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Journal of Sleep Research Apr 2022Insomnia is the most frequent sleep disorder, and the COVID-19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct...
Smartphone-based virtual agents and insomnia management: A proof-of-concept study for new methods of autonomous screening and management of insomnia symptoms in the general population.
Insomnia is the most frequent sleep disorder, and the COVID-19 crisis has massively increased its prevalence in the population, due to psychosocial stress or direct viral contamination. KANOPEE_2 is a smartphone-based application that provides interactions with a virtual agent to autonomously screen and alleviate insomnia symptoms through an intervention programme giving personalized advices regarding sleep hygiene, relaxation techniques and stimulus-control. In this proof-of-concept study, we tested the effects of KANOPEE_2 among users from all over the country (France) who downloaded the app between 1 June and 26 October 2020 (to focus on effects after the end of COVID-19 confinement). Outcome measures include insomnia severity (Insomnia Severity Index) and sleep/wake schedules measured by a sleep diary. One-thousand and thirty-four users answered the screening interview (M = 43.76 years; SD = 13.14), and 108 completed the two-step programme (M = 46.64 years; SD = 13.63). Of those who answered the screening, 42.8% did not report sleep complaints, while 57.2% presented mild-to-severe insomnia symptoms. At the end of the intervention, users reported significantly fewer sleep complaints compared with the beginning of the intervention (Insomnia Severity Index = 13.58; Insomnia Severity Index = 11.30; p < 0.001), and significantly increased their sleep efficiency (sleep efficiency = 76.46%; sleep efficiency = 80.17%; p = 0.013). KANOPEE_2 is a promising solution both to provide autonomous evaluation of individuals' sleep hygiene and reduce insomnia symptoms over a brief and simple intervention. These results are very encouraging for addressing the issue of insomnia management in people exposed to major psychosocial stress and the consequences of COVID-19 infection.
Topics: Adult; COVID-19; Humans; Middle Aged; Mobile Applications; SARS-CoV-2; Sleep Initiation and Maintenance Disorders; Smartphone; Treatment Outcome
PubMed: 34535942
DOI: 10.1111/jsr.13489 -
Renal Failure 2016Restless legs syndrome (RLS) is a common neurological movement disorder which is commonly seen in hemodialysis (HD) patients. Insomnia, depression, and anxiety disorders...
AIM/BACKGROUND
Restless legs syndrome (RLS) is a common neurological movement disorder which is commonly seen in hemodialysis (HD) patients. Insomnia, depression, and anxiety disorders frequently show concurrence. In this study, we aimed to investigate RLS and insomnia prevalence and related factors in HD patients.
SUBJECTS AND METHODS
Patients who were under HD treatment and healthy controls with similar mean age, sex ratio, and hypertension and diabetes mellitus frequency were included in this study. Depression, insomnia, and daytime sleepiness assessments were performed by using Beck Depression Inventory, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of RLS was made using the International RLS Study Group consensus criteria.
RESULTS
About 156 HD patients and 35 controls were enrolled. The mean age was 50.6 in the HD group and 49.7 in the control group. Female sex was 43.9% in the HD group and 57.1% in the control group. RLS was significantly more frequent in HD patients compared with controls. The rate of sub-threshold insomnia and insomnia with moderate severity was higher in HD patients. While insomnia severity score and diabetes mellitus were significantly associated with the presence of RLS, depression, RLS, older age, and being under HD treatment were independently associated with insomnia severity.
CONCLUSIONS
HD patients commonly have RLS and insomnia. Insomnia and diabetes mellitus seem to be major factors underlying RLS in HD patients. Furthermore, depression and RLS seem to be closely related to insomnia in these patients. Treatment of depression, insomnia, and RLS may be beneficial to improve quality of life in HD patients.
Topics: Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Prevalence; Renal Dialysis; Restless Legs Syndrome; Sleep Initiation and Maintenance Disorders
PubMed: 26554439
DOI: 10.3109/0886022X.2015.1111118 -
Journal of Psychiatric Research Oct 2019Although fatigue is common in insomnia, the clinical associates of fatigue in patients with insomnia are largely unknown. We aimed to investigate the clinical associates...
