Sleep hygiene in Iranian traditional medicine: A narrative review.

Poor sleep is common in Crohn's disease (CD), prospectively predicts worse disease course, and is often attributable to insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia disorder. CBT-I improves sleep and may improve pain intensity, pain interference, and inflammation. We sought to investigate whether CBT-I impacts these factors in patients with active CD. We recruited patients with insomnia and mild-to-moderate CD symptoms from an inflammatory bowel disease center. Exclusion criteria were other sleep disorders, significant psychiatric concerns, and presence of other common influences on sleep. Participants completed baseline assessments of sleep, pain, and inflammation then were randomized to receive CBT-I immediately, or wait 12 weeks and then repeat the baseline assessment and complete CBT-I. Similar assessments occurred immediately post-CBT-I and 1 month later. CBT-I included sleep restriction, stimulus control, sleep hygiene, arousal reduction, and cognitive therapy. A total of 26 participants completed the study. In group × time analyses, CBT-I led to greater reductions in insomnia severity (P < .001) and wake after sleep onset (P = .02) than waitlist. In pre- to post-treatment analyses, participants reported significant improvements in subjective measures of sleep continuity, CD symptom severity, pain intensity, and pain interference. C-reactive protein trended toward improvement. This study provides preliminary evidence of efficacy of CBT-I in people with CD. CBT-I improved self-reported sleep and may improve pain and CD symptoms. The results highlight the importance of addressing sleep concerns in inflammatory bowel disease, particularly in people with persistent pain or fatigue. Future trials powered to detect changes in pain and inflammation are warranted.

Higher morning NR1D1 (REV-ERBΑα) expression, robust circadian activity, and less light at night predict lower depression scores in arctic residents.

Beyond bedtime: Improving sleep and behavioral functioning in children with ADHD through targeted interventions.

Sleep, BDNF, and beyond: A comparative study of zolpidem and clobazam in insomnia treatment.

Introduction and objective Shift work, particularly night and rotating shifts, is increasingly common in sectors such as healthcare, transportation and industry, raising significant occupational health concerns. Circadian rhythm disruption compromises homeostasis, leading to hormonal, metabolic, and cardiovascular alterations. This review aimed to analyse evidence published between 2020–2025 on the association between shift work, metabolic syndrome, and cardiovascular diseases, exploring underlying pathophysiological mechanisms and discussing practical implications for occupational health. Methodology A narrative literature review was conducted through searches in Medline (via PubMed), Scielo, and Cochrane in April 2025. Articles published in Portuguese and English between 2020–2025 were included. Systematic and narrative reviews were considered as secondary sources. Earlier landmark studies were used only for conceptual framework. Evidence quality was assessed using the Strength of Recommendation Taxonomy. Results A total of 38 articles were identified, of which 10 met inclusion criteria. Evidence indicates an increased risk of Metabolic Syndrome (OR ~1.5) and Cardiovascular Diseases (RR ~1.2), with prevalence up to 33% among professional drivers. Longitudinal studies reported a dose–response relationship in exposures ≥10 years and gender differences, with higher risk among women. Main outcomes included abdominal obesity, hypertension, dyslipidemia, insulin resistance, and higher incidence of cardiovascular events. Metabolic Syndrome was defined variably, according to National Cholesterol Education Program – Adult Treatment Panel III, International Diabetes Federation, or World Health Organization criteria. In addition to international evidence, this review highlights Portuguese contributions published in the Revista Portuguesa de Saúde Ocupacional, reinforcing the national relevance of these findings. Discussion and Conclusion Shift work emerges as a modifiable risk factor for Metabolic Syndrome and Cardiovascular Disease, mediated by circadian disruption and hormonal and behavioral alterations. Despite consistent results, methodological limitations (such as cross-sectional designs, self-reported data, and heterogeneous definitions of shift schedules) restrict generalizability. Future long-term cohort studies should adopt standardized Metabolic Syndrome metrics and integrate objective circadian assessment. From an occupational health perspective, periodic cardiometabolic screening, sleep hygiene and healthy lifestyle promotion, and alignment of work schedules with individual chronotype are recommended to mitigate adverse effects, to increase work satisfaction and productivity. Keywords: Shift work, Circadian rhythm, Metabolic syndrome, Cardiovascular diseases, Occupational Health, Occupational Medicine and Occupational Nursing.

