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Climacteric : the Journal of the... Dec 2020The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women.... (Review)
Review
The menopausal transition is associated with an increased frequency of sleep disturbances. Insomnia represents one of the most reported symptoms by menopausal women. According to its pathogenetic model (3-P Model), different predisposing factors (i.e. a persistent condition of past insomnia and aging per se) increase the risk of insomnia during menopause. Moreover, multiple precipitating and perpetuating factors should favor its occurrence across menopause, including hormonal changes, menopausal transition stage symptoms (i.e. hot flashes, night sweats), mood disorders, poor health and pain, other sleep disorders and circadian modifications. Thus, insomnia management implies a careful evaluation of the psychological and somatic symptoms of the individual menopausal woman by a multidisciplinary team. Therapeutic strategies encompass different drugs but also behavioral interventions. Indeed, cognitive behavioral therapy represents the first-line treatment of insomnia in the general population, regardless of the presence of mood disorders and/or vasomotor symptoms (VMS). Different antidepressants seem to improve sleep disturbances. However, when VMS are present, menopausal hormone therapy should be considered in the treatment of related insomnia taking into account the risk-benefit profile. Finally, given its good tolerability, safety, and efficacy on multiple sleep and daytime parameters, prolonged-released melatonin should represent a first-line drug in women aged ≥ 55 years.
Topics: Antidepressive Agents; Cognitive Behavioral Therapy; Female; Hormone Replacement Therapy; Humans; Melatonin; Menopause; Middle Aged; Mood Disorders; Sleep Initiation and Maintenance Disorders
PubMed: 32880197
DOI: 10.1080/13697137.2020.1799973 -
American Family Physician Dec 2015Insomnia affects 10% to 30% of the population with a total cost of $92.5 to $107.5 billion annually. Short-term, chronic, and other types of insomnia are the three major... (Review)
Review
Insomnia affects 10% to 30% of the population with a total cost of $92.5 to $107.5 billion annually. Short-term, chronic, and other types of insomnia are the three major categories according to the International Classification of Sleep Disorders, 3rd ed. The criteria for diagnosis are difficulty falling asleep, difficulty staying asleep, or early awakening despite the opportunity for sleep; symptoms must be associated with impaired daytime functioning and occur at least three times per week for at least one month. Factors associated with the onset of insomnia include a personal or family history of insomnia, easy arousability, poor self-reported health, and chronic pain. Insomnia is more common in women, especially following menopause and during late pregnancy, and in older adults. A comprehensive sleep history can confirm the diagnosis. Psychiatric and medical problems, medication use, and substance abuse should be ruled out as contributing factors. Treatment of comorbid conditions alone may not resolve insomnia. Patients with movement disorders (e.g., restless legs syndrome, periodic limb movement disorder), circadian rhythm disorders, or breathing disorders (e.g., obstructive sleep apnea) must be identified and treated appropriately. Chronic insomnia is associated with cognitive difficulties, anxiety and depression, poor work performance, decreased quality of life, and increased risk of cardiovascular disease and all-cause mortality. Insomnia can be treated with nonpharmacologic and pharmacologic therapies. Nonpharmacologic therapies include sleep hygiene, cognitive behavior therapy, relaxation therapy, multicomponent therapy, and paradoxical intention. Referral to a sleep specialist may be considered for refractory cases.
Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Cognitive Behavioral Therapy; Education, Medical, Continuing; Female; Humans; Middle Aged; Practice Guidelines as Topic; Pregnancy; Relaxation Therapy; Sleep Initiation and Maintenance Disorders; United States
PubMed: 26760592
DOI: No ID Found -
Journal of Ethnopharmacology Jan 2021Ashwagandha (Withania somnifera (L.) Dunal.) is long known for its sleep-inducing effects. Ashwagandha can be proposed as an alternative to the recommended present... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study.
ETHNOPHARMACOLOGICAL RELEVANCE
Ashwagandha (Withania somnifera (L.) Dunal.) is long known for its sleep-inducing effects. Ashwagandha can be proposed as an alternative to the recommended present treatments for insomnia. This study aimed to evaluate the pharmacological effect of Ashwagandha root extract on sleep in healthy subjects and also in the subjects having insomnia.
MATERIAL AND METHODS
We performed a randomized, parallel-group, stratified design, placebo-controlled study. A total of 80 eligible participants, 40 in Arm-A (healthy) and 40 in Arm-B (insomnia) were assigned to two groups, either Ashwagandha or placebo and studied for 8-weeks. The assessment was done based on the sleep parameters (Sleep Onset Latency, Total Sleep Time, Wake After Sleep Onset, Total time in bed, and Sleep Efficiency), Pittsburgh Sleep Quality Index and Hamilton Anxiety scale-A questionnaire, mental alertness on rising assessment, and sleep quality questionnaire. Safety and adverse events along with the concomitant medication were also assessed.
