Sleep Hygiene Guidelines Research Articles

Healthy Sleep Practices for Consumers of Home Total Parenteral Nutrition: A Mixed-Methods Community-Based Participatory Study

BackgroundConsumers of overnight home parenteral nutrition (HPN) often experience sleep disruption; however, existing healthy sleep recommendations are widely inapplicable to consumers. ObjectivesThe aim of this mixed-methods, community-based participatory research study was to develop tailored recommendations on healthy sleep practices for HPN consumers. MethodsThe multipart study involved the following: 1) an initial draft of sleep recommendations based on the evaluation of existing general sleep hygiene guidelines by an expert panel of clinicians and consumers with lived experience; 2) semi-structured focus groups with consumers and clinicians; 3) pre- and post-knowledge tests completed by consumers, and 4) final approval of the recommendations by the expert panel. ResultsThe literature synthesis resulted in 51 recommendations evaluated for relevance for HPN consumers. Focus groups with 20 HPN consumers and clinicians contributed additional recommendations based on lived experience. Ultimately, the final resource included recommendations spanning 4 sections: getting ready for bed, preparing the bedroom for sleep, daytime behaviors, and overall strategies for better sleep. Of the 36 recommendations, 58% were derived from existing general sleep hygiene guidelines, and the remaining 42% addressed sleep challenges experienced uniquely by consumers, including nocturnal polyuria, noise/light from medical equipment, and infusion schedules. Knowledge tests completed by 10 additional consumers indicated a modest increase in sleep health knowledge. ConclusionsThe curated healthy sleep resource tailored for HPN consumers was facilitated by a multidisciplinary expert panel, a strategic collaboration with members of the HPN community and their clinicians, and in partnership with patient advocacy and support organizations. The wide distribution of these resources may improve the overall well-being of HPN consumers.

Hit the gym or hit the hay: can evening exercise characteristics predict compromised sleep in healthy adults?

Introduction: Recent sleep guidelines regarding evening exercise have shifted from a conservative (i.e., do not exercise in the evening) to a more nuanced approach (i.e., exercise may not be detrimental to sleep in circumstances). With the increasing popularity of wearable technology, information regarding exercise and sleep are readily available to the general public. There is potential for these data to aid sleep recommendations within and across different population cohorts. Therefore, the aim of this study was to examine if sleep, exercise, and individual characteristics can be used to predict whether evening exercise will compromise sleep. Methods: Data regarding evening exercise and the subsequent night's sleep were obtained from 5,250 participants (1,321F, 3,929M, aged 30.1 ± 5.2yrs) using a wearable device (WHOOP 3.0). Data for females and males were analysed separately. The female and male datasets were both randomly split into subsets of training and testing data (training:testing = 75:25). Algorithms were trained to identify compromised sleep (i.e., sleep efficiency <90%) for females and males based on factors including the intensity, duration and timing of evening exercise. Results: When subsequently evaluated using the independent testing datasets, the algorithms had sensitivity for compromised sleep of 87% for females and 90% for males, specificity of 29% for females and 20% for males, positive predictive value of 32% for females and 36% for males, and negative predictive value of 85% for females and 79% for males. If these results generalise, applying the current algorithms would allow females to exercise on ~ 25% of evenings with ~ 15% of those sleeps being compromised and allow males to exercise on ~ 17% of evenings with ~ 21% of those sleeps being compromised. Discussion: The main finding of this study was that the models were able to predict a high percentage of nights with compromised sleep based on individual characteristics, exercise characteristics and habitual sleep characteristics. If the benefits of exercising in the evening outweigh the costs of compromising sleep on some of the nights when exercise is undertaken, then the application of the current algorithms could be considered a viable alternative to generalised sleep hygiene guidelines.

