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Journal of Sleep Research Aug 2015Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was...
Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1-night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression.
Topics: Cohort Studies; Depression; Female; Humans; Incidence; Male; Middle Aged; Odds Ratio; Pennsylvania; Personality; Polysomnography; Sleep; Sleep Initiation and Maintenance Disorders; Time Factors
PubMed: 25728794
DOI: 10.1111/jsr.12285 -
Chest Feb 2013Chronic insomnia (symptoms for ≥ 6 months) is the most common sleep disorder, affecting 6% to 10% of adults in the general population, with even higher rates in... (Review)
Review
Chronic insomnia (symptoms for ≥ 6 months) is the most common sleep disorder, affecting 6% to 10% of adults in the general population, with even higher rates in patients with comorbid conditions (eg, hypertension, 44%; cardiac disease, 44.1%; breathing problems, 41.5%). Traditionally, chronic insomnia occurring with another condition has been considered secondary and rarely received direct treatment because treatment of the primary condition was expected to improve the insomnia. However, this approach often failed because chronic insomnia is maintained by behaviors, cognitions, and associations that patients adopt as they attempt to cope with poor sleep but that end up backfiring (eg, increasing caffeine, spending more time in bed, trying harder to sleep). Cognitive behavioral treatment of insomnia (CBTi) targets those behaviors, cognitions, and associations and is effective across a variety of populations, including those with medical and psychologic comorbidities. Thus, in 2005, a National Institutes of Health expert consensus panel on chronic insomnia recommended dropping the term "secondary insomnia" in favor of the term "comorbid insomnia." Because CBTi does not carry the risks associated with some sleep medications (eg, dependency, polypharmacy, cognitive and psychomotor impairment), it is an attractive option for patients with other conditions. Through the Society of Behavioral Sleep Medicine (www.behavioralsleep.org) and the American Board of Sleep Medicine (www.absm.org), it is possible to find practitioners with expertise in CBTi (as well as other aspects of behavioral sleep medicine) and other behavioral sleep resources. Given the currently limited number of trained practitioners, exploration of alternative delivery methods (eg, briefer protocols, self-help, Internet) to improve access to this highly effective treatment and expanded training in these treatments are warranted.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cognitive Behavioral Therapy; Comorbidity; Female; Heart Diseases; Humans; Hypertension; Lung Diseases; Male; Middle Aged; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Young Adult
PubMed: 23381322
DOI: 10.1378/chest.12-0731 -
Journal of Clinical Sleep Medicine :... Feb 2022To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and...
STUDY OBJECTIVES
To identify the association between insomnia symptoms and signs of prodromal neurodegeneration, including an analysis of potential differences between sleep-onset and sleep-maintenance insomnia.
METHODS
We included those aged 45-85 years, living in 1 of 10 Canadian provinces between 2012 and 2015 (at the baseline), recruited via 3 population-based sampling methods. Insomnia symptoms were assessed using questions adapted/modified from the Pittsburgh Sleep Quality Index. A panel of potential prodromal neurodegenerative markers including self-reported symptoms and objective gait motor, cognitive, and autonomic variables were assessed cross sectionally. We compared those who endorsed insomnia symptoms ≥ 3 times per week to controls, adjusting for age, sex, and education via logistic regression.
RESULTS
Overall, 2,051/30,097 people screened positive for sleep-onset insomnia alone and 4,333 for sleep-maintenance insomnia alone, while 2,371 endorsed both subtypes. On objective gait tests, participants with sleep-onset insomnia, but not sleep-maintenance insomnia, had worse balance (odds ratio [OR] = 1.33, 95% confidence interval = [1.16, 1.52]) and slower gait speed (OR = 1.52 [1.34, 1.73]). Although participants with any insomnia subtype endorsed more motor symptoms, these were more severe in those with sleep-onset insomnia (OR onset vs maintenance = 1.13 [1.07, 1.18]). On objective cognitive tests, those with sleep-maintenance insomnia scored normally. However, participants with sleep-onset insomnia performed worse on tests of verbal fluency (OR = 1.24 [1.06, 1.43]), immediate memory (OR = 1.23 [1.08, 1.41]), and prospective memory task (OR = 1.29 [1.11, 1.50]). The sleep-onset insomnia group also had lower heart rate variability (OR = 1.23 [1.07, 1.43]). Secondary analyses found generally similar results in young vs older age of insomnia development.
CONCLUSIONS
Compared to maintenance insomnia, those with sleep-onset insomnia have more motor, cognitive, and autonomic signs/symptoms. When evaluating neurodegenerative risk, differentiating insomnia subtypes may increase precision.