Background: Chronic insomnia is a common, underlined condition during old age. Long duration therapy for chronic insomnia leads to show symptoms of difficulty in day time functioning and other risk factors among geriatric population. Methods: An observational, cross-section study was conducted in the out patient department of geriatric medicine, Sir Sunderlal Hospital, BHU, Varanasi, to see the association of cognitive functions on old age chronic insomnia patients under long duration drug therapy. The chronic insomnia patients (age &gt;60 years) under long duration therapy (not less than twelve months) were screened for sleep quality and cognitive performance simultaneously with Pittsburgh sleep quotient index (PSQI) and Addenbrooke’s cognitive examination test, both in Hindi version. Results: Chronic insomnia was seen in high prevalence of 26% among old age population. Cognitive performance was significantly decreased in working memory in chronic insomnia subjects compared to their healthy counterparts (0.85±0.55, 1.71±0.53), other domains like orientation and coordination also showed symptoms of mild cognitive impairment, difficulty in day time functioning and other co morbidities among geriatric population. Chronic insomnia was significantly associated with concomitant diseases which include diabetes, hypertension, and arthritis. Based in a clinically significant study, 23% of patients with chronic insomnia did not perceive the ailment, and 32% more elderly women had insomnia than men of the same age. Conclusions: The study suggested the elderly population should be evaluated routinely for long-term use of hypnotic medications for chronic insomnia. The non pharmacological therapies may be included during treatment of geriatric population like maintenance of sleep hygiene; melatonin and bright light therapy.

Cognitive behavioral therapy for insomnia (CBT-I) will be compared with hormone replacement therapy (HRT) and sleep hygiene (active control treatment). The late menopausal transition is a vulnerable hormonal phase for women, where sleep disorders and vasomotor symptoms affect one out of three women. HRT is probably the most commonly used method to treat menopausal symptoms, including sleep problems. However, CBT-I is considered the treatment of choice for insomnia in adults in general. Despite this fact, there are only a few studies that have examined the effect of CBT-I in peri- and postmenopause and only one observational study comparing CBT-I and HRT for perimenopausal insomnia. Therefore, this study aims to compare the efficacy of HRT and CBT-I on subjective and objective sleep quality. Fifty-four late perimenopausal women will be randomly assigned to receive psychotherapist-led CBT-I, HRT (transdermal estradiol 1.5mg/d and oral micronized progesterone 200mg/day), or sleep hygiene (active control). Sleep quality will be continually assessed for 3 months, using validated questionnaires and an in-ear EEG device. Moreover, potential changes in the biofunctional status and age (27) and vasomotor symptoms will be assessed. The goal is to enable evidence-based treatment decisions for affected women to close the menopausal medical care gap and improve women's quality of life. TRIAL REGISTRATION {2A, 2B}: The study has been registered at ClinicalTrials.gov (Identifier: NCT06497894) on 11 July 2024.URL: (https://clinicaltrials.gov/ct2/show/NCT06497894). PROTOCOL VERSION AND TRIAL STATUS {3}: Protocol version 3.1 (30. April 2024). Recruitment has not started yet (15. August 2024). The recruitment is planned to begin on 01. November 2024, with an estimated completion date of 01. April 2026.

Insomnia symptoms during the perinatal period are prevalent and may contribute to negative mental health and birthing outcomes. Cognitive Behavioural Therapy for Insomnia (CBT-I) is a non-pharmacological therapy efficacious in the treatment of insomnia. Previous studies have shown the effectiveness of digital CBT-I during the perinatal period. However, to date, our understanding of whether this treatment can be effectively implemented in community perinatal care is limited. In this two-arm hybrid effectiveness-implementation type 1 randomised controlled trial (RCT), eligible pregnant individuals with self-reported insomnia symptoms (Insomnia Severity Index > 7) will be randomised to either the CBT-I intervention (Healthy Sleep Program) or active control (sleep hygiene education). The primary outcome is maternal insomnia symptom severity at (i) one pregnancy endpoint and (ii) averaged across three times post birth for the postpartum endpoint. An economic evaluation will assess cost-effectiveness. Barriers and enablers to sustained implementation will be explored using the Theoretical Domains Framework and the Practical Robust Implementation and Sustainability Model. This study will offer an understanding of the effectiveness, cost-effectiveness, and sustained implementation potential of a digital sleep health program in perinatal care. These outcomes will provide empirical evidence to inform broader implementation of a scalable sleep program to improve insomnia symptoms in perinatal populations. Australian New Zealand Clinical Trials Registry ACTRN12622000940774. Registered on 01/07/2022.

