts Questionnaire (IDSIQ). Safety endpoints included adverse events and the Visual Analog Scale for morning sleepiness.ResultsAt baseline, mean [standard deviation] WASO was numerically greater (110 [39] vs 92 [38] min) in older than younger adults, while LPS was comparable (~ 65 min). Mean baseline IDSIQ total and all domain scores were numerically lower (i.e. better) in older adults. Daridorexant caused similar reductions in WASO and LPS, and similar increases in sTST, from baseline, in both age groups; improvements were numerically greater with daridorexant 50 mg than 25 mg. At month 3, daridorexant 50 mg, compared with placebo, decreased WASO by a least-squares mean of 19.6 (95% confidence interval 9.7, 29.5) in older patients versus 17.4 min (10.7, 24.0) in younger patients and decreased LPS by a least-squares mean of 14.9 (7.5, 22.3) in older patients versus 9.7 min (3.7, 15.7) in younger patients. Daridorexant 50 mg increased sTST from baseline to month 3 by a least-squares mean of 59.9 (49.6, 70.3) in older patients versus 57.1 min (48.9, 65.3) in younger patients. Daridorexant 50 mg progressively improved IDSIQ total and domain scores from week 1 onwards similarly in both groups; daridorexant 25 mg improved IDSIQ scores, but only in younger adults. In both age groups, in comparison with placebo, the overall incidence of adverse events was comparable, and there were fewer falls on daridorexant. Daridorexant improved Visual Analog Scale morning sleepiness in both groups; daridorexant 50 mg increased the mean (standard deviation) Visual Analog Scale morning sleepiness score by 15.9 (20.7) in older adults and by 14.9 (18.7) in younger adults from baseline to month 3. In older adults, there was one case of sleep paralysis, and no cases of narcolepsy, cataplexy, or complex sleep behaviour.ConclusionsIn older patients with insomnia, as in younger patients, the efficacy of daridorexant is maximal on night-time and daytime variables at the higher dose of 50 mg. Older patients particularly require this dose to improve daytime functioning. Older patients are not at an increased risk of adverse events or residual effects the next morning after night-time administration of daridorexant, even at 50 mg. The dose of daridorexant does not need to be decreased for older patients.Clinical Trial RegistrationClinicalTrials.gov (NCT03545191) [first posted: 4 June, 4 2018], https://clinicaltrials.gov/ct2/show/NCT03545191.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-022-00977-4.

Do the relationships of physical activity and total sleep time with cognitive function vary by age and biological sex? A cross-sectional analysis of the Canadian Longitudinal Study on Aging

ObjectivesPhysical activity (PA) and total sleep time (TST) are each associated with cognition; however, whether these relationships vary by age and biological sex is unclear. We examined the relationships of PA or TST with cognition, and whether age and sex moderated these relationships, using baseline data from the Canadian Longitudinal Study on Aging (CLSA; 2010–2015). Study designA cross-sectional analysis of participants from the Comprehensive cohort of the CLSA with complete PA and sleep data (n = 20,307; age range 45–86 years). Main outcome measuresPA and TST were measured using the Physical Activity Scale for the Elderly (PASE) and self-reported TST over the past month. Cognition was indexed using a three-factor structural equation model (i.e., memory, executive function, and verbal fluency). ResultsNon-linear restricted cubic spline models indicated that PA and TST explained statistically significant (p < 0.01) but modest variance of each cognitive domain (<1 % of 23–24 % variance). Age and sex did not moderate associations of PA with any cognitive domain. However, age and sex moderated relationships of TST with cognition, whereby: 1) associations of TST with memory decreased with age for males and females; and 2) males and females had different age-associated relationships of TST with executive function and verbal fluency. ConclusionsPA and TST modestly contribute to multiple domains of cognition across middle and older adulthood. Importantly, the association of PA with cognition does not appear to vary across middle or older adulthood, nor does it vary by biological sex; however, TST appears to have a complex relationship with multiple domains of cognition which is both age- and sex-dependent.