CITATION
Yao CW, Pelletier A, Fereshtehnejad S-M, Cross N, Dang-Vu T, Postuma RB. Insomnia symptom subtypes and manifestations of prodromal neurodegeneration: a population-based study in the Canadian Longitudinal Study on Aging. . 2022;18(2):345-359.
Topics: Aged; Aged, 80 and over; Aging; Canada; Humans; Longitudinal Studies; Middle Aged; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 34314348
DOI: 10.5664/jcsm.9562 -
Drug and Alcohol Dependence Oct 2020Although insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and...
BACKGROUND
Although insomnia is highly prevalent in alcohol use disorders(AUD), its associations with the severity of alcohol use, pre-existing psychiatric comorbidities and psychosocial problems are understudied. The present study evaluates the interplay between these factors using a structural equation model (SEM).
METHODS
We assessed baseline cross-sectional data on patients with AUD (N = 123) recruited to a placebo-controlled medication trial. Severity of alcohol use was measured by the Brief Michigan Alcoholism Screening Test (B-MAST). Insomnia Severity Index was used to assess insomnia symptoms. The Hamilton scales for Depression and Anxiety, Short Index of Problems and Timeline Follow Back evaluated psychiatric symptoms, psychosocial consequences of drinking and level of alcohol consumption respectively. We used logistic regression to evaluate the association between insomnia and severity of alcohol use while controlling for covariates. We constructed a SEM with observed variables to delineate the effect of psychiatric symptoms, psychosocial factors and current alcohol use on the pathway between alcohol use severity and insomnia.
RESULTS
The sample was predominately male(83.9 %), Black(54.6 %) and employed(60.0 %). About 45 % of the participants reported moderate-severe insomnia.The association between insomnia and B-MAST attenuated after adjustment for demographics, psychiatric symptoms and psychosocial problems(OR[95 % CI] = 1.17(0.99-1.47). SEM findings demonstrated that B-MAST and insomnia were linked to psychiatric symptoms (95 % Asymptotic-Confidence Interval (ACI): 0.015-0.159, p < 0.05) but not to psychosocial problems or current alcohol use.
CONCLUSION
Among treatment-seeking patients with AUD, psychiatric burden mediated the relationship between severity of alcohol use and insomnia. Clinicians should screen for underlying psychiatric disorders among treatment-seeking patients with AUD complaining of insomnia.
Topics: Adult; Alcohol Drinking; Alcoholism; Anxiety; Comorbidity; Cross-Sectional Studies; Female; Humans; Logistic Models; Male; Middle Aged; Prevalence; Sleep Initiation and Maintenance Disorders
PubMed: 32768993
DOI: 10.1016/j.drugalcdep.2020.108189 -
Journal of Clinical Sleep Medicine :... Jun 2013Research suggests that rumination may play an important role in insomnia. Whereas some have suggested that rumination mainly relates to depression, the evidence suggests...
STUDY OBJECTIVES
Research suggests that rumination may play an important role in insomnia. Whereas some have suggested that rumination mainly relates to depression, the evidence suggests that there may be insomnia-specific rumination. This paper explores insomnia symptom rumination across two distinct samples of varying levels of depressed mood and insomnia symptom severity.
METHODS
The first sample consisted of nonclinical participants (N = 327) with a range of insomnia and depressed mood symptoms, and the second sample consisted of those who met both Major Depressive Disorder and Insomnia diagnoses (N = 66). Rather than relying on a measure developed for those with depression, we developed and tested an insomnia-specific measurement scale based on items from previous rumination studies and the addition of items derived from common daytime insomnia symptoms.
RESULTS
Internal consistency was highly acceptable across the two samples for the new insomnia-specific rumination measure (Cronbach α was 0.93 and 0.94). In the first study, poor sleepers reported significantly higher levels of daytime symptom rumination than did good sleepers. Across both studies, rumination about daytime insomnia symptoms and depression were significantly correlated; however, insomnia rumination scores predicted insomnia even after controlling for depression. Moreover, in Study 2, insomnia-specific rumination was related to insomnia, but general depressive rumination was not predictive of insomnia.
CONCLUSIONS
The findings provide support for the use of this insomnia-specific rumination scale; moreover the findings support previous observances regarding rumination about daytime insomnia symptoms that are not exclusive to depression.