Although fatigue is common in insomnia, the clinical associates of fatigue in patients with insomnia are largely unknown. We aimed to investigate the clinical associates of fatigue in patients with insomnia. Patients visiting the Stanford Sleep Medicine Center completed the Insomnia Severity Index (ISI), Insomnia Symptom Questionnaire (ISQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). Among 6367 patients, 2024 were diagnosed with insomnia (age 43.06 ± 15.19 years; 1110 women and 914 men) according to the ISI and the ISQ. Insomnia patients with severe fatigue (n = 1306) showed higher insomnia symptoms, daytime sleepiness, depression and longer habitual sleep duration than those without severe fatigue (n = 718). Higher insomnia symptoms, daytime sleepiness and depressive symptoms, and longer habitual sleep duration, independently predicted higher fatigue scores. Among insomnia patients with daytime sleepiness (ESS≥10), only habitual sleep duration and depression predicted fatigue scores. The interaction between insomnia severity and daytime sleepiness significantly predicted the severity of fatigue. Depression was a significant mediator between insomnia and fatigue. For 598 insomnia patients undergoing overnight polysomnography (PSG), no significant correlations were found between fatigue and any PSG parameters. The current study suggests that managing insomnia or depression may reduce the fatigue of insomnia patients, whereas arbitrary efforts to prolong sleep duration may worsen their fatigue.
Topics: Adult; Depression; Fatigue; Female; Humans; Male; Middle Aged; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Sleepiness
PubMed: 31272015
DOI: 10.1016/j.jpsychires.2019.06.021 -
Journal of Psychosomatic Research Feb 2017The individual occurrence of depression or insomnia is a risk factor for irritable bowel syndrome (IBS), but few researchers have evaluated the association between...
OBJECTIVE
The individual occurrence of depression or insomnia is a risk factor for irritable bowel syndrome (IBS), but few researchers have evaluated the association between comorbid depression and insomnia and IBS. The aim of the present study is to explore the relationship between IBS and the coexistence of depression and insomnia in a Korean population-based cohort study.
METHODS
A total of 3429 individuals who were enrolled in the Korean Genome and Epidemiology Study were analysed. Of the participants, 10.9% (n=374) were diagnosed with IBS based on the Rome II criteria. Regarding depressive symptoms, subjects were sub-divided into three groups based on the Beck Depression Inventory (BDI) score. Insomnia was defined as a positive response to at least one of three questions on sleep states.
RESULTS
The odds ratio (OR) of IBS increased proportionally as depressive symptoms worsened (OR: 1.64; 95% CI: 1.21-2.23 in middle tertile and OR: 2.61; 95% CI: 1.92-3.55 in highest tertile). Subjects with insomnia showed a higher OR of IBS than those without insomnia (OR: 1.81; 95% CI: 1.44-2.27). In the joint analysis of BDI and insomnia, the odds for IBS were significantly higher in all BDI tertiles with insomnia than in the corresponding BDI tertiles without insomnia. There was no significant interaction effect of BDI tertile and insomnia on IBS.
CONCLUSION
The presence of both depression and insomnia is significantly associated with IBS compared to each individual occurrence. Further prospective investigations are needed to explore possible causality between comorbid depression and insomnia and IBS.
Topics: Adult; Aged; Cohort Studies; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Female; Humans; Irritable Bowel Syndrome; Male; Middle Aged; Personality Inventory; Psychometrics; Republic of Korea; Risk Factors; Sleep Initiation and Maintenance Disorders; Statistics as Topic
PubMed: 28107884
DOI: 10.1016/j.jpsychores.2016.12.007 -
Sleep Dec 2017We aimed to identify the prevalence of circadian phase and phase angle abnormalities in patients with insomnia.
OBJECTIVES
We aimed to identify the prevalence of circadian phase and phase angle abnormalities in patients with insomnia.
METHODS
We conducted a cross-sectional, multicenter study at three sleep laboratories in the United States and Australia. Patients with insomnia and healthy control participants completed a sleep log for 7 days. Circadian phase was assessed from salivary dim light melatonin onset (DLMO) time during a 12-hour laboratory visit.
RESULTS
Seventy-nine patients meeting the Research Diagnostic Criteria for Primary, Psychophysiological, Paradoxical, and/or Idiopathic Childhood Insomnia (46 females, 35.5 ± 12.3 years [M ± SD]) and 21 controls (14 females, 34.4 ± 11.8 years). As compared to controls, patients with insomnia tried to initiate sleep on average at the same clock time (24:17 ± 1:17 hours vs. 24:13 ± 1:30 hours, respectively; p = .84) but had a later average DLMO times (20:56 ± 1:55 hours, 18:17-01:21 vs. 22:02 ± 2:02 hours, 17:11-04:52, respectively; p = .04). Consequently, patients with insomnia slept at an earlier circadian phase than controls (phase angle, bedtime-DLMO 2:13 hours (± 1:43) vs. 3:10 hours (± 1:08), respectively; p = .008), of whom 10% tried to sleep at or before DLMO (compared to 0 controls), and 22% tried to sleep before or within 1 hour after DLMO (compared to 6% of controls).