The influence of self-reported total sleep time and sleep quality on physical performance in junior tennis players

The influence of self-reported total sleep time and sleep quality on physical performance in junior tennis players

Bidirectional longitudinal dynamics of self-reported total sleep time and perceived stress: Establishing potential causal relationships

ObjectiveMost studies in developing countries suggest that less total sleep time (TST) increases subsequent perceived stress (PS) more consistently than the inverse, but have used statistical models that are not optimal when ratings are measured in close proximity. MethodsWe used multilevel dynamic structural equation modeling with Bayesian estimation, ideal for assessing longitudinal daily dynamic interplay between self-reported TST and PS (minimum of 30 days) in 92 Brazilian pre-university students. ResultsTST showed lower inertia than PS (autoregressive effect: TST perturbations influenced subsequent TST ratings less so than corresponding PS measures) and exerted negative prospective effects on PS (cross-lagged effect). ConclusionIn our developing nation sample, PS deviations from mean ratings took longer to return to baseline values than TST and PS was more sensitive to changes in prior TST than vice-versa, confirming previous findings. Future studies should confirm these findings with objective TST and stress measures.

Does total sleep time substantially increase after cognitive behavioral therapy for insomnia?

In most standardized approaches to cognitive behavioral therapy for insomnia, it is commonly the case that total wake time is reduced substantially during sleep restriction, but self-reported total sleep time (TST) is minimally affected. By follow-up, however, TST increases by almost 1 hour on average. A secondary analysis was undertaken to assess what percentage of participants meet or appreciably exceed baseline TST after cognitive behavioral therapy for insomnia. Data were drawn from a randomized controlled trial assessing acute and maintenance therapies for chronic insomnia (n = 80). The present analyses assessed the percentage of participants that 1) reached (≥ 0 minute increase) and 2) appreciably exceeded (≥ 30 minutes increase) baseline TST as assessed via daily sleep diaries at posttreatment and 3, 6, 12, and 24 months following treatment. By the end of acute treatment, 45% of participants reached or exceeded baseline TST. By 24 months follow-up, this percentage had increased to 86%. Only 17% of participants achieved a 30-minute increase in TST by the end of acute treatment, and this proportion only increased to 58% over time. These findings suggest that cognitive behavioral therapy for insomnia in its current form does not appreciably increase self-reported TST in a significant proportion of patients with insomnia. Whether participants would benefit from further increases in TST warrants investigation. The further titration of sleep opportunity may be useful to accelerate increases in TST, to extend the effect to a larger subset of patients, and/or to increase the magnitude of the TST gain. Scott H, Cheung JMY, Muench A, etal. Does total sleep time substantially increase after cognitive behavioral therapy for insomnia? J Clin Sleep Med. 2022;18(7):1823-1829.

Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials

Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials

Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses.

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age=39.54, SD=11.15) who completed 14days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9p.m.-6a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14days (n=101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

O020 What helped you and what prevented you from getting good sleep? Contribution of daily facilitators and barriers to adolescent sleep

Abstract Introduction This intense longitudinal study examined factors that facilitate and hinder sufficient and good quality sleep in adolescents’ everyday life. Methods 205 (54.2% female, 64.4% non-white) Year 10–12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys and wore actigraphy over 2 school-weeks and 2 subsequent vacation-weeks. Morning surveys assessed self-reported sleep and the usage of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models examined contribution of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlled for age, sex, race, place of birth, and study day. Schooldays/non-schooldays was included as a moderator. Results Seven facilitators and two barriers were endorsed by high proportions (&amp;gt;30%) of adolescents as frequently (≥50% days) helping/preventing them from achieving good sleep. Facilitators predicting longer TST and shorter SOL, were: “follow body cues”, “manage thoughts and emotions”, “create good sleep environment”, “avoid activities interfering with sleep” and “plan bedtime and go to bed as planned” (only TST on schooldays). Barriers predicting shorter TST and longer SOL, were: “pre-bedtime thoughts and emotions”, “unconducive sleep environment”, “activities interfering with sleep”, “inconsistent routines” and “other household members’ activities”. Overall, facilitators or barriers explained an additional 1–5% (p-values &amp;lt; .001) of variance beyond the covariates. Discussion Adolescents perceive a range of factors as facilitating and as preventing sufficient and good quality sleep in everyday life. These factors are predictive of their sleep duration and onset latency, and need further research to understand their functions and clinical implications.