Effects of Combined Binaural Beats on Sleep Quality, Insomnia Severity, and Sleep Hygiene Improvement in Insomniac Students

Background and Objective: In previous studies, multiple interventions to improve sleep quality were suggested in students with insomnia based on different results. The present study aimed to investigate the effects of combined binaural beat treatment on improving sleep quality in students with insomnia&#x0D; Materials and Methods: This was a randomized clinical trial, which included all students living in Neyshabur, Khorasan Razavi Province, Iran, in 2020. In terms of inclusion criteria, 34 students (12 women) were assigned randomly into two control (n = 17) and experimental groups (n = 17). A combined binaural beat treatment (α, θ, and δ) and sleep hygiene guidelines were given to the experimental group, but the control group only received the same sleep hygiene guidelines. Insomnia Severity Index, Sleep Hygiene Index, and Pittsburgh Sleep Quality Index were research instruments for this purpose. The results were analyzed with SPSS software.&#x0D; Results: The effect of the combined binaural beats on ISI (F = 31.16, P &lt; 0.001), sleep hygiene (F = 39.15, P &lt; 0.001), and sleep quality (F = 14.15, P &lt; 0.001) of students with insomnia was apparent during multivariate analysis of covariance (MANCOVA). The highest and lowest effects on the total value of sleep (effect size = 0.58) and the SHI (effect size = 0.35) were achieved by combined binaural beat treatment.&#x0D; Conclusion: The combined binaural beats (α, θ, and δ) improve total sleep quality, sleep hygiene, and ISI of students with insomnia. Besides, such a treatment can be utilized as a modern non-invasive intervention.

Effect of a lavender essential oil and sleep hygiene protocol on insomnia in postmenopausal women: A pilot randomized clinical trial

IntroductionInsomnia and vasomotor symptoms are frequently experienced during the menopausal transition and in postmenopause, worsening sleep maintenance and quality of life. Our study evaluated the use of lavender essential oil and sleep hygiene guidance on quality of life, sleep patterns and self-reported hot flashes in postmenopausal women with insomnia diagnosis. MethodsThis study is part of a larger experimental, double-blind, randomized controlled trial. We included 35 postmenopausal women with a diagnosis of insomnia who were distributed in two groups: A Placebo group (sunflower oil) and an Aroma group (Lavandula angustifolia essential oil); both inhaled the oils before bedtime for 29 days. The groups received sleep hygiene guidelines and weekly follow-up. Validated questionnaires were used to assess the effect of the intervention, and a sleep diary was used to assess sleep onset latency (SOL), total sleep time (TST), and sleep efficiency (SE) daily. Participants who complained of vasomotor symptoms at baseline kept a daily record of their frequency and intensity. ResultsAll participants benefited in almost all domains of quality of life and in the self-assessed TST and SE. The Aroma group achieved a significant improvement in their overall quality of life score over time. No differences were observed in respect of the hot flashes record and daytime sleepiness. ConclusionsThe aromatherapy intervention was effective in improving the overall quality of life in the Aroma group. Moreover, the sleep diary and sleep hygiene instructions helped all participants to, respectively, self-assess and improve their sleep patterns.

Healthy sleep practices for shift workers: consensus sleep hygiene guidelines using a Delphi methodology.

The unique requirements of shift work, such as sleeping and working at variable times, mean that current sleep hygiene guidelines may be inappropriate for shift workers. Current guidelines may also contradict fatigue management advice (e.g. advising against daytime napping). The present study utilized a Delphi methodology to determine expert opinion regarding the applicability of current guidelines for shift workers, the appropriateness of the term "sleep hygiene," and develop tailored guidelines for shift workers. The research team reviewed current guidelines and existing evidence to draft tailored guidelines. Seventeen individual guidelines, covering sleep scheduling, napping, sleep environment, bedtime routine, substances, light exposure, diet, and exercise were drafted. Experts from sleep, shift work, and occupational health fields (n = 155) were invited to review the draft guidelines using a Delphi methodology. In each round, experts voted on individual guidelines, with 70% agreement considered consensus. Where consensus was not reached, written feedback from experts was discussed and incorporated into subsequent iterations. Of the experts invited, 68 (44%) agreed to participate, with 55 (35%) completing the third (final) round. Most experts (84%) agreed that tailored guidelines were required for shift workers. Consensus was reached on all guidelines after three rounds. One additional guideline (sleep inertia) and an introductory statement were developed, resulting in a final set of 18 individual guidelines, termed "healthy sleep practices for shift workers." This is the first study to develop tailored sleep hygiene guidelines for shift workers. Future research should investigate the acceptability and effectiveness of these guidelines amongst shift workers.