CONCLUSIONS
A substantial proportion (10%-22%) of patients with insomnia initiate sleep at too early a circadian phase, implicating a circadian etiology for their insomnia. Outpatient circadian phase assessments should be considered to improve differential diagnoses in insomnia and to inform the development of appropriately timed circadian-based treatments.
Topics: Adult; Australia; Child; Circadian Rhythm; Cross-Sectional Studies; Female; Humans; Male; Melatonin; Middle Aged; Saliva; Sleep; Sleep Disorders, Circadian Rhythm; Sleep Initiation and Maintenance Disorders; United States
PubMed: 29029340
DOI: 10.1093/sleep/zsx163 -
International Journal of Audiology Apr 2019To assess the relationship between the loudness of tinnitus and insomnia via a mediation analysis.
OBJECTIVE
To assess the relationship between the loudness of tinnitus and insomnia via a mediation analysis.
DESIGN
Retrospective cross-sectional.
STUDY SAMPLE
417 consecutive patients seeking treatment for tinnitus in an Audiology Department in the UK.
RESULTS
Mediation analysis showed that the relationship between tinnitus loudness measured using the visual analogue scale (VAS) and insomnia measured using the insomnia severity index was fully mediated via depression measured using the Patient Health Questionnaire, tinnitus handicap measured using the Tinnitus Handicap Inventory and tinnitus annoyance measured using the VAS. The regression coefficients for the indirect effects of tinnitus loudness on insomnia were: via depression b = 0.53 (95% confidence interval, CI: 0.35-0.71); via the VAS for tinnitus annoyance, b = 0.33 (95% CI: -0.004-0.66); and via tinnitus handicap, b = 0.38 (95% CI: 0.16-0.6). The coefficient for the total indirect effect was b = 1.23 (95% CI: 0.89-1.58). The coefficient for the direct effect of tinnitus loudness on insomnia was b = 0.11 (95% CI: -0.27-0.51), a non-significant effect.
CONCLUSIONS
Insomnia is not directly related to tinnitus loudness. Depression, tinnitus handicap and tinnitus annoyance mediate the relationship between tinnitus loudness and insomnia.
Topics: Adult; Aged; Cross-Sectional Studies; Depression; Disability Evaluation; Female; Hearing; Humans; Irritable Mood; Loudness Perception; Male; Middle Aged; Patient Health Questionnaire; Retrospective Studies; Risk Factors; Severity of Illness Index; Sleep; Sleep Initiation and Maintenance Disorders; Tinnitus
PubMed: 30628492
DOI: 10.1080/14992027.2018.1537524 -
Scientific Reports Dec 2021Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power...
Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient; SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient; NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep; NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD (p = 0.03), with a trend observed for NSDD (p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.
Topics: Adult; Anxiety; Case-Control Studies; Depression; Female; Humans; Male; Middle Aged; Sleep Deprivation; Sleep Initiation and Maintenance Disorders; Sleep Stages; Stress, Psychological; Time Factors
PubMed: 34934082
DOI: 10.1038/s41598-021-03564-6 -
Archives of Gerontology and Geriatrics 2017Insomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been...
BACKGROUND
Insomnia is known to be associated with psychiatric disorders, other sleep disorders and medical conditions, but the prevalence of insomnia diagnosis has never been estimated according to its subtypes. We studied the prevalence and clinical characteristics of insomnia diagnosis and its subtypes in the Korean elderly population.
METHODS
Among 1423 sampled elderly individuals aged 60 years or older, 881 subjects participated in this study. The Athens Insomnia Scale was applied to detect insomnia symptoms, and insomnia diagnosis was finally evaluated using the international classification of sleep disorders, 2nd edition. To define insomnia subtypes, the DSM-IV-based interview, detailed history on sleep disorders and semi-structured interview for medical conditions were performed. Subsyndromal depression was defined when depressive symptoms did not meet the criteria for depressive disorders.
RESULTS
The prevalence of insomnia disorder was 32.8% in all subjects, with the prevalence being significantly higher in women than in men (37.9% vs. 25.2%; p<0.001). The prevalence of insomnia subtypes was as follows; psychophysiological insomnia (PI), 20.5%; insomnia due to mental disorder 7.2%; insomnia due to general medical conditions 2.9%; insomnia in other sleep disorders 2.2%, and insomnia due to substance use 0.2%. Among subjects with PI, subsyndromal depression was diagnosed in 53.7%.
