Sleep-related Daytime Impairment Research Articles

Preliminary evidence of psychological improvements and increased maternal-fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder.

Treating insomnia during pregnancy improves sleep and depressed mood. However, given well-established links between poor sleep and a broad spectrum of adverse maternal outcomes, the benefits of insomnia care may reach beyond sleep and depression. The present study evaluated the preliminary efficacy of 'Perinatal Understanding of Mindful Awareness for Sleep' (PUMAS)-a mindfulness sleep programme tailored to pregnancy that combines behavioural sleep strategies and meditation-for enhancing everyday mindfulness and maternal-fetal attachment, as well as for alleviating anxiety, repetitive thinking, and sleep-related daytime impairment. We conducted a secondary analysis of a single-arm proof-of-concept trial of 11 pregnant women with fifth edition of the Diagnostic and Statistical Manual of Mental Disorders diagnosed insomnia disorder who completed PUMAS (six sessions), which was delivered in an individual format via telemedicine video. Pre- and post-treatment outcomes included the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), Maternal-Fetal Attachment Scale (MFAS), Generalised Anxiety Disorder seven-item survey (GAD-7), Perseverative Thinking Questionnaire (PTQ), Daytime Insomnia Symptoms Response Scale (DISRS), and the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment Scale (PROMIS-SRI). Symptom changes were evaluated with paired-samples t tests. Results showed PUMAS patients reported large increases in CAMS-R (Cohen's dz = 1.81) and medium-large increases in MFAS scores (Cohen's dz = 0.73). Moreover, PUMAS patients reported large reductions in scores on the GAD-7 (Cohen's dz = 1.09), PTQ (Cohen's dz = 1.26), DISRS (Cohen's dz = 1.38), and PROMIS-SRI (Cohen's dz = 1.53). Preliminary evidence suggests that a mindfulness-based perinatal sleep programme may benefit several domains of maternal wellbeing beyond sleep and depression. PUMAS substantially enhanced patient ratings of everyday mindfulness and maternal-fetal attachment, while reporting alleviations in anxiety, perseverative thinking, insomnia-focused rumination, and sleep-related daytime impairment.

0241 Sleep Across the Lifespan in Hispanic/Latinx Adults

Abstract Introduction Studies examining racial/ethnic sleep disparities have observed that minoritized individuals are more likely to experience poor sleep compared to non-Hispanic whites. Existing research on Hispanic/Latinx (H/L) individuals further reinforces this assertion. However, to date, little attention has been paid to lifespan examinations of sleep within minoritized groups. The present study assessed sleep characteristics differences across the lifespan within a large sample of H/L adults. We hypothesized that older adults would report more concerns and symptoms associated with impaired sleep. Methods Participants included 1,072 (63.3% female; µ=36.43) adults who self-identified as H/L and completed an online survey assessing insomnia symptoms (Insomnia Severity Index), sleep-related daytime impairment (PROMIS Sleep-Related Impairment), sleep regularity (Sleep Regularity Questionnaire), subjective sleep quality (Pittsburgh Sleep Quality Index), and self-reported sleep duration. A One-Way ANOVA was utilized to detect mean differences in sleep markers across age groups [Young (18-25), Middle (30-50), and Late adulthood (55+)]. Significant mean differences were further analyzed with Duncan’s post hoc analysis. Results The One-Way ANOVA revealed significant mean differences across all sleep markers analyzed: insomnia symptoms, F(2, 1069)=67.459, p<.001; sleep-related daytime impairment, F(2, 1069)=77.465, p<.001; sleep regularity, F(2, 1069)=74.091, p<.001; sleep quality, F(2, 1069)=29.300, p<.001; and total sleep duration, F(2, 1069)=5.898, p=.003. Post hoc analyses revealed significantly more insomnia symptoms (µ=14.325) and poorer sleep quality (µ=1.623) in late adulthood compared to younger (µ=8.270; 1.092) and middle-aged (µ=10.186; 1.345). As well as significant elevations in sleep-related daytime impairment (µMiddle=22.314; µLate=23.508) and poorer sleep regularity (µMiddle=16.556; µLate=16.704) in middle and late adulthood compared to younger adults (µ=16.056; 13.054). Lasty, young adults slept (µ=6.756) significantly less than middle and late adulthood (µMiddle=7.025; µLate=7.162). Conclusion Results suggest that age is important factor in the consideration of sleep among H/L adults. These findings generally point to an increase in poor sleep as age increases. It’s important to consider this trend when working with minoritized individuals due to the disproportionate burden of sleep factors being potentially compounded by age. Support (if any) This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).