Topics: Adolescent; Adult; Affect; Aged; Behavioral Symptoms; Cognition; Comorbidity; Depression; Depressive Disorder, Major; Factor Analysis, Statistical; Female; Humans; Male; Middle Aged; Models, Psychological; Multivariate Analysis; Sleep Initiation and Maintenance Disorders; United States
PubMed: 23772190
DOI: 10.5664/jcsm.2752 -
Sleep Jan 2014While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with...
STUDY OBJECTIVES
While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with specific reference to acute and chronic insomnia, and (3) using polysomnography. In the present study, the association between insomnia and first-onset depression was evaluated taking into account these considerations.
DESIGN
A mixed-model inception design.
SETTING
Academic research laboratory.
PARTICIPANTS
Fifty-four individuals (acute insomnia [n = 33], normal sleepers [n = 21]) with no reported history of a sleep disorder, chronic medical condition, or psychiatric illness.
INTERVENTIONS
N/A.
MEASUREMENTS AND RESULTS
Participants were assessed at baseline (2 nights of polysomnography and psychometric measures of stress and mood) and insomnia and depression status were reassessed at 3 months. Individuals with acute insomnia exhibited more stress, poorer mood, worse subjective sleep continuity, increased N2 sleep, and decreased N3 sleep. Individuals who transitioned to chronic insomnia exhibited (at baseline) shorter REM latencies and reduced N3 sleep. Individuals who exhibited this pattern in the transition from acute to chronic insomnia were also more likely to develop first-onset depression (9.26%) as compared to those who remitted from insomnia (1.85%) or were normal sleepers (1.85%).
CONCLUSION
The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the "sleep architecture stigmata" of depression may actually develop over the course transitioning from acute to chronic insomnia.
Topics: Acute Disease; Adult; Affect; Age of Onset; Case-Control Studies; Chronic Disease; Depression; Disease Progression; Disease Susceptibility; Female; Humans; Male; Middle Aged; Polysomnography; Psychometrics; Risk Factors; Sleep; Sleep Initiation and Maintenance Disorders; Stress, Psychological; Time Factors; Young Adult
PubMed: 24470699
DOI: 10.5665/sleep.3316 -
Psychiatry Research Feb 2022The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to...
BACKGROUND AND OBJECTIVES
The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up.
METHODS
Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5 ± 11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia.
RESULTS
Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission.
CONCLUSION
The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Comorbidity; Female; Follow-Up Studies; Humans; Male; Middle Aged; Quality of Life; Sleep Initiation and Maintenance Disorders
PubMed: 34998087
DOI: 10.1016/j.psychres.2021.114349 -
Sleep Jan 2020To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.
STUDY OBJECTIVES
To examine economic aspects of insomnia and insomnia medication treatment among a nationally representative sample of older adult Medicare beneficiaries.
METHODS
Using a random 5% sample of Medicare administrative data (2006-2013), insomnia was defined using International Classification of Disease, Version 9, Clinical Modification diagnostic codes. Treatment was operationalized as one or more prescription fills for an US Food and Drug Administration (FDA)-approved insomnia medication following diagnosis, in previously untreated individuals. To evaluate the economic impact of insomnia treatment on healthcare utilization (HCU) and costs in the year following insomnia diagnosis, a difference-in-differences approach was implemented using generalized linear models.
RESULTS
A total of 23 079 beneficiaries with insomnia (M age = 71.7 years) were included. Of these, 5154 (22%) received one or more fills for an FDA-approved insomnia medication following insomnia diagnosis. For both treated and untreated individuals, HCU and costs increased during the 12 months prior to diagnosis. Insomnia treatment was associated with significantly increased emergency department visits and prescription fills in the year following insomnia diagnosis. After accounting for pre-diagnosis differences between groups, no significant differences in pre- to post-diagnosis costs were observed between treated and untreated individuals.
CONCLUSIONS
These results advance previous research into economics of insomnia disorder by evaluating the impact of medication treatment and highlighting important differences between treated and untreated individuals. Future studies should seek to understand why some individuals diagnosed with insomnia receive treatment but others do not, to identify clinically meaningful clusters of older adults with insomnia, and to explore the economic impact of insomnia and insomnia treatment among subgroups of individuals with insomnia, such as those with cardiovascular diseases, mood disorders, and neurodegenerative disease.
Topics: Aged; Aged, 80 and over; Cardiovascular Diseases; Female; Humans; Male; Medicare; Middle Aged; Mood Disorders; Neurodegenerative Diseases; Patient Acceptance of Health Care; Sleep Initiation and Maintenance Disorders; United States
PubMed: 31418027
DOI: 10.1093/sleep/zsz192 -
Sleep Medicine Feb 2017Task-switching deficits are common in older adults and in those with insomnia. Such deficits may be driven by difficulties with sleep continuity and dampened homeostatic... (Clinical Trial)
Clinical Trial
BACKGROUND
Task-switching deficits are common in older adults and in those with insomnia. Such deficits may be driven by difficulties with sleep continuity and dampened homeostatic sleep drive.