CONCLUSIONS
Nearly one third of Korean elderly individuals suffer from insomnia and insomnia patients showed diverse comorbid conditions, especially depressive symptoms. By establishing insomnia subtypes, we can plan to treat comorbid conditions as well as insomnia itself.
Topics: Aged; Aged, 80 and over; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Middle Aged; Prevalence; Psychiatric Status Rating Scales; Republic of Korea; Risk Factors; Sleep Initiation and Maintenance Disorders
PubMed: 27665575
DOI: 10.1016/j.archger.2016.09.005 -
Menopause (New York, N.Y.) Jul 2019Given the neurocognitive hyperarousal observed in patients with insomnia disorder and associations of nocturnal hot flashes with cardiovascular disease risk, we examined...
OBJECTIVES
Given the neurocognitive hyperarousal observed in patients with insomnia disorder and associations of nocturnal hot flashes with cardiovascular disease risk, we examined whether women with hot flash-associated insomnia disorder demonstrate exaggerated cardiovascular responsivity to acute stressors, and also a profile of psychological hyperarousal.
METHODS
Peri and postmenopausal women with and without hot flash-associated insomnia disorder underwent assessments of cardiovascular autonomic responsivity to acute stress paradigms and psychological hyperarousal. Hemodynamic responses (heart rate, blood pressure) to nociceptive, social-evaluative, and cognitive stress paradigms were measured in the morning. Psychological hyperarousal was evaluated using questionnaires assessing daytime and presleep hyperarousal, anxiety, and sleep-related cognitions.
RESULTS
Women (25 with and 15 without hot flash-associated insomnia) aged 53.4 ± 4.8 years reported a range of insomnia symptoms. Resting-state hemodynamics were similar between groups. Heart rate and blood pressure responses to stress paradigms did not differ by group nor did they correlate with insomnia severity. Women with insomnia disorder had higher generalized anxiety disorder scores (mean 2.7 ± 3.0 vs 1.0 ± 1.4; P = 0.05) and sleep-related cognitions than those without insomnia (P ≤ 0.05). Insomnia symptom severity was moderately correlated with presleep and daytime hyperarousal, anxiety, and sleep-related cognition (all r ≥ 0.43).
CONCLUSIONS
Though hot flash-associated insomnia is characterized by psychological hyperarousal before sleep and during the daytime, it does not relate to cardiovascular responsiveness to acute stressors. Our findings do not support the hypothesis that altered cardiovascular control is a potential mechanism by which hot flash-associated insomnia confers higher cardiovascular disease risk.
Topics: Aged; Anxiety Disorders; Arousal; Blood Pressure; Cardiovascular Diseases; Cardiovascular System; Cognition; Female; Heart Rate; Hot Flashes; Humans; Menopause; Middle Aged; Risk Factors; Sleep; Sleep Arousal Disorders; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires
PubMed: 30672883
DOI: 10.1097/GME.0000000000001298 -
Behavioral Sleep Medicine 2020: Poor sleep has been shown to have multiple negative outcomes during adolescence, in both academic and mental health domains. Several studies have identified the...
: Poor sleep has been shown to have multiple negative outcomes during adolescence, in both academic and mental health domains. Several studies have identified the association between poor sleep and suicide risk in adolescents. However, onset of and engagement in nonsuicidal self-injury (NSSI) is also common in this age group, but this behavior has rarely been studied in association with sleep in adolescent samples. In the current study, it was expected that poorer sleep and more symptoms of insomnia would associate with a greater likelihood of recent NSSI engagement and greater NSSI severity. : Data were collected from 387 community adolescents (mean age = 14.19, = 1.08), 9% of whom reported NSSI in the past 6 months. The gender breakdown was about even (52% female) and the majority of the sample was White (88.5%). : Adolescent participants were recruited from middle and high schools for a study on mental health and risk behaviors. Researchers visited schools and administered self-report questionnaires to students in large groups. Measures assessed NSSI engagement and severity features, overall sleep quality, and insomnia symptoms. : Results indicated that greater insomnia symptoms, but not overall sleep quality, were significantly associated with greater likelihood of recent NSSI engagement. Sleep variables were not significantly associated with NSSI severity among adolescents with recent NSSI. : Insomnia symptoms seem to be associated with recent engagement in NSSI. Adolescents who report symptoms of insomnia should also be assessed for self-harm behavior.
Topics: Adolescent; Adolescent Behavior; Female; Humans; Male; Risk-Taking; Self-Injurious Behavior; Sleep Initiation and Maintenance Disorders
PubMed: 30472890
DOI: 10.1080/15402002.2018.1545652