0149 Emotion Dysregulation and Sleep Disturbances in Trauma-Exposed College Students

Abstract Introduction Trauma-exposed individuals are at risk of developing symptoms of posttraumatic stress disorder (PTSD), which has been linked to both sleep disturbances and sleep-related daytime impairment. A growing body of literature suggests affective processes, such as negative and positive emotion regulation, may influence associations between PTSD and sleep. Therefore, our study aimed to examine if there was a direct effect of negative and positive emotion dysregulation on sleep disturbances and sleep-related impairment above the influence of PTSD symptoms. Methods Participants were 460 trauma-exposed college students (69.8% female; 62.0% White; Mage = 20.13 ± 2.94) recruited from the University of North Texas. Trauma exposure was assessed with the Life Events Checklist for DSM-5. Participants completed demographic questionnaires, the PTSD Checklist for DSM-5 (excluding sleep-related questions), the Difficulties in Emotion Regulation Scale (DERS-16), the Difficulties in Emotion Regulation – Positive (DERS-P), the PROMIS Sleep Disturbance (PROMIS-SD), and Sleep-Related Impairment (PROMIS-SRI) Short Forms. Multiple regression models with robust standard errors were conducted to examine associations between both positive and negative emotion dysregulation on sleep disturbances and sleep-related impairment, covarying for PTSD symptoms, age, gender, race, and ethnicity. Results Greater negative emotion dysregulation was associated with greater sleep disturbances (b = 0.06, SE = 0.03, p = .015, ηp2 = 0.01) above the influence of positive emotion dysregulation, PTSD symptoms, age, gender, race, and ethnicity (R2 = 0.28). Greater negative emotion dysregulation was also associated with greater sleep-related impairments (b = 0.20, SE = 0.03, p < .001, ηp2 = 0.08) above the influence of the same covariates (R2 = 0.31). Positive emotion dysregulation was not associated with sleep disturbances or sleep-related impairments. Conclusion Results suggest that more difficulty regulating negative emotions is linked to disturbed sleep among trauma-exposed individuals. Additional experimental work is needed to understand if regulating negative emotions via cognitive-behavioral strategies (e.g., mindfulness, cognitive restructuring) can lead to downstream improvements in sleep. Support (if any)

Effects of mindfulness-based stress reduction on adults with sleep disturbance: an updated systematic review and meta-analysis

ObjectiveMindfulness-based stress reduction (MBSR) is a meditation-based therapy originally recommended for stress management. However, it is currently used to alleviate sleep disturbances. Therefore, this contemporary systematic review aimed to elucidate...

0466 Living Alone as a Predictor of Symptom Change During Cognitive Behavioral Therapy for Insomnia

Abstract Introduction Interpersonal factors have implications for sleep quality. Research has begun to explore how such factors may play a role in cognitive behavioral therapy for insomnia (CBTI). This study investigated whether living alone predicts reductions in insomnia severity and sleep-related daytime impairment across the first two months of treatment in a trial of CBTI. Methods Participants were 224 middle-to-older-aged adults with insomnia (166 women, M age = 63.16) enrolled in the ongoing Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING). All study participants received CBTI, delivered either via a therapist or a validated software program. At baseline, participants indicated whether they lived alone or with at least one other person. The Insomnia Severity Index (ISI) and PROMIS Sleep-Related Impairment (SRI) short form were administered at baseline and two months after starting treatment. Mixed effects models assessed whether living alone predicted reduction in symptoms across the first two months of CBTI. Results Across the total sample, ISI scores decreased from baseline to two months (β=-3.52, SE=0.35, p<.001, 95% CI=-4.20, -2.84). Living alone was not associated with baseline ISI scores nor change in ISI score. A reduction in PROMIS SRI score was also observed in the total sample from baseline to two months (β=-4.18, SE=0.50, p<.001, 95% CI=-5.15, -3.21). Living alone was not associated with baseline SRI score, but it did predict reduction in SRI score (β=-3.23, SE=0.88, p=.001, 95% CI=1.31, 5.15). Participants living alone displayed less reduction in SRI compared to those living with at least one other person. Conclusion Participants undergoing CBTI who live alone experienced reduction in insomnia severity over the course of treatment, but they displayed less improvement in daytime sequalae of poor sleep compared to those living with others. Future studies should further explore how living status contributes to insomnia treatment response across both nighttime and daytime sleep symptomology. Regular engagement with others living in the home may be important for insomnia treatment to translate into perceived functional improvements during the day. Support (If Any) 1R01AG057500