Background: Academic performance among university students is shaped by multiple factors, especially during examinations. This study aimed to explore the relationship between sleep quality, executive attention, and anxiety to identify potential predictors of academic performance across different academic fields. Method: Fifty-one students, between 19 and 25 years (M = 20.04, SD = 1.11), enrolled in the second year in Medicine (27.5%), Law (39.2%), and Economics (33.3%) programs at a university in Lisbon. The sample has mostly full-time students (98.04%), and female (68.6%). Data collection took place during examination periods and included: Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESE), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), Stroop Test and Go/No-Go task. Results: Our findings revealed significant differences across academic fields: medical students reported poorer sleep quality, law students demonstrated reduced executive attention, and economics students exhibited better sleep but weaker inhibitory control. Sleep quality and state anxiety significantly predicted academic performance, whereas executive attention did not. Conclusions: These results underscore the importance of addressing sleep hygiene and anxiety management among university students, regardless of academic discipline. Institutional initiatives, including structured stress-reduction programs and educational support services, may equip students with the tools to manage academic pressures and enhance cognitive functioning and overall psychological well-being.

ABSTRACTDietary disorder is a growing health concern among adolescents, influenced by a combination of psychosocial, behavioral, and environmental factors. This study examines the relationship between sleep quality, sleep duration, and the severity of dietary disorders in Chinese adolescents. A cross‐sectional survey was conducted among 982 adolescents in Xiamen, China, capturing data on demographics, dietary habits, and sleep health through self‐reported questionnaires. Principal component analysis (PCA) showed that dietary disorder was significantly affected by poorer subjective sleep quality and shorter sleep duration. Generalized ordered logit regression and restricted cubic splines (RCS) analyses revealed that poor sleep quality and sleep curtailment were significantly associated with higher levels of dietary disorder. Specifically, adolescents with excellent sleep quality were 58% less likely to experience dietary disorder, while those with sleep curtailment were 82% more likely to exhibit dietary disorder. The findings suggest that sleep health plays a pivotal role in shaping adolescent dietary behaviors, and interventions targeting sleep quality and duration may mitigate dietary disorders. This research provides evidence for public health initiatives focused on improving sleep hygiene as part of efforts to enhance adolescent health outcomes.

Abstract Aim This study aimed to evaluate patient recovery and satisfaction through patient reported outcomes measures (PROMs) assessing pain, sleep quality and functional disability following laparoscopic cholecystectomy (LC) at a district general hospital. Additionally, the study assessed adherence to the National Institute for Health and Care Excellence guideline NG180 on the use of adequate multimodal analgesia for postoperative pain management. Method In this retrospective observational study, 34 patients who underwent LC between January 2024 and 2025 for multiple indications completed 15-minute telephone surveys, including a general health questionnaire, the Numerical Rating Scale (assessing pain), the Pittsburgh Sleep Quality Index, and the WHO Disability Assessment Schedule 2.0. Discharge summaries provided information regarding any prescribed pain relief. The Clavien-Dindo classification was used to grade postoperative complications. Results Overall mean pain score immediately post-LC was 5.39 (±2.79) out of 10, decreasing to 4.35 (±2.29) 2 days postoperatively. Pain subsided on average in 12.52 (±15.10) days. Mean sleep quality score was 9.26 (±4.50) out of 21, and functional disability averaged 21.20% (±16.87). Multimodal analgesia was used in 25 patients (73.5%). Conclusions Uncomplicated LC was associated with better pain, sleep quality and disability scores than grade II complications, but mean questionnaire scores showed no significant statistical difference. Further implementation of multimodal analgesia, sleep hygiene education and additional support to those with comorbidities could improve outcomes and reduce complications and morbidity. Future research should explore real-time PROMs over extended periods across demographics and comorbid populations.

