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Scientific Reports Jan 2021Subjective-objective discrepancy of sleep (SODS) might be related to the distorted perception of sleep deficit and hypersensitivity to insomnia-related stimuli. We...
Subjective-objective discrepancy of sleep (SODS) might be related to the distorted perception of sleep deficit and hypersensitivity to insomnia-related stimuli. We investigated differences in brain activation to insomnia-related stimuli among insomnia patients with SODS (SODS group), insomnia patients without SODS (NOSODS group), and healthy controls (HC). Participants were evaluated for subjective and objective sleep using sleep diary and polysomnography. Functional magnetic resonance imaging was conducted during the presentation of insomnia-related (Ins), general anxiety-inducing (Gen), and neutral (Neu) stimuli. Brain reactivity to the contrast of Ins vs. Neu and Gen vs. Neu was compared among the SODS (n = 13), NOSODS (n = 15), and HC (n = 16) groups. In the SODS group compared to other groups, brain areas including the left fusiform, bilateral precuneus, right superior frontal gyrus, genu of corpus callosum, and bilateral anterior corona radiata showed significantly increased blood oxygen level dependent (BOLD) signal in the contrast of Ins vs. Neu. There was no brain region with significantly increased BOLD signal in the Gen vs. Neu contrast in the group comparisons. Increased brain activity to insomnia-related stimuli in several brain regions of the SODS group is likely due to these individuals being more sensitive to sleep-related threat and negative cognitive distortion toward insomnia.
Topics: Adult; Aged; Brain; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Oxygen; Polysomnography; Severity of Illness Index; Sleep; Sleep Initiation and Maintenance Disorders; Young Adult
PubMed: 33452376
DOI: 10.1038/s41598-021-81219-2 -
The American Journal of Geriatric... Jun 2009The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety... (Comparative Study)
Comparative Study
OBJECTIVES
The purposes of this study are to determine the frequency and severity of insomnia symptoms and related complaints experienced by older adults with Generalized Anxiety Disorder (GAD) and compare them with older adults without GAD; compare insomnia symptoms among older adults with GAD with and without comorbid depression; determine if there are age differences in insomnia severity among people with GAD; and determine if there are differences in insomnia severity between older adults with GAD and older adults diagnosed with insomnia.
DESIGN
Cross-sectional.
SETTING
Participants were recruited through primary care clinics, advertisements, and mass mailings.
PARTICIPANTS
One hundred ten older adults; 31 with GAD, 25 with GAD and depression, 33 worried well, and 21 with no psychiatric diagnosis.
MEASUREMENTS
Psychiatric diagnosis, sleep disturbance, and health.
RESULTS
Participants with GAD with and without comorbid depression reported significantly greater sleep disturbance severity than participants with no psychiatric diagnosis and the worried well. There were no differences in sleep disturbances between older adults with GAD only and older adults with comorbid GAD and depression. The severity of sleep disturbance reported by older participants with GAD was greater than reports by young and middle-aged participants with GAD, and comparable with reports by older adults with a diagnosis of insomnia.
CONCLUSIONS
Ninety percent of older adults with GAD report dissatisfaction with sleep and the majority report moderate to severe insomnia. These findings support the assessment of sleep disturbances within the context of late-life GAD.
Topics: Age Factors; Aged; Aged, 80 and over; Analysis of Variance; Anxiety Disorders; Comorbidity; Cross-Sectional Studies; Depression; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Middle Aged; Severity of Illness Index; Sleep Initiation and Maintenance Disorders; Surveys and Questionnaires
PubMed: 19472436
DOI: 10.1097/jgp.0b013e3181987747 -
The Primary Care Companion For CNS... May 2020To assess insomnia and its health correlates among elderly primary care patients in India.
OBJECTIVE
To assess insomnia and its health correlates among elderly primary care patients in India.
METHODS
A multicenter, cross-sectional survey was administered to 1,770 elderly primary care patients from 71 government primary health centers in Kerala, India, from May to December 2016. Insomnia was evaluated using the Insomnia Severity Index. Basic demographics and information about medical illness were collected. Study instruments included the Patient Health Questionnaire-Somatic, Anxiety, and Depression Symptoms; Alcohol Use Disorders Identification Test; Fagerström Test for Nicotine Dependence; 12-item World Health Organization Disability Assessment Schedule; and World Health Organization Quality of Life-BREF.
RESULTS
Valid responses were received from 1,574 (89%) patients, of whom the mean age was 68.6 years and 55.5% were women. Clinical insomnia was reported by 11.8%, whereas 30.4% had subclinical insomnia. Primary care attendees with subclinical as well as clinical insomnia had increased odds of being older and female and having chronic medical illness compared with those without insomnia. Patients with clinical insomnia had increased odds of common mental disorders (anxiety, depression, and somatization) and greater disability compared with the subclinical or no insomnia groups. Those with subclinical insomnia had poor satisfaction with life compared to those with no insomnia.