Extreme sleep state misperception: From psychopathology to objective-subjective sleep measures

Study objectivesWe tested the hypothesis that patients with extreme sleep state misperception display higher levels of psychopathology and reduced quantitative estimation abilities compared to other patients with insomnia. Secondary aims included the evaluation of group differences in subjective self-reported quality of life and sleep quality and objective sleep parameters. MethodsIn this cross-sectional, observational study, 249 patients with insomnia underwent a video-polysomnography with a subsequent morning interview to assess self-reported sleep estimates and filled in a large battery of questionnaires. Patients were classified into High Misperception (HM) and Moderate Misperception (MM) groups, according to the complement of the ratio between self-reported total sleep time and objective total sleep time (Misperception Index). ResultsNo significant differences emerged in any of the psychopathological measures considered between the HM and the MM group. Similarly, no effect was observed in quantitative estimation abilities. HM patients displayed a significantly increased number of awakenings per hour of sleep and a reduced dream recall rate. Their overall sleep quality and quality of life was significantly impaired. ConclusionsFuture research on sleep misperception should focus on factors other than the level of psychopathology and estimation abilities, in particular sleep microstructure and quantitative EEG studies in both REM and NREM sleep.

Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo.

Study ObjectivesThis randomized, double-blind, placebo-controlled, crossover study was conducted to evaluate the safety and efficacy of 2 weeks of nightly sublingual cannabinoid extract (ZTL-101) in treating chronic insomnia (symptoms ≥3 months).MethodsCo-primary study endpoints were safety of the medication based on adverse event reporting and global insomnia symptoms (Insomnia Severity Index [ISI]). Secondary endpoints included: self-reported (sleep diary), actigraphy-derived, and polysomnography measurements of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE); and self-reported assessments of sleep quality (sSQ) and feeling rested upon waking. Adjusted mean differences between placebo and ZTL-101 were calculated.ResultsTwenty-three of 24 randomized participants (n = 20 female, mean age 53 ± 9 years) completed the protocol. No serious adverse events were reported. Forty mild, nonserious, adverse events were reported (36 during ZTL-101) with all but one resolving overnight or soon after waking. Compared to placebo, ZTL-101 decreased ISI (−5.07 units [95% CI: −7.28 to −2.86]; p = 0.0001) and self-reported SOL (−8.45 min [95% CI: −16.33 to −0.57]; p = 0.04) and increased self-reported TST (64.6 min [95% CI: 41.70 to 87.46]; p < 0.0001), sSQ (0.74 units [95% CI: 0.51 to 0.97]; p < 0.0001), and feeling of being rested on waking (0.51 units [95% CI: 0.24 to 0.78]; p = 0.0007). ZTL-101 also decreased actigraphy-derived WASO (−10.2 min [95% CI: −16.2 to −4.2]; p = 0.002), and increased actigraphy-derived TST (33.4 min [95% CI: 23.07 to 43.76]; p < 0.001) and SE (2.9% [95% CI: 2.0 to 3.8]; p = 0.005).ConclusionsTwo weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.Clinical TrialANZCTR; anzctr.org.au; ACTRN12618000078257.

577 Daily facilitators and barriers to adolescent sleep: Contribution to actual sleep over 28-days of school and vacation

Abstract Introduction Little is known about what adolescents perceive as helping (facilitators) or preventing (barriers) them from getting sufficient and good quality sleep, and how these factors contribute to their actual sleep. Methods 205 (54.2% female, 64.4% non-white) Year 10–12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys, and their sleep was measured via actigraphy over 2 school-weeks and 2 subsequent vacation-weeks. Morning surveys assessed self-reported sleep and the usage of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models were used to examine contributions of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlling for age, sex, race, place of birth, and study day, separately for school and non-school days. Results On average, adolescents reported using 3.7 facilitators and encountering 1.5 barriers daily. Compared to school, non-school days were characterised by more frequent use of facilitators and more barriers encountered. Overall, facilitators or barriers explained an additional 1–7% (p-values &amp;lt; .01) of variance beyond the covariates. Similar facilitators and barriers contributed to actigraphy and self-reported TST and SOL, however, self-reported sleep variables were more affected. Notable facilitators that predicted longer TST and shorter SOL were: “follow body cues”, “avoid activities interfering with sleep”, “create good sleep environment”, “plan bedtime and go to bed as planned” (only TST on school days), and “manage thoughts and emotions” (only SOL). Notable barriers that predicted shorter TST and longer SOL were: “pre-bedtime thoughts and emotions”, “inconsistent routines”, “unconducive sleep environment”, “activities interfering with sleep” (only non-school) and “other household members’ activities” (only SOL). Conclusion This intense longitudinal study showed that on a daily basis, adolescents perceive a range of factors as facilitating and preventing sufficient and good quality sleep. These factors are predictive of their actual sleep duration and onset latency and need further research to understand their functions and clinical implications. Support (if any):