OBJECTIVE
To identify the aspects of task switching affected by insomnia and its treatment, and to determine whether such effects are associated with sleep continuity and homeostatic sleep drive.
METHODS
Polysomnographic sleep and task switching were tested in healthy older adults aged 60-93 years with insomnia (n = 48) and normal sleeping controls (n = 51). Assessments were repeated in the insomnia group after eight weeks of cognitive behavioral treatment for insomnia. Sleep measures included wake after sleep onset (WASO) and quantitative indices of homeostatic sleep drive (delta power during nonrapid eye movement [NREM] sleep and the ratio of delta power during the first and second NREM periods). A cued task-switching paradigm instructed participants to perform one of two tasks with varying preparatory cue-target intervals, manipulating task alternation, task repetition, and task preparation.
RESULTS
The effect of preparatory cues on accuracy was diminished in the insomnia group compared with that in controls. Across the two groups, a stronger effect of preparatory cues was associated with a higher delta sleep ratio. Following insomnia treatment, task-repetition accuracy significantly improved. This improvement was associated with improvements in WASO. There were no group or treatment effects on response time or task alternation accuracy.
CONCLUSIONS
Effects of insomnia diagnosis and treatment apply to conditions that depend on the maintenance of a task set, rather than a domain general effect across task switching. Such effects are associated with homeostatic sleep drive and sleep continuity.
Topics: Aged; Aged, 80 and over; Cognitive Behavioral Therapy; Female; Humans; Male; Middle Aged; Reaction Time; Sleep Initiation and Maintenance Disorders; Task Performance and Analysis
PubMed: 28215233
DOI: 10.1016/j.sleep.2016.09.002 -
Journal of Clinical Sleep Medicine :... Mar 2020The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. No studies have evaluated the effect of sleep medication on... (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVES
The chronic pain disorder, fibromyalgia, is associated with sleep disturbance, typically sleep maintenance. No studies have evaluated the effect of sleep medication on pain sensitivity in this population. Suvorexant, an orexin antagonist approved for treatment of insomnia, was evaluated for effects on both sleep and the pain of fibromyalgia.
METHODS
Women age 21 to 65 years with fibromyalgia and comorbid insomnia (n = 10) were treated, double-blind, for 9 nights each with suvorexant, 20 mg and placebo in counterbalanced order. All were in good psychiatric and stable physical health and met American College of Rheumatology 2010 criteria for fibromyalgia and Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition criteria for insomnia. Screening 8-hour polysomnography (PSG) was used to rule out other sleep disorders. On nights 8 and 9 of each treatment 8-hour PSG were collected and on days 1 and 8 pain sensitivity was assessed at 1100 and 1500 hours by measuring finger withdrawal latency (FWL) to a radiant heat stimulus at 5 randomly presented intensity levels.
RESULTS
Suvorexant versus placebo increased total sleep time (7.2 versus 6.7 hours, P < .05) and reduced wake after sleep onset (37 versus 67 minutes, P < .04) with no night effects or interaction. Latency to persistent sleep and sleep stage measures were not altered. FWL on both am and pm tests varied as a function of intensity (P < .001). Average FWL (over 5 intensities and both days) was increased relative to placebo on both the am (13.9 versus 13.1 seconds) and pm tests (15.8 versus 14.1 seconds, P < .03) following suvorexant the previous night.
CONCLUSIONS
Suvorexant 20 mg in patients with fibromyalgia, improved sleep time and reduced next-day pain sensitivity on assessments of FWL to a radiant heat stimulus.
CLINICAL TRIAL REGISTRY
Registry: ClinicalTrials.gov; Name: A double-blind cross-over, study to compare the hypnotic, daytime sleepiness/fatigue, and pain effects of nighttime administration of suvorexant 20 mg versus placebo in patients with fibromyalgia and comorbid insomnia; Identifier: NCT02684136; URL: https://clinicaltrials.gov/ct2/show/NCT02684136.
Topics: Adult; Aged; Azepines; Cross-Over Studies; Double-Blind Method; Female; Fibromyalgia; Humans; Middle Aged; Pain; Sleep; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Triazoles; Young Adult
PubMed: 31992394
DOI: 10.5664/jcsm.8220