CONCLUSIONS
Insomnia in the elderly is frequent in primary care patients in India and has multiple negative health correlates. This study reiterates the need for more awareness with regard to detection and management of insomnia in the elderly population.
Topics: Age Factors; Aged; Aged, 80 and over; Chronic Disease; Comorbidity; Cross-Sectional Studies; Female; Humans; India; Male; Mental Disorders; Middle Aged; Primary Health Care; Sex Factors; Sleep Initiation and Maintenance Disorders
PubMed: 32441494
DOI: 10.4088/PCC.19m02581 -
Sleep Apr 2021Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway... (Randomized Controlled Trial)
Randomized Controlled Trial
Randomized controlled trial of an integrated approach to treating insomnia and improving the use of positive airway pressure therapy in veterans with comorbid insomnia disorder and obstructive sleep apnea.
STUDY OBJECTIVES
Cognitive behavioral therapy for insomnia (CBTI) for comorbid insomnia and obstructive sleep apnea (OSA) has had mixed results. We integrated CBTI with a positive airway pressure (PAP) adherence program and tested effects on sleep and PAP use.
METHODS
125 veterans (mean age 63.2, 96% men, 39% non-Hispanic white, 26% black/African American, 18% Hispanic/Latino) with comorbid insomnia and newly-diagnosed OSA (apnea-hypopnea index ≥ 15) were randomized to 5-weekly sessions integrating CBTI with a PAP adherence program provided by a "sleep coach" (with behavioral sleep medicine supervision), or 5-weekly sleep education control sessions. Participants and assessment staff were blinded to group assignment. Outcomes (baseline, 3 and 6 months) included Pittsburgh Sleep Quality Index (PSQI), 7-day sleep diary (sleep onset latency [SOL-D], wake after sleep onset [WASO-D], sleep efficiency [SE-D]), 7-day actigraphy (SE-A), and objective PAP use (hours/night and nights ≥ 4 h). Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) were also collected.
RESULTS
Compared to controls, intervention participants showed greater improvement (baseline to 3 and 6 months, respectively) in PSQI (-3.2 and -1.7), SOL-D (-16.2 and -15.5 minutes), SE-D (10.5% and 8.5%), SE-A (4.4% and 2.6%) and more 90-day PAP use (1.3 and 0.9 more hours/night, 17.4 and 11.3 more nights PAP ≥ 4 h). 90-day PAP use at 3 months was 3.2 and 1.9 h/night in intervention versus controls. Intervention participants also had greater improvements in ISI, ESS, and FOSQ-10 (all p < 0.05).
CONCLUSIONS
An intervention integrating CBTI with a PAP adherence program delivered by a supervised sleep coach improved sleep and PAP use in adults with comorbid insomnia and OSA.
TRIAL REGISTRATION
ClinicalTrials.govStudy name: Novel Treatment of Comorbid Insomnia and Sleep Apnea in Older VeteransURL: https://clinicaltrials.gov/ct2/results?cond=&term=NCT02027558&cntry=&state=&city=&dist=Registration: NCT02027558.
Topics: Adult; Aged; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Polysomnography; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders; Treatment Outcome; Veterans
PubMed: 33221910
DOI: 10.1093/sleep/zsaa235 -
BMC Musculoskeletal Disorders Mar 2018Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence...
BACKGROUND
Few studies have examined patterns of specific sleep problems among individuals with osteoarthritis (OA). The primary objective of this study was to examine prevalence of symptoms of insomnia and obstructive sleep apnea (OSA) among Veterans with OA. Secondary objectives were to assess proportions of individuals with insomnia and OSA symptoms who may have been undiagnosed and to examine Veterans' characteristics associated with insomnia and OSA symptoms.
METHODS
Veterans (n = 300) enrolled in a clinical trial completed the Insomnia Severity Index (ISI) and the Berlin Questionnaire (BQ) at baseline; proportions of participants with symptoms consistent with insomnia and OSA were calculated, using standard cut-offs for ISI and BQ. For Veterans with insomnia and OSA symptoms, electronic medical records were searched to identify whether there was a diagnosis code for these conditions. Multivariable linear (ISI) and logistic (BQ) regression models examined associations of the following characteristics with symptoms of insomnia and OSA: age, gender, race, self-reported general health, body mass index (BMI), diagnosis of post-traumatic stress disorder (PTSD), pain severity, depressive symptoms, number of joints with arthritis symptoms and opioid use.