0142 From Shore to Shipboard: Severity of Sleep Disturbance and Sleep-Related Impairment of Sailors Aboard US Navy Warships

Abstract Introduction Sleep quality is known to be negatively impacted during military operations at sea. Yet, there are limited naval studies that explore measures of sleep disturbances and sleep-related impairment, especially in relation to different warship classes. This analysis compares sleep disturbances and sleep-related impairment across two warship classes during similar at-sea periods. Methods 432 sailors (77.6% male; 27.4±7.1 years) participated in a training evolution aboard either a destroyer (DDG; n=194) or an amphibious class ship (LHD; n=238). Participants completed a 7-day recall questionnaire assessing their sleep and health behavior prior to getting underway (baseline) and 1–2 days prior to completing a 2-week underway (underway). Primary outcomes included the PROMIS Sleep-Related Impairment scale (P-SRI) and the PROMIS Sleep Disturbance scale (P-SD). While underway, participants self-reported their diet quality, daily caffeine and nicotine intake, overall health, and daily time spent exercising; these factors were included as covariates in all analyses. Linear mixed effects models were used to explore the within-subject effect of baseline vs. underway sleep and a between-subjects effect by ship class (i.e., DDG or LHD). Independent t tests and chi-square tests were used to compare ship groups at baseline. Results Participants within ship class had a similar age, time in military service, and sex (p≥.06). Across both ship classes, there were increases in severity of sleep-related daytime impairment and sleep disturbances between baseline and underway (P-SRI: B=5.2±0.6; P-SD: B=3.4±0.5; p<.001). Additionally, DDG participants had a significantly greater increase in sleep-related impairment between baseline and underway compared with their LHD-class counterparts (Group*Time interaction effect: B=4.3±0.9, p<.001; LHD: 54.5±0.6 [baseline] vs. 54.5±0.5 [underway], DDG: 54.9±0.6 [baseline] vs. 60.2±0.6 [underway]). Conclusion These results suggest sleep-related impairment and sleep disturbances are greater while underway compared with an in-port environment. Although preliminary, these results suggest that differential impacts on sleep-related impairment may occur across ship classes, even when undergoing similar underway events. Further research is needed to understand how insufficient sleep and its consequences change in shipboard environments and how these effects may vary between ship classes so as to better inform targeted naval-focused sleep health improvement strategies. Support (If Any) Military Operational Medicine Research Program under work unit no. N2010.

P153 Sleep timing and chronotype in perinatal periods: Longitudinal changes and associations with wellbeing from pregnancy to 2 years postpartum

Abstract Introduction Significant changes to sleep occur during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined associations between chronotype and insomnia, sleep-related impairment, and mood at seven different perinatal time-points. Methods Data were from a 2-arm randomised controlled trial testing behavioural sleep and diet interventions. A community sample of nulliparous females without severe sleep/mental health conditions participated. Participants self-reported bedtime, rise-time, chronotype (short Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over seven time points: gestation weeks 30 and 35, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 participants (mean age 33.4±3.4 years) took part. Mixed effects models adjusting for age and group allocation showed that both bed- and rise-times became progressively earlier by approximately 20–30 minutes over time (p<.001); chronotype shifted progressively towards more morningness (p<.01). After adjusting for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values<.001); at each time-point, associations between chronotype and symptoms of depression and anxiety were non-significant (p-values>0.65). Conclusions Sleep timing and chronotype became progressively earlier over the first two postpartum years. Greater morningness was associated with less sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms of these findings may be investigated through further research.

Improvements in Sleep Quality and Duration Following a Meditation Retreat: an Open-Trial Pilot Study

PurposeDisturbed sleep and other sleep-related problems have a negative impact on the human mind and body. Meditation practices are reported to improve physiological functions and might also have a positive impact on regulating sleep. This research investigates the efficacy of an advanced mind–body medicine intervention, called Hollow and Empty Meditation (HEM), on improving sleep quality.MethodsThe study was a single-arm open-trial pilot study which assessed 413 adults who underwent a 4-day meditation retreat offered by the Art of Living, called the Advanced Meditation Program (AMP), and experienced a novel meditation—HEM. Results were measured using a self-report questionnaire, the Pittsburgh Sleep Quality Index (PSQI), which was administered to the participants thrice: on the first day of the program (pre-intervention), immediately after program (post-intervention/Day 4), and on Day 40 (D40) after the program.ResultsThere was a significant difference in pre–post and pre–D40 scores in the population. Both sleep quality and sleep duration showed an improvement immediately after the AMP (post), and the residual impact was still experienced at D40, especially with the group with age > 36 years.ConclusionsThe use of HEM resulted in improvement in sleep quality not just immediately after the program, but had longer-term effects that extended over several weeks, helping remediate sleep problems among younger adults as well as older ones. It resulted in improvement in sleep quality as well as reduction in sleep-related daytime impairment, which have substantial constructive implications for well-being, everyday functioning and quality of life.