Occupational disruption (OD) is common during the perinatal period. Occupational therapy (OT) intervention may improve knowledge of perinatal occupational balance (OB) strategies. The aim of this exploratory study was to evaluate the effectiveness of an OT intervention in increasing knowledge of perinatal OB strategies among working first-time mothers (WFTMs). A total of 30 perinatal WFTMs attended a virtual OT educational workshop that addressed the OB constructs of stress management, energy conservation, sleep hygiene, and routine management. Pre- and post-intervention surveys measured OD and self-reported knowledge of OB strategies. Data were analyzed using descriptive statistics and paired samples t-tests. Participants reported moderate OD across all OB constructs. Statistically significant improvements were noted in knowledge of OB strategies to improve energy conservation (p = .003) and overall OB (p = .001). OT intervention can improve knowledge of OB strategies in perinatal WFTMs. Including OB education in routine perinatal care shows promise.

BackgroundPoor sleep is a modifiable factor associated with the development and progression of Alzheimer’s Disease (AD). Pharmacological treatments and Cognitive Behavioural Therapy for Insomnia (CBT‐I) which promote sleep have the potential to improve AD risk profile. In addition, prior research suggests that Dual Orexin Receptor Antagonists (DORAs), which are prescribed more and more to treat insomnia, could also help to decrease tau phosphorylation and concentrations of beta‐amyloid (Aβ) in the cerebrospinal fluid.ObjectiveTo study the impact of Lemborexant, a DORA, with or without CBT‐I on AD blood biomarkers and on cognitive performance in a population at risk of developing AD dementia.MethodWe will conduct a double‐blind randomized clinical trial in men and women aged 50 to 90 years old with symptoms of insomnia. 220 participants will be screened and randomized into 4 treatment groups over 12 months: Lemborexant, Lemborexant plus CBT‐I, placebo, or placebo plus CBT‐I. All participants will receive education on sleep hygiene measures.Primary OutcomesChange in (1) plasma p‐tau181 and (2) modified Preclinical Alzheimer’s Cognitive Composite score from baseline to 12‐months.Secondary OutcomesChange in (1) plasma p‐tau217, (2) CSF Aβ 42/40 and CSF p‐tau181, and (3) objective sleep measures measured with electroencephalogram (EEG) recording from baseline to 12‐months.Anticipated ResultsWe anticipate that Lemborexant will be associated with a reduction in plasma p‐tau181 over time compared to placebo. Lemborexant will improve sleep and cognitive performance compared to placebo, and the addition of CBT‐I will accentuate the beneficial effect on sleep and cognition but not on AD biomarkers.ConclusionThis study will grant us an opportunity to deepen our understanding of the therapeutic potential of sleep interventions and the influence of DORAs on AD prevention.

