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Schizophrenia Research Mar 2009Insomnia is a potential cause of anxiety, depression, and anomalies of experience; separate research has shown that anxiety, depression and anomalies of experience are...
Insomnia is a potential cause of anxiety, depression, and anomalies of experience; separate research has shown that anxiety, depression and anomalies of experience are predictors of paranoia. Thus insomnia may contribute to the formation and maintenance of persecutory ideation. The aim was to examine for the first time the association of insomnia symptoms and paranoia in the general population and the extent of insomnia in individuals with persecutory delusions attending psychiatric services. Assessments of insomnia, persecutory ideation, anxiety, and depression were completed by 300 individuals from the general population and 30 individuals with persecutory delusions and a diagnosis of non-affective psychosis. Insomnia symptoms were clearly associated with higher levels of persecutory ideation. Consistent with the theoretical understanding of paranoia, the association was partly explained by the presence of anxiety and depression. Moderate or severe insomnia was present in more than 50% of the delusions group. The study provides the first direct evidence that insomnia is common in individuals with high levels of paranoia. It is plausible that sleep difficulties contribute to the development of persecutory ideation. The intriguing implication is that insomnia interventions for this group could have the added benefit of lessening paranoia.
Topics: Adult; Anxiety; Depression; Female; Humans; Male; Middle Aged; Paranoid Disorders; Psychiatric Status Rating Scales; Residence Characteristics; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires
PubMed: 19097752
DOI: 10.1016/j.schres.2008.12.001 -
Sleep Jan 2020To assess whether perceived racial discrimination is associated with insomnia among Black women.
STUDY OBJECTIVE
To assess whether perceived racial discrimination is associated with insomnia among Black women.
METHODS
Data on everyday and lifetime racism and insomnia symptoms were collected from questionnaires administered in the Black Women's Health Study, an ongoing prospective cohort of Black women recruited in 1995 from across the United States. In 2009, participants completed five questions on the frequency of discriminatory practices in daily life (everyday racism) and six questions on ever experiencing unfair treatment in key institutional contexts (lifetime racism). In 2015, the Insomnia Severity Index was used to assess insomnia symptoms. We estimated odds ratios and 95% confidence intervals for associations of racism with insomnia, using multivariable logistic regression models adjusted for potential confounders.
RESULTS
The 26 139 participants in the analytic sample were 40-90 years old (median = 57 years, SD = 9.6 years). Higher levels of everyday racism and lifetime racism were positively associated with subthreshold (ptrend < .01) and clinical insomnia (ptrend < .01). Results remained unchanged after further adjustment for sleep duration and shift work.
CONCLUSIONS
Higher levels of perceived racism were associated with increased odds of insomnia among middle-aged and elderly Black women. Thus, perceived racism may contribute to multiple racial health disparities resulting from insomnia. Helping minority populations cope with their experiences of discrimination may decrease the significant public health impact of sleep disruption and subsequent diagnoses.
Topics: Adult; Black or African American; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Prospective Studies; Racism; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires; United States; Women's Health
PubMed: 31555803
DOI: 10.1093/sleep/zsz208 -
Sleep Sep 2011To estimate the prevalence and associations of broadly defined (i.e., meeting full ICD-10, DSM-IV, or RDC/ICSD-2 inclusion criteria) insomnia with work performance net...
STUDY OBJECTIVES
To estimate the prevalence and associations of broadly defined (i.e., meeting full ICD-10, DSM-IV, or RDC/ICSD-2 inclusion criteria) insomnia with work performance net of comorbid conditions in the America Insomnia Survey (AIS).
DESIGN/SETTING
Cross-sectional telephone survey.
PARTICIPANTS
National sample of 7,428 employed health plan subscribers (ages 18+).
INTERVENTIONS
None.
MEASUREMENTS AND RESULTS
Broadly defined insomnia was assessed with the Brief Insomnia Questionnaire (BIQ). Work absenteeism and presenteeism (low on-the-job work performance defined in the metric of lost workday equivalents) were assessed with the WHO Health and Work Performance Questionnaire (HPQ). Regression analysis examined associations between insomnia and HPQ scores controlling 26 comorbid conditions based on self-report and medical/pharmacy claims records. The estimated prevalence of insomnia was 23.2%. Insomnia was significantly associated with lost work performance due to presenteeism (χ² (1) = 39.5, P < 0.001) but not absenteeism (χ² (1) = 3.2, P = 0.07), with an annualized individual-level association of insomnia with presenteeism equivalent to 11.3 days of lost work performance. This estimate decreased to 7.8 days when controls were introduced for comorbid conditions. The individual-level human capital value of this net estimate was $2,280. If we provisionally assume these estimates generalize to the total US workforce, they are equivalent to annualized population-level estimates of 252.7 days and $63.2 billion.