225 Sleep Timing and Chronotype in Mothers: Longitudinal Changes and Associations with Wellbeing from Pregnancy to 2 Years Postpartum

Abstract Introduction Women experience significant changes to sleep during perinatal periods. Existing research focuses on sleep duration and quality, but not sleep timing or chronotype (i.e., preferred timing for activity and sleep). This study investigated change trajectories of sleep timing and chronotype from late pregnancy to two years postpartum, and examined longitudinal associations between chronotype and insomnia, sleep-related daytime impairment, and mood. Methods Data were from a 2-arm randomized controlled trial testing behavioral sleep and diet interventions. A community sample of nulliparous women without severe sleep/mental health conditions participated. Women self-reported bedtime, risetime, chronotype (reduced Morningness-Eveningness Questionnaire), Insomnia Severity Index, and PROMIS Depression, Anxiety, and Sleep-Related Impairment over 7 time points: 30 and 35 weeks’ gestation, and postpartum months 1.5, 3, 6, 12 and 24. Results 163 women (mean age 33.35 ± 3.42 years) took part. Mixed effects models controlling for age and group allocation showed that both bed- and risetimes became progressively earlier over time by approximately 20-30 minutes on average (p < .001); chronotype also shifted progressively towards morningness (p < .01). After controlling for covariates (sleep duration and efficiency, mental health history, social support, age, group allocation), greater morningness was significantly associated with lower symptoms of insomnia and sleep-related impairment over time (p-values < .001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (p-values > .65). Conclusion This is one of the first studies to examine longitudinal changes in sleep timing and chronotype from pregnancy to two years postpartum. Sleep timing and chronotype became progressively earlier over the first two postpartum years. The magnitude of changes is beyond what is expected with increasing age. Greater morningness was associated with lower sleep complaints and sleep-related daytime impairment during the postpartum period. The mechanisms underlying these associations require further research. Support (if any) Australasian Sleep Association, Monash University, Australian Government RTP Scholarship and National Health and Medical Research Council.

197 Refining the Subjective Assessment of Sleep: An SEM Approach

Abstract Introduction Given that sleep is multidimensional, the assessment of sleep requires an examination of a number of different domains. Accordingly, there is an abundance of self-report sleep questionnaires that are widely used for both research and clinical use. The surplus of available measures can be problematic, as it often leads to difficulties in selecting the best measure for a given purpose/context. In addition, the use of multiple measures to assess sleep may be an inefficient use of time and resources if they are not measuring unique constructs. The purpose of the current study is to evaluate the factor structure of five sleep measures. A confirmatory factor analysis (CFA) was initially used to evaluate whether each of these scales are measuring different factors of sleep, with follow-up exploratory factor analysis (EFA) as needed. Methods An archival analysis was performed using data from an online study, Investigating Sleep Across Normal Development (ISLAND Study). The sample consisted of 3,284 adults aged 18+. The following measures were utilized: RU SATED, PROMIS Sleep-Related Impairment, Sleep Self-Efficacy, Insomnia Severity Index, and the Sleep Regularity Questionnaire. Results As expected, the CFA model fit was determined to be poor and an EFA was then conducted to assess the factor structure of these scales. The EFA revealed a four-factor structure comprised of 25 items: Sleep-Related Daytime Impairment, Sleep Regularity, Sleep Disturbance, and Sleep-Related Daytime Enhancement. Conclusion The findings from the current study add to the literature supporting the multidimensionality of sleep, as well as the continued need to assess the various facets that comprise this construct. Although the literature supports the utility of these five measures, the present study found that within a community sample, these measures are not entirely unique. Further, the present study extends our knowledge and the literature by revealing a novel factor of sleep – Sleep-Related Daytime Enhancement. It may be worthwhile for researchers and clinicians to consider latent sleep factors that contribute to sleep disturbance and sleep health. Future work is needed to further confirm the observed factor structure and assess the psychometrics of this new scale. Support (if any) National Institute on Aging (K23AG049955, PI: Dzierzewski).