Food addiction (FA) is characterized by an insatiable urge to consume high-calorie, sugary, hyper-palatable foods beyond energy needs. This condition is associated with having obesity, binge eating, and comorbid physical, psychological, and social complications. While FA shares characteristics with other eating disorders, it is still understudied in many populations, especially university students. This study aims to assess the prevalence of FA among Palestinian university students and identify associated nutritional, social, psychological, and lifestyle factors. A cross-sectional study was conducted on university students using a random sampling technique. A paper-based structured questionnaire was used to collect data related to sociodemographic, medical history, FA using the Yale Food Addiction Scale (YFAS), and mental health using the Depression Anxiety and Stress Scale-21 (DASS-21). Dietary behaviour was assessed using the Mediterranean Lifestyle Index (MEDLIFE), while Body Mass Index (BMI) was used to evaluate weight status. The assessed lifestyle habits included quality of sleep using the Sleep Hygiene Index (SHI), physical status using the International Physical Activity Questionnaire (IPAQ), and smoking status. Data were analyzed using one-way ANOVA and Chi-square tests and multiple linear regression. The study involved 1435 participants, mostly female (66.2%), single (91.0%), and nonsmokers (71.1%). The study found that 79% of participants had no FA, 18% had mild addiction, and 3% had moderate to severe addiction. There was a significant relationship between smoking, chronic disease, SHI, or previous surgery and FA. However, there was no association between FA and other sociodemographic factors, medical history, lifestyle characteristics, or nutritional characteristics. The multiple linear models found that age (B = 0.080), anxiety (B = 0.120), depression (B = 0.154), SHI (B = 0.225), BMI (B = 0.153), Mediterranean diet (B = 0.106), and previous surgery (B = -0.064) are significant predictors of FA risk at p ≤ 0.001. Our study identified a notable presence of FA among university students. Key factors associated with FA included smoking, chronic disease, history of surgery, higher BMI, and adherence to the Mediterranean diet, as well as psychological factors such as stress, anxiety, depression, and poor sleep hygiene. These findings elaborate on the complex relationship of physical, psychological, and lifestyle factors contributing to FA. Further research is recommended to clarify the causal relationships behind these associations. level Ⅳ Food addiction (FA), a disorder defined by an insatiable need to consume high-calorie, sugary, and highly appealing meals more than energy requirements, is linked to having obesity, binge eating, and other medical, psychological, and social issues. The purpose of this study is to determine the prevalence of FA among Palestinian university students, as well as the dietary, social, psychological, and lifestyle aspects that contribute to it. The study discovered a 21% FA prevalence in the sample group, with 18% having mild FA and 3% suffering from moderate to severe addiction. These rates are greater than in the overall population but lower than in previous research including university students. The study discovered a link between FA and a variety of variables, including smoking, chronic disease, a history of surgery, and a higher BMI. Individuals with a history of chronic illness and surgery were likely connected to FA, possibly due to the psychological impact of long-term illness and body image concerns. A Mediterranean diet was associated with lower levels of FA. Stress, anxiety, sadness, and poor sleep hygiene were all also increasing the likelihood of FA. These findings emphasize the diverse character of FA, which is influenced by biological, psychological, and environmental factors, as well as the need for additional research to investigate these complicated relationships.

ABSTRACT This secondary analysis examined the effect of a 12 months intensive exercise-based life-style intervention (U-TURN) on obstructive sleep apnoea (OSA) severity measured with the apnoea-hypopnoea index (AHI), and its effect on sleep quality. Inclusion criteria: 1) T2D < 10 years, 2) BMI of 25 to 40 kg/m2, 3) taking ≤2 glucose-lowering medications. In addition to exercise and diet, the intervention included recommendations of high sleep hygiene. Sleep outcomes were determined with cardio-respiratory monitoring, the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). Participants included in the analysis: U-TURN, n = 61; standard care, n = 31. At 12-month follow-up, there was no difference in the change in AHI between the U-TURN and standard care groups (0.10 [95% CI, −1.40 - 2.20], p = 0.703). Likewise, the groups were similar with respect to the oxygenation of the blood, snoring, average and lowest O2, and periodic limb movement. The changes in ESS and PSQI did not differ between the groups (ESS: −0.56 [−1.62 - 0.50]; PSQI: −0.04 [−1.04 - 0.96]). In conclusion, no significant effect was observed, highlighting the complexity of OSA and underscoring the need for future research to determine the magnitude of weight loss re-quired and to elucidate the role of sex differences in effective treatment strategies.