Effects of morning and evening physical exercise on subjective and objective sleep quality: an ecological study.

To optimise the relationship between exercise and sleep quality, the intensity of exercise and its proximity to sleep are key factors to manage. Although low-to-moderate exercises promote sleep quality, late-evening vigorous exercise instead of morning should still be avoided. It potentially impacts the objective and subjective markers of sleep quality. In the present study, we investigated the effects of vigorous morning and evening exercise on objective and subjective sleep features in an ecological context. A total of 13 recreational runners (mean [SD] age 27.7 [7.2] years, four females) performed a 45-60 min run (70% maximal aerobic velocity) either in the MORNING (30 min to 2 h after waking-up) or in the EVENING (2 h to 30 min before sleep). The two exercise conditions were separated by a REST day. After each condition, sleep was objectively assessed using an electroencephalographic headband and subjectively using the Spiegel Sleep Inventory. Compared with REST, both MORNING and EVENING exercise increased the time spent in non-rapid eye movement (NREM, +24.9 min and +22.7 min; p = 0.01, η2 = 0.11, respectively). Longer NREM duration was mainly due to sleep stage 2 extension after both MORNING (+20.8 min) and EVENING (+22.8 min) exercise relative to REST (p = 0.02, η2 = 0.12). No other effect of exercise on either objective or subjective sleep could be observed. Exercise, independently of the time at which it takes place, leads to extended NREM sleep without other effects on sleep quality. Considering the crucial role of exercise in achieving good health, sleep hygiene guidelines should be updated to promote exercise at any time of the day.

0020 Associations between bedtime and waketime variability and sleep outcomes in autistic children

Abstract Introduction Up to 80% of autistic children experience sleep disturbances. Sleep hygiene guidelines advise patients to maintain consistent bedtimes and waketimes for the purpose of regulating one’s circadian rhythm. However, the relationship between bedtime and waketime variability and sleep outcomes in autistic children is unclear, and so the current study examines these associations. Methods One hundred thirty autistic children (Mage = 8.81 yrs, SD = 1.92 yrs, range = 6-12 yrs, 71% male) completed two weeks of daily sleep diaries with parental assistance and concurrently wore actigraphic wrist watches (Actiwatch-2, Respironics). Rest intervals in Actiware software were set using visual inspection while referencing self-reported bed/waketime. Boundaries of rest intervals were defined as the time when the child first attempted sleep to the time when the child vacated bed. Subjective and objective estimates of bedtime, waketime, total wake time during attempted sleep periods, and total sleep time were obtained. Bayesian multi-level models obtained individual estimates of average variability in bedtime and waketime. Multiple linear regressions were then used to examine associations between subjective and objective bedtime and waketime variability and total wake time and total sleep time, controlling for age and average levels of bed/waketime variability. Models were separated out by subjective/objective sleep outcomes (i.e., subjective waketime variability predicting subjective total sleep time). Results Greater objective waketime variability was associated with less objective total sleep time (B=-38.80, p&amp;lt;.001, partial eta-squared = .071). Greater subjective waketime variability was associated with longer subjective total wake time (B = 18.58, p=.02, partial eta-squared = .058) and shorter subjective total sleep time (B=-70.60, p&amp;lt;.001, partial eta-squared = 0.227). Conclusion While results do not possess causal implications, greater subjective and objective waketime variability are associated with poorer sleep outcomes in autistic children. Effect sizes ranged from approximately medium to large. Results suggest that bedtime variability may not be related to sleep outcomes in autistic children. Future studies should examine whether reductions in waketime variability mediate the effect of behavioral insomnia interventions on improved sleep in autistic children. Support (if any) MU Research Board Grant (McCrae, PI); Department of Defense Autism Research Program (McCrae, PI; W81XWH2010399); Thompson Center for Autism and Neurodevelopmental Disorders.