351 Informal Caregivers with Insomnia May Benefit From an Insomnia Treatment Using an Acceptance and Commitment Therapy Approach

Abstract Introduction Insomnia among informal caregivers (providing care to family/friends) is common and associated with worse mental and physical health outcomes. Traditional cognitive behavioral therapy for insomnia may be challenging for caregivers whose beliefs about sleep may relate to beliefs and behaviors that are intertwined with their unique situation of caregiving. We examined whether an insomnia treatment using an acceptance and commitment (ACT) approach (i.e. committing to values-based actions toward goals vs. experiential avoidance of distressing emotions/thoughts) plus sleep restriction, stimulus control and sleep hygiene improves sleep, mental health, and daytime symptoms among caregivers. Methods We analyzed data from women veterans with insomnia who were informal caregivers (mean age=44 years [range 25–57]; N=6) and were participating in a clinical trial of an ACT-focused treatment (termed ABC-I). We measured: Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), General Anxiety Disorder (GAD-7), 11 items assessing symptoms of daytime impairment due to poor sleep derived from the International Classification of Sleep Disorders-Third Edition, and the Acceptance and Action Questionnaire (AAQ). Student t-tests were used to compare outcomes between pre- and post-ABC-I. Results Caregivers showed significant improvements between pre- and post-ABC-I (all p-values<0.05) in the following outcomes: ISI (14.3±5.4 vs. 3.8±3.2), PHQ-9 (9.8±7.2 vs. 2.8±3.8), GAD-9 (9.0±6.6 vs. 2.0±1.8), and number of symptoms of sleep-related daytime impairment (6.8±4.0 vs. 3.8±3.5). Caregivers also showed improvement trends in PSQI (10.0±4.1 vs. 5.2±1.2, p=0.06) and AAQ score (24.0±12.7 vs. 16.2±8.0, p=0.05). Conclusion We found that caregivers with insomnia may benefit from ACT-based treatment in improving perceived sleep quality and insomnia, depression, anxiety, sleep-related daytime impairment and reduced experiential avoidance. This approach may increase motivation by linking the sleep program to core values, and acceptance and tolerance of emotions or thoughts may benefit caregivers with insomnia. Further studies using an ACT-based insomnia program are needed to test its effect in a larger sample of caregivers and evaluate benefits in terms of reduced stress and improved health. Support (if any) VA HSR&D (Martin IIR 13-058-2 and RCS-20–191), NIA (K23AG055668, Song), NHLBI (K23HL143055, Martin) of the NIH, VAGLAHS GRECC, and VA Office of Academic Affiliations (Kelly; Carlson).

Trait mindfulness predicts daytime sleep-related impairment after controlling nocturnal sleep symptomology

Given that sleep-related impairment during the waking period is proposed to play an important role in maintaining insomnia, more research is needed on factors that relate specifically to the daytime symptoms of sleep problems. This study investigated whether trait mindfulness predicts daytime impairment attributed to poor sleep after accounting for deficits in nighttime sleep quantity and quality. In a United States population-based online sample (N = 459), hierarchical multiple regression predicted sleep-related daytime impairment from mindfulness after controlling for demographics, general health status, self-estimated sleep efficiency, and subjective sleep disturbance. Mindfulness displayed robust negative correlations with both nighttime and daytime sleep symptoms. In the full hierarchical model predicting daytime sleep-related impairment, mindfulness explained significant outcome variance after controlling all covariates, including nocturnal sleep symptomology. Trait mindfulness may thus have implications specific to daytime detriments associated with poor sleep, and cultivating mindfulness skills may be a particularly useful strategy for addressing such difficulties.

0213 The Association Between Work-Related Job Demands and Daytime Impairment in Professional Firefighters

Abstract Introduction Sleep is an important predictor of daytime functioning and is impaired in first responders. The present study investigated whether job demands were associated with daytime impairment in professional firefighters. We hypothesized that the frequency of emergency calls would predict daytime impairment above and beyond years of service, sleep apnea risk, and sleep duration. Methods Participants were 267 (251 males; mean age=41.94) firefighters from the Richmond, Virginia Fire Department who completed pen-and-paper surveys in small groups assessing sleep duration (Pittsburgh Sleep Quality Index; PSQI), sleep apnea risk (STOP-BANG), job demands (number of emergency calls received per day), and sleep-related impairment (Patient Reported Outcomes Measurement Information System 8-item short-form; PROMIS). A three block hierarchical regression was used to assess the contribution of job demands to daytime impairment. Results The final model significantly predicted sleep-related daytime impairment, F(4,260)=11.51, p<.001, R2=.15. Each block in the model accounted for significant change in variance, years of service and sleep apnea risk (R2=.05), sleep duration (∆R2=.08), number of calls (∆R2=.01). Number of emergency calls significantly predicted daytime impairment (β=.14) above and beyond number of years of service (β= -.24), sleep duration (β= -.29), and sleep apnea risk (β=.03). Conclusion With 2–18 emergency calls per 24-hour period, the results suggest that job-related demands are a unique contributor to daytime functioning in professional firefighters. As such, it will be important for interventions aimed at improving sleep in professional firefighters to incorporate information unique to the profession (i.e., job specific demands and intensity of work) as specific treatment factors. Support This work was supported by the National Institute on Aging (K23AG049955, PI: Dzierzewski).