Background: An anterior cruciate ligament (ACL) rupture is one of the most psychologically demanding injuries in professional sport. This study aimed to describe a structured psychological intervention conducted during the rehabilitation process following an ACL rupture in a professional female futsal player. Methods: A single-case longitudinal design was implemented with three phases (pre-test, intervention, post-test) across a 12-month rehabilitation period. Psychological assessment was conducted at four key points: initial evaluation, rehabilitation follow-up, medical discharge, and three- and six-month follow-ups. The battery included perfectionism (FMPS), anxiety (STAI), depression (BDI-II), mental health indicators (DASS-21, GHQ-12), sleep quality (PSQI), pain perception and catastrophizing (VAS, PCS), mood states (POMS), psychological readiness for return to play (PRIA-RS), and perceived intervention effectiveness. The program consisted of 15 individual sessions plus a follow-up, combining cognitive–behavioral therapy principles, mindfulness-based techniques (relaxation, body scan, visualization), cognitive restructuring, sleep hygiene, goal setting, problem-solving, and emotional expression strategies. Results: Progressive and sustained improvements were observed in mood states and pain catastrophizing, along with enhanced sleep quality, psychological readiness, and reintegration into competition. Improved overall mental health indicators were also observed, supporting adherence to rehabilitation and return-to-play confidence. Conclusions: This case highlights the relevance of structured psychological intervention as an integral component of injury rehabilitation in professional athletes with ACL rupture, supporting its inclusion in multidisciplinary care and future research to optimize recovery and prevent maladaptive outcomes.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a multifactorial neurodevelopmental condition shaped by biological, environmental, and psychosocial influences. Beyond genetic vulnerability, emerging evidence highlights the developmental significance of contextual factors such as parent–child attachment, sleep hygiene, and emotional competence. This literature review synthesizes empirical findings examining how these three domains contribute to the development of ADHD in children. Understanding these mechanisms may help inform more comprehensive, family-centered approaches to ADHD prevention and management. Secure parent–child attachment was consistently associated with better emotional regulation, internalization of behavioral control, and reduced ADHD symptomatology, whereas maternal anxiety and low emotional availability were linked to greater symptom severity. Sleep hygiene also demonstrated a strong relationship with ADHD manifestations, with poor sleep routines, sleep disturbances, and inadequate sleep quality correlating with higher levels of inattention, hyperactivity, and emotional dysregulation. Interventions targeting sleep hygiene have been shown to improve both sleep and behavioral outcomes in ADHD populations. Furthermore, studies examining attachment and sleep jointly show that secure attachment promotes healthier sleep quality, and sleep quality partially mediates the relationship between attachment and well-being. In conclusion, the literature suggests that parent–child relational processes and sleep-related behaviors interact to shape self-regulatory development, which may influence ADHD symptoms.

BackgroundA previously conducted study reported that insomnia rates among oncology patients in Ireland are twice that of the general population, and that a breast cancer diagnosis was an independent predictor for clinical insomnia disorder. The aim of this study is to explore this interaction further in a larger cohort of breast cancer patients.MethodsWe evaluated sleep disturbance and sleep hygiene practices among adult breast cancer patients via questionnaires. Sociodemographic data, clinical characteristics, sleep history and attitudes towards sleep assessments were collected and analysed.ResultsThe comprehensive 40-item questionnaire was completed by 315 patients. Of this cohort, 56% reported a change in their sleeping patterns since their cancer diagnosis, with over 55% of the study population having sub-threshold or clinical insomnia disorder. Although 64.2% of patients believed that questions regarding sleep should be part of breast cancer assessment, only 32% recalled being asked about sleep by a healthcare worker. Moreover, only 27.1% of respondents felt their sleeping difficulties were adequately dealt with since their diagnosis.ConclusionIn summary, sleep disturbance is prevalent among breast cancer patients. Despite a majority of breast cancer patients recognising the importance of sleep assessment, a significant gap remains in healthcare providers addressing these concerns effectively.

ABSTRACT Background Black women are more likely to experience sleep difficulties compared to their White counterparts. This disparity may be fueled by differences in economic opportunities, race – and gender-based discrimination, and other societal factors. Guided by the socio-ecological model, the purpose of this study was to examine the multi-level barriers and facilitators of sleep among Black women in the United States. Methods A qualitative description study design was used. Semi-structured interviews were conducted in English among 28 Black women with sleep difficulties. Interviews were audio-recorded and transcribed. Thematic analysis was used to analyze data. Results Participants (mean age = 47.3 years) were primarily single (52%) and employed (84%). Through qualitative interviews, four key themes emerged: (a) Individual-level barriers and facilitators, such as chronic health issues, poor sleep hygiene, stress, trauma, financial strain, and coping strategies like prayer and relaxation routines; (b) Interpersonal influences, including caregiving demands, emotional burdens from family dynamics, and social support; (c) Community-level factors, such as neighborhood noise, violence, and safety concerns contributing to hypervigilance; and (d) Societal-level influences, notably the “strong Black woman” schema and experiences of racism and gendered discrimination, which shaped sleep experiences. Discussion and conclusion Black women’s sleep is impacted by intersecting factors across individual, interpersonal, community, and societal levels. Culturally grounded, trauma-informed, and equity-focused interventions, targeting all socioecological levels, are essential to improve sleep health of Black women.