0410 Lavender essential oil and sleep hygiene as therapeutic options for insomniac postmenopausal women: a randomized clinical trial

Abstract Introduction Menopausal transition and postmenopause often bring sleep complaints and insomnia, a common sleep disorder. In addition, women at this stage also experience vasomotor symptoms, which can compromise sleep maintenance and quality of life. This study aimed to observe the effect of an intervention with aromatherapy and sleep hygiene in the quality of life, self-related sleep pattern and hot flashes record in postmenopausal women with insomnia diagnosis. Methods This pilot study is a double-blind randomized clinical trial. Of the 135 women interested in participating in the study, 34 postmenopausal women met the inclusion criteria and completed the protocol. Volunteers were clinically diagnosed with insomnia and distributed in two groups: Aroma Group (Lavandula angustifolia essential oil) (n=17) and Placebo Group (sunflower oil) (n=17), both inhaled before bedtime for 29 days. The groups received sleep hygiene guidelines and were monitored weekly. To assess the effect of the intervention, the Menopause-Specific Quality-of-Life Questionnaire, intervention version (MENQOL-I), and Epworth Sleepiness Scale (ESS) were used. With data from the sleep diary, we evaluated sleep onset latency (SLO), total sleep time (TST) and sleep efficiency (SE) daily. Additionally, participants who complained of vasomotor symptoms were invited to fill out a hot flashes form, reporting the presence or absence of these symptoms, daily amount, and its intensity. Results The therapeutic approaches in this study benefited participants in both groups in almost all domains of quality of life and self-rated sleep patterns such as TST and SE. Particularly, the lavender essential oil intervention provided significant improvement in the overall quality of life score over time. No differences were observed considering the hot flashes record and sleepiness. Conclusion The aromatherapy intervention was effective in improving overall quality of life in the Aroma group. Furthermore, strategies such as sleep hygiene and a sleep diary helped participants to self-assess their sleep routine and improve it. Support (if any) This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, and Conselho Nacional de Pesquisa (CNPq). Laszlo (essential oils, books, foods, and aromatherapy products) donated the necessary oils for this project.

Patients with IBD Want to Talk About Sleep and Treatments for Insomnia with Their Gastroenterologist.

Poor sleep may be prospectively associated with worse disease course in inflammatory bowel disease (IBD). Chronic insomnia is the most common cause of poor sleep complaints in IBD and is theorized to be maintained by dysfunctional thoughts and behavioral patterns. However, data characterizing patterns specific to insomnia in IBD are lacking. Understanding the nuances of insomnia and patients' preferences for treatment is critical for addressing this significant comorbidity in IBD. We conducted an anonymous, mixed-method online survey of people with IBD and asked questions about sleep patterns, thoughts, and behaviors related to sleep, treatment preferences, and barriers to treatment. 312 participants (60.9% Crohn's, 66.3% women, mean age of 48.62years) were included in this study. Participants with insomnia were significantly more concerned about the consequences of sleep loss, felt more helpless about their sleep, and were more likely to engage in behaviors known to perpetuate insomnia (e.g., spending time in bed in pain; ps ≤ 0.001) than those without insomnia. 70.3% of participants were interested in discussing sleep as part of IBD care, 63.5% were interested in receiving sleep recommendations from their gastroenterologist, and 84.6% of those with insomnia were interested in participating in sleep treatments. Participants with IBD and insomnia are interested in treatment and reported patterns that can be targeted in Cognitive Behavioral Therapy for Insomnia, as opposed to traditional sleep hygiene guidelines. Additionally, people with insomnia engaged in several sleep-interfering behaviors related to pain. Clinical trials that target insomnia in people with IBD should include pain management in the intervention.

O061 Sleep hygiene guidelines for shift workers: consensus guidelines via a Delphi study

Abstract Introduction Current sleep hygiene guidelines are impractical for shift workers, given their inability to maintain regular sleep schedules. Further, the present guidelines contradict fatigue risk management advice (e.g., advising against caffeine and daytime napping). The aim of the present study is to develop a set of tailored sleep hygiene guidelines for shift workers via a Delphi approach. Methods Draft guidelines were developed by the research team, who reviewed the current guidelines and examined existing evidence on sleep hygiene in shift workers. Experts from sleep, shift work, and occupational health fields (n=155) were invited to review these draft guidelines via a three-round series of online questionnaires. In each round, experts voted on each guideline, with consensus reached once there was 70% agreement on including the item as written. Expert feedback from each round was discussed and incorporated by the research team as appropriate. Results The research team drafted 17 sleep hygiene recommendations, covering sleep scheduling, napping, sleep environment, substance consumption, diet, and exercise. Of those experts invited, 68 (44%) agreed to participate, with 55 of these (81%) completing all three rounds. Consensus was reached on all original items after three rounds, with two additional items (medication use and sleep inertia) and an introductory statement developed, to create a final set of guidelines with 19 items. Discussion This is the first study to create evidence-based, expert-developed sleep hygiene guidelines for shift workers. Future research is planned to investigate the acceptability and implementation of the guidelines amongst end-users.