Symptom Management Among Cancer Survivors: Randomized Pilot Intervention Trial of Heart Rate Variability Biofeedback.

Chronic cancer-related symptoms (stress, fatigue, pain, depression, insomnia) may be linked with sympathetic nervous system over-activation and autonomic imbalance. Decreased heart rate variability (HRV) is an indicator of autonomic dysregulation that is commonly observed among cancer survivors. HRV biofeedback (HRVB) training induces HRV coherence, which maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, wait-list-controlled, pilot intervention trial tested the hypothesis that HRVB can improve HRV coherence and alleviate cancer-related symptoms. The intervention group (n = 17) received 4-6 weekly HRVB training sessions until participants demonstrated skill acquisition. Controls (n = 17) received usual care. Outcomes assessed at baseline and follow-up included 15-min HRV recordings (HRV Coherence Ratio), and symptoms of: stress, distress, post-traumatic stress disorder (PTSD), pain, depression, fatigue, and sleep disturbance. Linear mixed models for repeated measures were used to assess Group-by-Time interactions, pre- versus post-treatment differences in mean symptom scores, and group differences at follow-up. Mean HRV Coherence Ratios (± standard error) improved in the HRVB group at follow-up (baseline: 0.37 ± 0.05, post-intervention: 0.84 ± 0.18, p = 0.01), indicating intervention validity. Statistically significant Group-by-Time interactions indicated treatment-related improvements in HRV Coherence Ratios (p = 0.03, Pre-vs. post-treatment effect size [Cohen's d]: 0.98), sleep symptoms (p = 0.001, d = 1.19), and sleep-related daytime impairment (p = 0.005, d = 0.86). Relative to controls, the intervention group experienced trends toward improvements in stress, distress, fatigue, PTSD, and depression, although no other statistically significant Group-by-Time interactions were observed. This pilot intervention found that HRVB training reduced symptoms of sleep disturbance among cancer survivors. Larger-scale interventions are warranted to further evaluate the role of HRVB for managing symptoms in this population. Registration: NCT03692624 www.clinicaltrials.gov.

Sleep Disruption Due to Stress in Women Veterans: A Comparison between Caregivers and Noncaregivers

ABSTRACT Objective/Background: Sleep problems are common in women and caregiving for an adult is a common role among women. However, the effects of caregiving on sleep and related daytime impairment are poorly understood among women veterans. This study compared stress-related sleep disturbances, insomnia symptoms, and sleep-related daytime impairment between women veterans who were caregivers and those who did not have a caregiving role. Participants: Of 12,225 women veterans who received care in one Veterans Administration Healthcare System, 1,457 completed data on a postal survey (mean age = 51.7 ± 15.9 years). Two hundred forty three (17%) respondents (mean age 53.8 ± 12.7 years) were caregivers for an adult, predominantly for a parent, providing transportation. Methods: The survey included items that addressed insomnia symptoms, total sleep time, sleep-related daytime impairments, caregiving characteristics, self-rated health, pain, stress, body mass index, and demographic information. Results: In adjusted analyses, caregiver status did not directly predict sleep complaints alone. However, in multiple regression analyses, being a caregiver (odds ratio 1.7, p = .001) significantly predicted stress-related sleep disturbance, even after adjusting for age, pain, self-rated health, and other characteristics. Furthermore, being a caregiver (β = 3.9, p = .031) significantly predicted more symptoms of sleep-related daytime impairment after adjusting for age, pain, self-rated health, and other factors. Conclusions: Compared to noncaregivers, women veterans who were caregivers for an adult were more likely to report stress causing poor sleep, and more daytime impairment due to poor sleep. These findings suggest the need to target stress and other factors when addressing sleep disturbance among women veterans who are caregivers.