RESULTS
Symptoms consistent with insomnia and OSA were found in 53 and 66% of this sample, respectively. Among participants screening positive for insomnia and OSA, diagnosis codes for these disorders were present in the electronic medical record for 22 and 51%, respectively. Characteristics associated with insomnia were lower age (β (SE) = - 0.09 (0.04), 95% confidence interval [CI] = - 0.16, - 0.02), having a PTSD diagnosis (β (SE) = 1.68 (0.73), CI = 0.25, 3.11), greater pain severity (β (SE) = 0.36 (0.09), CI = 0.17, 0.55), and greater depressive symptoms (β (SE) = 0.84 (0.07), CI = 0.70, 0.98). Characteristics associated with OSA were higher BMI (odds ratio [OR] = 1.13, CI = 1.06, 1.21), greater depressive symptoms (OR = 1.12, CI = 1.05, 1.20), and opioid use (OR = 0.51, CI = 0.26, 0.99).
CONCLUSIONS
Insomnia and OSA symptoms were very common in Veterans with OA, and a substantial proportion of individuals with symptoms may have been undiagnosed. Characteristics associated with insomnia and OSA symptoms were consistent with prior studies.
TRIAL REGISTRATION
NCT01130740 .
Topics: Aged; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Polysomnography; Prevalence; Sleep Apnea, Obstructive; Sleep Initiation and Maintenance Disorders; Veterans
PubMed: 29523117
DOI: 10.1186/s12891-018-1993-y -
The American Journal of Managed Care Nov 2007Insomnia affects a large percentage of the population, particularly the elderly. Literature reports varying estimates of prevalence, a variation that relates to the lack... (Review)
Review
Insomnia affects a large percentage of the population, particularly the elderly. Literature reports varying estimates of prevalence, a variation that relates to the lack of definition and consistency in diagnostic criteria. Primary insomnia (not caused by known physical/mental conditions) responds to pharmacologic therapy, while secondary insomnia(resulting from other illnesses, medications, or sleep disorders) responds to pharmacologic and psychologic treatments (cognitive therapy, relaxation techniques, stimulus control). Use of certain agents in the elderly and patients with abuse/addiction potential is a concern. Medicare Part D does not cover benzodiazepines (classified as controlled substances). Nonprescription agents are affordable but have sedation and anticholinergic side effects. Medication use should be considered a possible contributing factor. Insomnia patients experience significantly more limited activity and higher total health services than those without insomnia. Annual costs are between $92.5 billion and $107.5 billion. A standard definition and better pathways to recognize and treat insomnia are needed.
Topics: Age Distribution; Aged; Aged, 80 and over; Benzodiazepines; Comorbidity; Cost of Illness; Female; Histamine H1 Antagonists; Humans; Hypnotics and Sedatives; Male; Managed Care Programs; Middle Aged; Practice Guidelines as Topic; Prevalence; Receptors, Melatonin; Sex Distribution; Sleep Initiation and Maintenance Disorders; United States
PubMed: 18041870
DOI: No ID Found -
Sleep Jun 2016To investigate the long-term effects of therapist-guided Internet-based insomnia treatment on insomnia severity and sleep medication use, compared with active control. (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY OBJECTIVES
To investigate the long-term effects of therapist-guided Internet-based insomnia treatment on insomnia severity and sleep medication use, compared with active control.
METHODS
This study was an 8 week randomized controlled trial with follow-up posttreatment and at 6, 12, and 36 months, set at the Internet Psychiatry Clinic, Stockholm, Sweden. Participants were 148 media-recruited nondepressed adults with insomnia. Interventions were Guided Internet-based cognitive behavioral therapy for insomnia (ICBT-i) or active control treatment (ICBT-ctrl). Primary outcome was insomnia severity, measured with the Insomnia Severity Index. Secondary outcomes were sleep medication use and use of other treatments.
RESULTS
The large pretreatment to posttreatment improvements in insomnia severity of the ICBT-i group were maintained during follow-up. ICBT-ctrl exhibited significantly less improvement posttreatment (between-Cohen d = 0.85), but after 12 and 36 months, there was no longer a significant difference. The within-group effect sizes from pretreatment to the 36-months follow-up were 1.6 (ICBT-i) and 1.7 (ICBT-ctrl), and 74% of the interviewed participants no longer had insomnia diagnosis after 36 mo. ICBT-ctrl used significantly more sleep medication (P = 0.017) and underwent significantly more other insomnia treatments (P < 0.001) during the follow-up period.
CONCLUSIONS
The large improvements in the ICBT-i group were maintained after 36 months, corroborating that CBT for insomnia has long-term effects. After 36 months, the groups did not differ in insomnia severity, but ICBT-ctrl had used more sleep medication and undergone more other additional insomnia treatments during the follow-up period.