Sleep dimensions are associated with obesity, poor diet quality and eating behaviors in school-aged children.

ObjectivesThe aim of this cross-sectional study was to investigate the association between sleep dimensions (duration, patterns, and disturbances) with body mass index (BMI), diet quality, and eating behaviors in school-aged children. Additionally, we aimed to investigate whether obesogenic eating behaviors (higher food responsiveness, lower satiety responsiveness, and less slowness in eating) and poor diet quality could mediate the potential association between sleep and obesity in school-aged children.Materials and methodsFor all participants (n = 588 children, age 5–12 years; 51% girls) we evaluated: sleep dimensions, BMI, diet quality, eating behaviors (food responsiveness, satiety responsiveness and slowness in eating). Linear regression models were used to test associations between exposure and outcome variables. Additionally, path analysis was conducted to test whether eating behaviors mediated the relationship between sleep and obesity.ResultsShorter sleep duration (β = −0.722, p = 0.009) and greater sleep disturbances (β = 0.031, p = 0.012) were significantly associated with BMI. Additionally, we observed that diet quality was significantly associated with sleep duration (β = 0.430, p = 0.004), the midpoint of sleep (β = −0.927, p < 0.001), and sleep disturbances (β = −0.029, p < 0.001). Among other findings, greater sleep disturbances were associated with food responsiveness (β = 0.017, p < 0.001), satiety responsiveness (β = 0.015, p < 0.001), and slowness in eating (β = 0.012, p < 0.001). Importantly, food responsiveness was found as significant mediator of the relationship between sleep and BMI (R = 0.427, R2 = 0.182, p < 0.001).ConclusionsLate sleep patterns, short sleep duration, and greater sleep disturbances are significantly related with what and how school-aged children eat. Importantly, poor diet quality was significantly related to all three sleep dimensions, while eating behaviors had a significant relationship with greater sleep disturbances. These findings may be relevant to the development of behavioral targets to prevent childhood obesity, including sleep hygiene guidelines as a strategy to improve children's eating habits, as well as their BMI.

Evaluating mediation and moderation effects in call center employees: A correlational investigation into fatigue, general health, coping and sleep disturbances

Sleep disturbance is usually present in night-shift workers. The objective of this study was to explore the relationships among fatigue, general health, coping and sleep disturbance together with mediating role of general health and moderating role of coping strategies i.e. Task, Emotion oriented &amp;Avoidance in night-shift call center workers. Correlation research design was adopted with sample (N=200) assessed from call centers of Lahore by applying purposive sampling strategy. Data was obtained by administering Multi-dimensional Fatigue Inventory, General Health Questionnaire-28, Coping Inventory for Stressful Situations-21, and Screening Questionnaire for Sleep Disturbance in Shift Workers. Data was analyzed by using Pearson product moment correlation, Hierarchical Multiple Regression Analysis and Hayes Process Regression analysis. Results of this study state that fatigue correlated positively with general health and sleep disturbance. General health, task-oriented, emotion-oriented and avoidance coping strategies also have positive relationship with sleep disturbance. General health seems to have full mediation effect on the relationship of fatigue and sleep disturbance. Task and emotion-oriented coping strategies appear as a moderator while avoidance coping strategy does not appear as a moderator between the relationship of fatigue and sleep disturbance. This research has future implications for identifying night shift call centers workers having proneness to develop Shift work disorder due to sleep disturbance and provides them with better sleep hygiene guidelines to protect their health.

Is It Time We Stop Discouraging Evening Physical Activity? New Real-World Evidence From 150,000 Nights.