A combination of melatonin, vitamin B6 and medicinal plants in the treatment of mild-to-moderate insomnia: A prospective pilot study

ObjectivesCurrently available pharmaceutical therapies for sleep disorders have significant side effects and dependence potential, thus necessitating the need for alternative treatment approaches. This study investigated the effect of a combination of melatonin, vitamin B6 and medicinal plants in patients with mild-to-moderate sleep disorders. Design and settingThis was a 4-week, single-center, single-arm, open-label study conducted in 40 participants with mild-to-moderate insomnia, in Poland. InterventionParticipants received Novanuit® Triple Action (melatonin, vitamin B6, California poppy extract, passionflower extract, and lemon balm extract) capsules per day for two weeks. OutcomesUsing a daily electronic sleep diary, information was collected on sleep quality (assessed on a 0–10 scale), total sleep duration, sleep onset latency, sleep-related daytime impairment, and safety of the study medication. ResultsThere was a statistically significant (p < 0.001) improvement in sleep quality by the end of the 2-week treatment period, with mean sleep quality score increasing by 1.9 points from pre-treatment (5.4 points) to post-treatment (7.3 points). Similarly, statistically significant improvements were observed following treatment completion in sleep onset latency, total sleep duration, and sleep-related daytime parameters (p < 0.01 for all outcomes). Administration of the combination of melatonin, vitamin B6, and medicinal plants was associated with high compliance (39/40; 97.5%). No serious adverse events were reported. ConclusionsThis pilot study suggests that the combination of melatonin, vitamin B6, and medicinal plants may be beneficial in mild-to-moderate insomnia.

Health and demographic discriminators of an insomnia identity and self-reported poor quantitative sleep

ObjectivesTo identify factors that most saliently characterize the profile of individuals who complain of chronic insomnia, with or without quantitative sleep impairment. DesignCommunity-dwelling adults reported on their demographics and functioning via questionnaires and completed 2 weeks of sleep diaries. SettingShelby County in the Memphis, TN, area. ParticipantsPopulation-based sample, stratified by sex and age to maximally represent sleep and health across the life span. MeasurementsParticipants were classified into 4 groups according to whether or not they endorsed a chronic insomnia complaint and whether they demonstrated good or poor quantitative sleep on diaries. Discriminant analysis determined which of the following variables significantly maximized spread among the sleep groups: age, sex, race, body mass index, household education, number of medications, frequency of substance use, number of medical conditions, depression, anxiety, fatigue, daytime sleepiness, and daytime insomnia impact. ResultsOn the most powerful discriminant function, participants with more medical conditions, greater depression and anxiety, and older age were more likely to complain of chronic insomnia than to not complain and, within these levels, to have poor rather than good quantitative sleep. A second function found African Americans particularly likely to be noncomplaining poor sleepers compared to Whites. ConclusionsFindings make progress in clarifying the profile of individuals who self-identify as having chronically poor sleep. Notably, general depression and anxiety surpassed sleep-related daytime impairment measures in discriminating complaining sleepers. Negativistic self-appraisals driving diffuse psychological symptoms may thus be viable intervention targets for reducing persistent insomnia complaints independently of sleep-specific concerns.

Sleep regularity is associated with sleep-wake and circadian timing, and mediates daytime function in Delayed Sleep-Wake Phase Disorder

BackgroundIn healthy populations, irregular sleep patterns are associated with delayed sleep and poor functional/mood outcomes. Currently, it is unknown whether irregular sleep contributes to poor functional/mood outcomes in individuals with Delayed Sleep-Wake Phase Disorder (DSWPD). MethodsIn 170 patients with DSWPD, we collected sleep-wake patterns, dim light melatonin onset (DLMO), and functional/mood outcomes. The Sleep Regularity Index (SRI) and other sleep timing metrics were computed. Correlations of SRI were computed with phase angle (difference between DLMO and desired bedtime), sleep timing and quality variables, daytime function, sleep-related daytime impairment, mood, and insomnia symptom severity. Path analyses assessed whether SRI or total sleep time mediated the associations between sleep onset time and phase angle with daytime functioning, sleep-related impairment, and mood outcomes. ResultsHigher SRI was associated with earlier sleep and longer total sleep time, but did not relate to sleep quality, daytime function, or mood outcomes. Path analysis showed that phase angle was directly associated with all outcome variables, whereas sleep onset time was not directly associated with any. SRI mediated the effects of sleep onset time and phase angle on daytime function. Total sleep time mediated the effects of sleep onset time and phase angle on sleep-related impairment. ConclusionIndividuals with DSWPD who have more delayed sleep and a greater phase angle also have more irregular sleep. This suggests that it is not delayed sleep timing per se that drives poor functional outcomes in DSWPD, but rather the timing of sleep relative to circadian phase and resultant irregular sleep patterns.

Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial.

BackgroundDelayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled trials are lacking. This trial tested the efficacy of 0.5 mg melatonin, combined with behavioural sleep-wake scheduling, for improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired (or -required) bedtime (DBT).MethodsThis randomised, placebo-controlled, double-blind clinical trial was conducted in an Australian outpatient DSWPD population. Following 1-wk baseline, clinically diagnosed DSWPD patients with delayed melatonin rhythm relative to DBT (salivary dim light melatonin onset [DLMO] after or within 30 min before DBT) were randomised to 4-wk treatment with 0.5 mg fast-release melatonin or placebo 1 h before DBT for at least 5 consecutive nights per week. All patients received behavioural sleep-wake scheduling, consisting of bedtime scheduled at DBT. The primary outcome was actigraphic sleep onset time. Secondary outcomes were sleep efficiency in the first third of time in bed (SE T1) on treatment nights, subjective sleep-related daytime impairment (Patient Reported Outcomes Measurement Information System [PROMIS]), PROMIS sleep disturbance, measures of daytime sleepiness, clinician-rated change in illness severity, and DLMO time.FindingsBetween September 13, 2012 and September 1, 2014, 307 participants were registered; 116 were randomised to treatment (intention-to-treat n = 116; n = 62 males; mean age, 29.0 y). Relative to baseline and compared to placebo, sleep onset occurred 34 min earlier (95% confidence interval [CI] −60 to −8) in the melatonin group. SE T1 increased; PROMIS sleep-related impairment, PROMIS sleep disturbance, insomnia severity, and functional disability decreased; and a greater proportion of patients showed more than minimal clinician-rated improvement following melatonin treatment (52.8%) compared to placebo (24.0%) (P < 0.05). The groups did not differ in the number of nights treatment was taken per protocol. Post-treatment DLMO assessed in a subset of patients (n = 43) was not significantly different between groups. Adverse events included light-headedness, daytime sleepiness, and decreased libido, although rates were similar between treatment groups. The clinical benefits or safety of melatonin with long-term treatment were not assessed, and it remains unknown whether the same treatment regime would benefit patients experiencing DSWPD sleep symptomology without a delay in the endogenous melatonin rhythm.ConclusionsIn this study, melatonin treatment 1 h prior to DBT combined with behavioural sleep-wake scheduling was efficacious for improving objective and subjective measures of sleep disturbances and sleep-related impairments in DSWPD patients with delayed circadian phase relative to DBT. Improvements were achieved largely through the sleep-promoting effects of melatonin, combined with behavioural sleep-wake scheduling.Trial registrationThis trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000425897.

Objective cognitive functioning in self-reported habitual short sleepers not reporting daytime dysfunction: examination of impulsivity via delay discounting.

(1) Examine performance on an objective measure of reward-related cognitive impulsivity (delay discounting) among self-reported habitual short sleepers and medium (i.e. recommended 7-9 hours) length sleepers either reporting or not reporting daytime dysfunction; (2) Inform the debate regarding what type and duration of short sleep (e.g. 21 to 24 hours of total sleep deprivation, self-reported habitual short sleep duration) meaningfully influences cognitive impulsivity; (3) Compare the predictive utility of sleep duration and perceived dysfunction to other factors previously shown to influence cognitive impulsivity via delay discounting performance (age, income, education, and fluid intelligence). We analyzed data from 1190 adults from the Human Connectome Project database. Participants were grouped on whether they reported habitual short (≤6 hours) vs. medium length (7-9 hours) sleep duration and whether they perceived daytime dysfunction using the Pittsburgh Sleep Quality Index. All short sleepers exhibited increased delay discounting compared to all medium length sleepers, regardless of perceived dysfunction. Of the variables examined, self-reported sleep duration was the strongest predictor of delay discounting behavior between groups and across all 1190 participants. Individuals who report habitual short sleep are likely to exhibit increased reward-related cognitive impulsivity regardless of perceived sleep-related daytime impairment. Therefore, there is a reason to suspect that these individuals exhibit more daytime dysfunction, in the form of reward-related cognitive impulsivity, than they may assume. Current findings suggest that assessment of sleep duration over the prior month has meaningful predictive utility for human reward-related impulsivity.