CLINICAL TRIAL REGISTRATION
The trial was registered, together with a parallel trial, at Clinicaltrials.gov as "Internet-CBT for Insomnia" registration ID: NCT01256099.
Topics: Cognitive Behavioral Therapy; Female; Follow-Up Studies; Health Personnel; Humans; Hypnotics and Sedatives; Internet; Male; Middle Aged; Sleep; Sleep Initiation and Maintenance Disorders; Sweden; Time Factors; Treatment Outcome
PubMed: 27091535
DOI: 10.5665/sleep.5850 -
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 -
The Journals of Gerontology. Series A,... Dec 2013Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health...
BACKGROUND
Complaints of poor sleep are common among older adults. We investigated the prospective association between insomnia symptoms and hospitalization, use of home health care services, use of nursing homes, and use of any of these services in a population-based study of middle-aged and older adults.
METHODS
We studied 14,355 adults aged 55 and older enrolled in the 2006 and 2008 waves of the Health and Retirement Study. Logistic regression was used to study the association between insomnia symptoms (0, 1, or ≥ 2) in 2006 and reports of health service utilization in 2008, after adjustment for demographic and clinical characteristics.
RESULTS
Compared with respondents reporting no insomnia symptoms, those reporting one symptom had a greater odds of hospitalization (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.15-1.43, p < .001), use of home health care services (AOR = 1.29, 95% CI = 1.09-1.52, p = .004), and any health service use (AOR = 1.28, 95% CI = 1.15-1.41, p < .001). Those reporting greater than or equal to two insomnia symptoms had a greater odds of hospitalization (AOR = 1.71, 95% CI = 1.50-1.96, p < .001), use of home health care services (AOR = 1.64, 95% CI = 1.32-2.04, p < .001), nursing home use (AOR = 1.45, 95% CI = 1.10-1.90, p = .009), and any health service use (AOR = 1.72, 95% CI = 1.51-1.95, p < .001) after controlling for demographics. These associations weakened, and in some cases were no longer statistically significant, after adjustment for clinical covariates.
CONCLUSIONS
In this study, insomnia symptoms experienced by middle-aged and older adults were associated with greater future use of costly health services. Our findings raise the question of whether treating or preventing insomnia in older adults may reduce use of and spending on health services among this population.
Topics: Aged; Aged, 80 and over; Cohort Studies; Confidence Intervals; Cost Savings; Demography; Female; Health Care Surveys; Health Services for the Aged; Health Surveys; Home Care Services; Hospitalization; Humans; Logistic Models; Male; Middle Aged; Nursing Homes; Odds Ratio; Risk Factors; Sleep Initiation and Maintenance Disorders; United States
PubMed: 23666943
DOI: 10.1093/gerona/glt050 -
Journal of Clinical Sleep Medicine :... Nov 2020Social relationships are an understudied factor affecting insomnia. In particular, these effects have not been evaluated in the context of sex differences. In this...
STUDY OBJECTIVES
Social relationships are an understudied factor affecting insomnia. In particular, these effects have not been evaluated in the context of sex differences. In this study, we investigated differences between sexes with regard to the association between insomnia symptoms and social relationships.
METHODS
We used data from 2681 middle-aged adults (aged 40-64 years; females, 68.8%) from the Cardiovascular and Metabolic Diseases Etiology Research Center project. Insomnia symptoms were defined as difficulty with sleep induction or maintenance ≥3 nights per week. We assessed social network size and bridging potentials as indicators of social relationships. Social network size is a quantitative measure of the size of social relationships, and bridging potential is a qualitative indicator of the diversity and independence of these relationships. Multivariate regression analysis controlling for confounding factors was performed to evaluate associations between social relationships and insomnia symptoms.
RESULTS
Smaller social network size was significantly associated with sleep induction (adjusted odds ratio = 0.866, P = .015) and sleep maintenance (adjusted odds ratio = 0.862, P = .015) difficulties, but only in men. Poor bridging potential was also associated with sleep induction (adjusted odds ratio = 0.321, P = .024) and maintenance (adjusted odds ratio = 0.305, P = .031) difficulties only in men. For women, social relationship variables were not significantly associated with insomnia symptoms.
CONCLUSIONS
The association between insomnia symptoms and social relationships varied by sex, as noted by statistical analyses accounting for covariates affecting insomnia symptoms. These results suggest that qualitative assessments of social relationship variables should be considered in clinical practice, since these variables can be interpreted differently for men and women.
Topics: Adult; Female; Humans; Interpersonal Relations; Male; Middle Aged; Odds Ratio; Sex Characteristics; Sleep; Sleep Initiation and Maintenance Disorders
PubMed: 32713419
DOI: 10.5664/jcsm.8710