Professional and colloquial sleep hygiene guidelines advise against evening physical activity, despite meta-analyses of laboratory studies concluding that evening exercise does not impair sleep. This study is the first to investigate the association between objectively measured evening physical activity and sleep within a real-world big-data sample. A total of 153,154 nights from 12,638 individuals aged 18–60 years (M = 40.1 SD = 10.1; 44.5% female) were analyzed. Nighttime sleep and minutes of physical activity were assessed using Polar wearable devices for 14 consecutive days. Thirty minutes or more of moderate-to-near maximal physical activity during the 3 h before sleep onset were recorded in 12.4% of evenings, and were more frequent on weekdays than weekends (13.3 vs. 10.2% respectively, p < 0.001). Linear mixed modeling revealed that sleep efficiency was not significantly associated with evening physical activity, and that sleep duration was 3.4 min longer on average on nights following evenings in which participants engaged in 30 min or more of moderate-intense physical activity. Effects were found for sleep timing metrics, as evening physical activity was linked with earlier sleep onset and offset times (−13.7 and −9.3 min, respectively). Overall, these effects were greater– but still very small– on weekdays compared to weekends. The present study provides further evidence for the lack of meaningful links between sleep duration or quality and physical activity in the hours preceding sleep. Taken together with recent meta-analytic findings, these findings suggest that changes in public health recommendations are warranted regarding evening physical activity and its relation to sleep.

Lavender essential oil on postmenopausal women with insomnia: Double-blind randomized trial

BackgroundTo evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia. Participants35 postmenopausal women with a clinical diagnosis of insomnia were included, 17 in Aroma Group (AG) and 18 in Placebo Group (PG). MethodsIn this double-blind, randomized controlled trial, PG participants inhaled sunflower oil and AG participants inhaledLavandula angustifolia essential oil, for 29 days. Both groups received sleep hygiene guidelines before the intervention and weekly follow-up during it. Evaluations were performed before and after intervention. All statistical analyses and intention-to-treat test were performed in SPSS 22. Sleep quality (Primary outcome) was measured by Pittsburgh Sleep Quality Index. Secondary outcomes were polysomnography data, severity of insomnia, anxiety and depression symptoms, and postmenopausal symptoms. ResultsThere were no significant differences between groups after intervention in the primary outcome (P = 0.22; effect size=0.69); however, a tendency of improvement in wake after sleep onset (WASO) was observed (P = 0.07; effect size=0.81; B = 42.2). Both groups presented better sleep quality over time (AG P < 0.001; PG P = 0.011). AG participants showed a significant decrease in sleep onset latency (P = 0.001), depression levels (P = 0.025), hot flashes (P < 0.001), postmenopausal symptoms (P < 0.001) and, in polysomnography data, increased sleep efficiency (P = 0.002) compared to baseline. ConclusionAlthough no significant differences were observed between groups, our data presented a tendency of improvement in WASO. Moreover, AG participants had enhanced overall sleep pattern, quality and sleep efficiency. Weekly follow-up and sleep hygiene instructions were essential for both groups to show improvement in almost all outcomes. Clinical trial registrationBrazilian Registry of Clinical Trials, www.ensaiosclinicos.gov.br, RBR-5q5t5z.

0498 Effect of Lavender Essential Oil on Sleep in Postmenopausal Women with Insomnia: Double-Blind Randomized Controlled Trial

Abstract Introduction Sleep is essential for women’s health and its deprivation leads to serious physiological consequences. In addition, insomnia is a common complaint in postmenopausal women. Thus, the present study aimed to evaluate the effect of Lavandula angustifolia essential oil inhalation on sleep and menopausal symptoms in postmenopausal women with insomnia. Methods Experimental, double-blind, randomized controlled trial composed by 33 women (48 - 65 years) with clinical diagnosis of insomnia divided in two groups that inhaled different oils before sleep during 29 days: Placebo Group - PG (sunflower oil) and Aroma Group - AG (Lavandula angustifolia essential oil). Both groups received sleep hygiene guidelines and were followed weekly. To assess the effect of the intervention on menopausal symptoms the Menopause Rating Scale (MRS) and the Hospital Anxiety and Depression Scale (HADS) were used and for sleep evaluation the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) were used. Additionally, polysomnography were used to assess sleep pattern. All outcomes were evaluated before and after intervention. Statistical analysis was performed using SPSS 22 through Generalized Estimed Equations test with significance set at p≤ 0.05. Results Comparing the pre and post-intervention periods, AG participants had a significant decrease in sleep onset latency, depression level, hot flashes, menopausal symptoms and a significant increase in sleep quality. Polysomnography data showed increased sleep efficiency and decreased wakefulness after sleep onset on AG participants. After the intervention, all volunteers presented improvement in all outcomes of sleep and menopausal symptoms measured by questionnaires. Conclusion The intervention was effective in improving the sleep pattern of AG participants, but was not significant when compared to PG participants. In addition, sleep hygiene instructions were essential to improve the sleep pattern of all volunteers. Therefore, inhalation of lavender essential oil is a safe, low-cost practice that should be considered as a complementary option to conventional treatments, whether medical, psychological or other integrative and complementary practices. Support This research was supported by fellowships from Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001 and Conselho Nacional de Pesquisa (CNPq).