RESULTS
In both healthy and insomnia subjects, there was a significant improvement in the sleep parameters in the Ashwagandha root extract supplemented group. The improvement was found more significant in insomnia subjects than healthy subjects. Repeat measure Analysis of variance (ANOVA) confirmed the significant improvement in SOL (p 0.013), HAM-A outcomes (p < 0.05), mental alertness (p 0.01), and sleep quality (p < 0.05) of the insomnia patients. A two-way ANOVA was used to confirm the outcomes that denoted sleep onset latency (p < 0.0001) and sleep efficiency (p < 0.0001) as the most improved parameters, followed by TST (p < 0.002) and WASO(p < 0.040). All these parameters (SOL, TST, WASO, TIB, SE, PSQI, HAM-A, Mental Alertness, and Sleep quality) were also statistically assessed for the significant improvement within the group both for the treatment, and the placebo groups in the healthy and the insomnia datasets. Obtained results suggest statistically significant (p < 0.0001) changes between the baseline values and the end of the study results except for the HAM-A and the mental alertness scoresn the healthy subject group.
CONCLUSION
The present study confirms that Ashwagandha root extract can improve sleep quality and can help in managing insomnia. Ashwagandha root extract was well tolerated by all the participants irrespective of their health condition and age. Additional clinical trials are required to generalize the outcome.
Topics: Actigraphy; Adult; Double-Blind Method; Female; Healthy Volunteers; Humans; Male; Middle Aged; Plant Extracts; Plant Roots; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 32818573
DOI: 10.1016/j.jep.2020.113276 -
Journal of Consulting and Clinical... Jun 2015To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning.
METHOD
Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder-specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates.
RESULTS
During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed.
CONCLUSIONS
CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder-specific sleep diary scoring standards is highlighted.
Topics: Adult; Affect; Bipolar Disorder; Cognitive Behavioral Therapy; Female; Humans; Male; Middle Aged; Pilot Projects; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 25622197
DOI: 10.1037/a0038655 -
Sleep Feb 2017There is little information about familial aggregation of insomnia; however, this type of information is important to (1) improve our understanding of insomnia risk...
STUDY OBJECTIVES
There is little information about familial aggregation of insomnia; however, this type of information is important to (1) improve our understanding of insomnia risk factors and (2) to design more effective treatment and prevention programs. This study aimed to investigate evidence of familial aggregation of insomnia among first-degree relatives of probands with and without insomnia.
METHODS
Cases (n = 134) and controls (n = 145) enrolled in a larger epidemiological study were solicited to invite their first-degree relatives and spouses to complete a standardized sleep/insomnia survey. In total, 371 first-degree relatives (Mage = 51.9 years, SD = 18.0; 34.3% male) and 138 spouses (Mage = 55.5 years, SD = 12.2; 68.1% male) completed the survey assessing the nature, severity, and frequency of sleep disturbances. The dependent variable was insomnia in first-degree relatives and spouses. Familial aggregation was claimed if the risk of insomnia was significantly higher in the exposed (relatives of cases) compared to the unexposed cohort (relatives of controls). The risk of insomnia was also compared between spouses in the exposed (spouses of cases) and unexposed cohort (spouses of controls).
RESULTS
The risk of insomnia in exposed and unexposed biological relatives was 18.6% and 10.4%, respectively, yielding a relative risk (RR) of 1.80 (p = .04) after controlling for age and sex. The risk of insomnia in exposed and unexposed spouses was 9.1% and 4.2%, respectively; however, corresponding RR of 2.13 (p = .28) did not differ significantly.
CONCLUSIONS
Results demonstrate evidence of strong familial aggregation of insomnia. Additional research is warranted to further clarify and disentangle the relative contribution of genetic and environmental factors in insomnia.
Topics: Adult; Case-Control Studies; Cohort Studies; Family; Female; Humans; Longitudinal Studies; Male; Middle Aged; Risk Factors; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Spouses; Surveys and Questionnaires
PubMed: 28364499
DOI: 10.1093/sleep/zsw053 -
Clinical Therapeutics Apr 2022Sleep disturbance is common in primary care. The main treatment options include medication and cognitive behavioral therapy for insomnia. Best practice guidelines...
PURPOSE
Sleep disturbance is common in primary care. The main treatment options include medication and cognitive behavioral therapy for insomnia. Best practice guidelines recommend a collaborative decision-making approach to treatment. This study examined differences in insomnia treatment preferences based on demographic and clinical characteristics among primary care patients.
METHODS
A total of 200 patients (mean [SD] age, 54.92 [12.48] years) at a university medical center and community health clinic participated in brief screenings for insomnia, depression, anxiety, and insomnia treatment preference. Insomnia symptoms were measured with the Insomnia Severity Index, whereas depressive and anxiety symptoms were measured with the Patient Health Questionnaire 2 and Generalized Anxiety Disorder 2. χ analyses were performed to detect significant differences in preference between groups.
FINDINGS
A total of 46.5% of participants preferred medication and 56.0% preferred behavioral treatment (ratings not exclusionary). Preference for behavioral treatment was highest among severe insomnia presentations (15.2% preferred to 4.5% disliked; P = 0.002). Medication preference was higher among patients with elevated anxiety (57.3% preferred to 42.7% disliked; P = 0.017). Preference for behavioral treatment (66.7% preferred to 33.3% disliked; P = 0.012) and medication (56.8% preferred to 43.2% disliked; P = 0.016) was highest among those with elevated depression. Treatment preference only differed by age for behavioral treatment (P = 0.008). Preference was highest among patients ≤51 years of age (67.2% preferred to 32.8% disliked).