CONCLUSIONS
Insomnia is associated with substantial workplace costs. Although experimental studies suggest some of these costs could be recovered with insomnia disease management programs, effectiveness trials are needed to obtain precise estimates of return-on-investment of such interventions from the employer perspective.
Topics: Absenteeism; Adult; Cost of Illness; Cross-Sectional Studies; Employee Performance Appraisal; Employment; Female; Health Surveys; Humans; Male; Middle Aged; Sleep Initiation and Maintenance Disorders; United States; Young Adult
PubMed: 21886353
DOI: 10.5665/SLEEP.1230 -
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 -
Journal of Gerontological Nursing Nov 2022The purpose of the current study was to describe the experiences of middle-aged and older adults with chronic insomnia. A descriptive qualitative study design was used,...
The purpose of the current study was to describe the experiences of middle-aged and older adults with chronic insomnia. A descriptive qualitative study design was used, and semi-structured interviews were conducted with 17 participants from two primary clinic health centers in northern Taiwan. Mean age of participants was 64.3 years, most (58.8%) participants were middle aged (aged 40 to 64 years), and mean duration of insomnia was 5.6 years. Three themes emerged: , , and . Participants believed chronic insomnia contributed to an accumulation of anxiety and negative emotions, resulting in psychological burden. For participants with insomnia, because of their negative impressions of hypnotics, they usually sought alternative therapies to improve sleep. Health care providers should endeavor to understand the needs of individuals with insomnia and provide them with sleep hygiene knowledge and assistance in safe sleep practices. [(11), 21-28.].
Topics: Humans; Middle Aged; Aged; Sleep Initiation and Maintenance Disorders; Hypnotics and Sedatives; Sleep; Qualitative Research; Asian People
PubMed: 36286506
DOI: 10.3928/00989134-20221003-06 -
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 -
BMC Endocrine Disorders Sep 2022Epidemiological evidence suggests that inadequate sleep duration and insomnia may be associated with increased risk of metabolic syndrome (MetS). However, longitudinal...
BACKGROUND
Epidemiological evidence suggests that inadequate sleep duration and insomnia may be associated with increased risk of metabolic syndrome (MetS). However, longitudinal data with repeated measures of sleep duration and insomnia and of MetS are limited. We examined the association of sleep duration and insomnia with MetS and its components using longitudinal data from the Women's Health Initiative (WHI).
METHODS
The study included postmenopausal women (ages 50-79 years) diabetes-free at enrollment in the WHI, with baseline data on sleep duration (n = 5,159), insomnia (n = 5,063), MetS, and its components. Repeated measures of self-reported sleep duration and insomnia were available from years 1 or 3 of follow-up and of the MetS components from years 3, 6 and 9. Associations were assessed using logistic regression and generalized estimating equations models, and odds ratios and 95% confidence intervals (CI) adjusted for major risk factors were calculated.
RESULTS
In cross-sectional analysis, baseline sleep duration ≥ 9 h was positively associated with MetS (OR = 1.51; 95%CI 1.12-2.04), while sleep duration of 8- < 9 h was associated with waist circumference > 88 cm and triglycerides ≥ 150 mg/dL (OR = 1.18; 95%CI 1.01-1.40 and OR = 1.23; 95%CI 1.05-1.46, respectively). Insomnia had a borderline positive association with MetS (OR = 1.14; 95%CI 0.99-1.31), and significant positive associations with waist circumference > 88 cm and glucose ≥ 100 mg/dL (OR = 1.18; 95%CI 1.03-1.34 and OR = 1.17; 95%CI 1.02-1.35, respectively). In the longitudinal analysis, change from restful sleep to insomnia over time was associated with increased odds of developing MetS (OR = 1.40; 95%CI 1.01-1.94), and of a triglyceride level ≥ 150 mg/dL (OR = 1.48; 95%CI 1.08-2.03).
CONCLUSIONS
Among postmenopausal women in the WHI, sleep duration and insomnia were associated with current and future risk of MetS and some of its components.
Topics: Aged; Cross-Sectional Studies; Female; Humans; Metabolic Syndrome; Middle Aged; Sleep; Sleep Initiation and Maintenance Disorders; Women's Health
PubMed: 36104689
DOI: 10.1186/s12902-022-01138-9 -
BMC Complementary and Alternative... Jul 2016Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke. The aim of the present study was to... (Review)
Review
BACKGROUND
Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke. The aim of the present study was to summarize and evaluate evidence on the effectiveness of acupuncture in relieving insomnia after stroke.