0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia

Abstract Introduction Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia. Methods Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons. Results After Bonferroni corrections (p&amp;lt;.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes. Conclusion Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted. Support Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).

Plant Extracts for Sleep Disturbances: A Systematic Review.

Background Sleep complaints are common health issues in the general population. These conditions are associated with poorer physical and psychological activity, and they may have important social, economic, and personal consequences. In the last years, several food supplements with different plant extracts have been developed and are currently taken for improving sleep. Study Objectives. The aim of this study is to systematically review recent literature on oral plant extracts acting on sleep disorders distinguishing their action on the different symptoms of sleep complaints: difficulty in initiating or maintaining sleep, waking up too early, and quality of sleep. Methods We searched the PubMed database up to 05/03/2020 based on data from randomized, double-blind, placebo-controlled trials, noncontrolled trials, and cohort studies conducted in children and adult subjects. The search words used contained the following terms: oral food supplement and sleep disorders and the like. The most studied compounds were further analyzed with a second search using the following terms: name of the compound and sleep disorders. We selected 7 emerging compounds and 38 relevant reports. Results Although nutraceutical natural products have been used for sleep empirically, there is a scarcity of evidence on the efficacy of each product in clinical studies. Valerian and lavender were the most frequently studied plant extracts, and their use has been associated (with conflicting results) with anxiolytic effects and improvements in quality and duration of sleep. Conclusions Sleep aids based on plant extracts are generally safe and well tolerated by the population. More high-quality research is needed to confirm the effectiveness of food supplements containing plant extracts in sleep complaints; in particular, it would be interesting to evaluate the association between plant extracts and sleep hygiene guidelines and to identify the optimal products to be used in a specific symptom of sleep complaint, giving more appropriate tools to the medical doctor.

Association between weekend catch-up sleep and health-related quality of life of Korean adults.

Sleep debt is known to have harmful effects on health. Weekend catch-up sleep (CUS) is a behavior to cope with weekday sleep debt. However, it is unclear whether weekend CUS has advantageous effects on health because sleep hygiene guidelines recommend regularizing bed time and arousal time. The aim of this study was to identify whether weekend CUS behavior has an association with better health-related quality of life (HRQoL)According to the inclusion criteria, 4871 participants were selected from the 2016 Korea National Health and Nutrition Examination Survey. Sleep questionnaires and European quality of life scale-5 dimensions (EQ-5D) questionnaire were used to collect data about the participants’ sleep patterns and HRQoL. Odds ratios (ORs) with 95% confidence intervals (95% CIs) for each dimensional problem of EQ-5D were derived by logistic regression. Mean EQ-5D index scores were compared between weekend CUS and non-CUS groups based on their weekday sleep durations and quintile of chronotype.The ORs of dimensional problems of HRQoL of non-CUS group versus weekend CUS group were 1.63 (95% CI 1.07, 2.47) for usual activities, and 1.45 (95% CI 1.11, 1.90) for anxiety/depression. Mean EQ-5D scores of the weekend CUS group were significantly higher than those of the non-CUS group for sleeping less than 6 hours (0.953 ± 0.004 vs 0.936 ± 0.007, P = .036) and sleeping 6 to 7 hours (0.965 ± 0.003 vs 0.955 ± .0.004, P = .045). These findings were similar in the fourth quintile (Q4) of chronotype (0.965 ± 0.007 vs 0.951 ± 0.008, P = .008) and fifth quintile (Q5) (0.952 ± 0.006 vs 0.941 ± 0.007, P = .022).Weekend CUS behavior was associated with better HRQoL than non-CUS among Korean adults. Especially, it was significant in participants who slept for less than 7 hours or participants whose chronotype was the fourth or fifth quintile. Attention may be needed for subjects with sleep short time and later chronotype who do not have weekend-CUS behaviors, because there is a risk that their HRQoL might be compromised.