IMPLICATIONS
Primary care patients preferred behavioral and medication strategies for insomnia treatment. In addition, as mental health and sleep worsen, patients were more likely to prefer behavioral treatment. Knowledge of patient treatment preference may facilitate shared decision making, which increases patient satisfaction with care and engagement with treatment.
Topics: Anxiety; Cognitive Behavioral Therapy; Humans; Middle Aged; Primary Health Care; Sleep Initiation and Maintenance Disorders; Sleep Wake Disorders; Treatment Outcome
PubMed: 35361532
DOI: 10.1016/j.clinthera.2022.03.002 -
Praxis Jun 2017
Review
Topics: Adult; Age Factors; Aged; Health Status; Humans; Middle Aged; Patient Education as Topic; Polysomnography; Risk Factors; Sex Factors; Sleep Initiation and Maintenance Disorders; Sleep Stages; Switzerland
PubMed: 28635393
DOI: 10.1024/1661-8157/a002707 -
Journal of Psychiatric Research Jun 2016There are cross-sectional evidences of an association between sleep disorders and cognitive impairment on older adults. However, there are no consensus by means of... (Meta-Analysis)
Meta-Analysis Review
There are cross-sectional evidences of an association between sleep disorders and cognitive impairment on older adults. However, there are no consensus by means of longitudinal studies data on the increased risk of developing dementia related to insomnia. We conduct a systematic review and meta-analysis to evaluate the risk of incident all-cause dementia in individuals with insomnia in population-based prospective cohort studies. Five studies of 5.242 retrieved references were included in the meta-analysis. We used the generic inverse variance method with a random effects model to calculate the pooled risk of dementia in older adults with insomnia. We assessed heterogeneity in the meta-analysis by means of the Q-test and I2 index. Study quality was assessed with the Newcastle-Ottawa Scale The results showed that Insomnia was associated with a significant risk of all-cause dementia (RR = 1.53 CI95% (1.07-2.18), z = 2.36, p = 0.02). There was evidence for significant heterogeneity in the analysis (q-value = 2.4, p < 0.001 I2 = 82%). Insomnia is associated with an increased risk for dementia. This results provide evidences that future studies should investigate dementia prevention among elderly individuals through screening and proper management of insomnia.
Topics: Aged; Aged, 80 and over; Dementia; Humans; Middle Aged; Risk Factors; Sleep Initiation and Maintenance Disorders
PubMed: 27017287
DOI: 10.1016/j.jpsychires.2016.02.021 -
Psychiatry Research Jul 2023There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation...
Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study.
There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.
Topics: Middle Aged; Humans; United States; Aged; Loneliness; Sleep Initiation and Maintenance Disorders; Cohort Studies; Social Isolation; Sleep
PubMed: 37245484
DOI: 10.1016/j.psychres.2023.115266 -
Sleep & Breathing = Schlaf & Atmung Mar 2019The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We...
BACKGROUND
The relationship between insomnia and cardiorespiratory fitness (CRF), a well-established risk factor for cardiovascular disease, has not been extensively studied. We aimed to assess the independent association between insomnia and CRF in a population-based cohort of subjects aged 50 to 64 years.
METHODS
Subjects participating in the Swedish CArdioPulmonary bioImaging Study (SCAPIS) pilot cohort (n = 603, men 47.9%) underwent a submaximal cycle ergometer test for estimation of maximal oxygen consumption (VOmax). Data on physical activity and sedentary time were collected via waist-worn accelerometers. An insomnia severity index score ≥ 10 was used to define insomnia.
RESULTS
Insomnia was identified in 31.8% of the population. The VOmax was significantly lower in insomnia subjects compared with the non-insomnia group (31.2 ± 6.3 vs. 32.4 ± 6.5 ml* kg *min, p = 0.028). There was no difference in objectively assessed physical activity or time spent sedentary between the groups. In a multivariate generalized linear model adjusting for confounders, an independent association between insomnia status and lower VOmax was found in men, but not in women (β = - 1.15 [95% CI - 2.23-- 0.06] and - 0.09 [- 1.09-0.92], p = 0.038 and 0.866, respectively).
CONCLUSIONS
We found a modest, but significant, association between insomnia and lower CRF in middle-aged men, but not in women. Our results suggest that insomnia may link to cardiovascular disease via reduced CRF. Insomnia may require a specific focus in the context of health campaigns addressing CRF.
Topics: Cardiorespiratory Fitness; Cohort Studies; Correlation of Data; Cross-Sectional Studies; Exercise Test; Female; Humans; Male; Middle Aged; Oxygen; Pilot Projects; Risk Factors; Sex Factors; Sleep Initiation and Maintenance Disorders
PubMed: 30547350
DOI: 10.1007/s11325-018-1765-9