METHODS
Seven databases were searched from inception through October 2014 without language restrictions. Randomized controlled trials (RCTs) were included if acupuncture was compared to placebo or other conventional therapy for treatment of insomnia after stroke. Assessments were performed using the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI), the Athens insomnia scale (AIS), and the efficacy standards of Chinese medicine.
RESULTS
A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI (weighted mean difference, 4.31; 95 % confidence interval [CI], 1.67-6.95; P = 0.001) and by the efficacy standards of Chinese medicine (risk ratio, 1.25; 95 % CI, 1.12-1.40; P < 0.001). Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI (weighted mean difference, 4.44; 95 % CI, 2.75-6.13; P < 0.001) and the AIS (weighted mean difference, 3.64; 95 % CI, 2.28-5.00; P < 0.001).
CONCLUSIONS
Our results suggest that acupuncture could be effective for treating insomnia after stroke. However, further studies are needed to confirm the role of acupuncture in the treatment of this disorder.
Topics: Acupuncture Therapy; Aged; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Sleep Initiation and Maintenance Disorders; Stroke
PubMed: 27430619
DOI: 10.1186/s12906-016-1220-z -
BMC Psychiatry Sep 2022The objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as...
BACKGROUND
The objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as well as to calculate a cutoff score for the HAS-J and assess different levels of hyperarousal in insomnia patients and community dwellers.
METHODS
We recruited 224 outpatients receiving insomnia treatment (56.3% women; mean age 51.7 ± 15.6 years) and 303 community dwellers aged 20 years or older (57.8% women; mean age 43.9 ± 15.2 years). Exploratory and confirmatory factor analysis was performed to examine the factor structure of the HAS-J. Cronbach's α and McDonald's ω were then used to test internal consistency. To examine the scale's validity, we determined correlations between the HAS-J and other indexes and compared HAS-J scores between insomnia patients and community dwellers. We also compared HAS-J scores between two community-dweller groups (normal and poor sleepers) and two insomnia patient groups (with and without alleviation after treatment).
RESULTS
Following exploratory and confirmatory factor analysis, a 20-item measure emerged comprising three factors: "Introspectiveness and Reactivity," "Neuroticism," and "Insomnia." Confirmatory factor analysis showed a generally good fit for the model of the three-factor structure suggested by the exploratory factor analysis loadings (χ (163) = 327.423, (p < 0.001), CFI = 0.914, GFI = 0.872, AGFI = 0.835, RMSEA = 0.067). In insomnia patients, internal consistency indicated sufficient reliability of the HAS-J. Correlation analysis showed weak to moderate positive correlations of the HAS-J score with other indexes, indicating concurrent validity of the HAS-J. All HAS-J subscale scores were significantly higher in insomnia patients than in community dwellers. Additionally, the total score in patients with alleviation of insomnia was comparable to that in poor sleepers and significantly higher than that in normal sleepers.
CONCLUSIONS
This study demonstrated the reliability and validity of the HAS-J, indicating that it is useful as a clinical scale of hyperarousal. The high level of hyperarousal in insomnia patients who were assessed to be in remission by the Insomnia Severity Index suggests a risk of insomnia recurrence in these patients.
Topics: Adult; Aged; Arousal; Female; Humans; Japan; Male; Middle Aged; Psychometrics; Reproducibility of Results; Sleep Initiation and Maintenance Disorders
PubMed: 36123639
DOI: 10.1186/s12888-022-04243-0 -
The American Journal of Managed Care Feb 2009Changing sleep architecture in the elderly may increase their vulnerability to comorbid insomnia. Common comorbid conditions include chronic pain, depression, nocturia,... (Review)
Review
Changing sleep architecture in the elderly may increase their vulnerability to comorbid insomnia. Common comorbid conditions include chronic pain, depression, nocturia, and neurologic conditions such as Parkinson's and Alzheimer's disease. Diagnosing and treating comorbid insomnia in an older population poses special challenges for clinicians given the variety of coexisting medical and psychological conditions, polypharmacy, and the potential adverse effects of the most commonly used medications for insomnia in this population. Thus, the use of nonpharmacologic treatments, such as cognitive behavior therapy and relaxation techniques, is recommended before any medical approaches.
Topics: Aged; Clinical Trials as Topic; Comorbidity; Humans; Middle Aged; Quality of Life; Risk Factors; Sleep Initiation and Maintenance Disorders
PubMed: 19298102
DOI: No ID Found