What Are the Differences in Sleep Skills Between Insomnia Patients with and Without Need of Hypnotics?

Introduction We evaluated the difference in sleep skills between patients with and without need of hypnotics after sleep CBT. Methods Total 131 insomnia patients' sleep disturbances were assessed by visual analogue scales. Patients received 9 sessions of sleep CBT and were prescribed hypnotics for prn during 3 months. Sleep CBT was focused on the sleep hygiene and sleep stimulus-control guidelines. Sleep hygiene guidelines were Limit the time spent in bed (SH1), Get regular exercise (SH2), Avoid light at night (SH3), Avoid heavy meals or drinking (SH4), Quiet, dark, and comfortable bedroom (SH5), Avoid caffeine, alcohol, and nicotine (SH6), Relaxing bedtime routine (SH7),Llight bedtime snack (SH8), Remove the bedroom clock (SH9). Sleep stimulus-control guidelines were Go to bed only when sleepy (SSC1), Use the bed for sleeping or sex (SSC2), Get out of bed when unable to sleep (SSC3), Get up at the same time (SSC4), Avoid napping (SSC5). Each sleep skill state was evaluated by Likert scale, and they were compared between before and after CBT. Patients were divided into two groups: still need of hypnotics and no need of hypnotics after 3 months. Results Forty-six (35.1%) patients replied they needed not hypnotics any more, but 85 (64.9%) patients replied they still needed hypnotics after CBT. Sleep VAS (25.26±8.52 vs. 32.64±8.95, p Conclusions Among several CBT skills, regular moderate exercise in daytime and a relaxing bedtime routine seem to be key components.

How mindfulness changed my sleep: focus groups with chronic insomnia patients.

BackgroundChronic insomnia is a major public health problem affecting approximately 10% of adults. Use of meditation and yoga to develop mindful awareness (‘mindfulness training’) may be an effective approach to treat chronic insomnia, with sleep outcomes comparable to nightly use of prescription sedatives, but more durable and with minimal or no side effects. The purpose of this study was to understand mindfulness training as experienced by patients with chronic insomnia, and suggest procedures that may be useful in optimizing sleep benefits.MethodsAdults (N = 18) who completed an 8-week mindfulness-based stress reduction (MBSR) program as part of a randomized, controlled clinical trial to evaluate MBSR as a treatment for chronic insomnia were invited to participate in post-trial focus groups. Two groups were held. Participants (n = 9) described how their sleep routine, thoughts and emotions were affected by MBSR and about utility (or not) of various mindfulness techniques. Groups were audio-recorded, transcribed and analyzed using content analysis.ResultsFour themes were identified: the impact of mindfulness on sleep and motivation to adopt a healthy sleep lifestyle; benefits of mindfulness on aspects of life beyond sleep; challenges and successes in adopting mindfulness-based practices; and the importance of group sharing and support. Participants said they were not sleeping more, but sleeping better, waking more refreshed, feeling less distressed about insomnia, and better able to cope when it occurred. Some participants experienced the course as a call to action, and for them, practicing meditation and following sleep hygiene guidelines became priorities. Motivation to sustain behavioral changes was reinforced by feeling physically better and more emotionally stable, and seeing others in the MBSR class improve. The body scan was identified as an effective tool to enable falling asleep faster. Participants described needing to continue practicing mindfulness to maintain benefits.ConclusionsFirst-person accounts are consistent with published trial results of positive impacts of MBSR on sleep measured by sleep diary, actigraphy, and self-report sleep scales. Findings indicate that mindfulness training in a group format, combined with sleep hygiene education, is important for effective application of MBSR as a treatment for chronic insomnia.